The effectiveness of a visor as a surgical barrier: an inverted position is better

Limiting factors of face shield use for health professionals during the COVID-19 pandemic

BACKGROUND

Coronavirus disease (COVID-19) is caused by SARS-COV2, a highly transmissible and pathogenic viral infection, and was identified in December 2019 in Wuhan, China. Three months later, it became a severe pandemic.

OBJECTIVE

To identify scientific evidence on the use of face shields by health professionals during the COVID-19 pandemic period.

METHOD

An integrative literature review of articles obtained from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases was undertaken. For the search, controlled, non-controlled descriptors and specific keywords: "face shield," "fluid resistance procedure," "respiratory infections," "healthcare workers," "COVID-19," "aerosols," and "personal protection infection" were used.

RESULTS

The sample comprised seven studies. The available evidence has shown that face shields do not have a defined standard for their production-their effectiveness depends on the quality of the visor, structure, and fixation system. They must be used as adjuvants to other personal protective equipment (PPE), and their isolated use is not recommended due to the fragilities of peripheral face sealing, especially during the COVID-19 pandemic period.

CONCLUSION

Due to the shortage of this equipment, domestic face shields can be indicated if they meet production requirements, based on scientific evidence for their efficient use.

Pantallas faciales para el control de infecciones: una revisión

ResumenLas pantallas faciales son dispositivos que integran el equipo de protección personal utilizados por muchos trabajadores (por ejemplo, médicos, dentistas, veterinarios) para proteger la zona facial y las membranas mucosas asociadas (ojos, nariz, boca) de salpicaduras, rociadas y aspersiones de fluidos corporales. Generalmente, las pantallas faciales no se utilizan solas, sino junto con otro equipo de protección, por lo que se clasifican como equipo de protección personal complementario. Aunque hay millones de potenciales usuarios de pantallas faciales, las directrices para su uso varían en los distintos organismos gubernamentales y sociedades profesionales y existen pocas investigaciones que indaguen sobre su eficacia.

The effectiveness and efficacy of respiratory protective equipment (RPE) in dentistry and other health care settings: a systematic review

OBJECTIVE

The global pandemic of coronavirus disease-19, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is the latest hazard facing healthcare workers (HCW) including dental care workers (DCW). It is clear that the major mode of SARS-CoV-2 transmission is the airborne route, through inhalation of virus-infested aerosols and droplets. Several respiratory protection equipment (RPE), including masks, face shields/visors, and respirators, are available to obviate facial and conjunctival contamination by microbes. However, as their barrier value against microbial inhalation has not been evaluated, we systematically reviewed the data on the effectiveness and efficacy of facemasks and respirators, including protective eyewear, with particular emphasis on dental healthcare.

MATERIAL AND METHODS

PubMed, MEDLINE, the Cochrane Library, and Embase databases were searched between 01January 1990 and 15 May 2020.

RESULTS

Of 310 identified English language records, 21 were included as per eligibility criteria. In clinical terms, wearing layered, face-fitting masks/respirators and protective-eyewear can limit the spread of infection among HCWs. Specifically, combined interventions such as a face mask and a face shield, better resist bioaerosol inhalation than either alone. The prolonged and over-extended use of surgical masks compromise their effectiveness.

CONCLUSIONS

In general, RPE is effective as a barrier protection against aerosolized microbes in healthcare settings. But their filtration efficacy is compromised by the (i) inhalant particle size, (ii) airflow dynamics, (iii) mask-fit factor, (iv) period of wear, (v) 'wetness' of the masks, and (vi) their fabrication quality. The macro-data presented here should inform policy formulation on RPE wear amongst HCWs.

Development of a Sterile Personal Protective Equipment Donning and Doffing Procedure to Protect Surgical Teams from SARS-CoV-2 Exposure during the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has become an increasingly challenging problem throughout the world. Because of the numerous potential modes of transmission, surgeons and all procedural staff represent a unique population that requires standardized procedures to protect themselves and their patients. Although several protocols have been implemented during other infectious disease outbreaks, such as Ebola virus, no standardized protocol has been published in regard to the COVID-19 pandemic. Methods: A multidisciplinary team of two surgeons, an anesthesiologist, and an infection preventionist was assembled to create a process with sterile attire adapted from the National Emerging Special Pathogen Training and Education Center (NETEC) donning and doffing process. After editing, a donning procedure and doffing procedure was created and made into checklists. The procedures were simulated in an empty operating room (OR) with simulation of all personnel roles. A "dofficer" role was established to ensure real-time adherence to the procedures. Results: The donning and doffing procedures were printed as one-page documents for easy posting in ORs and procedural areas. Pictures from the simulation were also obtained and made into flow chart-style diagrams that were also posted in the ORs. Conclusions: Coronavirus disease 2019 (COVID-19) is a quickly evolving pandemic that has spread all over the globe. With the rapid increase of infections and the increasing number of severely ill individuals, healthcare providers need easy-to-follow guidelines to keep themselves and patients as safe as possible. The processes for donning and doffing personal protective equipment (PPE) presented here provide an added measure of safety to surgeons and support staff to provide quality surgical care to positive and suspected COVID-19-positive patients.

Workplace Exposures

Workplace exposure in colorectal surgery is unique compared with other surgical specialties and generally underreported. Although the most common device-associated exposure in surgery is suture needle injury, colorectal surgeons are increasingly exposed to gastrointestinal-related infectious agents, radiation, and other hazards in multiple different clinical settings. Highlighting the unique workplace exposures in colorectal surgery may help increase awareness, improve education, and identify possible targets for early intervention in order to minimize these risks.

Face shields for infection control: A review

Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays, and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment. Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available regarding their efficacy.