Prevention of Fogging of Protective Eyewear for Medical Staff During the COVID-19 Pandemic

Dear Editor:

The coronavirus disease (COVID-19) has caused huge harm worldwide.¹ COVID-19 is transmitted from person to person and spreads very quickly.^{2 , 3} Globally, 2,810,325 cases of COVID-19 have been confirmed by the World Health Organization, including 193,825 deaths, as of April 26, 2020. In China, there have been 84,338 cases and 4,642 deaths.⁴ As of February 29, 2020, an estimated 42,000 medical personnel have served as frontline staff and have been indispensable during this worldwide pandemic.⁵ More than 3,000 personnel in Hubei Province, China, were infected during the early stage of the pandemic because knowledge pertaining to the prevention and control of the virus was lacking.⁶

One medical staff member became infected despite wearing protective equipment and an N95 mask; the initial manifestation was unilateral conjunctivitis, which was followed by fever a few hours later.⁷ Many studies have noted the importance of wearing goggles to protect the eyes from severe acute respiratory syndrome coronavirus 2 infection when in contact with patients.10, 11, 8, 9 Through interviews with the medical staff at our hospital in Wuhan, China, we learned that the fogging of goggles was a problem when caring for COVID-19 patients. Fogging impairs vision, thus hindering work efficiency when nurses collect blood, for example. This may lead to failure to collect blood properly or even to injury to patients. Furthermore, fogging may delay tracheal intubation and deep vein catheterization. However, washing and reusing goggles increases the chance of infection.

To help ED health care staff overcome the problem of fogging, we retrieved papers from the China National Knowledge Infrastructure, Wanfang Data, and SinoMed databases, and interviewed medical staff in our hospital who were caring for COVID-19 patients. Four methods to overcome fogging were commonly employed: using washing-up liquid or hand sanitizer, and application of antifogging agents or iodophors12, 13, 14, 15, 16, 17, 18 (Table ).

Table.

Common methods used to overcome fogging of goggles

Method	Details	Fog-free duration (hours)
Using washing-up liquid12, 13,15	Wipe the goggles evenly using gauze, toilet paper, or cotton swabs, dry, and use.	4–612
Using hand sanitizer12,15,17,18	Wipe the goggles evenly using gauze, toilet paper, or cotton swabs, dry, and use.	2–4,12 ≤4,17 5–818
Application of antifogging agents12, 13, 14, 15,17	Spray antifogging agent evenly, dry, and use.	≤2,12 1–317
Application of iodophor12,14, 15, 16, 17	Pour iodophor on goggles directly or apply with cotton swabs, smear evenly, dry, and use.	≤2,12 4–6,16 ≤417

Three articles reported how washing-up liquid can prevent fogging;^{12 , 13 , 15} in one of these studies, the Whitecat brand (Shanghai Hutchison Whitecat Co Ltd) was used.¹² Four articles reported that hand sanitizer was used to prevent fogging;^{12 , 15 , 17 , 18} in 3 of these studies, the brand of hand sanitizer used was reported: Maokang (Maokang Medical),¹² Blue Moon (Blue Moon [China] Co Ltd),¹⁷ and Jiemiejing (Wuhan East Lake Star Technology Co, Ltd).¹⁸ Five articles reported that antifogging sprays were used;12, 13, 14, 15 ^{, 17} in 4 of these studies, a spray designed for swimming goggles or car headlights was used, but the brand was not specified.12, 13, 14, 15 Five articles reported that an iodophor could be used to prevent fogging.^{12 ,} 14, 15, 16, 17 One article reported that the antifogging effect of iodophor was better than that of an antifogging spray designed for swimming goggles.¹² However, in some cases the iodophor turned the goggle lenses brown, thus impairing the vision of the medical staff.¹² In addition, an iodophor generally takes longer than antifogging sprays (approximately 10 minutes) to dry completely. Three articles reported the following disadvantages of antifogging sprays: higher cost and the potential for damage to the eyes if sprayed incorrectly.^{12 , 13 , 15}

Two articles reported that using a film could prevent fogging.^{13 , 15} However, this method has the disadvantages of high cost, curling of the film (causing discomfort to the wearer), tearing of the film (potentially damaging the skin of the wearer), and the possibility of allergic reaction.¹³ Other studies used gels in a small number of subjects.^{16 , 17}

In conclusion, using washing-up liquid^{12 , 13 , 15 , 18} or hand sanitizer^{12 , 15 ,} 17, 18 is the most effective method for preventing goggles from fogging. We hope that these findings will help ED staff overcome the problem of fogging of protective eyewear and improve their work efficiency when treating patients with COVID-19.—Yuli Hu, MSc , Lan Wang, BSc, Sanlian Hu, MSc, and Fang Fang, BSc, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China; E-mail: liuliu9027@163.com [Sanlian Hu]

Author Disclosures

Conflicts of interest: none.

Funding

The authors were funded by the Public Health Emergencies of Hospital Emergency Nursing Human Resource Database to Development and Construction fund (grant number 2020RK44). The authors were also funded by the Anti-epidemic First-line Nurses’ Suggestions on the Sudden Coronavirus Diseases the Operational Training—Qualitative Research fund (grant number Jyhz2021).