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.