Healthcare workers’ faces have been reported to be the body part most commonly contaminated by splashes, sprays and spatter of body fluids. A face shield is classified as personal protective equipment (PPE) that provides barrier protection to the facial area and related mucous membranes (eyes, nose, lips). A face shield offers a number of potential advantages, as well as some disadvantages, compared with other forms of face/eye protection used in healthcare and related fields. The millions of potential users of face shields include healthcare workers, dental providers, veterinary care personnel, laboratory workers, pre-hospital emergency medical providers, police, firefighters, and custodial staff dealing with spills and contaminated waste. It is not precisely known when eye protection first came to be used in the medical field, but records indicate that a 1903 patent was granted to Ellen Dempsey of Albany, New York, for a transparent “sanitary face shield for protection from inhaling disease producing germs.” In 1974, James H. Bolker was granted a patent for a surgical hood with a clear, plastic faceplate that included a suction system to remove the exhaled breath from under the face plate and, in 1989, a cap with an incorporated face shield designed for non-surgical medical personnel was patented. The introduction of the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard 1910.1–030, as well as recent outbreaks of serious airborne infectious diseases (e.g., Severe Acute Respiratory Syndrome [SARS], Avian Influenza, etc.) and severe infectious agents associated with the potential for body fluid exposures (e.g., Ebola virus), have resulted in increased attention to face/eye protection. The purpose of this article is to provide the reader with a review of the use of face shields for infection control purposes in order to assist in the selection and proper utilization of this type of PPE.

1. Frame.

   Face shield frames used in healthcare are generally made of lightweight plastic. There are a variety of frame styles, including adjustable and nonadjustable frames that fully or partially encircle the circumference of the skull or those with eyeglass-type temple bars that are worn like standard eyewear There are also metal clip-on frames available that are designed to attach face shield visors to prescription eyewear, and some frames allow for the visor to be flipped up when not in use. A number of manufacturers offer detachable frames for easy change-out of the face shield visor. Some models also incorporate a brow cap into the frame that affords additional splash protection in the forehead region, as well as allowing for more visor distance from the face that better accommodates the wearing of additional PPE (e.g., goggles, loupes, prescription eyewear, respirators). Disposable visor-only face shields are also available that have a forehead foam cushion that provides a comfortable seal to the forehead

2. Suspension Systems.

   There are a variety of face shield suspension systems on the market that offer either fully or partially circumferential attachment features. Fully circumferential suspension systems include plastic headbands that are adjustable for comfort by a ratchet mechanism, pin-lock systems, or Velcro®; nonadjustable systems employ elastic straps . Some models utilize eyeglass-type temple bars for suspension with or without eyewear-like nose pads and bridge assemblies to assist in maintaining face shield position and stability on the face. A top band that is adjusted for depth is found on some models.

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