Week 6 - Contagious Disease

Front 1

Diseases Optometrists Encounter

Back 1

-HIV/AIDS
-Hepatitis
-TB
-Measles
-Mumps
-Chicken Pox/ shingles
-Glandular fever
-Influenza
-Infectious Conjunctivitis
-Adenovirus
-Creutzfeldt-Jakob disease (CJD)

Front 2

Disease Transmission Pathways

Back 2

-Doctor to Px
-Px to doctor
-Px to Px
-Idiopathic cases

Front 3

Risks of Infection in Practice

Back 3

-Removal of FBs
-Assessment of ocular trauma
-Assessment of conjunctivitis
-Assessment of microbial keratitis
-Lacrimal lavage, eye lash removal
-Expression of glands/ cysts
-Contact lens fitting
-Assessment of sick patients (cold and flu ect)

Front 4

Routes of Pathogen Access

Back 4

-Direct Contact: bacteria which don’t exist outside the body (blood borne)
-Indirect transmission: via inanimate objects
-Dust borne: pathogenic organism is in dust particles (virus, bacteria, fungi)
-Droplet: exhaled when coughing and sneezing
-Water-borne: clean drinking water
-Insect-borne: biting/ sucking insects transfer disease from infected animal to another
-Maternal Transmission: infection passed from mother to child in womb or birth

Front 5

Routes of Organism Access to Eye

Back 5

-Direct Contact: eg Herpes Simplex
-Airborne infections
-Insect borne: eg. Trachoma
-Migration of bacteria from the nasopharynx, sinuses, skin, mucosa
-Trauma
-Infected CL
-Infected eye drops, ointments
-Infected instruments

Front 6

Blood Borne Infections and Precautions

Back 6

-HIV, Hepatitis A, B, C
-Cannot tell if px is carrier
-Universal precautions
-Avoid contact with secretions and blood (gloves, goggles, mask)
-Lacrimal secretions not a major problem
-Transmission on CL/ tonometer probe

Front 7

HIV CLs Risks of Transmission and Protocol

Back 7

-HIV isolated from ocular tissues , tears and soft contact lenses
-Diagnostic lenses used on pxs
-10 min soak in 3% hydrogen peroxide will kill virus
- Heat disinfection effective
-Chlorhexidine containing solutions kill virus
-Saline does not kill virus
-Saline does not kill virus

Front 8

Hepatitis Risks of Transmission and Protocol

Back 8

-Aust had low incident of B and C but increasing
-Surrounding countries have high levels of incidence
-Contract from contact
-Health workers high risk (New Castle Hospital 4%, dentists 15.7%)
-Hep C low incidence in Aust. 0.3-1.5%
-Exceptions: Blood transfusion, IV drug users

Front 9

Adenovirus Risks of Transmission and Protocol

Back 9

-Highly contagious
-Survives on dry surfaces
-If suspect adenovirus don’t touch Px’s eye
-Quick look with slit lamp
-Px raises own lid
-Alcohol wipe chair and chin rest
-Wash Hands

Front 10

Means of Self-Protection

Back 10

-Immunisations
->Influenza
->Hepatitis B
->Measles, mumps, rubella, chicken pox
->Whooping cough
-Protective equipment
->Powder free surgical gloves (not latex) : contact with body fluids or high risk px
->Safety glasses (splash)
->Surgical masks- influenza
->Enclosed footwear

Front 11

Infection Control Method Terminology

Back 11

-Cleaning: removal of foreign material with water and detergents
-Disinfection: Inactivation of many pathogenic organisms but not all microbes
-Sterilization: Elimination of all viable micro-organisms (incl. bacterial spores)
-Reprocessing: processing of cleaning/ disinfection or sterilisation for reuse

Front 12

Disinfection Methods: Heat

Back 12

=Sterilisation
=60*C will kill most viruses, some bacteria and fungi
=Boiling required for spores
=Autoclaves: steam under pressure (120*C for 15min)
=Dry heat less efficient (160*C for 1hr for spores)
=Thermal disinfection of CL at 95*C

Front 13

Disinfection Methods: Alcohol

Back 13

=Disinfectant and cleaner
=CL cleaning solutions
=Disinfect instruments
=Destroys tonometer tips if soaked in for too long
=Not for ocular use (burns)
=70% alcohol will totally denude corneal epithelium with 10sec application

Front 14

Disinfection Methods: Povidine-Iodine (Betadine)

Back 14

=Ophthalmic preoperative preparation
=Stain washes off with water
=Kills bacteria (<1 min, spores more slowly)
=Does not burn skin
=Effects lasts at least 1 hr
=5% solution used to clean conjunctival sac before ocular surgery
=As a wash may limit adenoviral keratitis (burns)

Front 15

Disinfection Methods: UV Light

Back 15

=Sterilization
=Peak activity at 265nm, 240 to 280nm UVC
=Effective against bacteria , fungi and viruses
=No penetrance, only suitable for surface disinfection

Front 16

Procedures to Protect Pxs

Back 16

-Instruments
=Tonometrer and pachymeter probes, gonio lenses, fundus contact lenses
=Swab with 70% alcohol, air dry
=Do not rinse with saline
=Clean with soap, rinse, soak in 3% hydrogen peroxide or 70% alcohol for 5 min, rinse, air dry, alternate use of 2 prisms
=Strong disinfection can destroy lenses/ mirrors
=Disposable tonometer tip covers
-Contact lenses
=All need sterilization unless daily disposable
=Soft CL options: Soaking in solutions for several hours, 3% hydrogen peroxide, cannot be stored long term
=GP lens: cleaner, 3% hydrogen peroxide soak (3hrs), rinse, store dry
=Fissures in lens make harbour micro-organisms
=Infectious disease, dispose of CL immediately

Front 17

Recommended Practices to Prevent Infection

Back 17

-Disinfect equipment that will touch the eye/ skin (70% alcohol swabs)
-Clean work surfaces daily (1% sodium hypochlorite)
-Autoclave metal instruments
-Autoclave CL trial lenses or NaOH soak (disposable preferable)
-NCT tonometer methods
-Wash hands, cover all cuts
-Wear gloves with infectious cases
-Touch px skin as little as possible

Front 18

Practice Documentation for Infection Control

Back 18

-Hand Washing procedures
-Handling of waste and sharps
-Cleaning and decontamination of surfaces
-Tracking of equipment sterilisation/ autoclaving
-Use of protective clothing
-Needle stick injury protocol