Strategies for Optimizing the Supply of Eye Protection

Summary of Recent Changes

Audience: These considerations are intended for use by federal, state, and local public health officials; leaders in occupational health services and infection prevention and control programs; and other leaders in healthcare settings who are responsible for developing and implementing policies and procedures for preventing pathogen transmission in healthcare settings.

Purpose: This document offers a series of strategies or options to optimize supplies of eye protection in healthcare settings when there is limited supply. It does not address other aspects of pandemic planning; for those, healthcare facilities can refer to COVID-19 preparedness plans.

Surge capacity refers to the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility. While there are no widely accepted measurements or triggers to distinguish surge capacity from daily patient care capacity, surge capacity is a useful framework to approach a decreased supply of eye protection during the COVID-19 response. To help healthcare facilities plan and optimize the use of eye protection in response to COVID-19, CDC has developed a Personal Protective Equipment (PPE) Burn Rate Calculator. Three general strata have been used to describe surge capacity and can be used to prioritize measures to conserve eye protection supplies along the continuum of care.

• Conventional capacity: measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.
• Contingency capacity: measures that may be used temporarily during periods of expected eye protection shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies. While current supply may meet the facility’s current or anticipated utilization rate, there may be uncertainty if future supply will be adequate and, therefore, contingency capacity strategies may be needed.
• Crisis capacity: strategies that are not commensurate with U.S. standards of care but may need to be considered during periods of known eye protection shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies. Facilities can consider crisis capacity strategies when the supply is not able to meet the facility’s current or anticipated utilization rate.

CDC’s optimization strategies for eye protection supply offer a continuum of options for use when eye protection supplies are stressed, running low, or exhausted. Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and implemented sequentially. Once eye protection availability returns to normal, healthcare facilities should promptly resume standard practices.

Decisions to implement contingency and crisis strategies are based upon these assumptions:

1. Facilities understand their eye protection inventory and supply chain
2. Facilities understand their eye protection utilization rate
3. Facilities are in communication with local healthcare coalitions and federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional supplies
4. Facilities have already implemented other engineering and administrative control measures including:
   • Use physical barriers and other engineering controls
   • Limit number of patients going to hospital or outpatient settings
   • Use telemedicine whenever possible
   • Limit HCP not directly involved in patient care
   • Limit face-to-face HCP encounters with patients
   • Limit visitors to the facility to those essential for the patient’s physical or emotional well-being and care (e.g., care partner, parent)
   • Cohort patients and/or HCP
5. Facilities have provided HCP with required education and training, including having them demonstrate competency with donning and doffing, with any PPE ensemble that is used to perform job responsibilities, such as provision of patient care

Once availability of eye protection returns to normal, healthcare facilities should promptly resume conventional practices. Determining the appropriate time to return to conventional strategies can be challenging. Considerations affecting this decision include:

1. the anticipated number of patients for whom eye protection should be worn by HCP providing their care
2. the level of SARS-CoV-2 transmission in the community
3. the daily supply of eye protection currently remaining at the facility
4. whether or not the facility is receiving regular resupply with its full allotment.

Conventional Capacity Strategies

Use eye protection according to product labeling and local, state, and federal requirements.

In healthcare settings, eye protection is used by HCP to protect their eyes from exposure to splashes, sprays, splatter, and respiratory secretions. Disposable eye protection should be removed and discardedafter use. Reusable eye protection should cleaned and disinfected after each patient encounter.

Shift eye protection supplies from disposable to reusable devices (i.e., reusable face shields or goggles).

• Consider preferential use of powered air purifying respirators (PAPRs) or full facepiece elastomeric respirators which have built-in eye protection.
• Ensure appropriate cleaning and disinfection after each use if reusable face shields or goggles are used.

Contingency Capacity Strategies

Selectively cancel elective and non-urgent procedures and appointments for which eye protection is typically used by HCP.

Implement extended use of eye protection.

Extended use of eye protection is the practice of wearing the same eye protection for repeated close contact encounters with several different patients, without removing eye protection between patient encounters. Extended use of eye protection can be applied to disposable and reusable devices.

In areas of substantial to high transmission in which HCP are using eye protection for all patient encounters, extended use of eye protection may be considered as a conventional capacity strategy.

• Eye protection should be removed, cleaned, and disinfected if it becomes visibly soiled or difficult to see through.
  • If a disposable face shield or goggles is cleaned and disinfected, it should be dedicated to one HCP and cleaned and disinfected whenever it is visibly soiled or removed (e.g., when leaving the isolation area) prior to putting it back on. See protocol for removing and cleaning and disinfecting eye protection below.
• Eye protection should be discarded if damaged (e.g., face shield or goggles can no longer fasten securely to the provider, if visibility is obscured and cleaning and disinfecting does not restore visibility).
• HCP should take care not to touch their eye protection. If they touch or adjust their eye protection, they must immediately perform hand hygiene.
• HCP should leave patient care area if they need to remove their eye protection. See protocol for removing, cleaning, and disinfecting eye protection below.

Crisis Capacity Strategies

Cancel all elective and non-urgent procedures and appointments for which eye protection is typically used by HCP.

Use eye protection devices beyond the manufacturer-designated shelf life during patient care activities.

If there is no date available on the eye protection device label or packaging, facilities should contact the manufacturer. The user should visually inspect the product prior to use and, if there are concerns (such as degraded materials), discard the product.

Prioritize eye protection for selected activities such as:

• Essential surgeries and procedures for which eye protection is recommended.
• During care activities where splashes and sprays are anticipated.
• During unavoidable activities with prolonged face-to-face or close contact with a potentially infectious patient for which eye protection is recommended.

Consider using safety glasses (e.g., trauma glasses) that have extensions to cover the side of the eyes. 

• However, protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face likely do not protect eyes from all splashes and sprays.

Selected Options for Reprocessing Eye Protection

Adhere to recommended manufacturer instructions for cleaning and disinfection.

When manufacturer instructions for cleaning and disinfection are unavailable, such as for single use disposable face shields or goggles, consider:

1. While wearing a clean pair of gloves, carefully wipe the inside, followed by the outside of the face shield or goggles using a clean cloth saturated with neutral detergent solution or cleaner wipe.
2. Carefully wipe the outside of the face shield or goggles using a wipe or clean cloth saturated with EPA-registeredexternal icon hospital disinfectant solution.
3. Wipe the outside of face shield or goggles with clean water or alcohol to remove residue.
4. Fully dry (air dry or use clean absorbent towels).
5. Remove gloves and perform hand hygiene.
6. Cleaned and disinfected eye protection can be stored onsite, in a designated clean area within the facility.

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