Personal protective equipment (PPE) is fundamental to infection control, preventing the transmission of infectious agents between patients and healthcare personnel. The eyes are a vulnerable entry point for pathogens because the conjunctiva is a mucosal surface. Infectious diseases transmit directly when contaminated fluids splash onto this membrane or indirectly when contaminated hands touch the eyes. Therefore, eye protection serves as a physical shield, minimizing the risk of infection from splashes, sprays, and respiratory droplets.
Identifying Exposure Risks
The need for eye protection is tied to the potential for exposure to hazardous materials or actions. These hazards fall into several categories, all of which necessitate a physical barrier. The first involves direct contact with blood or other potentially infectious materials, including bodily fluids like urine, respiratory secretions, or wound drainage.
A second significant risk comes from procedures that generate aerosols or droplets, such as a patient’s uncontrolled coughing or sneezing. High-flow oxygen administration or using certain medical equipment can also convert fluids into fine particles that reach the mucous membranes of the eye. Federal occupational safety guidelines require eye protection whenever splashes, spray, spatter, or droplets of these materials are reasonably anticipated.
The third source of hazard is exposure to various chemicals used throughout the facility. This includes potent disinfectants, sterilization agents, and laboratory reagents. A splash of these substances can cause immediate and severe chemical burns to the cornea, making robust eye protection necessary for staff handling them.
Procedural Mandates for Eye Protection
Eye protection is mandated during clinical tasks that inherently carry a high risk of producing splashes or aerosols. One common procedure is suctioning, where the mechanical removal of respiratory secretions from the airway can result in spray. Similarly, any task involving airway manipulation, such as intubation or extubation, is considered an aerosol-generating procedure requiring eye protection for all personnel in the room.
Invasive dental procedures, including the use of high-speed drills or ultrasonic scaling devices, generate a fine mist of water, saliva, and blood that can carry pathogens. Wound care interventions, particularly irrigation and debridement, create splashes as fluids are forcefully directed into the wound bed to flush out debris and infectious material.
Staff in the sterile processing department must wear eye protection, especially during the decontamination phase where contaminated instruments are manually cleaned. This process involves scrubbing and rinsing instruments, which can generate fine sprays of blood, tissue, and cleaning chemicals. Personnel handling large volumes of potentially infectious waste or specimens, such as in a laboratory setting, must also utilize eye protection against accidental spillage or container breakage.
Environmental and Setting Requirements
In certain environments, the sustained presence of potential hazards mandates eye protection upon entry, regardless of the immediate action being performed. Operating Rooms (ORs) and labor and delivery suites require continuous eye protection for all surgical and support staff due to the sudden and high-risk nature of procedures involving blood loss and body fluids.
Specialized areas like autopsy and morgue settings necessitate the consistent use of eye protection due to the sustained risk of exposure to bloodborne pathogens and unfixed tissue. The use of oscillating saws during autopsy procedures can also generate bone and tissue aerosols.
Specialized laboratories, such as those for microbiology or pathology, require eye protection due to the routine handling of concentrated infectious specimens and hazardous chemical reagents. Entering a patient’s isolation room for a highly transmissible airborne or droplet pathogen requires eye protection as part of transmission-based precautions. In these environments, the barrier must remain in place for the duration of the staff member’s stay.
Selection and Maintenance of Eye Protection
The selection of protective eyewear must align with the specific hazards present, as not all devices offer the same level of protection. Standard prescription glasses or contact lenses are inadequate because they have gaps and are not designed to withstand impact or block fluid entry. Certified safety eyewear must meet performance standards, such as the American National Standards Institute (ANSI) Z87.1, ensuring resistance to impact, radiation, and chemical splash.
Protection options include safety spectacles with solid side shields, suitable for general impact protection but offering less defense against splashes. Goggles, particularly indirectly-vented or non-vented types, provide a sealed barrier offering superior protection against fluid splash and respiratory droplets. Full face shields protect the entire face but are generally considered a secondary layer and should be worn over primary eye protection like goggles.
Reusable eye protection must be properly maintained to ensure effectiveness and prevent contaminant transfer. After use, the device must be carefully removed by handling only the head strap or ear pieces. Reusable goggles and face shields must be cleaned with a neutral detergent, disinfected using a hospital-approved disinfectant, rinsed, and allowed to air dry before storage.