By Gary Evans, Medical Writer

Which healthcare worker body site is most frequently exposed to blood and body fluids, according to national surveillance data? The eyes have it.

The major cause of this is that workers don’t have access to eye protection, says Amber Hogan Mitchell, DrPH, MPH, CPH, president and executive director of the the International Safety Center.

The center runs the Exposure Prevention Information Network (EPINet) so hospitals can measure occupational exposures to sharps injuries and other blood and body fluid exposures. Hospital Employee Health asked Mitchell to comment on her call for a new “culture of accessibility” in healthcare, which would make routine access to eye protection a given.

HEH: This is kind of a new paradigm in looking at personal protective equipment (PPE). Is this something you thought of in light of our inability to be separated from smartphones?

Mitchell: We always have our phones accessible. How is it that we are not transitioning that accessibility demand to something that is going to protect us, like PPE? How can we shift that culture to, “Oh my gosh, I forgot my eye protection!” That panic that we have when we forgot our phones.

HEH: What trends are you seeing in eye exposures in surveillance data?

Mitchell: We know from our EPINet data that 65% of all exposures are to the eyes. We found that less than 6% of all those exposures are to employees who were wearing eye protection of any kind. That could be face shield, goggles, even eyeglasses with side shields.

I just did a presentation to the American Association of Critical-Care Nurses in Boston and I asked the audience why they felt this was the case. Most of them said it because the PPE — especially eye protection — is not accessible to them. They are frequently not on the infection control caddies or PPE carts. They may be somewhere off in a storage room, but healthcare workers don’t know where they are.

So the accessibility issue really rises to the top. Some hospitals are actually considering something like when a new employee starts and they get their ID badge, they also get to pick the kind of eye protection they like. They are given a badge and eye protection. More facilities are thinking about what longer-term, reusable PPE looks like as part of their uniform. Or for disposable eyewear, making space in wall caddies for that as well.

HEH: Is this primarily eye protection, or is there an accessibility gap for other PPE?

Mitchell: Patient rooms and exam rooms are all outfitted with multiple sizes of gloves. But I think people think about gloves more as protecting the patient than protecting themselves. Gloves have become more of an infection prevention protective barrier. When they are in an isolation room, there may be disposable gowns available outside that room or on a caddy.

But most of the exposures are actually happening to the face — there is limited accessibility for personal protective equipment that protects the mucous membranes like eye protection, surgical masks, and face shields. Accessibility has become a real problem.

HEH: You suggest that personalizing eye protection may lead to greater compliance.

Mitchell: Surgical personnel pick a surgical cap that really defines who they are — whether they like to cook, they like dogs, or surfing. You will see people with these different types of caps on that really reflect their personality. That may be a way to improve eye protection use — having different colors, themes, or styles.

There are several manufacturers making eye protection that looks more like outdoor protection or for sports lovers. There are a lot of different styles and sizes, and also prescription eye protection. We could have these available through discount codes or other ways people could pick their own style. Making reusable eye protection a more personal choice is an opportunity to increase compliance. It could be something that is comfortable to you, reflects your personality, or say if you are working in pediatrics, something that reflects your patients.

For disposable eyewear, I think it is really a matter of building out these traditional infection control caddies that are either wall- or cart-mounted. They should have areas for disposable eyewear that do not take up a lot of space. The reusable eyewear is sturdier and takes up more space, but disposable eyewear has come a long way.

I think the greater likelihood of increasing compliance is if people had a choice to wear something that best suited their personalities and their patients. There are vendors that have eye protection that is slip-resistant and really flexible. The technology for eye protection has come a long way from the rigid, heavy plastic of a decade ago.