Eye Protection for Infection Control

Adapted from CDC information

Airborne splashes and droplets containing viruses and bacteria can be transmitted via the mucous membranes of the eye. © Inna – stock.adobe.com

The COVID-19 pandemic has shone a bright, sustained and uncomfortable spotlight on the subject of infectious disease, but its spread has been a danger to humanity for as long as humanity has existed. While the respiratory system is often perceived as the most likely transmission route, the mucous membranes of the eye can provide access into the body for viruses and bacteria that can cause conjunctivitis and systemic infections like hepatitis B and C, herpes viruses and rhinoviruses. The introduction of infectious agents can be direct – by way of blood splashes, respiratory droplets generated during coughing – or indirectly, from touching eyes with contaminated fingers or other objects.

The Centers for Disease Control and Prevention (CDC) recommends eye protection for a variety of potential exposure settings where workers may be at risk of acquiring infectious diseases via ocular exposure. Eye protection provides a barrier to infectious materials entering the eye and is often used in conjunction with other personal protective equipment (PPE) such as gloves, gowns, masks or respirators. One thing to note: regular prescription eyeglasses and contact lenses are not considered eye protection.

As with all forms of personal protective equipment, eye protection should be appropriate for a given task and potential hazards and compliant with relevant regulations. It must be comfortable, adjustable to ensure a secure fit and it must allow for sufficient peripheral vision. When infections have occurred, a review of the resulting exposure incidents could be helpful in identifying protective eyewear that would be better suited for that work environment.

From Goggles to Contact Lenses

Goggles can provide effective protection from splashes, sprays and respiratory droplets, if they fit snugly – especially from the corners of the eye across the brow – and are indirectly vented. Splashes and sprays may be able to penetrate directly vented goggles. While older models tended to fog up and affect the wearer’s ability to see, newer styles reduce fogging by having better indirect airflow. Although goggles shield the eyes, they do not protect other parts of the face from exposure to hazardous droplets.

Face shields can protect the entire face – including the eyes – from infectious disease-causing materials. In order to do that, they must have both crown and chin protection and wrap around the face to the point of the ear, which reduces the likelihood that a splash could go around the edge of the shield and reach the eyes. Per ANSI/ISEA Z87.1-2020, American National Standard for Occupational and Educational Personal Eye And Face Protection Devices, face shields should be used in addition to goggles, not as a substitute for goggles in occupational environments in which there is a risk of chemical exposure.

Safety glasses should not be used for infection control purposes, although they are appropriate for impact protection.

Full facepiece elastomeric respirators and powered air-purifying respirators (PAPRs) are intended for respiratory protection, but they also provide optimal eye protection.

About Prescription Eyewear

Although there are prescription safety glasses with side shields, they do not prevent splashes or droplets from reaching the eye like goggles do. Wearing safety goggles over prescription eyewear is a better option. There are also special prescription inserts for goggles.

Both full facepiece elastomeric negative pressure (i.e., non-powered) respirators and tight-fitting powered air purifying respirators (PAPRs) require prescription inserts to avoid compromising the seal around the face. PAPRs designed with loose-fitting facepieces or with hoods that completely cover the head and neck may be more accommodating to prescription lens wearers.

Contact lenses, by themselves, offer no infection control protection. However, contact lenses may be worn with any of the recommended eye protection devices, including full-face respirators. Contact lens users should rigorously adhere to hand washing guidelines when inserting, adjusting or removing contact lenses.

Putting It All Together

Eye protection must work with other forms of PPE – or, with other types of eye protection, if they are to be worn together. For instance: safety goggles may not fit properly when used with certain half-face respirators, and similarly, face shields may not fit properly over some respirators. Once PPE requirements have been established for a specific infection control situation, the selected PPE should be pre-tested to assure suitable fit and protection when used as an ensemble. Elastomeric, full facepiece respirators and powered air-purifying respirators (PAPRs) have the advantage of incidentally providing optimal eye protection.

Removal and Cleaning

Eye protection should be removed by handling only the portion of this equipment that secures the device to the head (i.e., plastic temples, elasticized band, ties), as this is considered relatively “clean.” The front and sides of the device (i.e., goggles, face shield) should not be touched, as these are the surfaces most likely to become contaminated by sprays, splashes or droplets. Non-disposable eye protection should be placed in a designated receptacle for subsequent cleaning and disinfection. The sequence of PPE removal should follow a defined regimen that should be developed by infection control staff and take into consideration the need to remove other PPE (see donning and removing PPE).

Each worker should be assigned his/her own eye protection to ensure appropriate fit and to minimize the potential of exposing the next wearer. A labeled container for used (potentially contaminated) eye protection should be available in the HCW change-out/locker room. Eye protection deposited here can be collected, disinfected, washed and then reused.

Manufacturer guidelines for cleaning and disinfecting eye protection should be followed. Gloves should be worn during this process.

For more information about eye safety and PPE, visit https://www.cdc.gov/niosh.