Hand Washing

You cannot wash your hands enough. If you find yourself at a loose end, wash your hands. It goes without saying that you should wash your hands before and after patient contact.

Alcohol gel/foam (at least 60% alcohol) can be used as a substitute for hand washing unless there is physical soiling of your hands. 

Hand washing should be performed for at least 20 seconds using plenty of liquid soap/alcohol gel. Hot or cold water can be used.

Wearing gloves is not a substitute for adequate hand washing. You can still transmit the virus whilst wearing gloves. Gloves should be considered if you have allergic or irritant contact dermatitis or if there are any breaks in your skin.

Hands should be dried carefully with a disposable paper towel.

The hand washing technique in the video is similar to surgical preoperative handwashing.

A visual description can be seen here. This does suggest a longer duration for hand washing, however 20 seconds is adequate.

Room Disinfectant

Rooms should be disinfected after use.

All surfaces should be cleaned. These include slit lamp shields, keyboards/mouse, chairs/armrests and door handles. Equipment on work surfaces should be kept to a minimum. You should wash your hands after room disinfection. 

In the video I am using wipes containing cations (this one contains benzalkonium chloride 0.3-0.5%). They take about a minute to dry, this allows easy visibility confirming which surfaces have been cleaned. I suggest not using these to clean the gonioprism as it can cause some epithelial toxicity. Use alcohol to clean gonioprisms.

Alternatives include (these can be used in a spray or wipe):

• Methylated spirits/ Isopropyl alcohol minimum 60%
• Hydrogen peroxide 0.1-0.5%
• Sodium Hypochlorite (bleach) 2%

A full list of approved disinfectants for Covid-19 can be found here.

Face Mask Use

Face masks should ideally be changed between every patient; practically speaking, however, they may be changed every three hours, every clinic, or when wet. All staff who come into contact with the patient (this includes front desk) should ideally be wearing a mask.

You should clean your hands before putting on a face mask. The blue side of the mask should face outwards. If there is any text on the mask this usually faces outwards. Once the mask is on, mould or pinch the stiff edge to the shape of your nose.
 
Once you have your mask on do not fidget with it.

It is during mask removal that you are at highest risk of contracting the COVID-19 virus from the front surface of the mask so removal technique of the mask is critical.

If you are using an N95 or P95 mask these should be “fitted” and tested for any air leaks to ensure that they are working optimally. It is very unlikely that these will be readily available in the community.

With both the patient and the assessor wearing masks the risk of transmission drops significantly if the patient is an asymptomatic shedder - because of this you may wish to consider providing mask to patients in your practice.

Dispose of the mask directly into a bin and wash your hands after removal.