THE HYGIENIC OPTICIAN
By Maryann Santos, ABOM
Release Date: April 1, 2020
Expiration Date: May 1, 2021
This free continuing education course is brought to you through a generous educational grant from The McGee Group the manufacturers of Vera Bradley, Trina Turk, Life is Good and XOXO, just to name a few of their frame brands.
A word from the sponsor: "Here at The McGee Group, we are redirecting our marketing efforts to bring to you continuing education in the safety of your home. Prior to the CDC announcement for many of us to limit our business hours, we were receiving emails and calls daily asking for best practices to clean frames between patients. Working with our great partners at 20/20’s continuing education team we have taken that knowledge and developed this ABO training on hygiene in the workplace at no cost to you. Our goal is to have this training be both timely and impactful as we all review our business processes before we reopen. To all of the optical community from all of us at The McGee Group, stay safe. #AloneTogether" David Reeves – Director of Marketing
In this course, you will be introduced to various methods to implement in your optical dispensary in the form of policies and procedures on hand hygiene and infection control to help prevent the spread of germs:
- List areas that may contribute to the spread of germs in the optical dispensary.
- Describe best practices for in-office infection control.
- Create and implement an office hygiene policy for the optical dispensary.
Maryann Santos, ABOM
Maryann is the Vision Care Technology Program Director at Goodwin University and contributing author for 2020 Pro to Pro education.
This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). General Knowledge Course SWJHI300.
NOT JUST FOR GERM FREAKS
We all know the germaphobe, the one who hears a cough or sneeze from afar and pulls their shirt collar up over their nose. They may also carry multiple versions and scents of hand sanitizer. There also are those who keep their winter gloves on indoors, hoping to avoid contracting a cold or the flu. Do you bump elbows to greet one another (I do) during cold and flu season? Grocery stores offer wipes to sanitize the grocery cart handles. What about the obligatory "run the water on your hands for three seconds" that we have all witnessed in the public restroom? Typically, the individual would have made a beeline for the exit without washing their hands but saw you there. Handwashing is a big deal, and we need to be a part of the prevention of infection in our office. In the area of hygiene, what are we doing in the optical dispensary on a day-to-day basis? Did you know that there are hospitals that require staff to wear buttons on their lab coats that say, "Ask Me If I Washed My Hands?" This course is for all of us who come in contact with patients—that would mean all opticians and apprentices. According to the Center for Disease Control (CDC), hand hygiene is a good way to prevent the spread of infection. The alarming statistics show that on average, health care workers wash their hands less than half of the times that they should.
Are your hand hygiene practices deficient? Does your office promote hand hygiene in the form of policy and reminders? The goal of this course is to see hand hygiene, frame, workspace and equipment sanitization for infection control embedded in the culture of the optical dispensary.
You can evaluate where you are in your current office by answering the following questions:
- How readily available is alcohol-based hand sanitizer?
- Is soap always available at each sink?
- Are single-use disposable paper towels available at each sink?
- Do you have an office policy on hygiene and infection control?
- Is there a specific budget line item for hygiene and infection-control supplies?
- Is there signage or a poster above each sink displaying correct handwashing techniques?
- Are there workplace reminders on the importance of handwashing and/or infection control located throughout the workplace?
The information provided in this course will allow you to reflect on your current practices, introduce policies and procedures in your office, or simply revise and strengthen your current policies and procedures.
Let's be real. When we dispense a pair of glasses to a patient, our hands touch their heads. We ask the patient to turn left and right, peek behind their ears, folding their ear over to examine the temple bend and observe if we mastered molding the temple to the mastoid process. Do you wash your hands in between patients? Or do you go from patient to patient without even considering washing your hands with soap and water, and drying them with a disposable paper towel? Think about it—we are not only touching the patient's ears, but lifting up their hair and touching their cheeks.
During the course of a workday, opticians change nosepads multiple times. Is it common practice for you to wash your hands after removing the slimy green pads? Observe your colleagues, see if they are washing their hands, or if another "issue" pops up, and they attend to the next patient without washing their hands. Or dare we admit that it is we who move from patient to patient without washing our hands with soap and water?
Handwashing or using alcohol-based hand sanitizer is a simple and effective way of preventing the spread of germs, infections and disease. The technique used is critically important. According to a study on infection control, health care providers using alcohol-based hand sanitizer often miss their thumbs, fingertips and between fingers when applying. According to the Center for Disease Control's (CDC), Guidelines for Hand Hygiene in a Healthcare Setting, it is recommended that you wet your hands with water, apply the manufacturer's recommended amount of soap product to your hands and rub vigorously for 15 seconds. Make sure that all areas of the hands are thoroughly washed, including palms, top of hands and in-between the fingers. The next step is to rinse hands with water and dry with a disposable towel. Use the towel to turn off the faucet. Some sing the ABC song instead of counting to 15. Typically, most sing the song inside their head instead of aloud! This proper technique is very different from the handwashing we all have witnessed from time to time in public restrooms. You know the ones who are about to walk out of the restroom, see you, then run water on their hands for three seconds without soap, and rub their wet hands on their jeans. To collect information and data on hand hygiene, in addition to the CDC, the World Health Organization (WHO) is an organization that can be used to help develop policies and procedures on hand hygiene and infection control.
Handwashing must be done:
- Before eating
- After using restroom
- After blowing nose
- In-between patients
- After adjusting eyewear
- Before handling contact lenses
- Before handling frames either to put on display or the patient
- Before using contact lens fitting instruments
- After cleaning and sanitizing instruments
FRAMESIn the optical dispensary, the optician must be vigilant in protecting patients from the spread of germs when trying on frames. So let’s address sanitizing frames. For starters, patients need to be informed not to put the frames back on the board after trying them on as they need to be cleaned. We suggests you outfit the display area with baskets or trays lined with a disposable cloth. Since you may be working with someone else when the patient (self-serves) and takes frames off the display to try them on, we recommend posting signage that asks the patient to deposit tried-on frames in the basket so that they can be cleaned before the next patient tries them on. Since this is not currently a common practice for most offices, be sure to have a training session with your staff and collaborate on the verbiage to use in the signage and even the patient/optician dialogue.
Ophthalmic frames are made with a
variety of materials (metal, acetate, nylon,
titanium, wood, rubber, jewels, and more).
The optician must also be aware that
different frame materials exhibit different
chemical reactions to isopropyl
alcohol and sanitizers with high alcohol
content. For this reason, no
recommendation for frame
sanitization beyond using soap and
running water to wash away
contaminants will be offered in this
article. Due to the variability of frame
materials and components, it is advised
that you check with the frame
manufacturer for any sanitizing
recommendations. The McGee Group recommendation is to use hydrogen peroxide and Peroxyacetic acid-based products to clean their frames.
Does your pupilometer get the attention it needs? Or does it go from forehead to forehead, day after day, week after week, month after month, year after year without even a swipe of an alcohol pad? Some opticians have confided in me that they have never cleaned the pupilometer. Never. Not once. They admitted they never even thought to do that. It is not common practice to clean the forehead bar, nosepads and measuring window of the pupilometer. Let's think about that for a moment. How is it that many optical dispensaries are not considering standard health care hygiene practices? I can say there are many, as I have been observing dispensaries for years and have anecdotal evidence to support this claim. For those of you who practice proper optical dispensary hygiene, I applaud you. For those of you who do not have a system in place to clean your instruments, but want to demonstrate to your patients that you take hand hygiene and infection control seriously, the section titled "Creating an Office Hygiene Policy Manual" will help you to create an infection control station and office policies and procedures.
INFECTION CONTROL STATION/ HYGIENE STATION
Patients appreciate a clean and orderly environment. They also appreciate it when they witness their health care provider washing and drying their hands, cleaning and sanitizing equipment and all in a tidy work zone. What better way to show our patients that we take office hygiene seriously than by having an Infection Control Station? It can be as simple as an acrylic case filled with alcohol pads, alcohol-based hand sanitizer and a small garbage pail with a disposable trash bag. Depending on the size of your office, you can consider installing wall-mounted automatic hand sanitizer units. These no-touch dispensers are more appropriate than the ones that require your hand to touch the pump.
According to the World Health Organization (WHO), point of care is the place where three elements come together: the patient, the health care worker and care or treatment involving contact with the patient or their surroundings, within the patient zone. The patient zone is defined as the area within a radius of 6.5 feet from the point of care.
Point-of-care products should be accessible without having to leave the patient zone. Ideally, each dispensary table or workstation should be outfitted with an acrylic holder filled with alcohol wiping pads.
In clear view of the patient, the health care provider (you) must wash and dry their hands or use hand sanitizer before working directly with them. This shows the patient that you have a high-caliber office hygiene program— patients appreciate it! I know I do when I enter a health care environment. Before taking the patient's pupillary measurement, wipe the pupilometer down with an alcohol pad and dispose of it properly. Be sure to wipe the forehead bar and nosepads. Remember how few offices routinely wipe down the pupilometer before each patient!
After each patient, you must disinfect the fitting table area and all surfaces touched by patients. That includes bathroom fixtures, light switches, doorknobs, front desk counters, and chair arms. Another consideration is investing in pens to give away to your patients with your office's logo and contact information on there. When you need patients to sign, they can use a new pen and take it home with them.
Remember, according to the CDC: Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces. This process does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.
Disinfecting kills germs and disinfecting works by using chemicals to kill germs. This process does not necessarily clean dirty surfaces or wash away germs, but by killing germs on a surface, it can further lower the risk of spreading infection. And finally, Sanitizing lowers the number of germs on surfaces or objects to a safe level, as judged by public health standards or requirements. This process works by either cleaning or disinfecting surfaces or objects to lower the risk of spreading infection.
There are additional areas where there can be drastic changes, improvements, or tweaks, depending on where you are with regard to a hygienic dispensary.
1. Trays can be routinely cleaned and, yes, eventually replaced. Some of us have some old stragglers hanging around. Some offices use disposable cloths in the trays and discard after the job is dispensed.
2. Microfiber lens cloths should not be used over and over on patients' glasses after they come in for an adjustment. Cloths can be used on new glasses to shine up after final inspecting, and before adjusting. A new cloth can be used at dispense and given to the patient.
3. The Lensometers/Vertometers/Focimeters eyepieces must be cleaned with alcohol pads in-between users if used by more than one individual.
4. Ophthalmic hand tools must be routinely sanitized. Ophthalmic offices must have a routine maintenance plan. Think of it this way; someone comes into your optical shop to have their nose pads changed, do you remove them with a disposable cloth? Your fingers? Now, think about the blade. A best practice is to wipe the blade with an alcohol pad after unscrewing green and thickly coated nose pad screws.
What other high-touch areas can you think of that applies to your place of work? Reflect upon areas where you can improve to make your dispensary
CREATING AN OFFICE HYGIENE POLICY MANUAL
Office policy manuals are important for organizations of any size, as it uniformly communicates the policies to which employees must adhere. The manual, once established, must be followed, reviewed, monitored and updated. Office hygiene and infection-control policies and procedures must be outlined as to what tasks are to be done and the rationale behind them. Furthermore, it must be written to be clearly understood by all members of the organization. Comprehensive employee manuals must contain human resource (HR) policies consistent with federal law. For this course, we are focusing on office hygiene policy and procedure.
CREATING THE POLICY
If your office has a personnel manager, human resource department personnel or a corporate office, chances are you already have a policies and procedures manual. If not, you will have to identify an individual who can take on a project to create the policy. In either case, you will be starting from scratch or modifying an existing manual to include hygiene and infection control. This individual must be given time outside of their normal duties to fulfill what is required.
Additionally, this person should possess strong writing skills. If you have an "idea" person on staff, along with someone with strong writing skills, they can partner up to develop a draft. Once a draft is completed, it is beneficial to encourage input from other employees. This can be in the form of a committee, or everyone if you have a small staff. Communicate to the group the purpose of creating a hygiene policy and the value of incorporating feedback from staff. Staff and committee members need to be informed on the final approval process. Decide who will be responsible for final review before it becomes policy.
The manual needs to be clear, concise and provide directions, rationale and consequences if the outlined policy is not followed. Moreover, you will have to communicate with the staff the benefits of incorporating the hygiene/infection control policy, as they and the patients will mutually benefit.
Only with a well-documented policy will everyone have the same expectations and can be held to the same standard. Requiring that established policies and procedures be understood, read and signed by the employee, makes any necessary corrective action less subjective.
Small mom-and-pop shops and other sole-proprietorship optical establishments might not have an employee manual. If this is your situation, you should now be better prepared to implement one after completing this course. If you currently have an employee manual, but are missing a section on infection control and hygiene, here is your opportunity to add it. To increase the likelihood that the policy is understood by all and to ensure good ideas and suggestions, other staff members should be involved in the creation of a policy on hygiene and infection control.
IMPLEMENTATION AND BUY-IN
Start new-hires on the right foot, allow them to read the policy, and sign the document indicating they've read and understood the information within. Existing employees must be aware of any changes, additions or deletions of current policies or procedures as soon as they occur. Every three to five years, all employees should receive a copy or be provided a link to an electronic copy of the Office Policies and Procedures Manual. Electronic or handwritten signatures must be retained in the employee's personnel file.
Now that we have a procedure in place, how do we get "buy-in" from all employees? You already have written policies and procedures outlining and describing the importance of proper handwashing, of wiping down the pupilometer in between each patient and the value of infection control. It may be a challenge to change the established habits of some employees who are not accustomed to wiping down the pupilometer. Just like driving to work, some employees operate in a relatively unconscious manner; we don't think about the route we take to get there, we essentially do it out of habit.
Buy-in is critical for any new policy to be effective and ensure full staff member compliance. Initially, to make this happen, you need to convey the vision: Share the "why" behind implementing a hand hygiene and infection-control policy. You may need to show graphic pictures of very dirty nosepads to drive your point home. Provide specific examples of going from green and slimy nosepads (without washing your hands) to dispensing a pair of brand new glasses to a 3-year-old. Be vivid in your descriptions. Using visuals is a very effective way to do this.
Whether your office is a one-person show or a staff of 20-plus, you will need a system in place to ensure hygiene policy compliance. An identified staff member can be appointed as the compliance officer. The role of this individual is to ensure that policies and standard procedures are followed. This individual must be empowered to enforce the policies and implement corrective action. In corporate settings, the district manager could be the one empowered. In smaller practices, it can be the owner or office manager. For compliance, adequate funds must be provided to support the purchase and stock of supplies, such as alcohol pads, disinfecting wipes and sprays, and garbage pails with bags. New employees need to be trained, and the compliance officer would ensure that the new hire not only read the policy but sign a form attesting that they are aware of the policy and commit to comply.
Routine auditing must be performed to ensure and strengthen compliance. This routine auditing would include unannounced observations, including ensuring that all the necessary equipment and supplies are in stock. Document any areas in need of improvement along with those areas that comply. A summary of this report can be shared at the next staff meeting.
Managers can always point to the policy for noncompliance, when and if it occurs. The manager and or the compliance officer can recognize when training is needed in the area of hand hygiene or infection control. If it is observed that there are areas of noncompliance, such as employees not washing their hands before working with a patient, or evidence of staff not properly cleaning the pupilometer, they will recognize that additional training is needed.
According to research from Human Resources for Health, "Evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes." The study also found that repetitive instructions, instead of a single instruction, were shown to have superior outcomes. To provide more exposure to employees beyond in-service training, a way to incorporate hygiene can be in the form of a newsletter or a "friendly reminder" in paychecks, every so often.
Some professions conduct in-service training as part of professional development. In-services are vital to the development and maintenance of health care competencies of those working in a health care environment. As a rule, this is not customary with opticians. It would be interesting to collect data from opticians in the U.S., perhaps as a poll, on how many offices conduct in-service training, when and how often. The in-service training being referenced here should not be confused with continuing education. Typically, opticians partake in continuing education courses to maintain certification from ABONCLE for the National Opticianry Competency Examination (NOCE) and the Contact Lens Registry Examination (CLRE).
In-services can be held before regular office hours as a breakfast meeting and held quarterly. You can schedule the office to be closed on certain days for lunch and have a "Lunch-n-Learn." Annually, the office manager or compliance officer can lead the in-service topic on Hand Hygiene and Infection Control. This reminds employees how vital it is to abide by the policy and provide the best in patient care.
Another option for those offices with tech savvy staff members is to create computer based learning modules to meet the desired learning outcomes. Computer-based modules can be didactic with an individual viewing the lesson, followed by a post-quiz assessment. Didactic delivery in this context is when an instructor lectures to the learners, often using a slide presentation to summarize the information.
Other options include individuals viewing a computerized module in a group setting on a scheduled day. Group or individualized computer-based learning modules can include case studies that create an interactive learning environment, followed by a post-quiz assessment.
A blended approach using an instructor, supplemented by a computer-based case study or informative learning platform, also followed by a post-assessment quiz.
Remember, after training, solicit feedback from your participants. This can be in the form of a paper or electronic document. Often individuals will fill in the area designated, "How can we improve upon the delivery of training for future in-services?" You should take the feedback seriously and act on suggestions for improvement.
Taking this course on the importance of hand hygiene and infection control in the optical dispensary is the first step to implement the protocol in the workplace. You can now list areas that may contribute to the spread of germs in the optical dispensary and describe best practices for in-office infection control. Finally, you have the tools and motivation to create and implement an office hygiene policy for an optical dispensary. After developing and establishing policies and procedures, the next step is to spread the word to your professional colleagues. Collectively, we can promote this movement on social media platforms such as Opticians on Facebook (OFF), by contacting state societies and the Opticians Association of America.
For the CDC’s complete list of sanitizers that kill COVID-19 virus use this link: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2