Improving the availability, accessibility, and use of eye protection in patient care settings

To the Editor— The International Safety Center has been collecting occupational mucocutaneous exposure incidents for blood and body fluid splashes and splatters since the early 1990s through the Exposure Prevention Information Network (EPINet). In the last 5 years, according to aggregate data submitted via the EPINet network healthcare facilities and reported publicly, eye exposures often exceed 60% of all other mucocutaneous exposures reported to employee health.^1–5

Because EPINet is the only surveillance system in the world that captures mucocutaneous exposures from health systems and reporting them publicly, it provides the only representative data that exist, and these data clearly illustrate that eye exposures make up the largest percent of any other reported/reportable non-sharp blood and/or body fluid exposure and that small percentages of employees indicate they are wearing any form of eye protection (eg, goggles, eyeglasses with sideshields, or faceshield). Most of these exposures occur in the patient room or the exam room (28.1%–61.3%) (Table 1).^1–5

I read with interest Dr Mermel’s letter, “Eye Protection for Preventing Transmission of Respiratory Viral Infections to Healthcare Workers” (November 2018) about the serious risks of any type of infectious or bloodborne disease to the unprotected eye.^{6, 7} Improving eye protection availability, accessibility, and use in patient and exam rooms is crucial to protecting not only worker safety but also patient safety and clinical outcomes. There is growing support for Dr. Mermel’s recommendation “… to wear eye protection when caring for patients with suspected or proven respiratory viral infection. This protocol would err on the side of caution in an attempt to mitigate the risk of transmission to healthcare workers and others.”

The Centers for Disease Control and Prevention (CDC), the Association of periOperative Registered Nurses (AORN), the Occupational Safety and Health Administration (OSHA), and others recommend similar protective measures: to use “(m)ask and goggles or a face shield … Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.” Incidence data demonstrate that guidance is neither protective nor prescriptive enough. Because most mucus membrane exposures occur to the eyes and because eye protection use is low (2.8%–12.8%), more specific guidance needs to include use not only “when splashes or sprays are likely” but also with elements of measure, control, and surveillance (occupational health, environmental health and safety, industrial hygiene, employee health, infection prevention, etc. rounds). Healthcare employers should improve availability and accessibility of protective eyewear in patient, exam, and procedure rooms, similar to including infection prevention and control caddies (gloves, gowns) for transmission- and contact-based or isolation precautions.

Given the increasing prevalence in patients with coinfection of human immunodeficiency virus (HIV) and hepatitis C virus (HCV), hepatitis B virus (HBV), tuberculosis (TB), and multidrug-resistant organisms (MDROs) such as MRSA, protecting healthcare personnel is more critical than ever.^8–10 A single eye exposure can result in transmission of 1 or more pathogenic organisms that can result in occupational illness or infection.

Table 1. All Eye Exposure Incident Reports and Eye Protection Use Reported During that Exposure by Year; Exposure Prevention Information Network (EPINet) Healthcare Surveillance Research Group Network