Eyewear underappreciated form of PPE
Amid the debate over respiratory protection for health care workers, another form of personal protective equipment (PPE) has received little attention. Goggles are an important component of infection control, as health care workers are commonly exposed to infectious disease hazards through the mucous membranes of the eye.
"Goggles are well demonstrated to decrease transmission of pathogens like RSV [respiratory syncytial virus]," says Kent Sepkowitz, MD, director of hospital infection control at Memorial Sloan Kettering Cancer Center in New York City. "They almost certainly play a role in reducing transmission of SARS [severe acute respiratory syndrome] and the common cold."
In fact, transmission isn’t as likely to occur from breathing in the droplets when someone sneezes, he says. It often occurs when someone touches a contaminated surface, then rubs his or her eye. "The goggle is a barrier that keeps you from rubbing your eye," Sepkowitz explains.
Unfortunately, studies indicate goggles are underused. In one study of universal precautions in a community hospital emergency department, goggles were used only about half the time they were appropriate.1
"Traditionally, protection of the eyes has been recommended as part of universal precautions," says Linda Chiarello, an infection control consultant with the Centers for Disease Control and Prevention (CDC) in Atlanta. "I don’t think we really know the role of eye protection for preventing spread of respiratory diseases," she says. "In general, what we need to prevent is hand-to-eye touching."
A 1986 study showed goggle use helped prevent the spread of RSV infection in an infant ward. When goggles were used routinely during a three-week period, only 5% of the health care workers and 6% of the patients acquired nosocomial infections. When the goggle use ceased during a subsequent three-week period, 34% of the health care workers and 43% of susceptible infants became infected.2
Goggles and face shields were important components of protective gear during the SARS outbreak in 2003. But there has been little research on the effectiveness of different kinds of PPE in that outbreak, Chiarello notes.
One thing is clear: Goggles are essential to protect against splashes of blood and body fluids when health care workers are performing splash-prone procedures. For example, goggles are necessary when accessing a vessel under high pressure (such as arterial puncture), suctioning, or performing a procedure that causes aerosolization of body fluids, Chiarello says. "Preventing blood splashes to the eye is very important," she says.
There have been at least four documented cases of HIV and/or hepatitis C infection that involve splashes to the eye, according to information from the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. In one case, a health care worker contracted both HIV and hepatitis C from an eye exposure.3
Eye protection is especially important in the surgical setting — even by workers who are not in the immediate proximity of the operative site, says Jane Perry, MA, the center’s director of communications. Health care workers failed to wear protective eyewear (goggles, face shields, or eyeglasses with side shields) in 74% of 367 surgical exposure cases reported to the safety center’s EPINet system from 1997 to 2001, according to an analysis by Perry.4 In 24% of the eye exposure cases, the eye protection failed, perhaps because of gaps or other design flaws, she says.
"It’s important to look at what people are wearing in these settings and make sure they actually provide the protection that’s needed," Perry adds. For example, a simple foam band integrated into the face shield or device may prevent splashed blood from dripping down a health care workers face into the eyes.
"Even people who aren’t working close to the operative site can get splattered or sprayed by blood," she says. "That needs to be considered when you’re looking at requirements for wearing goggles and face shields."
One other important point: Eyeglasses are not a substitute for goggles. In fact, they may discourage health care workers from using goggles, leaving them unprotected from exposures, infection control experts say.
As bloodborne pathogen exposures decline with the use of safer sharps, other exposures may gain more attention. "The eyes are a proven route of transmission for bloodborne pathogens," Perry notes. "It’s worth spending the effort and energy to get the equipment that’s comfortable and provides all of the protection you need."
1. Henry K, Campbell S, Collier P, et al. Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals. Am J Infect Control 1994; 22:177-178.
2. Gala CL, Hall CB, et al. The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection. JAMA 1986; 256:2,706-2,708.
3. Ippolito G, Puro V, Petrosillo N, et al. Simultaneous infection with HIV and hepatitis C virus following occupational conjunctival blood exposure. JAMA 1998; 280:28.
4. Perry J. Safety: Protecting your eyes from sprayed, splashed blood. Outpatient Surgery Magazine 2003; 8:82.