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NSVC Re-Opening in the “COVID19 World”

Facts About Contact Lens Wear and Covid 19

  1. Staff and Doctor PPE, clothing and protection measures
    1. Face masks (N95) will be worn by doctors, techs, interns, and opticians (all those who come in relatively close contact with patients). For administrative staff, if you are interacting with patients within a 6-foot distance you also will be masked with surgical masks. Gloves will also be available for everyone’s use, however keep in mind that proper hand washing (see attached instructions) is likely more effective since glove contamination during use and improper removal reduces their effectiveness. Staff are instructed that if they must touch their face or adjust their face covering, they should perform hand hygiene immediately before and after. Staff and doctors will be wearing “scrubs” that can be washed each day after use.
    2. We will make sure that staff and doctors are symptom free each day.
    3. 1. We will have a non-contact thermometer available to assess temperature, as needed.

(NOTE: Temperature alone does not assess or exclude disease.). We will also have a blood oxygen finger measure, which may be even more sensitive for COVID disease. There will be a sign in sheet with name/date and area for indication of test results.

  1. 2. If staff report or appear ill, we will recommend that they seek medical care from their primary care physician.
  2. 3. Any staff who are symptomatic should stay home and notify NSVC immediately. If a staff member comes in and we feel that they are at risk or have a fever they will be asked to go home and contact their primary care physician. If confirmed COVID positive they and their team will need to be quarantined and contact traced.
  1. Personal and Environmental Disinfection
    1. Wash hands properly and frequently. Any patient interaction by doctors, interns, techs or opticians should have hand washing done prior to and following the interaction. This should be done in front of the patients if at all possible.
    2. Use of provided gloves – again hand washing is preferred and more effective, but if you wear gloves and you come in contact with patients or materials then the gloves should be properly removed and disposed (see attached document re-instructions).
    3. Hand sanitizers will be available throughout the office. Please again use as indicated prior to and following any patient interaction. Again, hand washing is preferred but use of sanitizers can be used as well. Use of a very small amount is all that is needed and will help us maintain supply.
    4. Administrative staff and personal work space disinfection: personal work space should be disinfected at the start of each day using provided spray disinfectants. Repeat of this should be done at the end of the day as well.
    5. Exam room and testing/procedure room disinfection: areas must be disinfected using provided spray disinfectants and alcohol pads. This should include desktops, chair headrests/armrests, any areas where instruments come in contact with examiner or patient. This should be done prior to each patient care experience and following. It is encouraged to do as much in front of patients if possible.
    6. General office cleaning: Our cleaning service will continue to clean the office twice weekly and pay special attention to the unique circumstances we are under.
  2. Other protective measures: we have purchased plexiglass barriers that have been placed at key positions at our check-in and check-out areas, our optical areas and contact lens dispensing/I&R areas. All doctors, techs and opticians will be provided scrub sets so that they can wear them and then bring home to wash each evening. Administrative staff have the option of wearing scrubs but are not required to. We will continue to provide PPE (masks/gloves) as long as required.
  3. Initial scheduling: we will begin with limited hours and limited number of patients scheduled per hour. The clinic schedule will be modified and updated as we move forward based on our experience as well as directives from the CDC, state government and our professional organizations.
  4. Contact Lens Specifics
    1. Patients who are currently wearing CLs will be asked to insert and remove CLs on their own unless we are refitting into a new modality that would require different I&R methods. They will be instructed to properly wash their hands prior to and following removal and insertion. If a CL case is provided by NSVC it will be disposed of after use.
    2. Diagnostic CLs: we will try to avoid the use of re-usable diagnostic CLs if at all possible. Virtual software assisted specialty CL design will be encouraged using topography/tomography measurements. When diagnostic re-usable CLs are required, after use the lenses are disinfected in hydrogen peroxide (ClearCare) WITHOUT the neutralizing disc for a minimum of 3 hours and then placed in with a neutralizing disc for over 4 hours and stored in a MPS solution if needed or preferably dry if rigid diagnostic CLs.
    3. Disposable CLs: diagnostic disposables are encouraged. Patients who are able to be treated with single use disposables should be encouraged to do so, especially during this time.
    4. Technician/Intern or Doctor CL handling: properly wash hands prior to and following handling of CLs and your insertion or removal of CLs from a patient’s eye. Use of hand sanitizer following is also required.
    5. Those patients who are stable in their disposable and/or non-medically necessary CLs in terms of vision, comfort and ocular health response and who are not comfortable in coming in for their due exams at this time can be shipped CLs directly with an extension of their CL prescription. They should be scheduled however for their annual comprehensive examination at a later date.
    6. Medically necessary CL patients, continuous wear CL patients and corneal reshaping/orthoK patients should be encouraged to be seen at their regularly scheduled time for examinations and advised that all precautions will be taken to ensure their safety.
  5. Optical Dispensary Specifics
    1. Limit patient presence in optical to 1 person for frame selection and 1 person for dispensing and/or adjustments. Must maintain 6 foot or greater separation of patients in the optical. Patients must wear mask. Opticians also will be masked.
    2. There is a plexiglass barrier in the frame selection area and one section open for direct measurements. The plexiglass section should be used for frame selection. Frames are passed back and forth through the opening in the plexiglass barrier. Gloves are optional and if not used must wash hands or use hand sanitizer prior to and immediately following any direct contact with frames, instruments and of course patients. When in open sections opticians should be masked. There is also a plexiglass barrier at the dispensing table. A frame can be placed back and forth under the barrier through the opening. Use of gloves and/or hand washing/hand sanitizers should follow instructions above.
    3. Frame selection and disinfection: During this time a patient may browse the frame boards but they are NOT to touch or remove frames from the boards. They must be accompanied by an optician. The optician will remove any frames from the boards selected by either the patient or the optician (we recommend that optician frame selection should be encouraged vs. patient browsing). Anytime a frame is removed from the board it MUST BE DISINFECTED. We will have a bin for touched frames and then have them cleaned and disinfected with a bath of warm/soapy water (per instructions from frame manufacturers and labs). They then will be dried and replaced on the boards. Opticians cleaning and disinfecting frames should wear gloves and dispose of afterwards.
    4. Appointments for frame dispensing should be encouraged. The same holds true for patients wanting to come in specifically for frame selection. Patients who have a dispensing appointment or frame selection appointment should call the office from their car and our optician or admin. Staff can text them to come in (again, alone unless a minor with one parent) and go directly to the appropriate space in the optical.
    5. Curbside dispensing is also encouraged. Walk-ins to optical are to be discouraged.
  6. Vision Therapy / VDRC Specifics:
    1. Our vision therapy service, VDRC will also resume vision therapy services for our patients. We will offer our patients the option of live traditional therapy visits (while utilizing appropriate PPE, physical distancing whenever possible and office/instrument disinfection procedures. The second option will be virtual/remote vision therapy sessions for those patients who are not comfortable yet with live traditional in office therapy.
  1. Considerations for At-Risk Patients:

Special consideration will be given to patients more likely to contract COVID-19, or those patients included in the “at risk” population. According to the CDC, this includes: people 65 and older, especially if in less than optimal health. People who are immunocompromised, and people of all ages with underlying medical conditions (particularly if not well-controlled) such as chronic lung disease, moderate to severe asthma, diabetes, serious heart conditions, severe obesity, chronic kidney disease, and liver disease. We all must be aware of this when scheduling and caring for such patients. Likely that we will only see these at-risk patients if they are in significant need of our services since they hopefully will avoid unnecessary activities. If we do see an at-risk patient, then let’s all pay even closer attention to their safety. Scheduling them in the first and last slots of the day and trying to physically separate them even more may be helpful.

  1. General Office Safety Protocol:
    1. Office Screening for patients, visitors and staff members for symptoms of COVID-19 upon their arrival at the facility, including utilizing non-contact temperature readers and/or blood oxygen level measurements
    2. If suspected of illness they should be referred to their primary care physician (PCP) and not permitted in the office.
    3. Any patients and visitors exhibiting signs of COVID-19 and seeking routine eye care should be rescheduled and referred to an appropriate healthcare provider.
    4. Any patients and visitors exhibiting signs of COVID-19 with urgent, emergent ophthalmic conditions should be treated if possible and then referred to an appropriate healthcare provider.
    5. Any staff member with a fever should not be permitted to work. Any staff member showing signs of COVID-19 should not be permitted to work and should be referred to an appropriate healthcare provider.
    6. “Contact Tracing": Our administrative staff will register patients and any visitors entering the facility, including contact information, to track who is in the building and during what time. This can be done electronically or recorded by a staff member to minimize contact between patients. This information can be used for contact tracing in the event of a COVID-19 event.
  2. Patient Instructions for Health and Safety:
    1. Patients should be advised to travel to the office with a minimum number of companions.
    2. Administrative staff should discuss with patients the need to reschedule their appointment if they develop fever or symptoms of COVID-19 leading up to the time of their appointment.
    3. Patients will call our main office number from their car upon arrival and our staff member will meet them in the vestibule where their temperature and blood oxygen levels will be measured. Should they be normal they will be escorted directly into patient care rooms (there will be no utilization of our waiting areas until further notice).
    4. Patients and visitors to the office should be informed in advance of the expectation that they wear their own mask or cloth face covering upon arrival to the facility. If not, they

will be offered a mask as supplies allow, which should be worn while they are in the facility if the patient is physically able to do so.

  1. They should also be instructed that if they must touch or adjust their cloth face covering, they should perform hand hygiene immediately before and after.
  1. Limit Patient Time in Office:

To try and limit the amount of time a patient is in the facility, clerical staff and patients should be prepared to conduct administrative work via alternate methods:

  • Schedulers should get all patient demographic, insurance and desired payment methods in advance if at all possible.
  • Have patients take photo of ID and insurance cards and e mail to administration in advance.
  • Try to limit time at check out: if a follow up or recall appointment can’t be made efficiently at checkout, we will put in place a system for our administrative staff to reach back out to the patient remotely following the appointment to schedule their next prescribed visit. If payment due that day can’t be made efficiently at checkout then again, we will put in place a system for our administrative staff to reach out to the patient remotely for credit card information or to confirm mailing of check to the office.
  1. Reporting

If our office is aware of a patient, visitor or staff with a diagnosis of COVID-19, the office will immediately report this information to the local health department for additional handling. Our office will assist the local health department when possible in identifying potential contacts of a determined infected patient, visitor or staff member.

CDC Recommended Hand Washing Method

Follow these five steps every time.

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.

Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.

Rinse your hands well under clean, running water.

Dry your hands using a disposable towel or air dry them.

 

CDC Recommended use of Hand Sanitizers

How to use hand sanitizer

Apply the gel product to the palm of one hand (read the label to learn the correct amount).

Rub your hands together.

Rub the gel over all the surfaces of your hands and fingers until your hands are dry. This should take around 20 seconds

  

Note: Sanitizers can quickly reduce the number of germs on hands in many situations. However, Sanitizers do not get rid of all types of germs.

Hand sanitizers may not be as effective when hands are visibly dirty or greasy.

 

REQUIRED TRAINING RESOURCES:

  1. CDC hand hygiene course: https://www.cdc.gov/handhygiene/training/interactiveEducation/
  2. How to don and doff a surgical mask: https://youtu.be/9VbojLOQe94
  3. CDC video on putting on N95: https://youtu.be/zNV6dK6Y-Ek  and removing N95: https://youtu.be/Z9Pk-YqUqjc
  4. CDC How to remove gloves: https://www.cdc.gov/vhf/ebola/pdf/poster-how-to-remove-gloves.pdf
  5. NY Times article on mask earing: https://www.nytimes.com/2020/04/08/well/live/coronavirus-facemask-mistakes.html