Emerging evidence shows that healthcare workers may contract occupational respiratory infections through eye exposures, a risk that is underappreciated and for which eye protection is rarely worn, a healthcare epidemiologist emphasizes.

“There’s a lot of new data [on] respiratory virus transmission that suggests ocular exposure is a vulnerability,” Leonard Mermel, DO, ScM, professor at Brown Medicine in Providence, RI, tells Hospital Employee Health.

In a recently published letter, Mermel warned that respiratory viruses can use the eye as a point of entry to begin replication and infection. Eye protection may be suboptimal unless there is a perceived potential for splash, and hand contamination during personal protective equipment (PPE) removal has been shown to lead to introduction of infections into the eyes.

“Based on the evidence to date, it would be prudent to wear eye protection when caring for patients with suspected or proven respiratory viral infection,” Mermel notes in the letter.1 “This protocol would err on the side of caution in an attempt to mitigate the risk of transmission to healthcare workers and others.”

Such an approach would be in addition to source control — such as requiring infected patients wear masks — as well as the recommendations for PPE use for patients in contact and droplet isolation precautions.

Given historic compliance problems, there is still the question of whether workers would don eye protection even if the risks of infection are underscored.

“We can make this easy by use of masks that are a combination mask/eye shield,” he tells HEH. “That’s what we’re trying to do here in my hospital system. That way, we make it easy to do the right thing, so healthcare workers don’t need to find separate masks and eye shields.”

Such an approach could not only prevent respiratory infections but lower the many blood and body fluid splashes that occur to the eyes.

According to data from the International Safety Center’s Exposure Prevention Information Network (EPINet), “nearly 50% of all occupational exposure incidents in healthcare occur to the eyes, and only 3% of employees indicate that they are wearing any kind of eye protection during that exposure,” says Amber Mitchell, PhD, director of the center.

These exposures have resulted in a variety of disease transmissions, underscoring the need for making eye protection easily accessible, she says. This is particularly true for patient and examination rooms, where the majority of occupational eye exposures are occurring.

“The peer-reviewed literature is rich with data on transmission of pathogens via eye exposures, including HIV, HCV, SARS, rabies, plague, influenza,” Mitchell says. “Since healthcare facilities do not do surveillance testing of healthcare workers, the real risk is unknown. That said, from what we do know, the risk cannot be emphasized enough.”


  1. Mermel, LA. Eye protection for preventing transmission of respiratory viral infections to healthcare workers. Infect Control Hosp Epidemiol. 2018;39(11):1387.
  2. International Safety Center. Report for Blood and Body Fluid Exposures. May 8, 2018. Available at: https://bit.ly/2SeiBIg.