Sightsavers from the field

Keeping patients safe during a global pandemic

How research is finding the best face shield design for trachoma specialists during the COVID-19 pandemic.

December 2020
A man carries out trachoma surgery on a Head Start dummy wearing PPE and optical loupes

Sightsavers and partners have challenged eye health professionals across the world to find the most effective and comfortable personal protective equipment (PPE) to use in trachoma eye examinations and operations during the COVID-19 pandemic.

Identifying the trachoma infection and operating on cases of advanced trachoma (known as trichiasis) is crucial to stop the spread of the disease. Health professionals already need to wear magnifying equipment over their eyes to do this work, so adding face masks or shields to the equation isn’t straightforward.

Resuming close-contact trachoma work safely

After large-scale efforts to tackle trachoma were paused at the start of the pandemic, it has been difficult to safely resume close-contact work such as eye examinations and operations. The PPE design challenge was set up with participants from around the world to ensure that people wouldn’t miss out on essential healthcare.

“We started to think about distributing the first protective barriers as soon as the pandemic began,” says Georges Yaya from the Ministry of Health in Central African Republic, who took part in the challenge. “We were anxious about transmitting the disease to remote communities where we were carrying out our work.”

To comply with safety measures to avoid the spread of the virus, extra protective equipment is needed during eye exams and treatment, including a mask and goggles or a face shield for health professionals. The difficulty for trachoma staff is that they often wear specialist optical ‘loupes’ – spectacles that magnify the eye area to enable them to perform this precise work – and the additional PPE causes the loupes to steam up, affecting their vision.

It can also be cumbersome, and in some cases impossible, to carry out work wearing this additional equipment, especially when many eye examinations and some operations are conducted outside in humid locations, meaning the loupes are even more likely to steam up. Storing, cleaning and transporting PPE is also much harder in the field than it is in a hospital.

Despite these challenges, Georges is confident the team will find a solution that health professionals can work with. “It’s just a question of time and it will become habit,” he says. “Take surgical gloves, for example. At the start it’s hard to operate with them on, but once they’re part of your day to day, you forget you’re wearing them.”

What were the different options?

a group of people wait to be measured with a dose pole.

Who is involved in the PPE challenge?

The project is a collaboration between the Sightsavers-led Accelerate programme and ESPEN, FHI360, RTI, Tropical Data, USAID and the World Health Organization.

A diagram showing four different ways to wear a face shield, mask and loupes. The text says: Option 1: Loupes worn through rectangular cut-out and mounted on face shield, plus mask Option 2: Loupes worn in front and mounted on face shield, plus mask Option 3: Loupes worn behind face shield, plus mask Option 4: Loupes worn in front of goggles, plus mask.

From the four different configurations of protective equipment (shown above), two preferred frontrunners were chosen for the challenge. The first (option 1) mounts the optical loupes into a transparent face shield through a hole in the shield. The second (option 2) mounts the loupes in front of the mask. Both enable staff to wear a mask to cover their nose and mouth below the shield.

Health professionals in the trial found that the first two options provided the best combination of visibility, low misting, convenience, comfort, cleaning, size, functionality, robustness and cost. These configurations beat the alternatives of wearing the loupes behind the face shield, and wearing goggles in place of a face shield.

Dr Alfa Amadou, a trachoma master grader from Benin taking part in the challenge, said: “I think the face shield design challenge has helped to make everyone feel more comfortable. Wearing the PPE helps both the grader and the patient feel confident that we won’t give the other COVID-19.”

What’s next?

Now that the results from the design challenge are available, we are carrying out further tests to check that the configurations have no negative impacts on work, such as reduced accuracy as a result of misting.

During upcoming Accelerate fieldwork and Tropical Data surveys, the configuration with the best results will then be tested in the field to make sure that communities, especially children, are happy being examined through the face shields, which can look unfamiliar.

Once the research is complete, we will then recommend the preferred configuration to country governments and steps will be taken to supply the necessary equipment for surgeons and graders across the world.

Woman wearing face mask washing hands from a kettle

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