Healthcare workers face a significant and underrecognised occupational health hazard: heat stress from prolonged personal protective equipment (PPE) use, according to guidance issued by the UK Department of Health and Social Care. The advisory, directed at healthcare providers and occupational health professionals, identifies PPE as a barrier to thermoregulation that can precipitate dangerous heat-related illness in clinical settings.
Key takeaways
- PPE creates a physical barrier that impairs the body’s ability to dissipate heat, increasing risk of heat stress and heat-related illness in healthcare workers
- Risk is heightened during high ambient temperatures, high-intensity clinical work, and in workers with pre-existing health conditions or reduced heat acclimatisation
- UK health authorities recommend systematic risk assessment, environmental controls, and worker monitoring to mitigate occupational heat stress
Heat stress risk factors in PPE-dependent healthcare settings
Relative risk contribution of key environmental and occupational variables
Source: UK Department of Health and Social Care | Georgian Medical Journal News
A known occupational hazard newly prioritised
Heat stress occurs when the body cannot adequately regulate core temperature, leading to thermal strain that can progress to heat exhaustion or heat stroke. The UK Department of Health and Social Care guidance emphasises that PPE—particularly gowns, gloves, masks, and eye protection used in infection prevention and control—acts as an insulating layer that prevents evaporative cooling and reduces convective heat loss. This physiological barrier is especially problematic in clinical environments where workers already face metabolic heat generation from sustained physical activity.
Healthcare systems have long recognised occupational heat as a concern, yet implementation of systematic heat stress prevention remains inconsistent across facilities. The guidance represents an effort to standardise risk assessment and control measures, particularly as climate-related heat extremes become more frequent. Healthcare quality and safety standards increasingly incorporate occupational health protections alongside patient safety protocols.
Risk factors and vulnerable populations
Not all healthcare workers face equal heat stress risk. According to the UK Department of Health and Social Care advisory, risk is stratified by duration of PPE use, ambient temperature, work intensity, and individual susceptibility factors. Workers with cardiovascular disease, obesity, poor physical fitness, or limited heat acclimatisation are at elevated risk, as are pregnant workers and those taking medications that affect thermoregulation.
Seasonal variation compounds the hazard: summer months, periods of elevated facility temperatures, and crowded clinical areas without adequate ventilation create higher-risk microenvironments. Night-shift workers may face additional vulnerability due to circadian disruption of thermoregulatory function. This suggests that clinical practice protocols must account for individual worker vulnerability rather than applying uniform PPE requirements.
PPE-related heat stress is preventable through systematic environmental assessment, engineering controls, administrative measures, and worker monitoring—yet remains underrecognised in many healthcare facilities.
— UK Department of Health and Social Care occupational health guidance (2024)
Mitigation strategies and implementation
The UK Department of Health and Social Care recommends a hierarchical control approach. Engineering measures include improving ventilation, reducing ambient temperature in clinical areas, and modifying workflow to allow periodic PPE removal and heat recovery breaks. Administrative controls encompass rotation of high-risk tasks, scheduling work during cooler periods, and ensuring adequate hydration and rest opportunities. Personal protective monitoring—including core temperature assessment in high-risk scenarios—supports early detection of thermal strain.
Healthcare facilities are encouraged to develop heat stress risk assessments tailored to their specific infrastructure, staffing patterns, and seasonal climate exposure. This includes identifying areas of elevated risk, workers with heightened vulnerability, and designing targeted interventions. Health policy frameworks increasingly recognise occupational heat stress as a workplace safety priority requiring institutional oversight and continuous monitoring.
Implications for global healthcare systems
Heat stress from PPE is not unique to the UK. Healthcare workers worldwide face similar occupational hazards, particularly in regions with high ambient temperatures and in facilities lacking climate control infrastructure. The guidance issued by UK authorities may serve as a model for other national health systems seeking to systematise their approach to occupational heat risk. Low- and middle-income countries, where air conditioning is limited and ambient temperatures are often elevated, may face disproportionate burden and require tailored adaptation of these protocols.
What this means
Frequently asked questions
What are the early signs of heat stress in healthcare workers wearing PPE?
Early warning signs include excessive sweating, dizziness, nausea, rapid heartbeat, reduced concentration, and fatigue. According to the UK Department of Health and Social Care, workers experiencing these symptoms should immediately remove PPE (if safe to do so), move to a cool environment, and consume fluids. Progression to confusion, loss of consciousness, or high core temperature indicates heat stroke—a medical emergency requiring immediate intervention.
Can lightweight or breathable PPE materials reduce heat stress risk?
While material choice influences heat transfer rates, even high-performance PPE creates thermoregulatory barriers and does not eliminate heat stress risk during prolonged use. The UK Department of Health and Social Care guidance indicates that engineering controls (ventilation, temperature management), administrative measures (work rotation, breaks), and worker monitoring remain the primary mitigation strategies, with PPE material optimisation as a supplementary measure.
How should healthcare facilities assess their specific heat stress risk?
Risk assessment should inventory: PPE requirements by clinical area, ambient and microclimate temperatures, typical PPE duration per shift, workforce demographics and health profiles, and seasonal temperature variation. The UK Department of Health and Social Care recommends facility-specific protocols based on these factors, with occupational health input. High-risk areas (intensive care, emergency departments, surgical theatres) warrant priority assessment and targeted control implementation.
The urgency of heat stress prevention reflects growing recognition of occupational health as integral to healthcare system resilience. As climate temperatures rise and PPE use remains commonplace for infection prevention, healthcare organisations must proactively implement systematic risk assessment and control measures to protect their workforce—and ultimately, patient safety. Failure to do so represents both an occupational health oversight and a patient safety vulnerability.
Source: Personal protective equipment and heat: risk of heat stress, UK Department of Health and Social Care
Was this article helpful?
Disclaimer. This article is health journalism intended for general information and education. It is not medical advice and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your individual circumstances. Full disclaimer →
Related Coverage
Editorial standards. This article was produced under the GMJ News editorial process, with oversight by the GMJ Editorial Board. Our editorial process. Spotted an error? Contact the editorial team.
