If you have read my previous columns, you have seen that our team worked to establish a restart protocol for each area of our practice. First, we decided who our experts were, and where we get our information (Are you Ready? June 2, 2020). Then we put our protocols for people into practice, so that our people are safe and healthy (Are You Set? June 16, 2020). Now, we are going to get our facilities ready to be a safe and productive environment.

Keep in mind that you not only have to provide a safe, clean environment, but your office has to look safe and clean at a glance to anybody coming into the space. It is not enough for you to clean the pens, for instance. The patients must see evidence that you are consistently cleaning the pens (Figure 1).

Figure 1
While it is important that you create a clean, safe environment, it is critical that everyone, patients, and staff immediately feel comfortable and safe when they enter the clinic.

Things have to change

Beginning with your reception area, let’s clean it up. No business cards, brochures, flyers, magazines, books, toys, or anything that anybody would be tempted to pick up and handle. Keep your hand out literature out of reach. 

Each chair in the waiting area must be at least six feet from the next chair. That is from armrest to armrest, not center to center. You are going to need fewer chairs anyway. Your patients need to be alone except for minor children and those with caregivers. 

Mark you floor with “Stand Here” positions. These are available from many sources and look much better and more professional than blue painter’s tape. Read the reviews of the product before you buy, some have less than adequate adhesive.

To mask or not to mask?

Viruses do not care how you feel about masks. Masks dramatically reduce the chance of transmission of many contagions, including COVID-19. We provide two medical masks per day for every employee and have extras if necessary. We also remind our patients to bring their own masks, but we have one for them if they forget.

Office cleaning

You need to sanitize each patient area after each patient has left the area. Exam rooms, dispensing tables, pretest rooms, etc. Maintain a log for each area and make someone responsible for each area every day. Develop a special checklist for each room and area of the clinic. Keep this log for a record.

We decided to use only office cleaning products that are EPA-approved to be effective against SARS-CoV-2 to wipe surfaces and instruments. The American Optometric Association recommends the following:  Plan a process to sterilize all equipment and materials, including frames, with best available disinfectant (best is diluted bleach solution or alcohol solutions with at least 70% alcohol). Alcohol swabs are sufficient on instruments.

Luxottica warns that alcohol solutions can damage their products. For frame sanitizer, we took their advice. We use a hydrogen peroxide wipe or a solution of 50/50 3% peroxide and water. We place each frame handled in a basket (Figure 2) and sanitize before going back to the board. We do not allow patients to try on frames by themselves.

Figure 2

Breath Shields

Protect yourself and your patients with breath shields. You can buy them, you can get them free from some manufacturers, or you can make them. If you have a laminator, just run an empty sleeve through the laminator. Cut out an opening that corresponds to the size of the instrument. They look professional, and they are cheap and easy. You can make one to fit almost every instrument from pupilometers to slit lamps, to phoropters (Figure 3,Figure 4,Figure 5). Use them anywhere you must be face to face with a patient.

Whenever possible find ways to reduce face-to-face patient contact. If you can, have your patient not sit directly across from the optician at the table. Most of our clinics have a double place table arrangement, like the photo (Figure 6).

Figure 3

Figure 4
Figure 5
Figure 6 

Your process needs cleaning too

Examine your patient flow. Try to establish a circular route for your patients through your office. Minimize people, especially patients passing in a hallway whenever you can. You have already determined the maximum number of people you can have in your office at a time. Make this a “never exceed” rule. You will have to limit the number of patients on your book.

Routine exams have a reasonably predictable duration, but medical visits do not. Limit those the most. Your Safety Officer at the door can call/text the next patient as each one leaves. One out, one in. Just like a night at a popular club. Except here, knowing the bouncer will not get you in any earlier.


Finally, let your staff and patients know that you care. They must believe that you take their health and safety seriously. 

  • Post signs in every exam room letting them know that you disinfected the room between each patient. Post a cleaning log on the door with time and initials of each cleaning.

  • Cleaning the bathrooms regularly is important, but so is making sure everybody knows it. Post a sign and cleaning log here too.

  • Do not forget the dispensing tables. Post a sign and log.

  • Whenever possible, the patient should see you wash your hands. Often. If you are going to wash your hands anyway, do it where patients can see you. 

  • Offer a place for patients to wash their hands. Don’t be pushy, just posting a welcoming instruction sign by the sink is enough these days.

Germ Shield with arm cutouts for eyewear fittings from Eye Designs Group.

Look around your office. Try to see it with new eyes. Look for ways to reassure your staff and patients that their health and safety is your first priority. Sometimes all that takes is a little sign.

We all want our lives to get back to the way they were before COVID-19, but we should remember this:

Adversity drives innovation. If we go back to the way it was before, we lose the lesson. Our opportunity for improvement is here. Grab it and go.