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Strategizing the Return to Practice – Part 2 May 5, 2020 Presenting Sponsor Conversations About COVID-19 for Eye Care Professionals

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Strategizing the Return to Practice – Part 2 May 5, 2020 Presenting Sponsor Conversations About COVID-19 for Eye Care Professionals Conversations about COVID-19 For Eye Care Professionals Strategizing the Return to Practice – Part 2 May 5, 2020 Presenting sponsor Conversations about COVID-19 for Eye Care Professionals Jason Brenner, MD Matthew Forgues, OD Amy Moy, OD Cornea and Refractive President, Director, Health Surgeon Massachusetts Society of Center Network Boston Eye Group Optometrists New England College Boston Laser of Optometry Conversations about COVID-19 for Eye Care Professionals Speakers have no Financial Disclosures to Report Equipment – Safereyecare.org Disinfection – Masks 1. Time 2. Heat 3. UVGI 4. VHP 5. Microwave? www.n95decon.org How long does it last? Storage in cold temp (below 22 C) may prolong life Viral load dependent IMO, for eye clinic 7 day rotation is adequate Masks - Heat 1. 70 for 5 minutes (Lancet) 2. 70 at 50-85% RH for 30 minutes (CDC) ℃ *Moisture ℃seems to be key for adequate sterilization Masks - UVGI (NIAID) • 260-285 nm • ≥1.0J/cm • Very hard for UV to hit all surfaces • It is available! UVGI Equipment Sanitation Bleach Alcohol* UV GI (5 tbsp /gallon) Chlorhexidine Betadine Zeiss: 70% IPA for HFA Equipment Sanitation Office Sanitation $$$ Disinfection Art by: Stefanie Trilling Disinfection of Office (COVID-19) Current CDC recommendations specific to COVID-19 include: ● Diluted household bleach ○ 5 tablespoons bleach per gallon of water ● Alcohol solutions with at least 70% alcohol. ● Common EPA-registered household disinfectants currently recommended for use against SARS-CoV-2: ○ Clorox brand products (e.g., disinfecting wipes, multi-surface cleaner + bleach, clean up cleaner + bleach) ○ Lysol brand products (e.g., professional disinfectant spray, clean and fresh multi-surface cleaner, disinfectant max cover mist), ○ Purell professional surface disinfectant wipes and more. ● The EPA offers a full list of antimicrobial products expected to be effective against COVID-19 based on data for similar viruses (EPA 2020) https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 Disinfection Guidelines For cleaning of general surfaces, use EPA’s updated list of disinfectants, which include: ● Hydrogen peroxide ● Lysol Brand All-Purpose Cleaner ● Clorox Multi-Surface Cleaner + Bleach ● Clorox Disinfecting Wipes ● Cidex Wipes ● Cavi-Wipes ● Purell Professional sanitizing wipes ● Oxivir Disinfection of Office (COVID-19) Items to Disinfect: ● Slit lamps, including controls and accompanying breath shields, should be disinfected, particularly wherever patients put their hands and face (AAO 2020). ● Doorknobs ● Exam Chair Seat and Arms ● Phoroptor ● Occluder, Near Point Cards ● Wipe down keyboards and computer mouse with disinfectant wipes as well. ● PPE should be disposed of in biohazard bin if known contamination, otherwise in trash can. Common Areas ● Remove all magazines and toys ● Post signs reminding of social distancing ● Remove pens from counters ● Hands-free hand sanitizer dispensers if possible ○ Provider can handle pump to dispense sanitizer for patient ● Assess air flow/circulation Artwork by: Stefanie Trilling Some tips from our Chinese colleagues in Wenzhou, China ● Air Flow ○ Open windows when possible ○ A/C has been shown to circulate the virus ● Disinfection of exam room after wiping down all instruments ○ UV light for entire room (must leave room due to high radiation), takes 2 hours ● Social distancing--slowly double patient capacity every 2 weeks, pending continued decrease of COVID cases Tonometry ● Avoid using Non-Contact Tonometry, especially with patients with red eyes ● Disposable tonometer tips, or use 10% bleach solution for disinfection. ○ Other options: 3% Hydrogen Peroxide: rinse with cold running water for 5 min ○ *10% Household Bleach: rinse with cold running water for 10 min; This is the only disinfectant recommended by both the CDC and the manufacturers. ○ Dakin solution ○ Disposable tips: more expensive, but best for infectious patients Humphrey Visual Field and Optos HVF: ● New guidelines to use 70% isopropyl alcohol spray solution with shielding of vulnerable gaps in the HVF unit. ● Unit should be on during disinfection in order for solution to circulate with normal airflow. Optos: ● Use 70% isopropyl alcohol to disinfect areas of patient contact. ● Not necessary to clean the inner bowl, which does not ● have patient contact. A tip from our Chinese colleagues in Wenzhou, China Video in waiting room that discusses new flow of exam: ● No unnecessary communication with doctor ● Cough/Sneeze etiquette ● No talking while in slit lamp ● Doctor will open doors ● No direct contact with doctor Other options: front desk explains flow of exam when scheduling appointment, automated appt reminder has recorded information for patient DISINFECTION • Products I have used over the years • Alcohol • Cavacide • Diluted Bleach • Wipes • Hydrogen Peroxide Wipes • Hypochlorous Acid • We have always stressed disinfection – We need to take it to a new level • Research commercial cleaning companies in your area DISINFECTION – HYPOCHLOROUS ACID • Wound care and lid care (Avenova) • Hand Prep • Surface Prep • Dry time • Ques of stability/longevity DISINFECTION: MORE OPTIONS • UV Disinfection • Far – UVC – light • Air Purifiers • Electrostatic Cleaning • Microsure DISINFECTION: UV • Wands • Room cleaners • Cabinets • Human Exposure concerns • Far – UVC – Light – safer DISINFECTION: ELECTROSTATIC DISINFECTION • Provides a broad-spectrum approach to disinfecting a complete surface area and entire room • Way to quickly and evenly coat a surface with disinfecting solution • Electrostatic applicator that gives negative charge to solution as it exits the nozzle • Charged molecules repel each other to evenly distance but will attract to surface applied to DISINFECTION: MICROSURE • 8 hour disinfection sanitizer • Traditional mode of actin is to attack the germ and use chemicals to destroy outer membrane = “chemical kill” • Microsure – uses millions of nanoscopic structures to form a new surface that results in a “mechanical kill” – Kills cells of the bio threat trying to attach to the object • Modify the surface to prevent adhesion, prohibit colonization, reproduction, and proliferation • Will not degrade or discolor - not harm by water Donning and Doffing PPE Putting on your PPE General flow for putting on: Taking off: ● Wash hands/apply hand ● Remove gloves and dispose sanitizer properly ● Put on surgical mask ● Wash hands/apply hand ● Put on goggles/face shield sanitizer ● Put on gloves ● Remove goggles/face shield ● Remove mask ● Wash hands/apply hand sanitizer Donning and Doffing a Surgical Mask Source: https://www.humanresourcesonline.net/h ow-and-when-to-wear-a-surgical-mask- during-the-wuhan-virus-outbreak How to reuse a mask ● Mark the outside of the mask so you can tell which is the outside of the mask. ● Store the bag in a paper bag or a plastic Ziploc-style sandwich bag. Never store in a purse or pocket. ● When storing, fold the mask in half so the outer surfaces are touching each other. Seal the bag if using a paper bag, but leave open if using a plastic bag (because it’s not breathable). ● Always use hand hygiene before and after handling mask. ● When pulling the mask back out of bag, grasp by the ear loops. Donning and Doffing Gloves Source: freepix.com Donning and Doffing Goggles Donning: Place over face and eyes and adjust to fit. Avoiding fogging: ● Soap residue ● Anti-fog material ● Anti-fog spray Image: slideplayer.com Elective Surgery – Where are we now? RSA Survey 4/24-5/3 225 Surgeons (43 States) Elective Surgery – When are we going? RSA Survey 4/24 - 5/3 225 Surgeons (43 States) Elective Surgery – Where are we going? RSA Survey 4/24-5/3 225 Surgeons (43 States) Intentional Limitations Upon Opening Elective Surgery – Referral Tips • 2-3 month backlog of cases • ORs will need to decompress also (less cases/day) • Hospital ASCs may remain closed • Consider a telehealth consultation if your local surgeon does them • Cataracts • 85 y/o grandma with 20/30 NS • 60 y/o working individual who may fail drivers test • Don’t wait on glaucoma, retina referrals Elective Surgery – LASIK • Ignore the optics, these are very low risk patients • Masks are creating issues for glasses • Economics will dictate a drop off anyway • Much easier to control and restrict workflow in LASIK suite than a surgery center • We are considering surgery on Saturdays when no one else is in clinic • Really no evidence of virus in tears of asymptomatic patients STAFFING • This is not legal advice: Consult and HR attorney and CPA • Reminder: stay at home order through 5/18, Statewide mask order 5/6 • States are opening in Phases: 1-4 • Currently in stage 1: essential only • Stages 2-4: low risk to high risk • MSO will send out notifications • Opening your office in stages • Demand • Reduced schedules STAFFING • Timing to bring back staff • Build in training time: at home, in office • Have written staffing protocols in place • PPP • UE • Prepare for staff disappointment – Returning to work STAFFING • Staff may not want to come back – educate them • UE • Safety – Make your employees feel safe • Stress protocols – PPE – CDC guidelines • Consider risk factors when bring employees back into office (age, medical Hx) • Work at home options (phones, billing, training, marketing and social media) • Be flexible with assignments – consider staggered shifts • *****Staff Temp start each shift – Update: maintain as private information STAFFING: PATIENT OR STAFF COVID + • Exposure to COVID positive patient or staff • CDC and OSHA
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