Gastrointestinal symptoms associated with PPE use among nurses in COVID-19 wards: a cross-sectional study.

Authors

Wenyu Li, Xutao Wu, Yani Yan, Zhiyang Xie, Tingting Huang, Lianlian Sun, Shaozhi Tian, Zhengjie Dai, Longcha Liu, Xiaoqun Xu

Published in

Frontiers in public health. Volume 14. Pages 1827949. Epub Jul 27, 2026.

Abstract

To investigate the prevalence of gastrointestinal symptoms (reflux, nausea, and vomiting) among nurses in COVID-19 isolation wards and identify associated factors, with a specific focus on discomfort caused by personal protective equipment (PPE).
A cross-sectional survey.
In March 2020, 354 of 368 eligible nurses (96.2% response rate) from the COVID-19 isolation wards of a designated hospital in Wenzhou, China, completed the survey. Data were collected using a demographic questionnaire, a self-rated PPE discomfort scale, the Gastroesophageal Reflux Disease Questionnaire (GerdQ), the Pittsburgh Sleep Quality Index (PSQI), and the Symptom Checklist-90 (SCL-90). Statistical assessments included univariate, correlation, and multivariable logistic regression analyses. Firth's penalized likelihood logistic regression and sensitivity analyses were applied to address sparse data in specific subgroups.
The overall prevalence of gastrointestinal symptoms in the cohort was 23.2% (82/354). Multivariable regression identified several independent factors significantly associated with these symptoms (all P < 0.01): severe PPE-induced discomfort (OR = 3.64, 95% CI: 1.95-6.80), elevated psychological stress (SCL-90 total score: OR = 1.14, 95% CI: 1.09-1.20), and poor sleep quality (PSQI total score: OR = 2.10, 95% CI: 1.51-2.92). Although univariate analyses suggested protective associations for prior intensive care unit (ICU) experience and male gender, these effects lost statistical significance following Firth correction. Temporally, 76.8% of symptomatic cases emerged within the first five days of the shift cycle.
Gastrointestinal symptoms are prevalent among nurses in COVID-19 isolation wards and are strongly associated with PPE-induced discomfort, psychological stress, and sleep disturbances. Although the cross-sectional design precludes causal inference, these findings underscore an urgent need for the ergonomic optimization of PPE to alleviate heat stress and physical burden. Furthermore, implementing rapid adaptation training programs and integrating psychological and sleep support into routine occupational health surveillance are vital to safeguarding frontline clinicians.

PMID:
42577379
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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