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Face shields for COVID-19 infection control

Introduction

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. Face shields protect medical and other emergency service personnel from biological splatter and are thought to extend the usefulness of face masks.

Face-Shield-components
Figure 1: Face shield components.

Commercially known as Infectious Disease Control shields and colloquially as “spit shields,” the worldwide demand for them has spiked with the recent viral pandemic. As existing manufacturers try to meet the demand, some companies in other businesses have begun producing face shields to donate to hospitals to make up for the shortage.

With cutting implements and assembly areas already available, sailmakers, upholstery manufactures, etc. can quickly gear up for manual production. Healthcare workers’ faces have been reported to be the body part most commonly contaminated by splashes, sprays and spatter of body fluids.

A face shield is classified as personal protective equipment (PPE) that provides barrier protection to the facial area and related mucous membranes (eyes, nose, lips).

A face shield offers several potential advantages, as well as some disadvantages, compared with other forms of face/eye protection used in healthcare and related fields shown in Table 1.

The millions of potential users of face shields include healthcare workers, dental providers, veterinary care personnel, laboratory workers, pre-hospital emergency medical providers, police, firefighters, and custodial staff dealing with spills and contaminated waste.

Infectious diseases (e.g., Severe Acute Respiratory Syndrome [SARS], Avian Influenza, etc.) and severe infectious agents associated with the potential for body fluid exposures (e.g., Ebola virus), have resulted in increased attention to face/eye protection.

face-mask-face-shield-comparison
Table 1 Comparison between the face mask and face shield.

Face shield design and structure

Visor: Visors, also referred to as lenses or windows, are manufactured from any of several types of materials that include polycarbonate, propionate, acetate, polyvinyl chloride, and polyethylene terephthalate glycol (PETG) and come in disposable, reusable, and replaceable models Acetate provides the best clarity and PETG tends to be the most economical, but polycarbonate is one of the most widely used.

Polycarbonate and propionate offer better, although still somewhat imperfect, an optical quality that aids in reducing eye strain.

Frame: Face shield frames used in healthcare are generally made of lightweight plastic. There are a variety of frame styles, including adjustable and nonadjustable frames that fully or partially encircle the circumference of the skull or those with eyeglass-type temple bars that are worn like standard eyewear.

There are also metal clip-on frames available that are designed to attach face shield visors to the prescription eyewear, and some frames allow for the visor to be flipped up when not in use.

Suspension Systems: There are a variety of face shield suspension systems on the market that offer either fully or partially circumferential attachment features.

Fully circumferential suspension systems include plastic headbands that are adjustable for comfort by a ratchet mechanism, pin lock systems, or Velcro nonadjustable systems employ elastic straps some models utilize eyeglass type temple bars for suspension with or without eyewear-like nose pads and bridge assemblies to assist in maintaining face shield position and stability on the face. A top band that is adjusted for depth is found on some models.

Lens plate Polycarbonate is the material of choice for many helmet-style face shields because of its optical clarity and impact resistance. Where the goal is mainly to protect the face and eyes against contact with bodily fluids, the material used for the lens plate can be less resistant to impact than polycarbonate as long as it maintains some optical properties. Some less costly materials include polyester (PET).

Sail works of Hood River, Oregon, is using 7 mils thick mono film, a polyester film used by sailmakers that is both clear and reasonably strong, to manufacture its emergency lens plate. The film is thin enough to cut with scissors yet sufficiently rigid to hold a shape. It probably would not protect against rioters throwing bricks, but certainly should manage to keep blood spatter at bay in an operating room.

Headband: Headbands for most personal protective equipment (PPE) such as welding helmets and medical face shields are generally injection molded affairs with adjustments for head size as well as helmet height.

Again, for emergency service personnel who require durable protection, this design makes sense. For medical teams, a simple foam band that rides on the forehead and holds the lens plate, coupled with an adjustable length of 1-in. wide elastic webbing is the approach that Sail works take.

The resulting product is inexpensive and disposable. Medical personnel prefers the entire assembly to be as light as possible.

Table 2: Material quantities
Materials Type of Materials
Marine Grade Vinyl, 16 or 20 gauge Vinyl Plastic Materials
Vinyl Sheet Fabrication
Ethylene Vinyl Acetate (EVA) Plastic Sheet & Sheeting
Vinyl Film
Foam, 1” x 1” Polyurethane Foam
Foam Water jet Cutting Services
Die Cut Foam
Foam Fabrication
Elastic, 3/8” to ½” Elastic Belts
Elastic Bands
Elastic Belting
Woven Elastics
Elastic Fabrics
Elastic Straps
Double-Sided Tape, 1” Double-Faced Tapes
Adhesive Skin Contact Tapes

Benefits: The idea behind face shields is also to extend the useful life of face masks, which too are now in great demand. Hospital workers are being asked to use the masks all day rather than disposing of them after each patient visit.

The face shields in theory protect the masks from the full onslaught of viral particles encountered throughout the worker’s day, enabling the masks to be used longer.

Face shield materials

Three of the materials used in face shields: acetate, PETG, and polycarbonate.  The strengths of each material should be taken into account when making a selection, to provide the best overall solution for different applications workers encounter.

There are reasons why each of these face shield materials exists and are in use: MCR Safety wants to provide you the exact PPE for your particular needs.

Acetate

Acetate face shields are used in chemical applications where optical clarity is needed. Cellulose acetate is a plant-based plastic that is hypoallergenic.  Acetate was first used for eyewear in the late 1940s because of the brittleness and other problems encountered with previously used plastics.

Acetate face shields offer the following benefits:

  • It is well-suited for applications requiring good optical clarity and rigidity
  • It does not become limp or distorted under normal temperatures
  • It offers high impact resistance and withstands crazing or cracking over a wide range of temperatures under normal stress
  • It is an excellent shield for grease and oils
  • It maintains flexibility over long periods

PETG

PETG is a thermoplastic polyester that provides excellent toughness, chemical resistance, and is easily die-cut for face shield use.  PETG offers excellent protection at a competitive price point.  PETG is great for face shields because:

  • It incredibly durable
  • It is highly impact-resistant
  • It can be sterilized

Polycarbonate

Polycarbonate is everywhere.  It is a naturally transparent, amorphous thermoplastic with applications beyond eyewear lenses.  However, polycarbonate has numerous benefits that make it a particularly great choice for safety eyewear:

  • It can internally transmit light almost as effectively as a glass
  • It is lighter than glass
  • It possesses a natural UV filter
  • It can withstand impacts far greater than many other commonly used plastics
Table 3: Face shield materials comparison chart
Acetate PETG Polycarbonate
Impact resistance Good Best Better
Heat resistance *** *** ***
Chemical resistance Best Good Better
Optical quality Best – 190°F Better – 180°F Good – 170°F
Scratch resistance *** *** ***
Material cost Highest Mid Lowest

Selection of face shields

Face shields are meant to be used as barrier protection for the facial area and associated mucous membranes from airborne body fluids (blood, saliva, bronchial secretions, vomit, urine, etc.) expelled as a result of various physiological processes (vomiting, coughing, sneezing, etc.) and medical, dental, and veterinary procedures (suctioning the airway, placing nasogastric tubes, obstetrical procedures, surgery, dental procedures, etc.).

Since there are currently no standards for face/eye protection against biological hazards and research data is scant, recommendations for the proper selection of face shields for infection control must rely on currently available knowledge, the task to be performed and the anticipated risk associated with the procedure.

The selection of the most appropriate face shield model(s) will depend on the circumstances of exposure, other PPE used concurrently, and personal vision needs. Face shields with single Velcro or elastic straps tend to be easiest to don and doff; doffing can be accomplished with a single hand.

To be efficacious, face shields must fit snugly to afford a good seal to the forehead area and also to prevent slippage of the device. Visors manufactured from acetate, propionate, and polycarbonate offer improved visual clarity and optical quality with the potential for less eye strain.

Visors that offer protection from UV light would be an important feature for individuals utilizing UV light sources (e.g., dental personnel). Face shields should be selected that have visors treated for anti-glare, anti-static, and anti-fogging properties.

For improved protection from infectious agents, face shields should be, at a minimum, full face length with outer edges of the face shield reaching at least to the point of the ear, include chin and forehead protectors, and cover the forehead.

Brow caps or forehead cushions should be of sufficient dimensions to ensure that there is adequate space between the wearer’s face and the inner surface of the visor to allow for the use of ancillary equipment (medical/surgical mask, respirator, eyewear, etc.).

Cost-effective considerations include disposable face shields vs. reusable models and those that offer replaceable parts. Although some models of industrial face shields could be used for infection control purposes (e.g., in the event of face shield shortages), they generally tend to be more expensive, heavier and bulkier than face shields used for infection control purposes.

Conclusions

Face shields are PPE that are commonly used as barrier protection for infection control purposes by numerous workers. There is no standard regarding face/eye protection from biological hazards and this deficit needs to be remedied as quickly as possible.

Due to the lack of a good facial seal peripherally that can allow for aerosol penetration, face shields should not be used as solitary face/eye protection, but rather as adjunctive to other PPE.

Acknowledgment

The author would like to thank the Management of GRG Institutions for their constant encouragement and motivation to carry out this work.

References

[1] Talikwa, L.: Facing up to wearing facial protection equipment. Managing Inf. Control 3–8 2002.

[2] International Safety Equipment Association (ISEA):“Draft ISEA 119: Standard for eye and Face Protection against Biological Hazards.”

[3] Mitchell, A.H.: A retrospect: PPE use then and now. Infect. Control Today 18:32–35 (2014).

[4] U.S. Patent Office: “Ellen Dempsey. Patent 737, 591. Sanitary Face Shield. 1903.”

[5] U.S. Patent Office: “James H. Bolker. Patent 3,943,575. Comfortable Surgical Hood. 1976.”

[6] U.S. Patent Office: “Darryl Dial, John M Geesbreght. Patent 4,805,639. Medical Cap with Face Shield.1989.”

[7] Occupational Health and Safety Administration (OSHA): “Blood Borne Pathogens Standard 1910.1030.”.

[8] Grainger. Quick Tips Technical Resources: “Quick Tip #373. Face shield Protection.”

[9] Beckerdite, K.: “Eye & Face Protection: Overcome the Challenges to Using Face shields. Indust. Hyg. & Safety.News. 2012.”

[10] Nighswonger, T.: “Face Up to Proper Protection. Environ Health Safety. 2000.”

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