Compliance

Create an infection prevention protocol

Learn these guidelines for stopping infections.

BY C. JOLYNN COOK, RN

Technicians must comply with good hand hygiene procedures to prevent the spread of infections.

It is easy to become complacent and overlook the necessary steps to prevent the spread of infection, especially in a hectic practice. Despite our day-to-day tasks, we must set aside the time to learn and educate staff about infection prevention practices and how to be safe while caring for patients.

Our awareness suddenly increased during the Ebola outbreak last fall, and we pay extra attention to those around us who exhibit signs and symptoms of infection during flu season. However, this level of alert attention should be ever-present in our daily routines as well.

Several key considerations are critical to the health and well being of our patients as well as technicians, nurses and physicians. New hires should be trained on the following infection prevention information.

Common pathogens

Every practice must provide training on OSHA’s Bloodborne Pathogens (BBP) standard. The BBP standard includes requirements for preventing infection by pathogens or the organisms in the blood that carry disease. Although BBP exposure risk is limited in ophthalmology office settings, we must know how to manage infectious material, should the situation present.

Common bloodborne organisms include the Ebola virus, Hepatitis B and C, HIV, and others. Personal protective equipment is essential when dealing with BBPs.

Hepatitis B vaccine is offered at no cost to any employee working in the practice in patient care areas that carry a risk of exposure to BBPs (e.g., technicians). The hepatitis B vaccine protects those who may be exposed to blood or bodily fluids while performing daily job duties. The vaccine is administered in three doses/injections. Once an employee has the series of injections, a booster is not typically needed. If you still have concerns after the injections, a titer can be drawn to check the immunization level. Conduct post-vaccination screening for protective levels of hepatitis B surface antibody after administering the third vaccine dose.

Your state may require vaccination for another easily spread illness: influenza. If not, annual flu shots are recommended by the Centers for Disease Control (CDC), especially for those with chronic health conditions or those working in health care. Encourage patients to reschedule routine eye care if they exhibit any signs or symptoms of influenza.

Also, it may be advantageous to provide annual influenza vaccines (at no charge) to employees and physicians as part of the practice wellness program. While you cannot require staff to receive influenza immunizations, education may help to underscore their importance.

Standard precautions

According to the CDC, “Standard Precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect healthcare personnel and prevent healthcare personnel from spreading infections among patients.”

Standard Precautions include the following:

• Hand hygiene. Think about all of the hands that touch a computer keyboard or mouse, telephone, door handles and many other surfaces. Hands are the most significant cause of the spread of illness, so technicians must comply with good hygiene procedures. Microorganisms are not visible to the naked eye, so hands may not appear or feel soiled when contaminated. The CDC and the World Health Organization advocate for alcohol-based hand rubs because they are both convenient and quite effective. Wash with soap and water when body secretions, such as blood, visibly soil hands.

• Personal protective equipment (PPE). Typically, PPE is not required for ophthalmic technicians while performing their daily routines, such as escorting patients to an exam room and performing patient screening and eye exams. However, when potential infection concerns are noted, such as conjunctivitis, or if the patient has open skin lesions, wear exam gloves. It is always better to be cautious.

• Safe injections. To prevent the transmission of BBPs between patients or between the patient and the technician or nurse rendering care, you must safely handle sharp instruments and needles in the ophthalmic practice. The CDC, along with the Safe Injection Practice Coalition, led the “One & Only Campaign” to address safe injection practices in healthcare settings. Recommendations include, “Use single-dose vials for parenteral medications whenever possible,” and “Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use.”

(For more training material on safe injection practices, visit www.OneandOnlyCampaign.org.)

Keep the office clean

Wiping equipment between each patient with 70% alcohol swabs or disinfectant wipes is effective and recommended. Many practices instruct technicians to wipe the slit lamp head and chin rests in the patient’s presence just prior to the exam, while taking information or while chatting with the patient.

Also, trash cans are breeding grounds for microorganisms. To reduce germs, keep trash covered, use trash cans with hands-free lids, and empty trash every day (at a minimum).

Personal hygiene

Don’t overlook personal hygiene and attire for preventing the spread of infection. We constantly touch, sit on and stand on soiled surfaces where microorganisms are present, which exposes our skin and clothing to colds, coughs and respiratory illnesses.

Whenever you leave work, shower and put on clean clothing. Also, keep work shoes at the office when possible and do not wear them outside — the street or parking lot can contaminate shoes. This helps to keep the clinical environment cleaner and healthier.

Continuing education

Initial training needs to be provided during orientation to all new employees, and annual training is necessary thereafter. Ongoing education through online resources and through various associations and organizations, such as BSM Distance Learning Courses, ASOA and JCAHPO, are the best resources that ensure proper policies and procedure are in place to protect employees in the practice.

Don’t become complacent. Stay safe and educated on infection prevention. OP

Ms. Cook is the administrator of the Laurel Eye Clinic and the Laurel Laser & Surgery Centers and is a Certified Ophthalmic Executive and Certified Administrator Surgery Center.