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Patient Care

Eye Protection: The Forgotten PPE

In EMT class and bloodborne-pathogens training, we’re taught to wear our gloves. Most EMS providers do so without thinking—they just pull them on as they exit their apparatus or approach a scene. They often carry extra pairs in their pocket or on their belt just in case.

Eye protection doesn’t seem to have the same sway. A 2016 study found its EMS usage varies based on department policy and personal preference. This article will review why eye protection for EMS is a sound idea and offer suggestions for how to be more consistent with wearing it.

Workplace Dangers

According to the American Academy of Ophthalmology, nearly 20,000 eye injuries occur at work each year.1 Further, nearly 90% of these injuries could be avoided if appropriate eye protection were worn. Granted, a majority of these injuries are industrial, rather than medical, yet EMS can find itself in nearly any situation rendering care.

According to the AAO, common causes of eye injuries include particles, debris, fluids, chemicals, and flying objects. Bloodborne and other pathogens, like the kinds to which EMS is repeatedly exposed, are part of this list. Additionally, much like your skin, your eyes can be harmed by repeated exposure to UV rays.

It is not known precisely when eye protection first came to be used in the medical field, but records indicate that a 1903 patent was granted to Ellen Dempsey of Albany, N.Y., for a transparent “sanitary face shield for protection from inhaling disease producing germs.”2 Today the relevant safety standards for eye protection are ANSI/ISEA Z87.1-2015, which prescribes the design, performance specifications, and marking of eye and face safety products worn in occupational settings, and OSHA’s 1910 standard on bloodborne pathogens.

According to OSHA, appropriate eyewear should have the “ability to protect against specific workplace hazards, should fit properly, and be reasonably comfortable to wear.”3 It should also “provide unrestricted vision and movement, should be durable and cleanable, and should allow unrestricted functioning of any other required PPE.”4   

If there is a foreseeable or expected blood or bloodborne pathogen contact with the mucous membranes of the eye, appropriate eye protection needs to be worn. Regular prescription glasses do not provide adequate eye protection. What does?

Eye-Protection Options

Goggles—According to the CDC, appropriately fitted goggles with a manufacturer’s antifog coating provide the most reliable practical eye protection from splashes, sprays, and respiratory droplets.5 Goggles, like the military-style ones often paired with EMS helmets, also protect from debris and particles. But while they protect the eyes, goggles typically do not protect the nose, mouth, or face. The same would be true for larger safety goggles, such as the kind you used to wear in high school science class.

Face shields—Face shields can be found as part of a fire or EMS helmet ensemble, stand-alone durable full shields, or disposable shields made of lightweight plastic film attached to a surgical mask. The advantage is that face shields provide protection for the entire face, although a disposable face shield will not protect the wearer from particles or weighted flying objects.

Safety glasses—Safety glasses typically provide good protection from debris and impact but are mediocre at best when it comes to splash and droplet protection. They can be combined with an N95 or other mask for mouth and nose protection from pathogens.

Full face respirators and SCBA masks—While both of these provide excellent protection from all eye injuries, they are not practical solutions for typical EMS responses.

Many departments have policies that require hand and eye protection on every patient contact. Santa Clara County (Calif.), for example, requires this, plus a surgical face mask or face shield if there is a chance of droplet or airborne transmission, such as through a patient coughing or vomiting or EMS providing invasive treatments.6

The most common form of glasses worn by EMS is sunglasses. Be sure your shades are UV-rated and, for extra protection, impact-protected as well. Remember, regular sunglasses may provide protection from the sun but will protect against few other hazards on the EMS scene.

If your department doesn’t have a policy requiring use of protective eyewear on every patient contact, it is up to you to create your own personal culture of safety. Get in the habit of donning goggles or safety glasses when you don gloves. Keep a surgical mask and/or disposable face shield in your pocket with your gloves. Don’t leave the goggles up on your helmet when working an accident scene. It’s your vision and your beautiful eyes—keep them both protected!

References

1. American Academy of Ophthalmology. Eye Injuries at Work, https://www.aao.org/eye-health/tips-prevention/injuries-work.

2. Roberge RJ. Face shields for infection control: A review. J Occup Environ Hyg, 2016; 13(4): 235–42.

3. Occupational Safety and Health Administration. Personal Protective Equipment, https://www.osha.gov/Publications/osha3151.pdf.

4. Princeton University, Department of Environmental Health and Safety. Personal Protective Equipment (PPE), https://ehs.princeton.edu/book/export/html/76.

5. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Eye Safety, https://www.cdc.gov/niosh/topics/eye/eye-infectious.html.

6. County of Santa Clara Emergency Medical Services System. Infectious Disease Control Measures, https://www.sccgov.org/sites/ems/Documents/pcm700/700-S/AO%20141008-8Policy700-S09.pdf.

Barry A. Bachenheimer, EdD, FF/EMT, is a frequent contributor to EMS World. He is a career educator and university professor with more than 30 years in EMS and fire suppression. He is currently an EMT with the South Orange (N.J.) Rescue Squad, a firefighter with the Roseland (N.J.) Fire Department, and an instructor at the National Center for Homeland Security and Preparedness in New York. Reach him at bbachenheimer@southorangerescuesquad.org. 

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