Exam Pass Notes - GOC Standard 12: Infection Prevention in Optical Practice

Download (Word)

Key takeaways

• Infection prevention and control (IPC) = patient safety. Visible, simple, consistent routines build trust and reduce harm.
• SICPs (Standard Infection Control Precautions) are baseline for every patient, every time: hand hygiene, correct PPE, respiratory etiquette, safe waste, and equipment disinfection.
• Most transmission in optics is via hands, droplets and fomites; focus on hand hygiene at the point of care, surface disinfection with correct contact time, and separation of clean/dirty zones.
• Proportionate, documented actions protect patients and staff - record who, what, when, and why.
• Domiciliary, locum, student and multi-site working demand standardised induction, portable supplies, and clear lone-worker escalation.
• Simple measurement (hand hygiene, instrument disinfection, spot checks) and short improvement cycles sustain gains.

Overview: what matters in optical IPC

• Risks derive from close face-to-face work, frequent hand - eye contact, shared instruments and high throughput.
• Break the chain of infection by removing a source, blocking the route, or protecting the host: clean hands, disinfected kit, single‑use items, and sensible source control (masks/tissues/ventilation).
• Match controls to the task risk: highest-risk tasks first (tonometry, slit-lamp contact, contact lens teaching), then broader clinic processes.

Standard Infection Control Precautions (SICPs)

• Hand hygiene:

• Use alcohol hand rub before and after patient contact when hands are not visibly soiled.
• Use soap and water after visible contamination or suspected certain pathogens (e.g., diarrhoeal illness).
• WHO 5 moments adapted: before touching patient; before clean procedures; after body fluid exposure risk; after touching patient; after touching patient surroundings.

• PPE:

• Gloves for drop instillation, CL handling, chemical cleaning or potential contact with body fluids.
• Aprons for domiciliary or messy tasks.
• Masks during respiratory peaks or by preference after risk assessment.
• Ensure correct donning/doffing to avoid self-contamination.

• Respiratory etiquette and source control: provide tissues and bins, signage, offer masks in respiratory seasons.
• Aseptic and non‑touch technique: prepare items in advance, avoid touching key parts, discard single‑use items immediately.
• Waste: segregate clinical waste, use foot-operated bins, manage sharps appropriately.
• Hand/skin care: provide emollients, avoid jewellery and long nails for clinical staff.

Equipment cleaning and disinfection - practical essentials

• Follow manufacturer instructions first (compatibility, contact time, rinsing).
• Prepare: de-power where needed, wear gloves for chemical handling, protect optics from pooling liquids/overspray.
• Tonometer prisms and tips:

• Prefer single‑use where available.
• If reusable: remove debris → disinfect with approved agent → full contact time → rinse/dry if required.

• Slit-lamp, chinrests, joysticks, fundus camera head/chin rests, PD metres, occluders, trial frames: clean detergent then disinfect touch points; allow full dwell time.
• Use separate clean and used cloths/wipes; label or tag "cleaned at" during busy sessions.
• Prevent damage: avoid pooling liquid, air-dry unless instructed, replace cracked pads/plastics.
• Keep COSHH and safety data accessible; store products in original containers.

Environmental cleaning and scheduling

• Short, frequent touch-point cleaning (between-patient room reset) outperforms infrequent deep cleans.
• High-touch public/staff areas: reception counters, pens, card machines, door handles - schedule wipes during peaks.
• Design cleaning schedules to fit clinic flow; use simple tick sheets and visible cues (clean/used bins).
• Spill response: stock kits for blood/vomit, train on PPE, absorbents, disinfectant and disposal; close area until dry and safe.
• Laundry: prefer disposable wipes; if reusable cloths used, wash at correct temperature and dry fully; mop colour-coding reduces cross-contamination.

Infectious eye disease - recognition & proportionate actions

• Common pathogens in optics: adenovirus, herpes simplex, bacteria causing conjunctivitis; respiratory viruses can have ocular features.
• Adenoviral conjunctivitis:

• Highly contagious via hands and surfaces.
• Treat with hand hygiene, single-use tissues, disinfect slit-lamp and contact surfaces with correct contact time, consider short staff exclusion if symptomatic.

• Herpes simplex keratitis / zoster ophthalmicus:

• Avoid touching lesions, maintain strict hand hygiene, urgent referral for red flags.
• Staff with cold sores: cover lesions where feasible, avoid tasks with high face proximity, reassign if frequent mask adjustments required.

• Red flags needing urgent escalation: severe pain, photophobia, reduced vision, corneal involvement, herpetic dendrites.
• Patient advice: avoid sharing towels, use single‑use tissues, clean spectacles, follow written easy-to-read guidance.

Practical incident responses (common scenarios)

• Missed tonometer prism disinfection:

• Immediately stop use, disinfect correctly with full contact time, assess exposure risk, inform line manager, seek IPC advice, consider patient contact if advised, review workflow to prevent recurrence; record who/what/when/why.

• Multiple trial frames used without cleaning:

• Remove frames, clean/disinfect all, temporarily remove from circulation, review room-reset checklist, add clean/used bins, brief team and assign second checker during peaks; document actions and review date.

• Staff with cold sore on clinic day:

• Allowed to work if lesion covered, strict hand hygiene, avoid CL teaching or tasks with close mouth/hand proximity; consider temporary task change if mask adjustments needed; record decision and review.

• Needle/sharp injury:

• Encourage bleeding, wash with soap and water, cover wound, report immediately, identify source safely, seek occupational health, consider RIDDOR if indicated; record events and follow-up.

Domiciliary and outreach practice

• Prepare: portable hand rub, gloves, wipes compatible with kit, spill/ waste bags, cable management to avoid trip hazards.
• On arrival: agree clean zone for kit, used area for contaminated items; perform hand hygiene before/after patient contact and before clean procedures.
• Environmental negotiation: ask about pets, smoking, space and ventilation pre-visit; agree respectful cleaning that maintains dignity.
• Returning to base: clean transport containers, restock PPE, replace spill-kit items, log issues and equipment faults.
• Care-home interface: check local policies, vaccination status, and arrange appointment times to minimise resident mixing.

Vaccination & staff health

• Recommended staff vaccines: seasonal influenza, COVID-19, MMR, varicella (where relevant), hepatitis B if sharps risk exists.
• Respect autonomy: record declines factually, manage risk with SICPs, consider masks during peaks, allocate lower-exposure roles if required during outbreaks.
• Patient queries: provide neutral, signposting information to NHS/GP services; avoid detailed counselling beyond scope.
• Maintain confidential staff vaccination records, support access to vaccines, and update induction materials annually.

Documentation, accountability and records

• Keep IPC records short and factual: who performed action; what product/method used; when it happened; why changes were made.
• Useful record types:

• One-page IPC risk assessments (hazards, controls, owners, review dates).
• Cleaning logs: date, area, initials, product used, issues.
• Incident reports: time/place, people involved, first aid, products used, escalation decisions.
• SICP/competency checks: attendance, assessor, date, remedial coaching notes.

• After lapses/incidents: document immediate actions, patient communications (if any), ownership of corrective actions and review dates.
• Store personal health data minimally and securely; keep reflections or staff wellbeing notes separate from clinical records.

Measuring what matters & improving practice

• Track a few high-yield indicators:

• Hand hygiene compliance at point of care.
• Instrument disinfection audits (e.g., tonometer prism contact time).
• Environmental spot checks (chins, joysticks, reception counters).

• Run short focused audits (2-week tests) on single processes to find quick wins.
• Improvement cycle: identify problem → choose control → test (2 weeks) → review data → adopt/adapt/drop → document outcome with owner/date.
• Share results visually at point of care; thank staff who report near misses; embed IPC prompts in huddles and handovers.

Training, induction and culture

• Induct locums, students and visitors using a one-page sheet covering: hand hygiene, PPE choices, instrument disinfection, spill response, COSHH location.
• Use brief observed practice and spot checks to maintain standards.
• Encourage a blame-aware reporting culture; thank and feed back improvements. Short refresher training after changes or incidents.

Quick practical checklists (for daily use)

Hand hygiene & PPE (point of care)

• Alcohol rub: before touching patient, before clean procedure, after potential exposure, after touching patient, after touching patient surroundings.
• Soap & water: if visibly soiled or after certain pathogens.
• Gloves: use for drops/CL handling/chemical cleaning; change between patients.
• Apron: for domiciliary or messier tasks.
• Dispose and perform hand hygiene immediately after glove removal.

Tonometer prism workflow

• Wear gloves.
• Remove visible debris.
• Disinfect with approved agent → ensure full contact time (use timer) → rinse/dry if required.
• Record cleaning if in high throughput (tag or log).
• Prefer single‑use tips where available.

Between-patient room reset (short)

• Hand hygiene before and after patient contact.
• Wipe chin/headrest, joystick, forehead band, trial-frame nose pads.
• Replace single-use items (tissues, paper covers).
• Check clean/used bins and replenish sanitiser and tissues.

End-of-day checks

• Clean and store equipment; label cleaned items.
• Empty and line bins, replace liners.
• Check spill kit, eye wash, PPE stocks and expiry dates.
• Restock portable domiciliary bags.

Incident immediate documentation (minimum)

• Time, location, persons involved.
• Immediate first aid and products used.
• Who was informed (manager/IPC/occupational health).
• Actions taken and who owns follow-up.

Governance & review

• Keep policies and product choices under annual review, plus after refits, new equipment or outbreaks.
• Record policy updates with date and approver; retrain briefly and sample practice within a week.
• Quarterly review of incident themes to prioritise improvements and resource allocation.

Use these pass notes to structure clinic checklists, short audits and induction sheets. Keep records factual, proportionate and focused on safety; visible, simple IPC routines at the point of care are the most effective defence against cross‑infection in optical practice.