Assessing health care worker perceptions of face coverings during the COVID-19 pandemic

METHODS

Employees at the hospital were asked to participate in a brief, voluntary, electronic survey, which was approved by the Institutional Review Board. The survey had 29 questions across 6 domains (demographics and COVID-19 status, use, comfort, safety, communication, and device comparison). All employees were eligible to complete the survey, which was distributed through an internal electronic newsletter on 3 occasions over a 3-week period.

The analysis focuses on differences in workers’ perceptions between face masks and face shields. Differences in proportions were compared using a χ² test, Fisher exact test, or 1-way ANOVA when appropriate. All tests of significance were 2-tailed with an alpha of 0.05. All statistical analyses were performed using R 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

During June 19–July 13, 2020, 1,109 electronic survey responses were collected. Approximately half of the respondents provide direct patient care (568, 51.2%). Among them, the highest percentage of responses (180, 32%) came from nursing personnel (nurses, nursing assistants, and medical assistants), followed by physicians and medical students (77, 14%). Nearly one-third (168, 29%) cared for laboratory-confirmed COVID-19 patients, while 24 reported a history of COVID-19 infection.

Among respondents providing direct patient care (ie, clinical workers), 88% (497) wear face coverings more than 4 hours per day in comparison to 50% (271) of nonclinical workers (P< .001). Of these, 95% (471) wear both face mask and face shields, while only 1% (5) wear face masks only and 4% (21) wear face shields. Outside of the workplace, 93% (498) reported wear face coverings (face mask 85%, face shields 2%, both 13%). Among employees wearing glasses, 33% (179/548) reported that face masks interfere with their work compared to 26% (147/548) for face shields (P= .034).

Clinical workers found face masks significantly more comfortable than face shields (32.7% vs 23.5%), though there was no difference for nonclinical workers. Both groups reported that breathing is easier with face shields (69.9% vs 20.3%). Both groups also felt that face masks were easier to remove (87.2% vs 77.3%) and provided better visual clarity (50.1% vs 27.5%) than face shields. Nonclinical workers felt more claustrophobic while wearing face masks compared to face shields (34.7% vs 23.9%) but the difference was not significant for clinical workers. Both groups reported feeling too warm more commonly while wearing face masks compared to face shields (67.6% vs 46.4%). Face masks were better in terms of less work interference (28.1% vs 50.4%) and were much lighter than face shields (91.6% vs 33.0%) for both groups. Device-related skin irritation or itching was attributed to face masks more than face shields in both groups (46.2% vs 31.5%).

Regarding communication, both clinical and nonclinical employees found hearing others easier while wearing face masks in comparison to face shields (61.6% vs 25.3%). Clinical workers feel that others can hear them more clearly while wearing face masks rather than face shields (19.9%% vs 10.9%) and nonclinical workers reported that face shields were better (21.9% vs 14.1%); however, both devices were felt to be limiting in that regard. By a small but statistically significant margin, clinical workers found masks to feel more protective (71.5% vs 65.7%), while nonclinical workers felt face shields were more protective than face masks (76.0% vs 68.2%). Respondents, in general, reported that face masks were more likely to protect others when compared to face shields (87.1% vs 78.5%). Both clinical and nonclinical workers reported that they change or disinfect their face shield after each use more than for face masks (59.5% vs 37.0%). They also reported that they touched their face in a 4-hour time period more often with face masks when compared to face shields (40.0% vs 25.6%).

When respondents were asked which face covering they prefer, clinical workers preferred face masks (35.7%) over face shields (25%), as compared to nonclinical workers who preferred face shields (39.2%) to neither face mask nor face shield (25.4%; P < .001) (Table 1 ).

DISCUSSION

The COVID-19 pandemic continues to challenge health care executives, health care personnel, and policy makers. It strained the capacity of hospitals and created shortages of PPE.⁷ Nonetheless, employee wellbeing and safety remained a top priority.⁸

In this study, we evaluated employee perceptions of face masks and face shields regarding their comfort and acceptability. While face shields were reported to be better for breathing, cleanability, and prevention of face touching, face masks were found to be lighter and easier to wear especially among workers providing patient care. A combination of face masks and prescription glasses produced significant work interference, which was not true for face shields.

CONCLUSIONS

Overall, face shields were found to be less comfortable to wear despite it being easier to breathe while wearing them. That is one of the reasons why clinical workers preferred to wear face masks rather than face shields. The degree of comfort might be related to the fact we issued industrial-grade shields to workers providing patient care, which are far heavier. In response, we are evaluating lighter models to improve comfort and tolerability. Re-assessment of PPE and worker perceptions will need to be performed as products evolve and transmission dynamics are better understood.