Clinical Optometric Procedures: Infection Control

Clinical Optometric Procedures: Infection Control

CHAPTER 1 – INFECTION CONTROL

• This chapter will include a review of:
• Hygiene
• Care of solutions and pharmaceutical agents
• Disinfection
• Protection
• Biohazards
• HIV/AIDS and infection control

INTRODUCTION

Infection Control is an absolutely essential component of the practice of primary eyecare. Given the risks of being exposed to infectious organisms, it is recommended that all patients be treated as potentially infected individuals. The clinician must be knowledgeable & remain vigilant about proper hygienic procedures for routine and specialized eye care. While the optometric environment has been rarely noted to involve invasive procedures, there are numerous optometric procedures that involve contact with mucous membranes and this very frequently is the area of contact with pathogenic organisms.

There are several guidelines that the eye care practitioner should follow in order to minimize the risk of cross infection, that is, from ensure that the practitioner does not transfer infection to the patient or vice versa.

HYGIENE

Hygiene begins with very simple and basic steps. Hand washing, the most essential personal procedure, must become a reflex and should be performed before, during and after patient examinations.

Hand Washing

Figure 1.1 provides a diagrammatic representation of the process of hand washing. In cases where there are no levers to close the water supply, the clinician should use a clean tissue to close the tap and discard the tissue thereafter. International Centre for Eyecare Education Figure 1.1 Hand washing procedure

Suitable hand washing agents listed from the most effective antimicrobial activity includes alcohol preparations, chlorhexidine, iodophors and plain soap. Newer developments in maintaining hand hygiene include alcoholbased hand gels which can be very effective in situations where adequate hand washing facilities are unavailable.

Cleaning of Surfaces

Surfaces such as tabletops need to be cleaned with commercial solvents or solutions to remove dust, dirt, oils or other accumulations that may harbor organisms (Fig.1.2). Instruments should be constantly cleaned. Areas of dermal contacts (e.g. phoropters, slit lamp, headrests, etc.) must be wiped with alcohol swabs after examination of each patient.

Figure 1.2 Cleaning of surfaces International Centre for Eyecare Education

CARE OF SOLUTIONS AND PHARMACEUTICAL AGENTS

Expiration Dates of Solutions

Dates on solution and medication bottles should be respected and bottles that are outdated or opened for more than 1 month should be discarded (Fig.1.3). It is advisable to record the opening date on the bottle.

Figure 1.3. On expiry, medication/solution should be discarded if seal packed and open bottles should be discarded as per the clinician’s suggestion or should be used for a month only Contamination of Bottles

Contamination of bottles should be avoided not to spread organisms from one patient to another. Bottle tips should not come in contact with eyes or dermal areas (Fig. 1.4). Bottle caps must not be placed on surfaces but rather remain in the practitioner’s hand until the bottle is recapped after instillation of drugs.

Figure 1.4 Contact from the nozzle of the bottle should be avoided to prevent contamination

DISINFECTION

Disinfection involves the treatment of surfaces or medical devices by an agent to destroy infectious organisms.

Tonometer tips, gonioscopes and other eye contact devices should be washed with soap and water after use then soaked for 10 minutes in a disinfecting agent. The recommended agent is 1-part house bleach to 100 parts distilled water solution. Hydrogen peroxide (3%) can also be used instead of bleach solution but it is more costly.

Following disinfection, rinse with sterile saline and air dry.

Unused bleach: water solution is good for two weeks. The solution used in vials for the disinfection process of instruments must be changed daily. The vials must also be washed with soap and water. Extending soaking beyond 10 minutes can damage the instruments and is not recommended.

An alcohol swab can also be used to wipe the eye contact devices in the presence of low infection risks and if (for some reason) the above steps cannot be performed. Treating every patient as potentially infectious, however, the bleach/water or peroxide methods should be respected as much as possible.

Contact lenses should be washed, rinsed, disinfected & stored appropriately after each trial using an approved method. Usually contact lenses are cleaned with contact lenses specific cleaning agent, rinsed with saline and disinfected in 3% hydrogen peroxide. The peroxide is then neutralized appropriately and the lenses are stored in multi-purpose solution. Alternatively, contact lenses can be cleaned with a cleaning agent, rinsed and disinfected in a contact lens autoclave in sterile non-preserved saline.

Surgical instruments should be ideally heat-sterilized by autoclave or by ethylene oxide gas sterilization and sterile wrapped for storage. An alternative, more “office-based” approach is to wash the instruments with soap and water (using cleaning brushes) and store them in a stainless steel tray with appropriate commercial storage solutions (eg. Benzalkonium Chloride). The solution needs to be changed weekly. To dry store, the instruments are rinsed with saline and air-dried. Before use, they are again cleaned, disinfected with the solution and rinsed with saline.

PROTECTION

Latex gloves should be worn whenever there is a risk of contact with body fluids or tissues, especially in the presence of a skin break on the patient or you (Fig.1.5). Always wash hands before and after glove use. Eye protection, masks and gowns should also be remembered and used in instances when there may exist the possibility of liquid or tissue splashes.

Figure 1.5 Wearing latex gloves decrease chances of exchange of body fluids between the patient and clinician incase of any skin break

BIOHAZARDS

Waste products (tissues, cotton tip applicators, etc.) should never be left around to be picked up and disposed later. Wastes should always be disposed immediately in the proper wastebaskets with a garbage bag. Blood & tissue products must be separated and disposed in specially marked garbage bags. Needles, blades and sharps go in specifically dedicated hard plastic containers marked for dangerous and contaminated products (Fig.1.6).

Figure 1.6 Sign indicates that the bag contains dangerous and contaminated products International Centre for Eyecare Education

HIV/AIDS AND INFECTION CONTROL

The current global HIV/AIDS epidemic and the increased risk of cross infection, has provoked a greater emphasis on disinfection of instrumentation in the health care environment and protection against cross contamination. HIV has been found in tears and has also been isolated from contact lenses and ocular tissues; however, there have been no reports of transmission through these routes. Infection of this type generally requires that there must be direct contact between blood or body fluids and mucous membranes or damaged skin. The practitioner with any sort of open wound on the hands should ensure that they are gloved when handing a patient to protect the patient if the practitioner is infected or protect himself if the patient is infected. International Centre for Eyecare Education Section A – PRELIMINARY EXAMINATION