KING KHALID HOSPITALINFECTION PREVENTION

ANDCONTROL MANUAL

OPHTHALMOLOGY CLINICDr. Nahla Abdel Kader, MD, PhD.

Infection Control Consultant, MOHInfection Control CBAHI Surveyor

Infection Prevention Control DirectorKKH.

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DEFINITION

To provide clear guidelines for the appropriate methods of disinfection of those ophthalmologic instruments for which sterilization is not recommended and to provide guidelines on the use and storage of multidose vials.

COMMENTS

Outbreaks can occur in the ophthalmology setting resulting from cross contamination of Tonometer tips and multidose vials.Outbreaks of epidemic keratoconjunctivitis due to adenovirus type 8 have been documented in ophthalmology clinics, and linked to inadequately disinfected Tonometer tips.

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A• General Recommendations

B

• Medication Including Mulitdose vials (MDV’S)

C

• Disinfection of Ophthalmological instruments for which steam sterilization is not recommended

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PROCEDURA. General Recommendations

1. There should be a hand hygiene facility in each patient care area used exclusively for hand hygiene.

2. Cleaning of items in preparation for disinfection/ sterilization should take place at a separate sink to that used for hand hygiene.

3. It is the responsibility of all Health Care Workers (HCW) to observe Standard Precautions to the wearing of personal protective equipment (PPE) when exposure to blood or body substances is anticipated.

4. Adequate PPE should be available to meet clinical requirements at all times.

5. Clean and sterile items may be stored in the same area.

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PROCEDURA. General Recommendations

6. Personal effects eg. bags, books, magazines should be stored in staff lockers and not in any other area of the clinic.

7. All horizontal surfaces should be cleaned daily before work begins, with a hospital approved (tuberculocidal) disinfectant, and thereafter between patients. Visible soiling should be removed first with a hospital approved detergent with water and friction before disinfection.

8. A hospital approved sharps disposal container should be available at point of use in all patient care areas.

9. A program for fridge cleaning and temperature monitoring should be established, with record keeping.

10. Medication and food items should not be stored together.11. Food and drink should only be consumed in a designated area for

this purpose.

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PROCEDURB. Medication Including Mulitdose vials

(MDV’S)

1. Medication intended for internal or external use should be labeled accordingly and stored separately.

2. MDV’s should be labeled with the opening date.3. MDV’s should be used according to manufacturers’ instructions.4. MDV’s should be discarded when:

1. Empty.2. The expiration date is reached.3. Contamination of the vial is known or suspected.

5. MDV’s should be accessed with a sterile needle each time, and the needle removed on completion. The needle should not be left as permanent access, as it will provide a portal of entry for micro-organisms.

6. The rubber stopper of MDV’s should be wiped with Isopropyl Alcohol 70%, and allowed to air dry before needle insertion.

7. Eye medications ( drops, ointments) intended for single patient use only should be discarded once treatment is completed.

8. Applicators of eye medications intended for single use should not come in contact with the eye or periobital area. A separate applicator should be used for each eye, and labeled accordingly.

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PROCEDURC. Disinfection of Ophthalmological instruments for

which steam sterilization is not recommended

1.1. General Recommendations1. Instruments that are visibly soiled should be washed with

a hospital – approved detergent and water with friction prior to disinfection.

2. The presence of blood or proteinous material may inactivate the disinfectant.

2. Tonometer TipsIn a busy ophthalmology clinic a fast and effective method of disinfection is recommended: a. The tonometer tip should be cleaned and disinfected

immediately after use. b. The tonometer tip may be disinfected by one of the two

following methods: 1. Isopropyl Alcohol 70% .

a. The tonometer tip should be wiped clean and then disinfected with 70% Isopropyl Alcohol.

b. Apply Isopropyl Alcohol 70% to all surfaces of the tonometer tip, ensuring the entire surface is treated container.

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PROCEDURC. Disinfection of Ophthalmological instruments for

which steam sterilization is not recommended

c. Apply friction to clean the surfaces. The mechanical wiping action contributes to the effective removal of viruses.

d. The Alcohol should be allowed to completely air dry to promote effective disinfection through adequate contact time of the alcohol, and to ensure that no residual alcohol is transferred to the ocular surface.

2. Hydrogen peroxide 3%.a. The tonometer tip should be wiped clean and then disinfected with 3%

Hydrogen peroxide.b. Apply hydrogen peroxide 3% to all surfaces of the tonometer tip,

ensuring the entire surface is treated.c. Using a hydrogen peroxide soaked sponge apply friction to clean all

surfaces of the tonometer tip.d. The hydrogen peroxide should be in contact with the tonometer

surface for at least 5 minutes.e. Rinse the tonometer thoroughly with distilled water to ensure

removal of the hydrogen peroxide.f. Dry the tonometer with a disposable clean tissue following the wash

disinfection process.

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PROCEDURC. Disinfection of Ophthalmological instruments

for which steam sterilization is not recommended

3. Laser Lenses

Before cleaning, disconnect the power plug.1. Cleaning of optical surfaces (Lenses): The lens should be cleaned and disinfected immediately after use. Wash lens thoroughly with soap and water. Rinse lens. Dry with a paper towel. Apply isopropyl alcohol 70% to all surfaces of the lens. Allow to air

dry. Replace lens in box.2. Cleaning of painted surfaces:Never use aggressive or abrasive cleaning agents, always use thedisinfectants approved by (the product evaluation committee) the hospital.

• Clean and disinfect the device case as well as foot switch, chin rest and forehead strap by wiping.

• In cleaning and disinfecting the equipment, make sure that no moisture gets into the device and the foot switch.

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