Hand hygiene is considered the most important and effective infection prevention and control (IPAC) measure to prevent the spread of COVID-19. All Team Members must clean their hands before and after every patient interaction and after any contact with a patient’s eye/tears, and upon the insertion and removal of gloves. Cleaning hands with soap and water for at least 20 seconds is recommended. In order for hands to be cleaned at the right time, it is necessary to be able to clean hands at the point-of-care. Where there is no sink in the room, alcohol-based hand rub (ABHR) may also be used (a minimum of 70 per cent alcohol).
We have placed a hand sanitizing station at the office’s entrance/reception, and elsewhere in the office, for use by patients. All persons must sanitize their hands upon first entering the office.
Personal Protective Equipment (PPE)
PPE is worn to prevent the transmission of microorganisms from patient to staff and from staff to patient. All of our Optometrists and staff must wear PPE covering their mouth, nose, and eyes when interacting with patients (i.e., whenever they are within 2 m of one another).
Eye protection includes safety glasses, safety goggles, face shields and visors attached to masks. Eye protection should provide both front and side coverage. Prescription glasses, without a side shield, are not acceptable as eye protection.
Surgical masks are considered an appropriate alternative to N-95 respirators as long as optometrists are not performing aerosol-generating procedures. The risk of droplet dispersal is further reduced by the patient also wearing a mask. Our office will not allow any person (> 2 years of age) into our office who is not wearing a mask (disposable/reusable). When scheduling appointments, patients will be advised to arrive to the office wearing a mask.
All of our Optometrists should wear gloves and/or use disposable cotton tip applicators whenever they are touching patients’ eyes or eyelids. Wearing gloves is not a substitute for hand hygiene.
All of our Optometrists and our staff are expected to wash any worn gowns or clothing at the end of each day. Everyone will be educated on how to safely put on and take off PPE.
Precautions to Maintain Physical Distancing
Physical distancing (> 2 m) – Our practice has taken steps to ensure that whenever possible physical distancing can be maintained. We have changed the frequency and interval of appointments scheduled. We will emphasize punctual arrival for appointments and only admit patients to the office by appointment and only at the time of their appointment. This includes appointments for eye examinations, as well as the dispensing of spectacles and contact lenses.
We have repositioned chairs in the reception/waiting area and used ground markings at the entrances and throughout the office. We have limited the number of people allowed in the office and exam room(s) at any time in accordance to guidelines set at the time. We will also advise patients that they attend their appointment alone or with as few other people as possible (e.g., one parent/support-person/substitute decision maker).
Whenever possible, all staff is to keep a distance of at least two metre between themselves and anyone else, including co-workers and patients.
All staff and Optometrists are to attend team meetings virtually.
Contact-less procedures – We have adopted contact-less procedures where possible, including but not limited to, contact-less payment systems, when collecting patient information, and the electronic delivery of prescriptions and receipts (e.g., by email).
Protective barriers – We have installed slit lamp shields and other protective barriers, e.g., plexiglass barriers have been installed in reception and pre-test wherever possible.
All Team Members are to use appropriate products provided by Dundas Optometry Clinic to clean and disinfect items as outlined in our Standard Operating Procedures (SOP) listed in Appendix A. Each member of our team (optometrists, staff) must review our SOPs related to infection control.
This SOP features two components:
Public component is the public areas of the office that are not involved in patient care.
This includes waiting rooms, offices, corridors, bathrooms and service areas. Areas designated in the public component are cleaned with a detergent.
Clinical component is the area involved in patient care. This comprises the clinical areas of the office, including examination rooms, procedure rooms, diagnostic and treatment areas. Areas designated in the clinical component are cleaned with a detergent and then disinfected with a hospital grade disinfectant. ‘High-touch’ surfaces may require more frequent cleaning.
Every device or appliance (including eyeglass frames) that patients come into contact with must be disinfected before use with the next patient. All Team Members are to follow the manufacturer’s instructions regarding appropriate contact time and the use of disinfectants, in order to provide appropriate disinfection and avoid damaging equipment or appliances.
Low-level disinfection is generally appropriate for diagnostic equipment, chairs, frames, occluders, pens, etc. Low-level disinfectants include, but are not limited to:
• Alcohols (70-95% ethyl or isopropyl alcohol)
• Chlorine (1:50 dilution of household bleach)
• QUAT (quaternary ammonium cation); multiple commercial types, e.g., Fantastik disinfectant all-purpose cleaner
• 7% hydrogen peroxide enhanced action formulation
• phenolics (i.e., Lysol, Pine Sol)
High-level disinfection is appropriate for contact lens cases, contact lenses, and generally any equipment that touches patients’ eyes (e.g., spuds, alger brushes, lacrimal dilators, lid tools, tonometer probes, gonioscopy lenses, etc.). After disinfection, saline-rinse followed by air dry is generally appropriate.
High-level disinfectants include, but are not limited to:
• 2% glutaraldehyde
• 6% hydrogen peroxide
• 7% hydrogen peroxide enhanced action formulation
• 0.2% peracetic acid
• 0.55% ortho-phthalaldehyde (OPA)
When in doubt, high-level disinfection is recommended.
Equipment disinfection and hand washing should be performed in front of patients, where possible. Dundas Optometry Clinic will provide all proper cleaning and disinfecting agents.
Team Members must not present to work when ill with symptoms of infection. Any person with symptoms of COVID-19 should stay home, contact their primary care provider or Telehealth Ontario, and should not return to work until they are asymptomatic and have been cleared by their primary care provider or Telehealth Ontario of any concern of COVID-19. All staff and doctors must self-declare their health status before the start of every shift. Wherever possible each staff and doctor will work at a dedicated work stations and efforts will be made to have patients interact with as few staff as possible.