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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations of any consistent protection to the wearer, and even source protection can vary significantly depending on the construction and fit of the face covering.
Second, a number of studies suggest that, properly worn over the nose and mouth, facemasks provide better protection than face coverings, which is an important consideration in healthcare settings where there are regular, known exposures to COVID19positive persons. For example, one randomized trial of cloth face coverings compared rates of clinical respiratory illness, influenza-like illness, and laboratory-confirmed respiratory virus infections in 1,607 healthcare workers in 14 hospitals in Vietnam MacIntyre et al., March 26, 2015. Infection risks were statistically higher in the cloth face covering group compared to the facemask group: The risk of influenzalike illness was 6.6 times higher, and the risk of laboratory-confirmed respiratory virus infection was 1.7 times higher, in those who wore cloth face coverings compared to those who wore facemasks. Another study which reviewed respiratory protection for healthcare workers during pandemics showed greater protection from surgical masks compared to face coverings Garcia-Godoy et al., May 5, 2020.
Finally, Ueki et al., June 25, 2020
evaluated the effectiveness of cotton face coverings, facemasks, and N95s a commonly used respirator in preventing transmission of SARSCoV
2 using a laboratory experimental setting with manikins. The researchers found that all offerings provided some measure of protection as source control, limiting droplets expelled from both infected and uninfected wearers, but that facemasks and N95s provided better protection than cotton face coverings.
Specifically, the researchers found that when spaced roughly 20 inches apart, if both an infected and uninfected individual were wearing a cotton face covering, the uninfected person reduced inhalation of infectious virus by 67%.
But if both individuals were wearing facemasks, exposure was reduced by 76% and when an infected individual was wearing an N95, exposure was reduced by 96%.
Third, cloth face coverings do not function as a barrier to protect employees from hazards such as splashes or large droplets of blood or bodily fluids, which is a common hazard in healthcare settings. And finally, OSHA has previously established that medical facemasks are essential PPE for many workers in healthcare, as enforced under both the PPE standard 29 CFR 1910.132 and
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more specifically, the Bloodborne Pathogens standard 29 CFR 1910.1030.
Given the health outcomes related to COVID19 and the exposure characteristics found in healthcare settings e.g., splashes or large droplets of blood or bodily fluids, OSHA has determined that cloth face coverings are not appropriate for workers in these settings. Research clearly indicates that facemasks provide essential protection for workers in covered healthcare settings.
II. Need for Face Shields The term face shield, as used in this ETS, is a device typically made of clear plastic, that covers the wearers eyes, nose, and mouth, wraps around the sides of the wearers face, and extends below the wearers chin. Face shields have long been recognized as effective in preventing splashes, splatters, and sprays of bodily fluids and have a role in preventing the primary route of droplet transmission, although not aerosolized transmission. As explained above, OSHA has determined based on the best available evidence that facemask usage is a necessary protective measure to prevent the spread of COVID19 for any covered employee.
However, the use of face shields, a less protective barrier, is permitted to either supplement facemasks where there is a particular risk of droplet exposure, or as an alternative option in certain limited circumstances where facemask usage is not feasible.
Face shields are proven to provide some protection to the wearer from exposure to droplets, and OSHA has long considered face shields to be PPE
under the general PPE standard 29 CFR
1910.132 and the Eye and Face Protection standard 29 CFR 1910.133
for protection of the face and eyes from splashes and sprays. The potential protective value of face shields against droplet transmission is supported by a 2014 study, in which NIOSH
investigated the effectiveness of face shields in preventing the transmission of viral respiratory diseases. The purpose of the study was to quantify exposure of cough aerosol droplets and examine the efficacy of face shields in reducing this exposure. Although face shields were not found to be effective against smaller particles, which can remain airborne for extended periods and can easily flow around a face shield to be inhaled, the face shields were effective in blocking larger aerosol particles median size of 8.5 mM. Face shields worn over a respirator also reduced surface contamination of the respirator by 97%. The studys final conclusion was that face shields can be
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a useful complement to respiratory protections; however, they cannot be used as a substitute for respiratory protection, when needed Lindsley et al., June 27, 2014. A recent update of the Lindsley study Lindsley et al., January 7, 2021 found that face shields blocked only 2% of aerosol produced by coughing. These findings suggest that face shields might be a relevant form of protection in healthcare settings to protect employees from droplet exposure when they could have close contact with individuals who are potentially infected with COVID19.
Face shields have proven less effective as a method of source control or a method of personal protection than facemasks. For example, in considering face shields value as source control, Verma et al., June 30, 2020 observed the effect of a face shield on respiratory droplets produced by simulating coughs or sneezes with a manikin. The face shield initially blocked the forward motion of the droplet stream, but droplets were then able to flow around the shield and into the surrounding area. The study authors concluded that face shields alone may not be as effective in blocking droplets.
In another study, Stephenson et al., February 12, 2021 evaluated the effectiveness of face coverings, facemasks, and face shields in reducing droplet transmission. Breathing was simulated in two manikin heads a transmitter and receiver that were placed four feet apart. Artificial saliva containing a marker simulating viral genetic material was used to generate droplets from the transmitter head. The researchers found that face coverings, facemasks, and face shields all reduced the amount of surrogate genetic material measured in the environment and the amount that reached the receiver manikin head at four feet. While face shields reduced surrogate genetic material by 98.6% in the environment and 95.2% at the receiver, genetic material was still deposited downward in the immediate area of the transmitter, suggesting that use of face shields without a facemask could result in a contamination of shared surfaces. This limits the effectiveness of face shields alone as a method of source control for shared workspaces. Additionally, face shields used as personal protective devices showed that the face shields protected the wearer from large cough aerosols directed at the face, but were much less effective against smaller aerosols which were able to flow around the edges of the shield and be inhaled Lindsley et al., June 27, 2014.
Based on this evidence, OSHA has determined that face shields are not
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