advice and guidance on keeping patients and staff safe

Please bear in mind that this advice is constantly changing (and is still subject to some debate as to how it is implemented in community optometry.)

 

Some of the advice below talks about when performing Aerosol generating procedures -- which have been advised against in optometry practice by the college of optometrists (please see advice below dated 01/04/2020 and still displayed as current advice on 05/04/2020 @17:23)

 https://www.college-optometrists.org/the-college/media-hub/news-listing/coronavirus-covid-19-guidance-for-optometrists.html

 

Aerosol generating procedures

  • Because of the risk of aerosols or splashing of tears, do not use air-puff tonometry. If you normally use air-puff tonometry, consider whether this is really needed. For example if the patient has normal discs and visual fields then do you need to measure their IOP? Although they will not produce aerosols, similar considerations would apply if your only method of tonometry is using a Perkins or iCare tonometer, because of the close contact with the patient that is required.
  • Because of the risk of aerosols, do not use Alger brushes.  If you need to remove a rust ring, use a needle instead.

 

Government advice as of 02/04/2020

 

 CEM/CMO/2020/014

COVID-19: PPE Guidance Update 02.04.2020

Dear colleagues,

The UK Government and NHS leaders from a range of medical and nursing professional groups have published new guidance on personal protective equipment (PPE) for NHS staff who are likely to come into contact with patients with COVID-19.

The guidance has been agreed by the four UK Chief Medical Officers, Chief Nursing Officers and Chief Dental Officers in the UK and endorsed by the Academy of Medical Royal Colleges and is applicable in all parts of the UK.

The updated guidance reflects the fact that COVID-19 is now widespread in the community, meaning clinicians are more likely to see patients with the virus. The guidance is based on the best scientific evidence and is consistent with what WHO recommends in circumstances and settings with the highest risk of transmission.

We know that those of you on the frontline may be anxious about access to PPE. We want to reassure you that this guidance will both provide more consistent guidance stratified by risk and protect stock levels through preventing unnecessary use.

The tables outlining the guidance are attached, but please see a summary below.

  • • Any clinician working in a hospital, primary care or community care setting within two metres of a suspected or confirmed coronavirus COVID-19 patient should wear an apron, gloves, surgical mask and eye protection, based on the risk.

 

  • • Recognises that clinicians may wish to wear an apron, gloves, surgical mask and eye protection when assessing patients in any setting, where the risk of COVID19 is unknown

 

  • • In some circumstances PPE, particularly masks and eye protection which is there to protect the health and care worker can be worn for an entire session and doesn’t need to be changed between patients, as long as it is safe to do so.

 

  • • More detail on what PPE to use in different clinical scenarios as well as community settings, such as care homes and caring for individuals in their own homes.

 

  • • When carrying out aerosol generating procedures (AGPs) clinicians should wear a higher level of protective equipment, these are listed out in the guidance.

 

  • • Use of aprons rather than gowns for non-aerosol generating procedures, including advice on thoroughly washing forearms if there is a risk of exposure to droplets, consistent with the UK policy of bare below the elbows and evidence reviews on the risks of healthcare acquired infections.

 

  • • WHO recommends the use of FFP2 masks but the UK has gone further and recommends the use of FFP3 masks. However, we are clear that FFP2 have been approved by the WHO and can be used safely if needed. There is good stock of FFP3 masks in the UK.

 

We appreciate the incredible work you are doing in this epidemic, as does everyone in the country. PPE is part of ensuring this can be done in the safest way possible and hope this guidance helps to ensure everyone can have access to the appropriate level of protection.

 

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control