contact lens care and compliance

Office Infection Prevention Goes Beyond Contact Lens Care

BY MICHAEL A. WARD, MMSC, FAAO

Recently a patient arrived for her routine contact lens evaluation with her son in tow. Nothing unusual, except that he was wearing a mask, coughing excessively and appeared ill. Upon questioning, the mother revealed that the child was recently diagnosed with influenza H1N1 and could not attend school, so she brought him along to her appointment. What was she thinking?! If the child is too ill and contagious to go to school he should be at home, not contaminating the waiting room and putting others at risk.

Hopefully the H1N1 strain of influenza-A will be in our history by the time this is in print, but it is likely that it will compete with our seasonal flu. Infection control plans, policies, and procedures are important patient care requirements in all medical offices.

Fight Infection in Your Practice

It is incumbent upon medical personnel to prevent transmission of infection. Healthcare workers should be immunized (see Centers for Disease Control recommendations at www.cdc.gov/ncidod/dhqp/wrkr_immune.html), and those infected should follow work restriction policies. Immediately place patients who have known transmissible disease in designated examining rooms to separate them from others.

Adenovirus keratoconjunctivitis (AKC, or epidemic keratoconjunctivitis) is the most common transmissible viral infection in the ophthalmic setting. Dart et al (2009) studied the effect of an infection-control policy. Suspected AKC cases were segregated in separate waiting and examination rooms and had their examinations expedited, thus reducing exposure to staff and patients. They noted that handwashing and instrument disinfection alone were insufficient to prevent nosocomial infections during an epidemic, but that segregating suspected infectious patients reduced nosocomial infection rates from 48.4 percent to 3.4 percent.

There are other measures you can take to prevent the spread of infection. Wipe office furniture and equipment daily with appropriate disinfectant. Disinfect tonometer tips and Ascan probes with 3% hydrogen peroxide for 10 minutes. Alternatively, disinfect tonometer tips with a 70% alcohol wipe. Handheld occluders, phoropter face shields, stethoscopes, and scleral depressors may be disinfected with 70% alcohol wipes.

Disinfect GP diagnostic lenses with peroxide (see “Revisiting GP Diagnostic Lens Care,” November 2009 Contact Lens Care and Compliance column). Sterilize reusable hydrogel lenses by autoclave (see “In-Office Hydrogel Contact Lens Disinfection,” Contact Lens Care, July 2005).

Lens Care Reminders

Don't forget to remind your patients of proper contact lens care:

• Wash hands before handling lenses and care products.
• Replace lenses as prescribed.
• Rub and rinse lenses daily.
• Make sure ‘spare’ soft lenses are new, unopened, and in original containers.
• Empty case and air dry daily.
• Use fresh solutions daily; do not top-off.
• Scald case with freshly boiled water weekly and replace often.

CLS

For references, please visit www.clspectrum.com/references.asp and click on document #170.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service.