Advice on the use of Face Shields in – COVID-19

MINISTRY OF HEALTH WELLNESS AND THE ENVIRONMENT
Advice on the use of face shields in the context of COVID-19
September 4th 2020

Background

Antigua and Barbuda saw its first case of COVID-19 in March 2020. In order to control the
outbreak, the government of Antigua and Barbuda implemented several public health measures
such as the wearing of facemasks, social and physical distancing and handwashing. Compliance
with all these measures including physical distancing, hand hygiene, respiratory etiquette and
adequate ventilation in indoor settings is essential for reducing the spread of SARS-CoV-2, the
virus that causes COVID-19.

Introduction

Face shields are designed to be used provide protection from splashes of biological fluid
(particularly respiratory secretions), chemical agents and debris into the eyes. In the context of
protection from SARS-CoV-2 transmission through respiratory droplets, they are used by health
workers as personal protective equipment (PPE) for eye protection in combination with a
medical mask or a respirator.

In the context of COVID-19 in community settings, some children and adults may not be able to
wear a mask for a variety of reasons (e.g. health issues, fear of mask), and thus, face shields may
be considered as an alternative to masks as respiratory droplet protection or as source control,
based on availability, improved feasibility and better tolerability.

While a face shield may confer partial protection of the facial area against respiratory droplets
with the added benefit of ease of use, the effectiveness of face shields for source control has not
yet been adequately studied. Droplets may be exhaled or inhaled from the open gaps between the
visor and the face, which is a disadvantage inherent to its design. Other design disadvantages
include glaring, fogging, optical imperfection, and being bulkier than goggles and safety glasses.
There are many emerging face shield designs that attempt to overcome these limitations, but
current laboratory testing standards only assess face shields for their ability to provide eye
protection from chemical splashes. Further research and laboratory challenge standards are
urgently needed to investigate the effectiveness of face shields for respiratory droplet protection
and/or source control.

Purpose of the document

Some persons have been using to use face shields as a replacement of face masks. This document
provides information on the use of face shields in Antigua and Barbuda in the context of the
COVID-19 pandemic.

These guidelines were adapted for Antigua and Barbuda from information from the World
Health Organization. The MOHWE will continue to monitor emerging information on the use of
face shields for the prevention of respiratory virus transmission and update this document as new
evidence emerges.

Specific Recommendations

1. At present, face shields are considered to provide a level of eye protection only and
should not be considered as an equivalent to masks with respect to respiratory droplet
protection and/or source control.

2. The Ministry of Health Wellness and the Environment advises that when physical
distance cannot be maintained, and in special situations where it is not practical to wear a
mask (for example, among children with hearing loss or other disabilities or health
conditions that limit compliance with wearing fabric or medical masks and consequently
their utility), face shields may be used while taking the following considerations into
account:

• The face shield is an incomplete physical barrier and does not provide the
filtration layers of a mask.
• The face shield should cover the entire face, be wrapped around the sides of the
face and extend to below the chin.
• Reusable face shields must be properly cleaned (with soap or a detergent and
water), disinfected (with 70-90% alcohol) and stored after each use. Face shields
that will withstand the use of disinfectants without damaging their optical
properties should be selected.
• Maintaining physical distance of at least 1 m (3.3 feet) should be maintained
where feasible, with ongoing promotion of frequent hand hygiene and respiratory
etiquette.
• Caution should be taken to avoid injury when children don, wear, and doff face
shields and they should be supervised at all times.