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COVID-19 (CORONAVIRUS) UPDATE 5/14/20

Below is the Guidance for Care for Sacco Eye Group During the COVID-19 Pandemic. These guidelines are outline the measures we are implementing to assure patient safety while at the same time providing comprehensive eye care services. It is for informational purposes for our guests in our office. Not only do you want you to come see us, we want this to be your safe space for health care. Beautiful Vision does not have to be risky.

Core Principles: Screening, Physical Distancing, Infection Control Practices, Protective Measures

The provision of eye care services is essential for the state’s residents and has been delivered safely for patients with emergency and essential needs by Doctors of Optometry since the beginning of the pandemic. This document outlines the strategy and core principles for re-opening the practice after the COVID19 pandemic was declared. As patients begin seeking deferred care and additional in-person eye care services, formalized protocols will give guidance to maintain a safe environment for patients and employees in the facilities.

In addition to following state-issued directives, we are reviewing and implementing CDC and AOA guidelines when appropriate. This plan is based on the availability of information and materials at the time it was written and will be reviewed and amended as circumstances change.

Core Principle 1: Staff, Patient and Visitor Screening

Sacco Eye Group staff will screen patients, visitors, and staff members for symptoms of COVID-19 upon their arrival at the facility. Staff will be logged in and allowed to work only after passing the COVID-19 screening questionnaire and a mandatory non-contact temperature screening.

Please see attached OHSU Best Practices addendum for screening criteria, disinfection guidelines and reference list

An attempt will be made to obtain the COVID-19 screening questionnaire information from patients prior to their appointment during a telephone history interview. An attempt will be made to perform the Patient Prep Encounter and sign off before the patient gets to the office. This may be done by telephone. We will include non-contact temperature readers for patients when available. If taken, patient temperatures will be documented as part of their record. Patients and visitors exhibiting signs or symptoms of COVID-19 should be rescheduled, unless an emergency dictates otherwise, and referred to an appropriate healthcare provider.

When scheduling appointments, we will 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. A temperature of greater than or equal to 100.9F upon entering the office should be further triaged by the doctor before admitting for care.

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 should be offered a mask or cloth face covering as supplies allow, which should be worn while they are in the facility if the patient is physically able to do so. 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. Masks and cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

We 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 also be used for contact tracing in the event of a COVID-19 flare-up.

Core Principle 2: Physical Distancing Measures

Our practice will implement physical distancing measures to limit close contact between individuals inside the facility. These measures will take different forms as the pandemic runs it course to a hopeful resolution.

It is recommended that individuals maintain six feet of distance between each other when practical. Sacco Eye Group will accomplish this using signage, tape, barriers if applicable, and directing patients to appropriate locations during their visit. Additionally, the reconfiguration or removal of waiting room and exam room seating may be appropriate.

Strategies to manage patient flow and maintain physical distancing will include, but are not limited to:

  • Requesting patients call or text the office upon arrival so entrance to and movement through the facility can be coordinated by staff,
  • Instructing patients that companions should remain outside of the facility and not accompany the patient unless they are a parent/guardian of the patient or if they are a true care giver and need to assist the patient,
  • Considering separate operating hours for vulnerable populations,
  • Triaging and categorizing patient visits to address urgent patient needs first, and to facilitate patient flow to prevent too many patients in the office at a given time
  • Establishing an appropriate timeframe in between patient appointments,
  • Adherence to a “ONE patient per examination room” guideline
    • "Family visits” are discouraged
    • Parents should bring only the child to be seen, without siblings
    • Only those essential aids to the patients will be allowed in the examination room
  • Implementing curbside dispensing of contact lenses and glasses when possible,
  • Limiting the number of patients and staff members within the optical dispensary area at any one time and/or limiting the amount of time patients may be in the optical dispensary,
  • Considering limiting “walk-ins” for the optical dispensary to prevent overcrowding,
  • Allowing as many staff members as possible to work from home,
  • Staggering staff lunch to avoid crowding in the break room,
  • Continuing to offer telehealth services when appropriate, and
  • Limiting care to one doctor examination days until the time is appropriate to return to a two doctor examination day

Staff and patients should be prepared to conduct administrative work via remote methods to limit the amount of time the patient is in the facility. This could be accomplished through an online payment portal, using traditional mail, over the phone or through an app on a mobile device. Additionally, it is recommended that all paperwork, including patient history forms, be made accessible to patients prior to appointments for completion, for example, patients are encouraged to fill out their history forms online ahead of their appointed time. In some instances, we may consider mailing the forms to patients, providing a link on their website with a fillable or printable PDF, or obtaining information over the phone. We may utilize mobile apps that can scan documents provided the information shared via smartphones and other devices are transferred securely in compliance with state and federal regulations.

Core Principle 3: Infection Control and Disinfection Practices

Sacco Eye Group doctors and staff will take steps to help prevent the spread of the virus through infection control measures and disinfection practices. Hand sanitizer and other sanitary products will be readily available for employees and patients throughout the facility.

We will continue to use germicidal wipes to clean exam chairs and all equipment after every patient encounter in a top to bottom, left to right, “clean to dirty” direction as follows:

  • Keyboards, mouse, occluders and desk should be first as these are handled by the doctor and staff
  • Attention to phoroperter, examination chair and slit lamp should be cleaned next
  • Finally, the phone must be disinfected (if used) and the light switches/flags/door knobs
  • In the event a patient must be seen who exhibits upper respiratory or COVID-19 symptoms, or in whom secretions are more likely (i.e. viral conjunctivitis) the patient will be appropriately masked and placed into a room immediately. Doctor and staff will have PPE as necessary and the room will be flagged with either an airborne or droplet precaution sign.
  • Entry into the room are only available after thorough disinfection and the room will flagged as such so it is clear it is safe for entry
  • When available only disposable tonometer tips will be used. If not available disinfection with bleach as recommended by AAO and CDC is still an accepted practice as per:

Disinfection of Tonometers
Junk, Anna K. et al.
Ophthalmology, Volume 124, Issue 12, 1867 – 1875

  • Visual field studies will be suspended, unless urgent, for the immediate future. Patients will be required to use a mask during testing. See

Cleaning Guidance for the Humphrey
Field Analyzer (HFA) by Zeiss

We will regularly perform enhanced environmental cleaning of commonly touched surfaces, such as workstations, counters, railings, door handles, clipboards, pens, chairs and other public area surfaces throughout our work day.

Care will be taken in the handling of eyeglass frames and other products to limit opportunities for the transfer of the live virus. For example,

  • A staff member wearing gloves and a mask can assist a patient in obtaining frames from the selection and transport them with a tray or other receptacle to the fitting area.
  • Once a patient has completed their selection process, the staff member can disinfect each pair of frames before replacing them on display.
  • Staff should consult with frame representatives regarding proper care of frames so as not to cause damage, and follow CDC guidance on disinfection methods for these items. A link to CDC disinfection guidelines can be found in the resource section below.

Early research indicates that it is still safe for patients to wear contact lenses. However, it is recommended that patients consider discontinuing contact lens use while they are sick. To ensure patient safety, we will follow strict contact lens hygiene within the office as outlined by the American Optometric Association Contact Lens and Cornea Section, and the American Academy of Optometry. These hygiene guidelines may be found here:
https://files.constantcontact.com/fd2dfe10101/245857f9-caeb-4d9c-ad18-7fb256518562.pdf

Due to the nature of placing a new wearer in contact lenses (handling, fluids, face to face interaction with trainer and number of visits to the office) new contact lens fittings will temporarily be suspended.

Our office will post signage from the CDC and/or the Ohio Department of Health on office doors with information for patients about best practices, such as:
https://www.cdc.gov/flu/pdf/protect/cdc_cough.pdf


Core Principle 4: Protective Measures

We have implemented a short and long-term plan for obtaining and utilizing protective equipment for the office.

All doctors and staff members are strongly encouraged to wear masks and should consider wearing gloves and protective eyewear when interacting with patients. Some equipment may be unavailable due to shortages and we will continue to review CDC guidelines and utilize the best methods available to provide protection for patients and staff members. Updated CDC guidelines on this topic can be found here:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

As noted above, patients should also be asked to wear cloth face coverings or masks at all times while inside the facility. In accordance with CDC guidelines, staff members who do not interact with patients may be able use other methods of protection, such as cloth face coverings, if masks are not available in an adequate supply.

Doctors and staff members should wash hands before and after each patient encounter. Any gloves which are utilized during patient care should be properly removed and disposed of after each patient encounter.

A barrier shield may also be used around testing equipment and administrative areas due to the potential for close contact. Slit-lamp barriers or breath shields will be used.

Staff members will have access to disinfectants, hand sanitizer, and soap and water. Staff members will receive job-specific training on utilizing these resources, including instruction on how to safely touch or adjust their mask or cloth face covering and performing hand hygiene immediately before and after. Proper donning and doffing protocols will be followed when necessary (see attached document).

Our management will regularly reinforce key messages – stay at home when ill, use cough and sneeze etiquette, and practice regular hand hygiene – to all staff members and consider placing posters reiterating these issues in areas where they are most likely to be seen.


Resources:

Ohio Department of Health’s Stay at Home Order:

https://content.govdelivery.com/attachments/OHOOD/2020/04/02/file_attachments/1418062/Signed%20Amended%20Director%27s%20Stay%20At%20Home%20Order.pdf

State of Ohio COVID-19 Resources:

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/home

CDC Guidelines for Infection Control COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html

CDC Guidelines for Disinfection Methods:

https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

CDC Guidelines for Cloth Face Coverings for the General Public:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

FDA masks guidelines:

https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks

Ohio Optometric Association:

https://www.ooa.org

American Optometric Association COVID-19 Resource Page:

https://www.aoa.org/coronavirus


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