Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

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Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : LC05 - LC08 Full Version

Difficulties Faced by the Healthcare Workers Wearing Personal Protective Equipments in COVID-19 Pandemic during Summers of Mumbai City

Published: August 1, 2021 | DOI:
Swanit Hemant Deshpande, Sudatta Waghmare, Hiteshi Jain, Swarika Hemant Deshpande

1. Bonded Assistant Professor, Department of General Surgery, BYL NAIR Charitable Hospital and TN Medical College, Mumbai, Maharashtra, India. 2. Assistant Professor, Department of General Surgery, BYL NAIR Charitable Hospital and TN Medical College, Mumbai, Maharashtra, India. 3. Bonded Assistant Professor, Department of Opthalmology, BYL NAIR Charitable Hospital and TN Medical College, Mumbai, Maharashtra, India. 4. Final Year Resident, Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Sudatta Waghmare,
Assistant Professor, Department of General Surgery, BYL NAIR Hospital,
Mumbai Central, Mumbai, Maharashtra, India.


Introduction: The coronavirus pandemic poses a massive challenge for the healthcare system and overburdens the Healthcare Workers (HCWs) in a developing country like India. The coronavirus may survive on various surfaces and/or aerosols for hours to days, making it a necessity to use Personal Protective Equipment (PPE) while treating infected patients. Wearing the PPE is often uncomfortable while working, more so in the summer season, when the temperatures in a tropical country like India are soaring.

Aim: To identify, quantify and highlight the difficulties faced by the HCWs while wearing PPEs.

Materials and Methods: This descriptive cross-sectional study was conducted in June 2020, by a team of researchers working in a government owned designated Coronavirus Disease-2019 (COVID-19) hospital in metropolitan city, West India. The questionnaire was prepared for a multicentre survey for 230 HCWs who had used PPE kits during their COVID-19 duties. The online questionnaire responses were recorded in an Microsoft Excel sheet and the results were analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0.

Results: Total 230 responses were received out of which 74% were doctors, 21.7% nurses and 4.3% paramedical staff. The mean duration of work was 6.24 hours and per duty one, PPE was used by almost all of the respondents. The most common difficulty faced by the responders while on duty was excessive sweating (96%/n-221), itching of the nose (56%/n-129) and face (50.9%/n-117). While after the duty 61.7% of respondents reported being dehydrated and 68.2% complained of de novo headache. In a subset with a history of migraine, almost all reported worsening of migraine with increased frequency and severity of attacks. Many (40%) reported occasionally lowering the masks or face shield due to unbearable heat, risking self-contamination.

Conclusion: The PPEs in current use and in the hot and humid conditions of summer months in tropical countries poses a unique challenge for the HCWs. Customisation of PPEs and working conditions is essential in the mitigation of the problems faced by the HCWs.


Coronavirus disease-2019, Dehydration, Health administration, Migraine, Public health

The coronavirus pandemic poses a massive challenge for healthcare systems around the world. With over 19 million cumulative COVID-19 positive cases, India is one of the worst-hit countries, second only to the Americans (1). Treating such patients may demand close patient contact sometimes in enclosed spaces for hours together, which makes the HCWs especially vulnerable to disease transmission. Official reports in India released to the media claim that as of April 2020, more than 700 doctors in the country have sacrificed their lives in their line of duty. Around 17,975 doctors have been infected in the state of Maharashtra alone (1).

The coronavirus may survive on various surfaces and/or aerosols for hours to days, making it a necessity to use PPE while treating infected patients. PPE reduces exposure to risk in addition to enabling HCWs to provide effective care to patients (2),(3),(4). Wearing the PPE is often uncomfortable while working, more so in the summer season, when the temperatures in a tropical country like India are soaring and facilities like centralised air conditioners are unavailable or are shut down for the fear of spreading the infection. In addition to reduced manual dexterity and impaired visibility, users have also found verbal communication difficult while wearing the PPE (5).

There are very few studies on this topic from within India. On literature search, authors could find only one such study, conducted in New Delhi (6). Hence, it is important to highlight the myriad of issues faced by HCWs while using PPE and quantify them to find acceptable solutions to combat them and bring about changes to make the work atmosphere healthy and pleasant.

Material and Methods

This descriptive cross-sectional study was conducted in June 2020, by a team of researchers working in a Government Hospital in Western India. The hospital was a designated Coronavirus Disease-2019 (COVID-19) treatment centre. The Institutional Ethics Committee permission was obtained to recruit a maximum of 300 subjects for the survey (IEC number: 2022/49).

Inclusion criteria: HCWs who had completed atleast 15 days of COVID duty in total in the city of Mumbai, having worn the PPE kit during each duty atleast once. Written informed consent was obtained from the participants prior to the study were included.

Exclusion criteria: Those participants who were pregnant, those who had not worked in COVID-19 wards and those who had not worn PPE were excluded from the study.

Sample size calculation: The respondent-to-item ratio principle was applied to estimate the effective sample size. Twenty compulsory responses were kept in the questionnaire. By applying the 5:1 ratio rule for sampling size, a minimum of 100 respondents were required.

The researchers prepared an electronic questionnaire for a multicentre survey in urban India among HCWs who had used PPE kits during their COVID-19 duties (Table/Fig 1). The simple multiple-choice questionnaire was validated for internal consistency with the help of discrete options and by eliminating the scoring system. Two investigators independently assessed the questionnaire. The validation was done in different time scales. Respondents were allowed to fill in the questionnaire by themselves and hence inter-rater reliability was ensured. By allowing the respondents to edit the responses even after the first submission, the test-retest validation of the questionnaire was ensured. The reliability of the test was calculated using the Cronbach’s alfa test was 0.78. The validity score assessed by calculating the average congruency percentage was 90% (expert 1-100% and expert 2-80%).

The invitation to participate in the study was sent through e-mail to HCWs who had done COVID-19 duties and worn PPE kits at various government-designated COVID-19 hospitals in the Mumbai city.

Those accepted to be part of the survey were sent a link to the questionnaire through e-mail. The submission form was kept open for 30 days. Anonymity was maintained in recording and analysing the data.


B#BPPE-B?B Use of protective apron or gown covering the body (upper limbs, lower limbs, the feet, the torso and double hand gloves), a hood for the head, face shield and face mask (N-95) (7).

COVID-19 ward- both wards and ICUs where the patients including the suspected patients of COVID-19 and diagnosed patients of COVID-19 were kept (7).

Statistical Analysis

Outcome measures were recorded automatically upon submission to Google Drive and downloadable in the form of Microsoft Excel spread sheet tabulation. Subsequently, the validation of data was done and then preliminary analysis was done by data categorisation and graphical representation. Chi-square test was used to calculate p-value. A p-value <0.05 considered statistically significant. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0.


A total of 250 HCWs were contacted to be part of the study, out of which 20 declined to participate. In total, 230 responses were received at the close of the study from 5 different government institutions across the city. In total, 141 (61.3%) HCWs were from BYL Nair Charitable Hospital, 20 (8.7) from TN medical college, 25 (10.9%) From KEM Hospital, 23 (10%) from Sion Hospital, 21 (9.1%) from Cooper Hospital. The detailed distribution of HCWs is depicted in (Table/Fig 2). All the participants (100%) reported be wearing all the components of PPE (Gown/plastic apron, double gloves, Face shield, Face mask, foot and leg coverings (Full Hazmat Suite) while working in the COVID-19 wards.

The median completed duty period was 14 days {IQR (Inter Quartile Range)=7-14 days}. The mean duration of the duty hours per day was 6.24 hours (IQR=5.8 to 6.8). The duration of the duty hours per day was maximum with the nursing staff, the mean duration being 6.7 hours. The mean duration of wearing PPE was 6.6 hours.

There were various difficulties faced by the HCWs both during and after the duty hours. They have been tabulated in (Table/Fig 3).

Total 142 HCWs (61.7%) (Table/Fig 3) felt they were dehydrated at the end of the six hours shift. Although only one of the 142 HCWs needed medical attention to deal with dehydration. While 5 respondents reported the need to doff the PPE before the duty hours due to dehydration. Many of the participants (40%) adjusted their N95 masks and lowered their face shields intermittently due to breathing issues or due to excessive heat while being aware of the risk of self-contamination.

Total 157 (68.2%) HCWs (Table/Fig 3) faced a de novo headache after the use of PPE. The headache was reported 2 to 6 hours after the duty by 97% of the HCWs complaining of a headache. Of the HCWs experiencing headaches, 15 (9.5%) had a history of migraine and they complained of worsening of the migraine. They complained of increased frequency and severity of migraine attacks after the duty hours.

The PPE made it difficult to do routine ward procedures more challenging. The most difficult procedure to perform in PPE was reported to be endotracheal intubation by 55%. HCWs followed by central venous catheter insertion 30% (Table/Fig 4).

All of the HCWs (100%) thought that there is an increased risk of spread of COVID-19 through centralised air conditioning systems. Hundred and six HCWs (46.1%) were apprehensive of the use of these air conditioners. The majority of HCWs 124 (53.9%) despite being aware of the increased risk, wanted the air conditioning to be used.

The HCWs reported the procedure of emergency intubation (57%) to be associated with the maximum risk of infection followed by Cardiopulmonary Resuscitation (CPCR) (21%) and nasopharyngeal swab (Table/Fig 4).

Fifty percent of the HCWs had given an oropharyngeal or nasal swab for COVID-19 testings (RT-PCR for COVID-19). Eleven HCWs (4.78%) reported having had a positive swab report for COVID-19 during the duty period. There was no statistical significance amongst those reported to have compromised their safety and those having been reported as COVID-19 positive (Chi-square test p-value=0.23).


The HCWs in Mumbai faced a unique challenge in working with PPE and adjusting to the hot and humid conditions. Cases of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections increased over 375 times within 50 days around the duration of the study (8). The difficulties faced by the HCWs in working with PPE are very important as they might be significant barriers in the delivery of healthcare services to the patients.

In our study, the most common problem associated with using PPE kits were excessive sweating (96%). The HCWs also reported itching of the body parts to be a bothersome difficulty during their duty. De novo headaches and worsening of migraine were the other difficulties faced by the HCWs. India is a tropical country and Mumbai city with its hot and humid conditions during the peak summer months made the difficulties even more pronounced. There was a lot of apprehension with hospitals to prevent the spread through droplets and hence central air conditioning was kept shut in most of the hospitals (9). This added to the problems faced by the HCWs working with PPE. The majority of HCWs 124(53.9%) wanted the air conditioner to be functional accepting the risk of infection.

Although the dehydration experienced by the HCWs rarely required any medical attention, one respondent reported to have had severe dehydration needing overnight hospitalisation. There have been similar incidences in the literature (10). Fluid loss with heat stress has been perceived to be restrictive when working temperatures are beyond 28°C (11). Double gloves have been reported to result in reduced dexterity in fine manual work (11),(12). Many of the participants (40%) adjusted their N95 masks and lowered their faces shields intermittently due to breathing issues or due to excessive heat while being aware of the risk of self-contamination. There was no statistical significance amongst those reported to have compromised their safety and those having been reported as COVID-19 positive (Chi-square test p-value=0.23).

There is a need for modifications of the working environment and customising PPEs. Solutions offered by certain studies include reducing elective surgical procedures, the use of PPEs from disposable to re-usable ones, and preferring regional anaesthesia over general anaesthesia wherever possible (13). Another possible modification can be cost-effective, reusable customised PPE made of water-impervious polyester fabric 190 threads, which can be disinfected in 1% hypochlorite solution for 20 minutes (14). The analysed results can be used by the PPE designers to make any possible changes in the design of PPE, the administrators can use this data to educate the HCWs and make the new HCWs aware of the probable challenges that one may face.

There was one similar study done a month after the inception of this study, the study has been compared with the current study in (Table/Fig 5) (6).

The strengths of our study include surveying all types of HCWs who had used PPE kits. Anonymity and confidentiality were maintained concerning the institution and the personnel. The study covers all the important issues faced by workers faced by the HCWs.


A relatively small sample size and no randomisation limit the analysis and interpretation of the study.


De novo headaches, dehydration, excessive sweating and itching are the most common challenges faces by the HCWs after wearing PPE. Decreased dexterity and compromised vision with PPE leads to increased difficulty in performing ward procedure more difficult even to experienced HCWs. Heat and humidity significantly increased the challenges faced by HCWs working in PPE in the city of Mumbai during the peak of the pandemic.


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Vidua RK, Chouksey VK, Bhargava DC, Kumar J. Problems arising from PPE when worn for long periods. Med Leg J. 2020;88:47-49. 10.1177/0025817220935880. [crossref] [PubMed]
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DOI and Others


Date of Submission: Jan 13, 2021
Date of Peer Review: Feb 01, 2021
Date of Acceptance: May 27, 2021
Date of Publishing: Aug 01, 2021

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Jan 15, 2021
• Manual Googling: May 13, 2021
• iThenticate Software: Jun 21, 2021 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)