COVID-19 Guidance

In the context of the Coronavirus outbreak we are experiencing, Primary Eyecare is working hard with all key stakeholders to ensure we have appropriate processes in place to enable safe and effective care for patients and practitioners through the locally commissioned services that we contract with optical practices to deliver.

Further to the announcement from Government and the NHS on 4th January 2021.

Delivery of locally commissioned diagnostic and monitoring services should continue – including but not limited to the following:

- Cataract Services – Pre and Post-Op Follow Up Service
- Glaucoma services – including referral filtering services (i.e. repeat readings, enhanced case finding) and monitoring
- Children’s Post Vision Screening Service
- Low Vision

Optical practices should deliver these services in line with the service specification while maintaining the same precautions for all patients. This includes;

- Infection control procedures
- Use of PPE
- COVID screening questions

First Contact Services (CUES or MECS)

Due to COVID-19 there is a need for us to minimise the risk to patients and staff.

Risk Reduction

We recommend that, to not require people to make visits to the practice unnecessarily, you should conduct a virtual consultation/telemedicine in the first instance where possible and appropriate.
Where a patient has recent onset mild red eye related symptoms encourage self-care wherever possible by directing patient to purchase appropriate over the counter medications.
A practitioner should be ensuring that they clean down slit lamp and wash hands before and after each patient.
Slit Lamp Shields – practices should consider the use of slit lamp shields to create a barrier between patient and practitioner as contact area with patient is less than 1 metre. These can be purchased but also made, see helpful links:
- https://www.youtube.com/watch?v=pXm624pBDUM&feature=youtu.be
- https://www.youtube.com/watch?feature=youtu.be&v=G5wxU2UV0nI&app=desktop
Ensure you check your practice Infection control measures against the QiO Infection Control Checklist. Practices must complete this at least annually.

College of Optometrists Guidance

Ensure that you are familiar with the College of Optometrists COVID 19 clinical guidance which is regularly reviewed and updated

https://www.college-optometrists.org/clinical-guidance/covid-19-clinical-guidance#

Personal Protection Equipment (PPE)

Primary care practices should not be seeing patients with symptoms of COVID-19.

We recommend that, to preserve supplies of PPE and not require people to make visits to the practice unnecessarily, you should conduct a virtual consultation in the first instance.

NHS supply of PPE for optical practices has been implemented nationally and can be accessed by the portal which can be found here.

Distancing and scrupulous hand-washing remain essential. The new guidance now recommends that clinicians should assess risk of infection to themselves and their patients. For the direct care or assessment (within 2 metres) of a patient or resident that is not currently a possible or confirmed COVID-19 case they should wear. PPE should always be worn before entering the room where the patient is, put the PPE on in the following order

1. single use disposable plastic apron
2. fluid resistant surgical mask (sessional use, based on risk assessment)
3. reusable face or eye protection (sessional use, based on risk assessment)
4. single use gloves

Public Health England have produced a poster for clinicians which can be displayed in practices:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878056/PHE_COVID-19_visual_guide_poster_PPE.pdf

Latest College of Optometrist guidance on COVID-19 and PPE in particular can be found on their Update page:

https://www.college-optometrists.org/the-college/media-hub/news-listing/coronavirus-2019-advice-for-optometrists.html

Putting On (Donning) and Removal (Doffing) of Personal Protective Equipment

Public Health England have produced guidance for putting on and removing personal protective equipment, these resources can be used in optical practices as posters to provide a reminder for staff.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875211/Putting_on_PPE_for_non-aerosol_generating_procedures_quick_guide.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875212/Taking_off_PPE_for_non-aerosol_generating_procedures_quick_guide.pdf

Clinicians using PPE should watch the video below before using PPE:

https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-non-aerosol-generating-procedures

PPE Waste Disposal

Waste from possible cases and cleaning of areas where possible cases have been (including PPE, disposable cloths and tissues):

Should be put in a plastic rubbish bag and tied.
The plastic bag should then be placed in a second bin bag which is tied when full. You may choose to use a large pedal operated bin for the second bin bag.

Waste should be stored safely and kept away from area’s where staff may come into contact with it. You should not put your waste in communal waste areas until the waste has been stored for at least 72 hours.

If storage for at least 72 hours is not appropriate, arrange for collection as a Category B infectious waste either by your local waste collection authority if they currently collect your waste or otherwise by a specialist clinical waste contractor. They will supply you with orange clinical waste bags for you to place your bags into so the waste can be sent for appropriate treatment.

Infection Control – Hand Hygiene

Washing hands

It is still essential to ensure scrupulous hand hygiene at all times. You should also continue to maintain a high standard of infection control every time. Clean the consulting room door handle, computer keyboard, slit lamp joystick and clinical area regularly with an alcohol wipe. The resources below give further advice on hand hygiene.

https://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands/

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877530/Best_Practice_hand_wash.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877529/Best_Practice_hand_rub.pdf

Notification Protocol

Steps to take if optical practice is unable to deliver service due to staff absence or a period of closure.

At the earliest opportunity where a period of non-service delivery occurs the optical practice should notify Primary Eyecare Services at hello@referral.support or via the help bubble on the Opera platform. Further information will be requested regarding the situation of the practice.

Practice should put sign at entrance (as well as on your website) instructing patients trying to access First Contact Services (E.g. MECS or CUES) where to find contact details for alternative optical practices (e.g. Primary Eyecare website), where possible.

A telephone answer machine message should include details of where alternative practice contact details can be found (e.g. Primary Eyecare website), where possible.

Where a practice remains open but a practitioner is unavailable then alternative arrangements must be made for the patient by another optical practice.

Catch It. Bin It. Kill It.