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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.
        • Guan W.J.
        • Ni Z.Y.
        • Hu Y.
        • et al.
        Clinical characteristics of coronavirus disease in China.
        COVID-19 is transmitted from person to person and spreads very quickly.
        • Zhu N.
        • Zhang D.
        • Wang W.
        • et al.
        A novel coronavirus from patients with pneumonia in China, 2019.
        ,
        • Li Q.
        • Guan X.
        • Wu P.
        • et al.
        Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.
        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.
        World Health Organization
        Coronavirus disease 2019 (COVID-2019): situation report-97.
        As of February 29, 2020, an estimated 42,000 medical personnel have served as frontline staff and have been indispensable during this worldwide pandemic.
        • Ge J.
        • Meng J.
        Work experience of front line nurses from Guangdong Province fight war against COVID-19 in Wuhan: a qualitative study.
        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.

        National Health Commission of the People's Republic of China. Briefing on the pneumonia epidemic situation [in Chinese]. http://www.nhc.gov.cn/xcs/fkdt/202003/d82639cb25ab491dbb4f232385c46e8f.shtml. Published March 1, 2020. Accessed May 18, 2020.

        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.
        • Yuen K.S.
        • Chan W.M.
        • Fan D.S.
        • Chong K.K.
        • Sung J.J.
        • Lam D.S.
        Ocular screening in severe acute respiratory syndrome.
        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.
        • Morgan I.G.
        • French A.N.
        • Ashby R.S.
        • et al.
        The epidemics of myopia: aetiology and prevention.
        • Wiboonchutikul S.
        • Manosuthi W.
        • Likanonsakul S.
        • et al.
        Lack of transmission among healthcare workers in contact with a case of Middle East respiratory syndrome coronavirus infection in Thailand.
        • Li J.O.
        • Lam D.S.C.
        • Chen Y.
        • Ting D.S.W.
        Novel coronavirus disease 2019 (COVID-19): the importance of recognising possible early ocular manifestation and using protective eyewear.
        • World Health Organization
        Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim Guidance.
        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 iodophors
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        • An G.
        • Zhu Y.
        Two simple methods dealing with the problem of fogged goggles during the protection against coronavirus disease 2019.
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        • Guan W.
        • Guo Y.
        • Zhu L.
        The experience of using goggles.
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        (Table).
        TableCommon methods used to overcome fogging of goggles
        MethodDetailsFog-free duration (hours)
        Using washing-up liquid
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        Wipe the goggles evenly using gauze, toilet paper, or cotton swabs, dry, and use.4–6
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        Using hand sanitizer
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        ,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        ,
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        Wipe the goggles evenly using gauze, toilet paper, or cotton swabs, dry, and use.2–4,
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ≤4,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        5–8
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        Application of antifogging agents
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        • An G.
        • Zhu Y.
        Two simple methods dealing with the problem of fogged goggles during the protection against coronavirus disease 2019.
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        ,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        Spray antifogging agent evenly, dry, and use.≤2,
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        1–3
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        Application of iodophor
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • An G.
        • Zhu Y.
        Two simple methods dealing with the problem of fogged goggles during the protection against coronavirus disease 2019.
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        • Guan W.
        • Guo Y.
        • Zhu L.
        The experience of using goggles.
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        Pour iodophor on goggles directly or apply with cotton swabs, smear evenly, dry, and use.≤2,
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        4–6,
        • Guan W.
        • Guo Y.
        • Zhu L.
        The experience of using goggles.
        ≤4
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        Three articles reported how washing-up liquid can prevent fogging;
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        in one of these studies, the Whitecat brand (Shanghai Hutchison Whitecat Co Ltd) was used.
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        Four articles reported that hand sanitizer was used to prevent fogging;
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        ,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        ,
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        in 3 of these studies, the brand of hand sanitizer used was reported: Maokang (Maokang Medical),
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        Blue Moon (Blue Moon [China] Co Ltd),
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        and Jiemiejing (Wuhan East Lake Star Technology Co, Ltd).
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        Five articles reported that antifogging sprays were used;
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        • An G.
        • Zhu Y.
        Two simple methods dealing with the problem of fogged goggles during the protection against coronavirus disease 2019.
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        ,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        in 4 of these studies, a spray designed for swimming goggles or car headlights was used, but the brand was not specified.
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        • An G.
        • Zhu Y.
        Two simple methods dealing with the problem of fogged goggles during the protection against coronavirus disease 2019.
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        Five articles reported that an iodophor could be used to prevent fogging.
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • An G.
        • Zhu Y.
        Two simple methods dealing with the problem of fogged goggles during the protection against coronavirus disease 2019.
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        • Guan W.
        • Guo Y.
        • Zhu L.
        The experience of using goggles.
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        One article reported that the antifogging effect of iodophor was better than that of an antifogging spray designed for swimming goggles.
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        However, in some cases the iodophor turned the goggle lenses brown, thus impairing the vision of the medical staff.
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        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.
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        Two articles reported that using a film could prevent fogging.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        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.
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        Other studies used gels in a small number of subjects.
        • Guan W.
        • Guo Y.
        • Zhu L.
        The experience of using goggles.
        ,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        In conclusion, using washing-up liquid
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • Hu J.
        • Zhao J.
        Anti-fog skills for medical goggles during the period of prevention and control of Coronavirus disease 2019.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        ,
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        or hand sanitizer
        • Kong F.-J.
        • Li L.-C.
        • Li X.-L.
        • et al.
        Application effect of several anti-fogging methods on medical goggles in COVID-19 isolation ward.
        ,
        • Liang Tuantuan
        • Chen Y.
        • Li L.
        • et al.
        The anti-fogging treatments of medical goggles during the Covid-19.
        ,
        • Li L.
        • Cai X.
        The observation of the application and effect of using different anti-fogging methods in the intensive care isolation units during Covid-19.
        • Peng J.
        • Xiao L.
        • Kong W.
        The anti-fogging application of the antibacterial hand gel to the reuse goggles during the protection against Covid-19.
        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 ).

        Acknowledgments

        Yuli Hu, Lan Wang, and Fang Fang contributed equally to this work.

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