OK, class, I wrote this for my IH pals on another forum but it is not posted yet. You get both barrels on the face shield thingie.
The workers I protect are in the arts and entertainment fields. These folks are the ultimate tough audience. So my training PowerPoints and the articles and books I write must be unambiguous, graphic, and occasionally funny. I use all of my 80 years of entertainment experience, starting with my first professional work in Vaudeville at age three.
The inclusion of the recommendation to use face shields instead of masks in the AIHA back-to-work plans has made in necessary for me to use this experience to address this topic. I couldn't find a study on the shield in the journals I monitor, so I Googled "masks v face shields" and read the articles and interviews of those recommending the shields.
Aha! My first point will be that the proponents of the shields are all medical doctors and professors. I've been on the Board of Advisors of Mt. Sinai's Occupational Medical Clinic for decades so I know that hospitals have industrial hygienists on staff. Doctors are fit tested and follow the recommendations of industrial hygienists, not the other way around. If the doctors are qualified to make industrial hygiene recommendations, then perhaps I could ask members of AIHA to remove my appendix. I'm sure, by now, there are some who would.
The article is in JAMA, not in an IH publication. The article is in the "Viewpoint" section and not a study - it is an opinion. The JAMA article has a figure which is bullet points comparing the face mask and face shield. The shield wins on every point except the very first one - the one that counts. This one says the shields are "open on the sides--providing some possibility for aerosols and particles to float in."
SOME POSSIBILITY? Particles may FLOAT IN? Instead, every time the person in the shield inhales they suck in the air and its particles from the sides and from under the shield. Every time they exhale their own breath and particles go out every which-a-way. That shield is "breathing." (Here I intend to add an artist's graphic.)
In my PPE PowerPoint I have flash pictures of the large and small particles created when people sneeze both out in the open and when wearing a mask. And yes, some small particles do come through the surgical mask. But I can hardly WAIT to see a picture (or another graphic) of a sneeze behind a face shield! A close up of the person's face and shield right after the sneeze would be equally of interest.
And the final reason the doctors say we should use shields is that the surgical masks and cloth masks don't work at all. Well, there is some data showing they sorta do. Off-line, a kind CIH sent me 5 supportive studies to add to my collection. One was a prepublication copy of an article called Face Masks Against COVID-19: An Evidence Review (doi:10.20944/preprints20204.0203.v1). The 19 authors from all over the world synthesized data from 46 studies and they concluded that the masks help and should be used. We can quibble about the data, but at least there IS data.
On the shield side, there is not one study, not one sneeze picture, bobkes. Common sense, science, and my industrial hygiene training dictate: no data, no go.
-----Original Message-----
From: Michael Schaffer <MichaelS**At_Symbol_Here**PSYCHEMEDICS.COM>
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Sent: Wed, May 20, 2020 5:43 am
Subject: Re: [DCHAS-L] DRAFT - Please review and send comments.
We have adopted the policy of utilization of both face shields along with cloth face masks, social distancing and gloves worn in the laboratory as well as rotating staff two weeks on and two weeks off.
We have installed purell dispensers throughout the building and are swapping all manual operations to automated ones as much as possible.
We take temperatures of anyone entering the building.
We show mandatory videos on safety and health as it now relates to Covid-19 to all employees.
We are always looking for suggestions to make the lab a safer place for our staff.
Michael I. Schaffer, Ph.D., F.A.B.F.T., NRCC-TC
(800) 522-7424 (toll free) Extension 140
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Yes, John, I have a question that is slightly off this topic, but as a former respirator expert, you might be best person to answer this question.
The AIHA back-to-work plans and two other union plans I have evaluated suggest using a face shield alone instead of any kind of mask. Now I've see a lot of mask studies, some even on DIY masks. While the protection they offer is not perfect, they at least do SOMETHING. But a piece of plastic that the air can go freely around on three sides which is hung a couple inches from the face, clearly stops almost nothing -- nothing going out, and nothing coming in. What memo did I miss here?
I even have a fact sheet from Canada warning healthcare workers to refuse to comply when employers tell them that the face shield alone is enough. So this monster has legs.
I've suggested workers tell employers they will comply with this face shield plan the minute the employer shows them one peer reviewed study demonstrating the efficacy of this procedure. And since there doesn't appear to be one anywhere, they are safe so far.
-----Original Message-----
From: John Callen <jbcallen**At_Symbol_Here**GMAIL.COM>
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Sent: Tue, May 19, 2020 7:40 pm
Subject: Re: [DCHAS-L] DRAFT - Please review and send comments.
Thanks Ralph for your comments below.
Again, I want to emphasize from my previous suggestions that PREPARE/CHECK FACILITIES should include how to control public and semi-private bathrooms which are "high touch" areas. I mentioned that faucets, soap and towel dispensers, toilets and drinking fountains should be motion activated and NO hand dryers, please! The one other item which also must be addressed is access in/out of the bathroom and toilet stalls themselves. To avoid touching door handles, knobs or plates, access should be automatic as for physically challenged individuals or remove the door completely and place a partition in front of it as you find in many of the airport concourses. As for the toilet stalls, maybe we should go back to open stalls without doors; however, I do not know if that would be a Federal, State or Local Department of Health violation or just a public outcry regarding privacy. Regardless, many institutions will have to increase their custodial staff to service and maintain their public bathrooms on a more frequent basis or have full time attendants.
In much as bathrooms are an area of "high touch" so are vending machines for tools, PPE and other supplies and those for beverages and/or snacks. What disinfection/sanitation procedures must be established for them before and after each use?
For Barrier/Location Marking, while some institutions do have the luxury of having a "Sign and Graphics Department," many do not. As a FYI, although there are many local or regional suppliers, there are at least two national manufacturers who could help with your needs and you may know of them already: ARC (San Ramon, CA) and The Brady Company (Milwaukee, WI). You may want to check their websites so you don't have to proverbially "reinvent the wheel."
If you have any questions or comments, please let me know. Thanks!
3M Personal Safety Division - Retired
Maybe thinking practically opens up people to too much liability?
You make good points about the challenges that reopening with very little fundamental data available about the epidemic and the subsequent cultural shifts that will be required available.
However, my sense is that liability is not the concern; the most recent list of operating scenarios for how we might open here had 11 possibilities. These are too many to think about practically at operational safety level. This list is being winnowed down as more data becomes available (financial and student count data as much as scientific data), but I suspect that it will be another month before there's enough clarity to get concrete planning underway.
Thanks for raising these considerations that we are all working with.
- Ralph
Ralph Stuart, CIH, CCHO
Environmental Safety Manager
Keene State College
603 358-2859
ralph.stuart**At_Symbol_Here**keene.edu
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