Covid-19 and your eye examination

Covid 19 symptoms can be avoided by wearing of face masks ideally the surgical mask n95 mask type.

The outbreak of SARS-CoV-2 causing disease COVID-19 was declared by the World Health Organization as a global pandemic on 11 March 2020.
Infection control by healthcare institutions is one of the key factors in limiting the spread of COVID-19, in addition to other nosocomial diseases.

The World Health Organization (WHO) and the Australian Department of Health maintain that wearing a face mask while seeing healthy, asymptomatic, low-risk patients is unnecessary. Nevertheless wearing a medical mask is one of the prevention measures that can limit the spread of certain respiratory viral diseases, including COVID-19. However, the use of a mask alone is insufficient to provide an adequate level of protection, and other measures should also be adopted. Patients sometimes would wear masks during testing of the visual field in automatic perimetry bowls.

COVID-19 (SARS-CoV-2) is a novel coronavirus that is an enveloped, single-stranded RNA virus believed to spread person to person via respiratory droplets. This occurs when an infected person coughs or sneezes, or when people touch a surface with the virus present from an infected person, then touch their eyes, mouth or nose.
Patients may be asymptomatic and infected, and potentially have viral shedding for 20 days. Symptomatic patients typically present with a respiratory illness such as cough, shortness of breath and fever. Other patients may have eye pain, headaches and fatigue. The incubation period averages 5-7 days.

We are still open looking after your eye health needs. We are taking every possible precaution to protect your health. We are sanitising all equipment each time it is used and prescreening prior to each patient attending to ensure that no one is displaying any symptoms associated with coronavirus.

• We are using infection control methods including face shields and goggles, P2, N95, and surgical masks and for cleaning our practice, testing equipment, and consultation rooms before and after every patient use. We are being diligent with cleaning and disinfecting these areas for patient and staff safety.
• All staff are regularly using hand sanitiser and washing their hands thoroughly throughout the day.
• We are using the Visi2 centration system to take all our biometric measurements for spectacles, which is a contactless method.

• If you need to replenish contact lenses, replenish solutions or collect spectacles and are unable to come in we will happily arrange for these to be posted to you.
If you have concerns about the health of your eyes and are unable to attend the practice we can provide advice to you over the phone.

We are closely monitoring the current COVID-19 situation and following the guidelines released by both the Department of Health and Human Services and Optometry Australia to help prevent the spread of the virus.

• In the event that you, or someone you have had close contact with, is diagnosed with COVID-19 and you have visited the practice within the last 14 days, we ask that you notify us as soon as possible so that we can take appropriate and necessary measures. If you have any questions or concerns, please phone us on 64921999 or email us at [email protected]

There is no requirement to cancel or postpone your appointment if:
• You are feeling well as we enforce social distancing and density requirements.

• HAVE NOT travelled outside Australia in the last 14 days

• HAVE NOT been in contact with any individual who has travelled outside Australia in the last 14 days.
However, as a courtesy to our staff and other patients, we ask that if you have a cold, fever, sore throat, etc, to ring us before coming for advice.

Coronavirus causes and symptoms. What we can do

Fever above 38 degrees, cough, difficulty breathing, close contact, droplets
Isolate early, safety equipment, disposable tissues, hand cleaning, surface decontamination

  1. We receive daily updates from the relevant government bodies, infectious control medical experts. We are prepared and aware of the risks.
  2. As health professionals, we have strict infection control protocols and sterilisation.
  3. We are cleaning all touchable surfaces between patients including disinfecting frames after being handled.
  4. We have all patients use our hand sanitiser upon arrival and when leaving the clinic.
  5. If you feel unwell or have been in contact with someone who has, isolating yourself until you have been given the all-clear is the right thing to do!

Tristel Duo OPH is an approved Instrument Grade – High-Level Disinfectant.
Tristel Duo OPH is chlorine dioxide in a foam, designed specifically for the high-level disinfection of ophthalmic and optical medical devices. Tristel Duo is more compatible than alternative disinfectants such as sodium hypochlorite, aldehydes, peracetic acid or alcohol.

Tristel human healthcare products utilise chlorine dioxide for disinfection. Chlorine dioxide is a fast and effective disinfection agent activated at the point of use and does not carry many of the drawbacks of conventional disinfection chemistries. It has both a strong OH&S profile for staff and patients, and for material compatibility. The products are bactericidal, viricidal, fungicidal, mycobactericidal and sporicidal.

For devices that contact the surface of the eye or secretions, Tristel Duo OPH is used as is TGA approved specifically for high-level disinfection of small devices such as tonometer prisms and gonioscope lenses, pachymeters, ultrasound A- and B-scanners, etc.

For all clinic surfaces (whether treatment room, medical surfaces such as headrests, reception desks or cabinetry), Tristel Jet Gel is effective against all organisms of concern in 30-seconds of contact.

EFFICACY AND SAFETY COMPARISON  TRISTEL DUO OPH AND 70% IPA

Hazard Statements DUO OPH  has no hazardous classifications according to CLP, wheras IPA is a highly flammable liquid and vapour and can cause  serious eye irritation, drowsiness and dizziness.

 TRISTEL DUO OPH70% IPA
Gram-negative bacteria
(e.g. Pseudomonas aeruginosa)
30 secs5 mins
Gram-positive bacteria
(e.g. Staphylococcus aureus)
30 secs5mins
Yeast
(e.g. Candida albicans)
30secs5mins
Fungi
(e.g. Aspergillus brasiliensis)
30 secs5mins
Viruses
(e.g. Adenovirus, Herpes simplex virus)
30 secsNA
Mycobacteria
(e.g. Mycobacterium terrae)
2 minsNA
Bacterial spores
(e.g. Clostridium sporogenes)
2 minsNA

Duo Wipes re low-linting, non-scratching, and non-absorbent. This means they apply the chemistry effectively and efficiently (rather than absorbing it) and leave surfaces pristine and clean.

Studies comparing  the ‘absolute risk’ of viral infection or transmission for people with eye protection – such as a face shield or goggles – compared to those without found those with no eye protection faced a 16% likelihood of contracting the virus, while those adopting the protective measure reduced their chances to 5.5%, equating to a 10.5% difference or a 3x decrease in risk.  

tristel disinfection products

HOW TO PROTECT YOURSELF AND THE PEOPLE YOU ARE CARING FOR FROM INFECTION WITH COVID-19

Washing hands with soap and water is ideal whenever possible because handwashing reduces the amounts of all types of germs and chemicals on hands. But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others.

  • What safeguards are in place if I am examined?

  • Patients are triaged  over the phone or at a safe. Telehealth consultation, if appropriate is offered.

  •  Discretionary rescheduling certain non-urgent appointments.  Make tissues, face masks and alcohol-based hand sanitiser available in waiting areas. Perform frequent hand hygiene after contact with respiratory secretions and contaminated objects or materials
     Follow respiratory hygiene techniques (i.e.. covering mouth or nose during coughing or sneezing with a medical mask, tissues or sleeve or flexed elbow, followed by hand hygiene).  Immediately dispose of tissues into a hands-free waste receptacle
     Use appropriate PPE, such as surgical masks, P2/N95 masks, gloves, eye protection and breath shields for the slit-lamp
     Use disposable equipment where possible.  Perform systematic and enhanced decontamination of work surfaces after each patient
     Staff not to attend work when unwell and also to have vaccinations as part of the employment. Encourage home delivery of spectacle/contact lenses to reduce the number of potentially infectious people visiting the practice

How long can Coronavirus live on different surfaces?

COVID-19: Background
• Coronaviruses are a family of viruses that can make humans sick
• The new coronavirus disease, officially known as COVID-19, originated in China in 2019 and has since spread around the world
• Most people, around 80% who become infected with COVID-19, will experience only mild symptoms and fully recover without any special treatment
• Some people, around 15% of those who become infected with COVID-19, will experience moderate symptoms
• A small number of people who become infected with COVID-19, approximately 5%, may experience severe symptoms and get very sick
• It is important to know how to protect yourself, your family and your community

The most common symptoms of COVID-19 are:

• fever
• flu-like symptoms such as coughing, sore throat and fatigue
• shortness of breath.
• Not everyone who has symptoms like these has COVID-19 as there are several other illnesses that can cause these symptoms

Higher Risk Populations Some people at higher risk for developing serious illness from COVID-19 including:

• older people
• those with underlying medical problems including high blood pressure, heart problems, diabetes, respiratory disease or immune deficiencies (low immunity).
• experience higher rates of chronic diseases compared to other Australians and may be at higher risk of serious illness.

COVID-19; Who can catch it?
• Anybody can be infected
• COVID-19 does not discriminate between race nor gender, therefore, we are all at risk of infection
• We all need to be safe
• There are important things that we can do to protect ourselves, our family and those in our care

How does COVID-19 spread?

• COVID-19 spreads from person to person through droplet transmission.  Droplets are small pieces of saliva, which are produced when a person coughs or sneezes,  Droplets usually travel no further than one metre through the air
• You can become infected if: 

  • You have close contact with an infected person who coughs or sneezes or if you touch an object (e.g. door handle) contaminated from a cough or sneeze from a person with COVID-19 and touch your eyes, nose or mouth.
    Droplets cannot go through the skin and can only lead to infection if they touch your mouth, nose or eyes

Handwashing
• The most important thing you can do to protect yourself is to wash your hands regularly with soap and water or rubbing an alcohol-based sanitiser onto your hands
• This is important because washing your hands kills viruses that may be on your hands
• Make sure that people in your care also wash their hands regularly
• This is especially important after going to the toilet, blowing their nose and before and after eating
• Visitors should wash their hands on entering and leaving.
• Promoted by signs to remind people sanitiser available

• Avoid touching your face as much as possible
• This is important because virus-containing droplets on your hands can be transferred to your eyes, mouth or nose where they can infect you
• Most of us touch our face many times per hour without realising
• Try to stop yourself touching your face, and encourage others to do the same

 

Social Distancing

• Maintain at least 1.5 metres distance between yourself and anyone who is coughing or sneezing
• This is important because if you are too close to someone you might breathe in droplets they cough or sneeze
• If you are further away than 1.5 metres, it is very unlikely that you will breathe in droplets that might contain COVID-19
• Help those that you care for by keeping 1.5 metres between themselves and others
• This is especially important if you’re out and about
• Avoid large public gatherings, unless essential
• Remember that COVID-19 can be transmitted by droplets that can be passed from hand to hand including handshakes

Use good respiratory hygiene
• Make sure you and the people around you follow good respiratory hygiene.

  • This means covering your mouth and nose when you cough and/or sneeze with:
    A tissue that you put in the bin straight after use, your bent elbow and to maintain social distancing.
  • Respiratory hygiene is important because droplets spread the virus. By following good respiratory hygiene you ‘catch’ any droplets that might be produced, and this protects the people around you from viruses including COVID-19.
    Remind those in your care to use good respiratory hygiene
    Make sure that when you are out and about you carry tissues for yourself and others to use
    Remind those in your care to clean their hands after coughing or sneezing
  • What about masks?
    • Wearing a facemask in public won’t help to protect you from infection
    • Only wear a mask if you are sick with symptoms that might be due to COVID-19 (especially coughing) or looking after someone who may have COVID-19
    • There is a shortage of masks and we need to save them for use when they are needed for sick people or for those looking after them
    • Remember the best ways to protect yourself and others against COVID-19 are:  Regularly wash your hands, Use respiratory etiquette to catch your cough or sneeze  
  • Centers for disease control and prevention advise the n95 mask with ear loops to protect the wearer. Disposable masks can be utilised depending upon the respiratory need.

Food Safety  

• From the information we know at present, COVID-19 doesn’t seem to be spread by food
• However, you should still make sure you prepare food safely to make sure that you and
others don’t get sick from other diseases
• This is important when you are preparing food for yourself and for those in your care

• washing hands between handling raw and cooked foods
• cooking and proper handling of meat products
• using different chopping boards for raw meats and cooked foods
• ensuring all meats are cooked thoroughly. When you are preparing food, you should always:
• practise good respiratory etiquette and if you have symptoms of a respiratory illness you should avoid preparing food for other people.

Managing visitors
• Keeping safe from COVID-19 does not mean having any social life for yourself or those in your care
• It is important to maintain relationships
• People who are unwell should be advised to stay in their own homes and not visit others
• This is particularly important to enforce in residential settings where people should stay in their own room
• Visitors to residential facilities should be encouraged to wash their hands on entering and exiting the facility and before and after visiting any resident

Taking people in your care out in public
• Regular hand hygiene, social distancing, and respiratory etiquette are essential in public settings
• Practice hand hygiene after touching shared surfaces (e.g. in shops, cafes or on public transport)
• To maintain social distancing, you should avoid large public gatherings, unless essential

Protecting yourself and others in the workplace

  • You can help keep yourself and others safe by practising good infection and prevention and control in your workplace
  • You can use the same principles at work and at home:
  • Clean your hands regularly
  • Practice social distancing
  • Practice respiratory etiquette Practical tips for protecting yourself and others in the workplace
  • Put marks on the floor to ensure customers stand at least 1.5 metres away from the counter and from each other
  • Practise hand hygiene between customers
  • If you are in an open plan office
  • Make sure there is at least 1.5 metres between yourself and the next work station
  • Have meetings in large enough rooms for everyone to sit 1.5 metres apart (mark the desks with tape)
  • Ensure you wipe down surfaces in your work area regularly
  • If you are doing household deliveries:
  • If possible avoid face to face contact with those inside the house e.g. leave goods at the front door and call the house occupants to let them know their delivery has arrived
  • If you need to have face to face contact with those inside the house then stand at least 1.5 metres back from the door when it is answered
  • Practice hand hygiene when you get back in the car after every delivery
  • Wipe down surfaces in your car (including the steering wheel and door handles) regularly
  • Practice regular hand hygiene
  • Practice social distancing
  • Practice respiratory etiquette
  • Seek medical advice, remember to call first, and inform your workplace if you have symptoms. Keep yourself and others safe
  • Remember whilst COVID-19 can seem scary, you can help to stop it spreading, protect yourself and those in your care.
  • Most importantly wash your hands and make sure those in your care do the same.
  • Practice respiratory etiquette and make sure those in your care do the same
  • Practice social distancing and make sure those in your care do the same

Masks and Covoid-19

Those who are sick should wear a mask if they must go out. (Ideally, however, those who are sick should stay at home and those confirmed to have COVID-19 should be isolated and cared for in a health facility and their contacts quarantined).
Home caregivers should wear a mask to protect themselves and prevent further transmission.
Health workers should wear medical masks and use other protective equipment when dealing with suspected or confirmed COVID-19 patients.

In areas with widespread transmission, medical masks for all people working in clinical areas of a health facility should be worn. In areas with community transmission, members of the general public aged 60 and older and those with underlying conditions should wear a medical mask in situations where physical distancing is not possible. The general public should wear non-medical masks where there is widespread transmission and when physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments.

Cloth masks should consist of at least three layers of different materials: an inner layer being an absorbent material like cotton, a middle layer of non-woven materials such as polypropylene (for the filter) and an outer layer, which is a non absorbent material such as a polyester or a polyester blend.

Travel and COVID-19

• Currently, many cases of coronavirus in Australia are imported from overseas
• Therefore, if you are a frontline healthcare worker, carer, volunteer or have close contact with high-risk persons and you have recently travelled overseas, you may be asked to stay away from work for a certain period after your return
• Please review the below link for the latest updates and recommendations https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel- coronavirus.htm

What if I develop symptoms of COVID-19?

  • If you develop symptoms such as fever, dry cough, sore throat, and fatigue, you should:
  • stay at home and practice standard infection control precautions
  • seek medical advice, it is important to call ahead first:
  • go to www.healthdirect.gov.au; or
  • Call the National Coronavirus Information and Triage Line (1800 020 080); or
  • Call your usual care provider and inform your workplace. What if someone in my care develops symptoms of COVID-19?
  • If someone in your care has symptoms of COVID-19, you should:
  • Keep them at home, or if they are in a group facility keep them isolated in their own room
  • Ensure they practice standard infection control precautions and seek medical advice promptly, remember to call ahead first.
  • If someone in your care is suspected by a medical professional as having COVID-19 then you will need to practice further infection control measures including the use of appropriate personal protective equipment (PPE)
  • You will need to seek further advice on this from your local public health unit or infection control specialist Key messages for COVID-19
  • You can help protect yourself, your family, your workplace and your community
  • Stay informed on the latest developments about COVID-19. Click here for Up to date information at https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert
  • Monitor news updates regarding local events and gatherings
  • Follow current advice given by your national and local public health authorities.
  • 1-3% of patients with COVID may have some form of red-eye/conjunctivitis. The actual risk of transmission through tears is considered to be quite low, however, the discovery of viral RNA in infected patients means avoiding aerosol-generating procedures and following triaging, disinfection and appropriate personal protective equipment (PPE) practices.

  • Those  who recover from Covid may have increased risk of strokes, lung damage, heart damage, blood clots and is more serious in the elderly whereas polio in the past having similar mortality rates effected more of the youth   

Cleaning and disinfection
• Regular cleaning of your environment, at home, in your car and at work is essential
• This is because droplets from an infected person can fall on a surface, and be transferred to
someone else’s hands if they touch the surface
• You should regularly clean frequently touched surfaces, for example, tables, doorknobs, light switches
• To clean use a detergent solution according to the manufacturer’s label,preferably Tristel products to disinfect.
• Remember to check the product label for any precautions you should take when using it, such as wearing gloves or making sure you have good ventilation

NHRMC Feb 2020 Infection control guidelines state ultra-violet light in the UV-C wavelength range (200 to 270 nanometers) has microbiocidal properties against multiple pathogens. The International Commission on Illumination (Commission Internationale de l´Eclairage ) is the authority on all matters relating to the science and art of light and lighting, colour and vision, photobiology and image technology.

While UV-C is extremely useful in disinfection of air and surfaces (  the 200-220nm range is effective against viruses and bacteria and is safe to be used without causing damage to human tissue cells/mammalian skin, longer wavelengths may cause skin cancer and cataracts ) or sterilization of water, the CIE and the World Health Organisation (WHO) warn against the use of UV disinfection lamps to disinfect hands or any other area of skin.

There is insufficient evidence-based data on its use.  UV deactivation of COVOID only occurs with the correct dose, exposure time and wavelength, and by clean nonshadowed or non obstructed contact. UV-C can be very hazardous to humans and animals and should only be used in carefully controlled circumstances. UV-C can cause photodegradation of materials and this should be considered where susceptible materials, such as plastics, are in the exposed environment.

Tristel is the only Medical grade disinfectant that is TGA approved, and suitable.

 

Surface disinfection options

– Ask patients to use hand sanitiser before entering the practice
– Follow social distancing and encourage patients to remain 1.5m from the desk
– Desks clear of clutter
– EFTPOS terminals with an appropriate disinfectant between patients and encourage contactless payments over cash
– Minimise patient use of pens, and sanitise before and after use
– The daily log kept of patients/people in the practice in case contact tracing needs to occur
– Wipe down of all surfaces (door handles, tabletops, light switches, chairs) and desks
– Removal of all flowers, tea/coffee facilities and toys
– Tissues and face masks are readily available

Sodium hypochlorite is often used in “at home” situations

 Clean with mild pH neutral detergent or soap
 Rinse with sterile water/saline before disinfecting
 Soak in sodium hypochlorite (5000ppm) for 10 minutes
 Rinse with sterile water/saline
 Air dry or dry with a sterile, soft disposable cloth. Note: The appropriate concentration of sodium hypochlorite is 5000ppm, approximately 0.5%. Household bleach is 5-6% sodium hypochlorite, so a 1:10 dilution of bleach (1 part bleach, 9 parts water) equals 5000ppm.

Contact lens disinfection protocols

A review of evidence, published in  Clinical and Experimental Optometry, indicates the eye is an unlikely site for SARS‐CoV‐2 infection, though ocular manifestations such as conjunctivitis and presence of SARS‐CoV‐2 in tears had so far only been found rarely in people with confirmed, symptomatic COVID‐19.

All cases of kerato conjunctivitis, especially those with associated upper respiratory tract symptoms, however mild, should be considered as potential COVID‐19 cases.

Scrupulous contact lens hygiene practices should continue to be advocated, along with use of correct wear, care, cleaning and replacement of lenses and lens cases, given the need for contact lens wearers to touch their face and eyes on application and removal.

Cleaning Rub with a daily surfactant cleaner for RGP lenses or multipurpose solution (MPS) for soft and hybrid lenses. Rinsing Rinse with sterile saline or MPS for at least 30 seconds

Inspection Inspect the lens for damage/defect and dispose of appropriately if necessary. Preparation Fill a non-neutralising CL case with 3% hydrogen peroxide

Disinfection Soak lens for at least 3 hours without neutralising Neutralisation For soft and hybrid lenses, refill a neutralising case with fresh hydrogen peroxide and add neutralising tablet/disk. Soak for recommended neutralisation time (e.g. 6 hours)

Rinsing Rinse with sterile saline (or MPS). Storing Store RGP lens dry after wiping with a clean, lint-free tissue. Use disinfected tweezers to store the soft or hybrid lens in MPS. For soft or hybrid lenses, it is recommended to repeat the full disinfection process every 28 days.

Soft contact lenses can also be sterilised in an autoclave at 134°C for at least 3 minutes or 121°C for at least 10 minutes

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