Protective masks, gloves, plastic face-domes, disposable suits for staff
Surgical masks at all time, N95 masks for extended, closer work
Patients requested to arrive with masks and gloves We are primarily a Lions
Eye Clinic. Our patient population for the most part immigrant, low economic.
Not feasible. We provide masks. Gloves not necessary, actually, counter
productive outside the OR as they quickly become contaminated. All patients
use hand sanitizer when they arrive, wash hands in sink ( all exam rooms have a
sink) and sanitizer when they . Our private patients are well equipped when
they arrive- I wish I had the quality of air filter masks they are wearing!
Hand-sanitizers omnipresent and used extensively
This was always part of our MO. Mounted in all rooms, all hallways. If you
can't wash, you sanitize entering room, and leaving room
All 'contact' surfaces cleaned between patients - door handles, camera
all-around, chairs and arm-rests, etc.
Again, always part of our disinfection protocols. Everything when patient
leaves, and cleaning chinrest in front of patient when they arrive. Hospitals
have much more stringent protocols than private practices. Thus, we were
already well stocked with supplies when this hit.
Potential installation of plexiglass sheets between technician and patient
(commercial models already available in some places...)
Haag Streit plastic barriers already on our BX instruments. I'm working with
local plastics manufacturer to custom build barrier screens for Heidelberg,
Optovue, etc
Exam rooms aired out as much as possible, doors kept open as much as possible
during exams (we put portable screens in front of the exam door for a feeling
of privacy)
Our rooms are well ventilated. No need there. One patient, one room, always
our policy. Our diagnostic rooms are not the usual, cram something in where
there is a spare corner. They are thoughtfully layed out, one patient, one
instrument with SOLID walls between each instrument ( HIPPA ) I know MANY
private practices where they are doing OCT in the hallway next to the bathroom,
etc etc. Crazy!
extra fans in rooms to help with ventilation, pre-set down-time between
patients to allow for air-exchange in room
We have a professional HVAC filtering system which is checked monthly by
Engineering. Good ventilation.
Waiting room chairs spaces apart, no large groups of patients / family allowed
at any given time
Our waiting room is small, this has been one of our greatest challenges. Our
patient population come with a) driver b) interpreter c) grandma d) all kids
in the family c) a few spare cousins. I joke, but one patient can come with
10 people. We are struggling to insure that only patient comes up with them-
we have iPads on demand interpreters that works very well.
Temperature checkpoints at entrance to the clinic
Yes, we have LVN's and a mobile professional WOW station for temp checks. Keep
in mind, some of the deaths to COVID, temp was not present. Not entirely
foolproof as an indicator. We have large signs everywhere, we screen by phone
before they come, and again when they check in. Hospital doing the same.
Now, one BIG question has to do with visual-field testing.
I am a trained perimetrist of 35+ years. In my humble opinion there is no
"emergency' VF that cannot be sufficiently documented ( given the times and
constraints ) by history and confrontation. If Neuro event, thresholding is
not necessary and confrontation fine. Stroke, tumor, ONH swelling- while a
full VF is "nice", like color fundus, documentary only. The Glaucoma fields
can percolate another month or so. Absolutely NO VF's in our clinic at this
time. The time together, the closeness, just doesn't warrant it. Our Retina,
Glaucoma and Neuro MD's agree. Ask the question- would you order this on your
elderly mother? Generally, that's your answer....
Be careful washing that VF bowl with just anything. There is a certain
integrity that must be maintained for calibration of the unit. Follow your
manufacturer's recommendations for cleaning, just as you would for your camera
lenses.
No FA's, and OCT on a limited basis only. Makeshift large plastic barriers in
place, and permanent solutions being sought as I type this.
Denice Barsness, CRA, COMT, ROUB, CDOS, FOPS
Ophthalmic Diagnostic Services.
