Understanding Infection Prevention Practices in Optometry Clinics

SIGNIFICANCE The Los Angeles County Department of Public Health investigated an outbreak of epidemic keratoconjunctivitis secondary to adenovirus linked to a single optometry clinic between June and July 2017. Suboptimal infection prevention practices were identified in the implicated clinic. PURPOSE The purpose of this study was to determine infection prevention practices in optometry clinics within Los Angeles County. METHODS A 17-question survey on infection prevention practices among a sample of optometry providers in the county was conducted by the Los Angeles County Department of Public Health. The survey was administered via e-mails sent to a local optometric society's Listserv and in person at a local continuing education event for optometrists. The results were analyzed and are represented as percentages. RESULTS There were 42 responses, 20 via the online survey (response rate, 15%) and 22 via the in-person survey (response rate, 22%). More than half had no written hand-hygiene policy (58.5%, n = 24/41), 46.2% (n = 18/39) did not wear gloves while examining patients with eye drainage, and about half (48.6%, n = 18/37) did not use droplet precautions for patients with respiratory symptoms. The vast majority used multidose eye-drop vials (92.5%, n = 37/40), but 41.6% (n = 15/36) did not discard the vial if the tip came into contact with conjunctiva/skin/environmental surface. To ensure a clean tonometer for each patient, the majority (68.4%, n = 26/38) used 70% isopropyl alcohol, 47.4% (n = 18/38) used noncontact tonometers, and 23.6% (n = 9/38) used disposable tips (answers not mutually exclusive); none used bleach. CONCLUSIONS Our data highlight several areas of concern in the practice of standard or transmission-based precautions in the sampled population. First, hand-hygiene policies are not well enforced. Second, personal protective equipment is not appropriately used while examining potentially infectious patients. Third, eye-drop vials are not consistently discarded if contaminated with eye secretions. Lastly, a large proportion of surveyed practices use inadequate disinfection techniques of tonometers.