Section: UTMB On-line Documentation Subject: Healthcare Epidemiology Policies and Procedures Topic: Ophthalmology

2.12 - Policy 10.18.07 - Revised 1979 - Author

2.12 Ophthalmology

Purpose	To outline guidelines for infection control practices in Ophthalmology.
Audience	All employees of UTMB hospitals and clinics, contract workers, volunteers, and students in the Department of Ophthalmology.
Policy	• Hands shall be washed before and after each patient contact (even if gloves are worn). All employees are required to wash their hands before beginning work, after using the rest room and prior to leaving work. • For routine patient care (contacts) liquid lotion soap in the dispenser shall be used for handwashing. • Antiseptic (antimicrobial) handwashing products shall be used for handwashing prior to the performance of high risk procedures such as insertion or manipulation of an invasive device or before surgical procedures and operations (even minor surgical procedures), and in all ICUs. • Antiseptics that do not require water for use, such as alcohol gels, may be used for hand disinfection in place of an antimicrobial handwash. Hands that are grossly contaminated must be washed with lotion soap prior to hand disinfection. • Handwashing brushes shall be single-use. • In the absence of a true emergency, personnel shall always wash their hands: - before performing invasive procedures, whether or not sterile gloves are worn; - before and after contact with wounds, whether surgical, traumatic, or associated with an intravenous device; - between all patient contacts and after contact with a source that is likely to be contaminated with virulent microorganisms or hospital pathogens such an object or device contaminated with secretions or excretions from patients. • Gloves shall be worn when exposure to blood or any other body fluids, excretions or secretions is likely. • For a given patient, site care shall start at the cleanest site (i.e., mouth care) and progress to the dirtiest site (i.e., urinary catheter care). When going from a dirty site to a clean site, hands shall be washed between sites.
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Routine Handwashing Procedure	• Use warm water to wet the hands. • Apply lotion soap. • Work up a good lather. • Apply with vigorous contact on all surfaces of the hands. • Wash hands for at least 10-15 seconds. • Rinse, avoid splashing. • Keep hands down so that run off will go into the sink and not down the arm. • Dry well with paper towel and use the paper towel to turn off the faucet. • Discard the towels into the appropriate container.
Hand Antiseptics	• Same as hand washing except substitute an antimicrobial soap for the lotion soap. • Alcohol gel may be substituted for antimicrobial soap. The following technique should be applied: - If hands are visibly soiled, wash hands with lotion soap prior to application of alcohol gel. - Apply enough alcohol gel to cover the entire surface of hands and fingers. - Rub the solution vigorously into hands until dry. - Use of alcohol gels may be result in a sticky residue on hands. Wash with lotion soap periodically to remove the gel residue.
Fingernails	Healthcare workers with direct patient contact must maintain their fingernails so that the tips of the nails do not extend past the ends of their fingers. The nail surface should remain smooth. Artificial nails/wraps or acrylic overlays are not permitted. Nail polish must not be chipped or cracked.
Instruments	• Speculums that are used for eye examinations must be sterile. • Clinic staff will maintain a supply of sterile speculums for the doctors performing eye exams. • Once the speculum has been used, the physician will return it to clinic staff for reprocessing. • Transport all non-disposable instruments in the sterile field to the dirty room for reprocessing.
Eye drops	• Eye drop medications must be discarded and replaced with a new bottle once a month. • The bottle should be dated when opened. • When administering eye drops, do not touch the dropper to the eye. Discard the bottle if the dropper comes in contact with the eye.
Retrobulbar Injections	• After administering retrobulbar injections, immediately place the needle and syringe into the sharps container. • All instruments used during retrobulbar injections are disposable.
Disinfection of Tonometer Prisms	• Tonometer prisms must be disinfected after each patient use. • Saturate a cotton ball with 70% ethyl alcohol and mechanically disinfect the prism. Allow it to air dry before use. • Discard the bottle of alcohol after one month.
Tono-Pen 2	• The Ocu-Film tip cover of the Tono-Pen 2 is for single use only. The tip cover must be changed after each patient use. • Keep the probe tip protected with an Ocu-Film tip cover when not in use or in storage. • The probe post must be cleaned with optical quality compressed gas before the first use each day, before instrument storage, in the event of unanticipated readings, or if a “good” calibration check cannot be obtained. Refer to the manufacturer’s guidelines.
References	• HS International Goldmann Applanation Tonometer Instruction Manual. HAAG-STREIT AG, CH-3098, Koeniz, Switzerland.