Personal protective equipment (PPE) for trachoma graders and trichiasis surgeons in the context of COVID-19

Main Objectives

The objectives of the study are split across three phases:

Phase 1: Selection of PPE configurations for further research

Assessment of four possible PPE configurations by Tropical Data master graders and HEADSTART master trainers. HEADSTART is a training mannequin for trichiasis surgeries.

Two configurations were short-listed for phases 2 and 3: Option 1: “Loupes worn through rectangular cut out and mounted on face shield” and Option 2: “Loupes worn in front and mounted on face shield mask”.

Phase 2: Classroom testing of PPE configurations to determine the potential impact on clarity of vision of: i) graders while conducting trachoma grading of images on a mobile phone; ii) surgeons conducting surgery on HEADSTART surgical simulation devices.

Phase 3: Field testing of PPE configurations to assess the hypothesis that the face shield configuration is not associated with any problems of acceptance by the wearer during large scale surveys or during trichiasis surgery.

To test the research hypothesis the following acceptance ‘key determinants’ will be examined:

1.  Operational performance: operational performance of trachoma graders and surgeons while undertaking their respective procedures using the face shield with loupes.
2.  Comfort and wearability: features of the face shield with loupes that predict comfort and tolerability among trachoma graders and surgeons in the field.
3.  Decontamination and reuse: Assess ease to clean and decontaminate the face shield as well as to replace parts.

Summary

This research in Ethiopia, Nigeria, Tanzania and Nauru responds to questions raised about the integration and interface of COVID-19 PPE items with ocular loupes (required to correctly grade trachoma during surveys and see during trichiasis surgery) and potential impact on routine trachoma grading and trichiasis surgery.

It is unknown whether wearing loupes with a face shield and mask is tolerable over long periods of time, as would be routinely required during surveys and surgical outreach. Trachoma survey graders mostly perform their roles outside, often in hot and/or humid conditions while trichiasis surgeons conduct surgeries in rooms with natural ventilation rather than air conditioning and additionally, may be hot and/or humid.

The study will provide the necessary insight into operational acceptance of face shields for trachoma grading and trichiasis surgery during routine programme activities and is expected to guide the adaptation of survey and surgery implementation activities.

Resources

• RTI International article: Adapting in a pandemic: simple innovations for big impact in trachoma elimination