A mixed methods study on effectiveness and appropriateness of face shield use as COVID-19 PPE in middle income countries

Aug 26, 2026

Background: Face shields were widely used in 2020–2021 as facial personal protective equipment (PPE), but real-world user priorities and usage habits—especially in limited resource settings—were not well aligned with laboratory evidence on protective potential. Methods: Relative protective potential of 13 face shield designs was tested in a controlled laboratory, then community and healthcare workers in Brazil and Nigeria were surveyed and compared with laboratory findings. Results and conclusions highlight no fully eliminating exposure and the need for designs balancing protection with usability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

American Journal of Infection Control 50 (2022) 878−884 Major Article A mixed methods study on effectiveness and appropriateness of face shield use as COVID-19 PPE in middle income countries Julii Brainard PhD a,*, Samantha Hall BSc Honsb, Mike van der Es MBA a, Adekemi Sekoni PhD c, Amy Price DPhil d, Maria Clara Padoveze PhD e, Folasade T. Ogunsola PhD c, Lucia Yasuko Izumi Nichiata PhD e, Emilio Hornsey BSc f, Brian Crook PhD b, Ferla Cirino MSc g, Larry Chu MDd, Paul R. Hunter MB ChB, MBA a a Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK b UK Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK c College of Medicine, University of Lagos, Lagos, Nigeria d Stanford University School of Medicine, Stanford, CA e School of Nursing, University of Sao Paulo, Csar, S~ao Paulo, Brazil f UK Public Health Rapid Support Team, UK Health Security Agency, and London School of Hygiene & Tropical Medicine, London, UK g Diadema Municipal Health Department, Diadema, S~ao Paulo, Brazil Key words: Droplets Infection control Brazil Nigeria Respiratory pathogen | A B S T R A C T | | --- | | Background: Face shields were widely used in 2020-2021 as facial personal protective equipment (PPE). Laboratory evidence about how protective face shields might be and whether real world user priorities and usage habits conﬂicted with best practice for maximum possible protection was lacking − especially in limited resource settings.
Methods: Relative protective potential of 13 face shield designs were tested in a controlled laboratory setting. Community and health care workers were surveyed in middle income country cities (Brazil and Nigeria) about their preferences and perspectives on face shields as facial PPE. Priorities about facial PPE held by survey participants were compared with the implications of the laboratory-generated test results.
Results: No face shield tested totally eliminated exposure. Head orientation and design features inﬂuenced the level of protection. Over 600 individuals were interviewed in Brazil and Nigeria (including 240 healthcare workers) in March-April 2021. Respondents commented on what inﬂuenced their preferred forms of facial PPE, how they tended to clean face shields, and their priorities in choosing a face cover product. Surveyed health care workers commonly bought personal protection equipment for use at work.
Conclusions: All face shields provided some protection but none gave high levels of protection against external droplet contamination. Respondents wanted facial PPE that considered good communication, secure ﬁxture, good visibility, comfort, fashion, and has validated protectiveness.
© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. | * Address correspondence to: Julii Brainard, Norwich Medical School, University of East Anglia, BMRC 01.01a, UEA Plain, Norwich, Norfolk NR4 7TJ, UK. [E-mail address:](E-mail address: j.brainard@uea.ac.uk)[ j.brainard@uea.ac.uk](E-mail address: j.brainard@uea.ac.uk) (J. Brainard). Funding/support: This project was primarily funded by the World Health Organization based on a grant from the German Federal Ministry of Health (BMG). Dr. Brainard and Professor Hunter Suppressed were also funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, King’s College London and the University of East Anglia. The views expressed are those of the author (s) and not necessarily those of the NIHR, UK HSA or the Department of Health and Social Care. Open access of this article is sponsored by the World Health Organization. Conﬂicts of interest: Forms from all authors are available. Professor Hunter does many media appearances related to the pandemic but neither this nor activities of any co-author appear to present

FAQs

What gap the study addresses about face shields as COVID-19 PPE?

Laboratory evidence on face shield protective potential existed, but information on whether real-world user priorities and usage habits matched best practices—particularly in limited resource settings—was lacking.

How was the protective potential of face shields evaluated?

Thirteen face shield designs were tested for relative protective potential in a controlled laboratory setting, assessing how orientation and design features influenced protection.

What did the study conclude about the effectiveness of face shields?

All tested face shields provided some protection, but none gave high levels of protection against external droplet contamination; respondents also emphasized secure fit, good visibility, comfort, communication, fashion, and validated protectiveness.

Aug 26, 2026

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