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CORRESPONDENCE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 57

Simultaneous donning of goggles and face shield is an overkill and interferes with care of Covid-19 patients


Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication10-Aug-2021

Correspondence Address:
Aditya Baksi
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-258X.323457


How to cite this article:
Baksi A, Vuthaluru S. Simultaneous donning of goggles and face shield is an overkill and interferes with care of Covid-19 patients. Natl Med J India 2021;34:57

How to cite this URL:
Baksi A, Vuthaluru S. Simultaneous donning of goggles and face shield is an overkill and interferes with care of Covid-19 patients. Natl Med J India [serial online] 2021 [cited 2021 Oct 15];34:57. Available from: http://www.nmji.in/text.asp?2021/34/1/57/323457

The spread of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) may occur through the conjunctiva, although this is not a common route of transmission.[1],[2],[3] The Centers for Disease Control and Prevention guidelines recommend using either goggles or a face shield as a component of personal protective equipment (PPE) for eye protection.[4] However, the exponential increase in cases of Covid-19 has led to the adoption of certain safety measures, such as concomitant use of goggles and face shield, despite lack of any evidence. I (AB) work in a hospital where concomitant use is practised. After some time, I found the goggles particularly uncomfortable, due to fogging and pain caused by pressure on the nasal bridge. I felt a constant urge to adjust the goggles to lessen the pressure on my nose. Soon, I noticed some abrasions and erythema over the bridge of my nose, which then turned into pustules, compelling me to discontinue wearing goggles. I continued wearing a face shield for eye protection, and realized that it was much more comfortable without the goggles. The pressure on my nose reduced, there was less fogging, better visibility and better peripheral vision. Most important, it allowed better ventilation, making it much less claustrophobic. This had a direct effect on patient management, and I felt more motivated to work. I communicated more with patients and co-workers.

Whereas previously I was eagerly waiting for my shift to end, I no longer minded a delay in handover. A detailed handover is extremely important, especially when there are four 6-hour shifts in a day, where the cumulative loss of information can be substantial at the end of the day. Three weeks past my posting, I was asymptomatic and tested negative for SARS-CoV-2 antibody.

Notably, the WHO guideline for PPE use in filovirus disease outbreak specifically advised against simultaneous use of goggles and face shield, as it has not been found to offer any additional protection and causes more discomfort and fogging.[5] Fogging results in compromise in patient care and safety of healthcare workers (HCWs). Face shields have been found to be less affected by fogging compared to goggles. Wearing goggles is even more cumbersome for HCWs who wear prescription glasses. There is no evidence of greater effectiveness of a combination of goggles and face shield than face shield alone. The addition of goggles to the PPE not only adds to the discomfort of HCWs but also to healthcare expenses for any government, in an already resource-constrained setting. The use of goggles in addition to face shield can be recommended for high-risk aerosol-generating procedures such as intubation or endoscopy, but routine use even in general wards with relatively stable patients does not seem justified.

In the present scenario of HCWs working under severe psychological and physical stress,[6],[7],[8] a simple step of omission of goggles (while continuing the use of face shield) can go a long way in improving patient care as well as well-being of HCWs.

Conflicts of interest. None declared

 
  References Top

1.
Lu C, Liu X, Jia Z. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet Lond Engl 2020;395:e39.  Back to cited text no. 1
    
2.
Centers for Disease Control Prevention. Coronavirus disease 2019 (COVID-19)–transmission. Available at www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html (accessed 13 Jul 2020).  Back to cited text no. 2
    
3.
Transmission of SARS-CoV-2: Implications for infection prevention precautions. Available at www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions (accessed on 13 Jul 2020).  Back to cited text no. 3
    
4.
Centers for Disease Control Prevention. Coronavirus disease 2019 (COVID-19). Available at www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html (accessed on 13 Jul 2020).  Back to cited text no. 4
    
5.
World Health Organization. Personal protective equipment for use in a filovirus disease outbreak. Available at www.who.int/csr/resources/publications/ebola/ personal-protective-equipment/en/ (accessed on 13 Jul 2020).  Back to cited text no. 5
    
6.
Gold JA. COVID-19: Adverse mental health outcomes for healthcare workers. BMJ 2020;369:m1815.  Back to cited text no. 6
    
7.
Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine 2020;24:100424.  Back to cited text no. 7
    
8.
Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of healthcare providers during the COVID-19 crisis in China: A qualitative study. Lancet Glob Health 2020;8:e790–8.  Back to cited text no. 8
    




 

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