Concerning ill patients: Should they stay or should they go?

January 23, 2018
Patient precautions, policies for keeping flu at bay.
Patient precautions, policies for keeping flu at bay

America's influenza epidemic is at its peak, making it especially important for optometric practices to take extra precautions to prevent the spread of illness.

Unusually active this season, the flu is reported widespread in every state in the country except Hawaii, according to the Centers for Disease Control and Prevention (CDC). The federal agency chalks up the season's severity to the prevalent influenza A strain in circulation, H3N2. Although the flu's impact varies by season, H3N2 seasons tend to be more serious due in part to the flu vaccine's difficulty with the strain.

"All of the states, 49 at least, are reporting in the same week widespread activity. That hasn't happened in the past 13 years," said Dan Jernigan, M.D., director of the CDC's Influenza Division, during the CDC's Public Health Grand Rounds on Jan. 16. "This is something we don't normally see, but the take-home message here is that flu is in a lot of places at the same time."

Consequently, it's crucial that optometric practices take appropriate steps to ensure doctors and staff not only double down on effective infection control procedures, but also limit the likelihood of illness entering the office. Despite practices' best-laid plans and preparations, there's one factor beyond providers' control—patients.

David Krumholz, O.D., State University of New York College of Optometry professor and author of the continuing education Infection Control in Optometric Practice, available through the AOA's Paraoptometric Resource Center (PRC), says doctors and staff come into contact with patients on a daily basis, upping the possibility of encountering a sick, contagious patient.

"Often, it is not apparent who might have an infectious disease and who might not, so we have to take precautions with everyone," Dr. Krumholz notes. "Some of these precautions are simple, common sense; others require more thought."

Reasonable precautions amid epidemic

While proper hygiene practices would fall under the common-sense category, optometric practices must consider many options for limiting the spread of contagions. Erlinda Rodriguez, CPO, AOA PRC Committee chair and office administrator in a New Jersey practice, offers several tips used in their practice.

  1. Post notice. During flu season, many optometric practices hang a sign on their door advising sick patients of expectations for their visit. "We have a sign/notice to patients advising them to communicate any symptoms of a cold or infection to our staff upon arrival to the office," Rodriguez says. But some offices go even further, ranging from asking patients to reschedule their appointments until they're well to handing out facial masks to sick patients in order to prevent spreading sickness through coughs or sneezes.
  2. Separate sick patients. "In our practice, we have an assigned examination room with a built-in exhaust to help eliminate any airborne pathogens. When a patient walks in with an apparent cold or infection, the staff takes them directly to the assigned examination room and does not make them wait in the reception area or waiting room to avoid contaminating other patients," Rodriguez says.
  3. Eliminate contamination. Once the sick patient has left the examination room, it's important to thoroughly clean, disinfect or sterilize surfaces and materials as necessary. Standard cleaning and disinfection procedures are adequate for minimizing flu infection. Be sure to pay close attention to instruments or equipment that may contact contagious hosts, including phoropters, slit lamps, exam chairs, condensing lenses, etc.

Finally, encourage doctors and staff alike to get a flu vaccination. Although the CDC estimates that this year's vaccine effectiveness against H3N2 is around 30 %, its effectiveness against the H1N1 strain and influenza B viruses is about 50-60 %. Despite these numbers, a vaccine can reduce the overall severity and duration of the flu, and significantly reduces the risk of flu-related death, especially among children.

Read more about common infections seen in the optometric practice.

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