Introduction
The wearing of personal protective equipment (PPE) is essential during the care of
a patient positive or suspected for coronavirus disease 2019, as the transmission
is mainly through the respiratory route or contact with infected secretions or droplets.[1] A practical concern that has emerged over the last few weeks has been the performance
of duties for long hours donning the PPE. The customary clinical and laboratory shifts
are 6 to 8 hours, a period often quoted that of an endless hunger and thirst.[2] Energy and hydration during this shift are an issue as the PPE precludes any intake
once donned, until doffing. In high-intensity workplaces such as intensive care units,
improper nutrition and hydration can affect decision-making. Being at the forefront
of caring for these patients, good immunity is essential, too. In endurance workouts
such as long distance running and cycling, a rigorous routine to achieve optimal nutrition,
maintain hydration, and develop immunity through diet is often resorted to. An approach
of similar nature can help during the long duty hours with PPE.
The human body is alkaline and maintains a pH between 7.35 and 7.45. The pH of the
body is influenced by any food or liquid intake. Like many food items containing large
amounts of nitrogen, chlorine, and phosphorus (such as meats), which tend to be acidic,
the food we consume can be modified to make it alkaline. Foods rich in calcium, potassium,
sodium, and magnesium (e.g., leafy greens) tend to be alkaline forming. Lemon, despite
being acidic (pH 2.0), has an alkaline effect on the body.[3] The stress of the current pandemic, uncertain times added to the duty, can lead
to unhealthy eating habits, further affecting overall health. Attention to adequate
hydration, diet, and intake of immunity building nutrition is fundamental.
Hydration
Adequate hydration must be ensured throughout the day, especially in the period of
6 to 8 hours before the duty. The day should start with the intake of warm water with
lime. As regular tea or coffee is acidic, it is beneficial to switch to herbal or
green tea.[4] The addition of ginger, cardamom, basil, mint, or jaggery to the herbal tea is encouraged.
Intake of a large quantity of liquids before duty might lead to early micturition
reflex. Instead, wet foods such as dal khichdi, kidney beans (Rajma), thick soups, and vegetables such as brinjal, tomatoes, and cucumber contain a high
percentage of water (77–97%). Avoid too much salt in diet as this may enhance thirst.
Instead, consume natural salt-containing foods such as spinach, beetroot, and carrots.
It is good to ensure water intake of at least 3 L of fluid in the period before and
after the duty hours.
Nutrition
The dietary aspect can be modified for optimal nutrition as well as energy during
the strenuous period of duty with PPE. It is important to incorporate, as much as
possible, three meals per day. The timing of the major meals can be adjusted as per
duty timings. The main meal before duty should be ~2 hours prior. This timing of the
major meals gives the body the basic energy needs. A snack, portion of which is one-third
of the main meal, can be consumed 20 to 30 minutes before donning the PPE. This helps
to top up the energy levels. For the main meals, complex carbohydrate diets with a
combination of protein are excellent for giving sustained energy for long hours of
duty. Breakfast can include oatmeal, broken wheat (Dalia), cheese, beaten rice preparations (Poha), and eggs. Whole millets or brown rice along with lentils (Dals) are ideal for the main meals. Eggs and chicken can be included in the main meals.
Greens such as beans, spinach, broccoli, and different kinds of vegetables should
form the backbone of the diet. Vegetables give vitamins and fiber and increase the
water content in the body. A small snack just before donning the PPE can be dry fruits
such as dates, dried figs, almonds, and pistachios.[5] Rich carbohydrate fruits such as a banana, mango, grapes, and papaya or even a small
meal such as a sandwich, steamed rice cakes (Idli), yogurt, or an extension of lunch can give sustainable calories as top-up energy
for the duty hours.
Similar foods should also be kept handy post shifts along with adequate hydration.
This is beneficial as the rituals of doffing, compulsory shower, travel back from
the workplace, and the necessary precautions before entering the place of stay may
delay the main meal.
Immunity
The importance of good immunity cannot be undermined during this stressful period.
As a healthcare worker, along with external protection with appropriate PPE, good
immunity is essential. The immunity of the body can be increased by dietary modifications.
The inclusion of ginger, cinnamon, organic honey, and lime boosts immunity.[6] Hence, lime can be added to meals that increase the absorption of iron, too. Probiotics
such as curds, yoghurt, and fermented foods such as Idli or rice pancakes (Dosa) improve the gut immunity.[7] Herbs such as garlic, ginger, turmeric, and black pepper improve the immunity of
the respiratory tract.[8] Foods and fruits rich in vitamin C, such as lime, capsicum, guava, broccoli, and
tomatoes and those rich in vitamin A such as carrots, pumpkin, sweet potato, mangoes,
and papaya are excellent additions to the diet. Supplements of vitamin C, vitamin
E, omega-3 fatty acids, and zinc are good for overall immunity.[9]
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