key: cord-0902545-ogehgfke
authors: Alzunitan, Mohammed A; Perencevich, Eli N; Edmond, Michael B
title: Assessing Healthcare Worker Perceptions of Face Coverings During the COVID-19 Pandemic
date: 2020-09-24
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2020.09.006
sha: 263002fe51a914941ac54695b9445ac85fa9c492
doc_id: 902545
cord_uid: ogehgfke

The Coronavirus Disease 2019 (COVID-19) pandemic created a significant disruption in the personal protective equipment (PPE) supply chain while simultaneously creating unprecedented demand for their use. Hospitals pursued different PPE strategies based on local factors, PPE availability, and interpretation of the evolving data on the epidemiology of the disease. After instituting universal face coverings, we sought to assess the comfort and tolerability, along with the advantages and disadvantages for face masks and face shields through a survey of employees at an academic medical center.

unprecedented demand for their use. Hospitals pursued different PPE strategies based on local factors, PPE availability, and interpretation of the evolving data on the epidemiology of the disease. After instituting universal face coverings, we sought to assess the comfort and tolerability, along with the advantages and disadvantages for face masks and face shields through a survey of employees at an academic medical center.

By August 5, 2020, the United States approached 4.9 million confirmed cases of Coronavirus Disease 2019 (COVID-19) with more than 160,000 deaths. 1 The pandemic created a significant disruption in the personal protective equipment (PPE) supply chain that forced a reassessment of infection prevention practices. 2 Different PPE strategies emerged as hospitals assessed PPE supplies in the context of local disease prevalence, and interpreted the emerging data on disease transmission.

Face shields are reusable and offer more facial protection compared to face masks. [3] [4] [5] Universal use of face masks and face shields has been advised to control the spread of COVID-19. 6 On March 18, 2020, our hospital began providing all clinical and non-clinical employees with face shields for protection to be worn at all times. They were industrial-grade shields mainly from UTM ® , SAS Safety Corp. ® , and several other suppliers. On April 20, 2020 surgical masks were also required for all patient care. We aim to assess and compare the comfort and tolerability of face masks and face shields for employees and determine the advantages and disadvantages of both at an academic medical center.

Employees at the hospital were asked to participate in a brief, voluntary, electronic survey, which was approved by the Institutional Review Board. The survey had 29 questions across 6 domains (demographics and COVID-19 status, use, comfort, safety, communication, and device comparison). All employees were eligible to complete the survey, which was distributed through an internal electronic newsletter on three occasions over a 3-week period.

The analysis focuses on differences in workers' perceptions between face masks and face shields. Differences in proportions were compared using a Chi-square test, Fisher's exact test or one-way ANOVA when appropriate. All tests of significance were two-tailed with an alpha of 0.05. All statistical analyses were performed using R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria).

During June 19-July 13, 2020, 1,109 electronic survey responses were collected.

Approximately half of the respondents provide direct patient care (568, 51.2%). Among them, the highest percentage of responses (180, 32%) came from nursing personnel (nurses, nursing assistants, and medical assistants), followed by physicians and medical students (77, 14%).

Nearly one-third (168, 29%) cared for laboratory-confirmed COVID-19 patients, while 24 reported a history of COVID-19 infection.

Among respondents providing direct patient care (i.e., clinical workers), 88% (497) wear face coverings more than 4 hours per day in comparison to 50% (271) of non-clinical workers (p<0.001). Of these, 95% (471) wear both face mask and face shields, while only 1% (5) 27.5%) than face shields. Non-clinical workers felt more claustrophobic while wearing face masks compared to face shields (34.7% vs. 23.9%) but the difference was not significant for clinical workers. Both groups reported feeling too warm more commonly while wearing face masks compared to face shields (67.6% vs 46.4%). Face masks were better in terms of less work interference (28.1% vs. 50.4%) and were much lighter than face shields (91.6% vs. 33.0%) for both groups. Device-related skin irritation or itching was attributed to face masks more than face shields in both groups (46.2% vs. 31.5%).

Regarding communication, both clinical and non-clinical employees found hearing others easier while wearing face masks in comparison to face shields (61.6% vs 25.3%). Clinical workers feel that others can hear them more clearly while wearing face masks rather than face shields (19.9%% vs 10.9%) and non-clinical workers reported that face shields were better (21.9% vs. 14.1%); however, both devices were felt to be limiting in that regard. By a small but statistically significant margin, clinical workers found masks to feel more protective (71.5% vs 65.7%), while non-clinical workers felt face shields were more protective than face masks (76.0% vs. 68.2%). Respondents, in general, reported that face masks were more likely to protect others when compared to face shields (87.1% vs. 78.5%). Both clinical and non-clinical workers reported that they change or disinfect their face shield after each use more than for face masks (59.5% vs. 37.0%). They also reported that they touched their face in a four-hour time period more often with face masks when compared to face shields (40.0% vs. 25.6%).

When respondents were asked which face-covering they prefer, clinical workers preferred face masks (35.7%) over face shields (25%), as compared to non-clinical workers who preferred face shields (39.2%) to neither face mask nor face shield (25.4%), (P<0.001).

The COVID-19 pandemic continues to challenge healthcare executives, healthcare personnel, and policy makers. It strained the capacity of hospitals and created shortages of PPE. 7 Nonetheless, employee wellbeing and safety remained a top priority. 8 In this study, we evaluated employee perceptions of face masks and face shields regarding their comfort and acceptability. While face shields were reported to be better for breathing, cleanability, and prevention of face touching, face masks were found to be lighter and easier to wear especially among workers providing patient care. A combination of face masks and prescription glasses produced significant work interference, which was not true for face shields.

Overall, face shields were found to be less comfortable to wear despite it being easier to breathe while wearing them. That is one of the reasons why clinical workers preferred to wear face masks rather than face shields. The degree of comfort might be related to the fact we issued industrial-grade shields to workers providing patient care, which are far heavier. In response, we are evaluating lighter models to improve comfort and tolerability. Re-assessment of PPE and worker perceptions will need to be performed as products evolve and transmission dynamics are better understood.

Funding / Support: This work did not receive any financial support.

None to report. 

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