Updated Clarification on Use of Eye Protection in Nursing Homes

LeadingAge NY nursing home members have requested clarification on guidance regarding the use of eye protection in nursing homes to prevent COVID-19 transmission. After asking the Department of Health (DOH) for additional clarification surrounding its universal eye protection guidance, LeadingAge NY was advised that nursing homes are required to follow all State and federal guidance regarding the use of universal eye protection. We were also pointed back to the November 2020 Health Advisory issued by the Department. That guidance applies to all health care settings and "strongly recommends" (but does not require) "universal use of eye protection by healthcare personnel for all patient interactions."

LeadingAge NY has also reviewed the Centers for Disease Control and Prevention (CDC) guidance on this topic and compiled the following highlights:

The CDC's Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (which apply to health care personnel (HCP) generally) include the use of eye protection by HCP in counties with substantial or high community transmission and when caring for patients who have tested positive for COVID-19 or are suspected of being infected with COVID-19. The following are pertinent excerpts from this guidance:

If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis). Additionally, HCP working in facilities located in counties with substantial or high transmission should also use PPE as described below:
- National Institute for Occupational Safety and Health (NIOSH)-approved N95 or equivalent or higher-level respirators should be used for:
  - All aerosol-generating procedures (refer to Which procedures are considered aerosol generating procedures in healthcare settings?)
  - All surgical procedures that might pose higher risk for transmission if the patient has SARS-CoV-2 infection (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract).
  - NIOSH-approved N95 or equivalent or higher-level respirators can also be used by HCP working in other situations where additional risk factors for transmission are present, such as the patient is not up to date with all recommended COVID-19 vaccine doses, unable to use source control, and the area is poorly ventilated. They may also be considered if health care-associated SARS-CoV-2 transmission is identified and universal respirator use by HCP working in affected areas is not already in place.
  - To simplify implementation, facilities in counties with substantial or high transmission may consider implementing universal use of NIOSH-approved N95 or equivalent or higher-level respirators for HCP during all patient care encounters or in specific units or areas of the facility at higher risk for SARS-CoV-2 transmission.
- HCP working in facilities located in counties with substantial or high transmission should also wear eye protection (i.e., goggles or a face shield that covers the front and sides of the face) during all patient care encounters.
When caring for a patient with suspected or confirmed COVID-19, the CDC recommends the following:
- HCP who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to Standard Precautions and use a NIOSH-approved N95 or equivalent or higher-level respirator, gown, gloves, and eye protection (i.e., goggles or a face shield that covers the front and sides of the face).
- Additional information about using PPE is available here.

In addition, CDC guidance on managing HCP who are exposed to COVID-19 provides that when assessing whether a staff member has had a higher-risk exposure and must be excluded from work, the use of eye protection reduces the risk and may prevent a work exclusion.

The CDC's Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes states that HCP should wear eye protection when caring for residents who are in quarantine or who have suspected or confirmed COVID-19 infection. The following are some relevant excerpts from the guidance:

Manage Residents who had Close Contact with Someone with SARS-CoV-2 Infection
- Residents who are not up to date with all recommended COVID-19 vaccine doses and who have had close contact with someone with SARS-CoV-2 infection should be placed in quarantine after their exposure, even if viral testing is negative. HCP caring for them should use full PPE (gowns, gloves, eye protection, and N95 or higher-level respirator).
Manage Residents with Suspected or Confirmed SARS-CoV-2 Infection
- HCP caring for residents with suspected or confirmed SARS-CoV-2 infection should use full PPE (gowns, gloves, eye protection, and a NIOSH-approved N95 or equivalent or higher-level respirator).
Outbreak Response and Residents Not Up to Date with COVID-19 Vaccine Doses
- These residents should generally be restricted to their rooms, even if testing is negative, and cared for by HCP using an N95 or higher-level respirator, eye protection (goggles or a face shield that covers the front and sides of the face), gloves, and gown. They should not participate in group activities.

It is important to note that the November 2020 DOH Health Advisory and the CDC documents are guidelines, and nothing in either document is noted to state that staff must wear protective eyewear at designated times. Rather, all documents state that staff should wear it. It is best practice from an infection control standpoint when in outbreak mode and anytime you have an individual who is potentially COVID-19-positive. LeadingAge NY will continue to advocate for the Department to loosen their restrictions around staff needing to wear universal eye protection outside of outbreak times. We continue to urge you to share what you are seeing and hearing from the Department when they are in your buildings, specifically around PPE wearing, so that we can share with the membership.

Contact: Mark Kepner-Clough, mkepner-clough@leadingageny.org, 518-728-2365