Dr. G. Raby & associés
Optométristes ● Optometrists
23 Main South, C.P. 1449, Alexandria (Ontario)
Téléphone: (613) 525-2753 ● Fax: (613) 525-1317
Dr. Geneviève Raby, O.D.○ Dr. Joshua C. Smith, O.D., M.Sc., B.Sc.
INFECTION CONTROL AND STANDARD OPERATING PROCEDURE
UPDATED MAY 22,2020 following the recommendations for return to practice from the Ministry of Health of Ontario and the College of Optometrists of Ontario.
DISINFECTION
Checkmark forms are used to follow strict disinfection standards. Disinfection is completed in full after each patient encounter as well as every two hours for common patient areas that have not been frequented by patients or staff. Extensive disinfection will be performed at the end of each shift (5 hours) in all clinic areas including those not frequented by patients (staff workstations and common rooms).
Disinfection products used in clinic vary according to type of required disinfection (standard or high) and also according to the equipment or surfaces that are sanitized. All products used are compliant and recognized by the MOH, the COO, and the instrument manufacturer recommendations. We use: A15 hospital grade disinfectant spray, 70% isopropyl alcohol, 3% hydrogen peroxide, diluted 50/50 3% hydrogen peroxide, Lysol wipes, Clorox spray, Lysol toilet bowl cleaner.
A summary of our disinfection protocol is posted in the clinic. Our full disinfection protocol and standard operating procedure is available to our patients.
PERSONAL PROTECTIVE EQUIPMENT (PPE)
PPE is worn in clinic by all staff members according to the guidelines established in training. This includes wearing a surgical or KN95 mask at all times at clinic AND wearing a face shield or safety glasses (with protective shields) whenever it is not possible to be 2m away from the patient. Nitrile gloves can be worn during procedures that involve touching the patient and they are also available when handling patient frames. Staff members have been trained on donning and doffing of PPE (videos, PPT presentations, and demonstrations). Resources are managed responsibly to avoid excessive use. Masks are discarded when soiled. Staff have a mask for each day of the week. When the mask is clean, it is stored in a container and kept to be reused 7 days later. Gloves are discarded immediately when they are removed. Staff wear clean uniforms on a daily basis. Staff members are not permitted to eat or to drink on the clinic main floor. Use of personal cell phones is avoided as much as possible on the clinic main floor. Cell phones must be disinfected when arriving and when leaving the clinic.
All patients over the age of 2 are obligated to wear a mask at all times while in clinic. They are encouraged to bring their own masks. If they do
not have a mask, they are available for a small fee at the clinic. This information is provided on patient pre-appointment call and also posted at our office door.
HAND HYGIENE and PHYSICAL DISTANCING
Staff have been trained on hand hygiene as well as all other measures to help prevent the spread of disease such as wearing a mask in public, coughing or sneezing in a tissue or in the crook of their arm, maintaining healthy living standards and reporting any changes to their health.
Hand hygiene will be performed by staff members before and after each patient encounter as well as throughout a patient encounter whenever they are in contact with the patient or their belongings (glasses). Hand sanitization stations and office signage are installed at the clinic entrance, at the dispensary, at the reception and dispensary workstations, at the frame adjustment counter, in the exam lanes. Handwashing stations are installed in the exam lanes, in the pre-test and CL room, in the washroom and in the staff common room.
Physical distancing (2m) is maintained as much as possible in the clinic by patients and staff. Signage is installed throughout the premises.
Staff work at a single individual workstation.
Staff is split in two teams that work alternating shifts and that do not meet.
SCREENING AND RISK ASSESSMENT
Staff members perform daily COVID-19 self assessment checks and temperature checks. A logbook is signed on a daily basis. Staff members presenting with any symptom will stay home for the day and observe their symptoms. When in doubt, a staff member who thinks he/she could be ill will remain at home and contact Telehealth, the local Health Unit or their PCP. Return to work will not be considered until there is a full resolution of all symptoms and the staff member has been cleared by the PCP, Health Unit or TeleHealth.
If a member of the team or someone who has visited the clinic is confirmed with COVID-19, the local Public Health Unit will be advised immediately.
Patients are screened on the telephone before their appointment and again upon entry to the clinic. Patient temperatures can be checked on entry to the clinic.
A login sheet is kept that includes the date, name, telephone number, time in and time out of clinic for anyone who enters the premises and who uses curb pickup.
ADAPTED PHYSICAL SETTING AND PROCEDURES
The following changes have been applied to comply with MOH and COO recommendations:
- Everyone presenting to the clinic must have an appointment. This includes patients coming for frame selections, adjustments, repairs. The front door will remain locked to control entry.
- Staff are conducting a telephone interview with patients prior to their appointment time to reduce the time spent in office.
- Preadjustments are being performed on glasses to promote curb pickup.
- Patients who can be seen by teleoptometry are being seen by this method rather than in person.
- All patients requiring an appointment and those who have had cancelled appointments are being triaged according to established conditions and risk of severe illness due to COVID19 (age, DM, cancer, immunosuppression, HTN, respiratory illness).
- Patient appointments are spaced out to allow disinfection between each and also to preserve physical distancing.
- Staff shall maintain physical distancing as much as possible. Talking is kept to a minimum.
- Plexiglass shields are installed at the reception and dispensary counters.
- Breath shields are installed on: phoroptors, slit lamps, pupillometer.
- Unidose diagnostic drops and disposable tonotips are used in the high risk clinic.
- No other patients than the ones seeing a doctor are admitted inside the clinic during the high risk clinic.
- Visual fields are performed only when necessary using disposable eye patches. Staff will perform the test while standing outside the testing room.
- Tonometry (direct contact with the eye) is being performed only when necessary.
- Doctors conduct their examination standing as far away as possible from the patient.
- New contact lens fittings and teachings are not being performed at present time.
| AREA | SUBAREA | DEVICE | LEVEL | FREQUENCY | AGENT |
| RECEPTION | ENTRANCE | Door handles and frame (4) | std | every patient | HG disinfectant |
| Sanitization station (pump/shelf) | std | every patient | HG disinfectant | ||
| Door lock | std | every patient | Wipes | ||
| Glass on doors | std | end of shift | HG disinfectant | ||
| WAITING ROOM |
Coat hooks | std | every patient | HG disinfectant | |
| Chair | std | every patient | HG disinfectant | ||
| Reception counter (patient side) | std | every patient | HG disinfectant | ||
| Reception plexiglass (patient side) | std | every patient | HG disinfectant | ||
| Sanitization station | std | every patient | HG disinfectant | ||
| Light switch | std | end of shift | HG disinfectant | ||
| WORK STATIONS |
Reception counter (staff side) | std | 2 hours | HG disinfectant | |
| Computer screens | std | end of shift | Wipes | ||
| Telephones | std | enf of shift | Wipes | ||
| Mouse | std | enf of shift | Wipes | ||
| Keyboards | std | end of shift | Wipes | ||
| Printer | std | end of shift | Wipes | ||
| Drawer handles | std | end of shift | HG disinfectant | ||
| Sound system and remote | std | end of shift | Wipes | ||
| Plexiglass (staff side) | std | end of shift | HG disinfectant | ||
| Chair | std | end of shift | HG disinfectant | ||
| DISPENSARY | ADJ/REPAIR | Counter | std | every patient/2hrs | HG disinfectant |
| Chair | std | every patient | HG disinfectant | ||
| Adjustment tools | std | every manipulation | Alcohol | ||
| Drawer handles | std | end of shift | HG disinfectant | ||
| FRAME GALLERY |
Counters | std | every patient/2hrs | HG disinfectant | |
| Mirors | std | every patient/2hrs | HG disinfectant | ||
| Drawer handles | std | end of shift | HG disinfectant | ||
| Patient frame bins | std | every patient | HG disinfectant | ||
| Trialed frames and patient frames | std | every patient | Hydrogen peroxide | ||
| Chairs (2) at measurement counter | std | every patient | HG disinfectant | ||
| Measurement instruments | std | every patient | Alcohol | ||
| WORK STATIONS |
Frame gallery counters (patient side) | std | every patient | HG disinfectant | |
| Frame gallery plexiglass (patient side) | std | every patient | HG disinfectant | ||
| frame gallery sanitization stations | std | every patient/2hrs | HG disinfectant | ||
| Frame gallery counters/desk (staff) | std | end of shift | HG disinfectant | ||
| Frame gallery plexiglass (staff side) | std | end of shift | HG disinfectant | ||
| Drawer handles | std | end of shift | HG disinfectant | ||
| Payment terminal | std | every patient | Wipes | ||
| Automated lensmeter | std | end of shift | Alcohol | ||
| Manual lensmeter | std | end of shift | Alcohol | ||
| PAL ID | std | end of shift | Alcohol | ||
| Computer screens | std | end of shift | Wipes | ||
| Telephones | std | enf of shift | Wipes | ||
| Mouse | std | enf of shift | Wipes | ||
| Keyboards | std | end of shift | Wipes | ||
| Printer | std | end of shift | Wipes | ||
| Chair | std | end of shift | HG disinfectant | ||
| EXAM WAIT AREA | WAITING ROOM |
Chair | std | every patient | HG disinfectant |
| light switches | std | end of shift | HG disinfectant | ||
| Flags | std | 2 hours | HG disinfectant | ||
| WASHROOM | Door handles (2) | std | each use | HG disinfectant | |
| Counter | std | each use | HG disinfectant | ||
| Mirror | std | each use | HG disinfectant | ||
| Faucets and sink | std | 2 hours | HG disinfectant | ||
| Toilet (outside and bowl) | std | each use | Toilet bowl cleaner | ||
| Soap dispenser | std | each use | HG disinfectant | ||
| Paper towel dispenser | std | each use | HG disinfectant | ||
| PRETEST/ CL ROOM |
Counters | std | every patient/2hrs | HG disinfectant | |
| Door handles (3) | std | every patient | HG disinfectant | ||
| drawer handles | std | end of shift | HG disinfectant | ||
| Faucets and sink | std | end of shift | HG disinfectant | ||
| Paper towel dispenser | std | end of shift | HG disinfectant | ||
| Instrument tables | std | every patient | Wipes | ||
| Patient stool | std | every patient | HG disinfectant | ||
| Staff stool | std | end of shift | HG disinfectant | ||
| Camera and Autorefractor | std | every patient | Alcohol | ||
| Camera and autorefractor lenses | std | end of shift | Lens cleaner/paper | ||
| Computer screen | std | end of shift | HG disinfectant | ||
| Keyboard and shelf | std | end of shift | HG disinfectant | ||
| Mouse | std | end of shift | HG disinfectant | ||
| Computer switch | std | end of shift | HG disinfectant | ||
| Drawer handles | std | end of shift | HG disinfectant | ||
| Autoclave | std | end of shift | HG disinfectant | ||
| Timer | std | end of shift | HG disinfectant | ||
| Light | std | end of shift | HG disinfectant | ||
| TESTING ROOM |
Counters | std | every patient | HG disinfectant | |
| Computer screen | std | end of shift | HG disinfectant | ||
| Keyboard and shelf | std | end of shift | HG disinfectant | ||
| Mouse | std | end of shift | HG disinfectant | ||
| Printer | std | end of shift | HG disinfectant | ||
| Patient stool | std | every patient | HG disinfectant | ||
| Staff stool | std | end of shift | HG disinfectant | ||
| Instrument tables (2) | std | every patient | Wipes | ||
| Patient stool | std | every patient | HG disinfectant | ||
| Visual field | std | every patient | Alcohol | ||
| OCT | std | every patient | Alcohol | ||
| OCT keyboard | std | end of shift | HG disinfectant | ||
| Diagnostic lenses | std | every patient | Lens cleaner | ||
| Fans and Lenses | std | end of week | Lens cleaner/paper | ||
| EXAM LANES | Biomicroscope | std | every patient | Alcohol | |
| Biomicroscope table and handles | std | every patient | Wipes | ||
| Instrument stand | std | every patient | Wipes | ||
| Retinoscope, ophthalmoscope, light | std | every patient | Alcohol | ||
| Phoroptor | std | every patient | Alcohol | ||
| Small instruments bin | std | every patient | HG disinfectant | ||
| Small instruments | std | every patient | UV sterilizer | ||
| Small surgical instruments (metal) | high | every patient | Autoclave | ||
| Tonometry tip | high | every patient | Hydrogen peroxide 10 min | ||
| Gonioscope | high | every patient | Alcohol | ||
| Manual keratometer | std | each patient use | Alcohol | ||
| Instrument stand light | std | each patient use | HG disinfectant | ||
| Counters | std | every patient | HG disinfectant | ||
| Computer screen | std | end of shift | HG disinfectant | ||
| Keyboard | std | end of shift | HG disinfectant | ||
| Mouse | std | end of shift | HG disinfectant | ||
| Sanitization station | std | end of shift | HG disinfectant | ||
| Sink and faucets | std | every patient | HG disinfectant | ||
| Soap dispenser | std | every patient | HG disinfectant | ||
| Mirror | std | every patient | HG disinfectant | ||
| light switch (3) | std | every patient | HG disinfectant | ||
| Patient chair and armrests | std | every patient | HG disinfectant | ||
| OD chair | std | end of shift | HG disinfectant | ||
| BASEMENT | KITCHEN | Hooks | std | end of shift | HG disinfectant |
| Counter | std | end of shift | HG disinfectant | ||
| Sink and faucets | std | end of shift | HG disinfectant | ||
| Mirror | std | end of shift | HG disinfectant | ||
| Fridge door | std | end of shift | HG disinfectant | ||
| Door handles | std | end of shift | HG disinfectant | ||
| Water dispenser | std | end of shift | HG disinfectant | ||
| CONFERENCE ROOM |
Personal PPE stations | std | end of shift | HG disinfectant | |
| Table | std | end of shift | HG disinfectant | ||
| Chairs | std | end of shift | HG disinfectant | ||
| Stairwell ramp | std | end of shift | HG disinfectant |
*HG disinfectant: Hospital grade disinfectant, Wipes: Lysol wipes (or equivalent), std: standard