female nurse wearing protective gown over scrubs, surgical mask, bouffant cap and eyewear
Nursing News August 13, 2021

By Debra Wood, RN, contributor

PPE for Nurses: A Bad Fit for Women?

Although nurses, physicians and other healthcare workers have struggled for years with poor fitting personal protective equipment (PPE), the COVID-19 pandemic has called attention to the need for properly fitting PPE—particularly for women in healthcare.

“We are being exposed 24/7 now to a virus that’s almost as infectious as chickenpox,” said Saralyn Mark, MD, founder of SolaMed Solutions and impact of Gender/Sex on Innovation and Novel Technologies (iGIANT) in Washington, DC. “The level of PPE we need now is so different.”

Poorly-fitting PPE can leave nurses vulnerable to infections, Mark added. Female healthcare workers are more likely to become infected with COVID-19 than males, something she attributes to ill-fitting PPE. A 2020 study in Hospital Practice found “improperly fitting masks in healthcare professionals may have contributed to their eventual COVID-19 infection.”

“Ill-fitting PPE risks the health and safety of nurses and other healthcare workers,” said Gyorgy Madarasz, at the International Council of Nurse in Geneva, Switzerland. “They are uncomfortable, restrictive and unsafe.”

The problems with improper fit for PPE

PPE standards have been normalized to fit the average U.S. or European Caucasian male, which makes them too large for many healthcare professionals, who are women.

Women have learned to adapt to it, Mark said. However, she added, “We can do better.”

Properly fitting personal protective equipment requires more than a smaller size for women. It also needs to account for ergonomics, body proportion and movement, Mark explained.

Nurses sometimes use duct tape to tighten up a gown or shorten the legs of a body suit. They may double loop a mask around their ears, but that can leave gaps.

Large gloves, for example, make it hard to do work; oversized masks make it hard to see and do not create a proper seal,” Madarasz said. “Hazmat suits are designed with men in mind, so female healthcare workers may find them oversized and impractical.”

Madarasz added that, “PPE should not be produced in ‘one size fits all.’ Fit-testing should be part of official hospital occupational health and safety programs.”

Steps to deliver better PPE for nurses

“Raising awareness is the first step,” Mark said. Nurses should feel empowered to ask their organizations for properly fitting PPE.

One of the problems, Mark explained, is that PPE is considered a throwaway item, and hospitals and health systems do not want to invest in it. However, the cost of an employee becoming ill with COVID-19 or another infectious disease can lead to increased workers’ compensation premiums and staffing challenges, which contribute to poorer care.

“I think we can make it cost-effective, especially with a large population base,” Mark said. “Often in times of adversity, we have the greatest innovation. It’s that time now to do it.”

If nursing organizations and other groups go to manufacturers like 3M to demand changes in PPE, it will happen, said Mark. The push for more PPE to be made in the United States could present an “extraordinary opportunity” for changing from the unisex fitting equipment.

Teaming up to address proper fit for PPE

Multiple organizations have called for PPE that fits more people, including the American Medical Association, which has called for “the diversification of PPE design to better fit all body types.”

iGIANT aims to ensure everyone is given a fair shot, and PPE is one of its missions, Mark said.

Improperly fitting PPE is solvable, according to Rachel Thompson, a policy associate at Women in Global Health (WGH) in London, which will work with the World Health Organization on the issue.

WGH has conducted an online survey of healthcare workers and PPE to learn more from healthcare professionals about the challenges. It then plans to reach out to entrepreneurs to develop design solutions.

The American Nurses Association (ANA) also has expressed concern about properly fitting PPE.

“Access to PPE and achieving the proper fit is crucial to effective and quality patient care during this public health crisis, and all nurses and health care professionals must be protected and supported so they can safely care for patients and educate the public while working to end the COVID-19 pandemic. We must continue to safeguard nurses’ well-being and heed their invaluable insights so that the nation can recover faster and stronger,” the ANA said in a statement.

“We need a concerted effort, because people’s lives are on the line,” Mark said. “This is a life and death situation. We now have the capability to develop the design elements to meet the needs of the individual and there is no reason not to, because we can give everyone a fighting chance to survive.”

 

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