Guidelines for Indiana Optometrists on Vision Care Protocols During COVID-19

Core Principles: Screening, Physical Distancing, Infection Control Practices, Protective Measures

Core Principle 1: Screening

• Staff Screening
o Screen staff for symptoms of COVID-19 upon arrival at the facility.
o Use non-contact thermometers when available.
o Any staff member showing signs of being sick should not be permitted to work and should be referred to their primary care provider. The staff member should provide a statement from their family doctor stating that they are ready to return to work.
• Patient and Visitor Screening
o Screen patients and visitors for symptoms of COVID-19 upon arrival at the facility.
o Use non-contact thermometers when available.
o Patients and visitors showing signs of being sick should be rescheduled, unless an emergency dictates otherwise, and referred to their primary care provider.
o Discuss with patients the need to reschedule their appointment if they develop a fever or symptoms of COVID-19 prior to the time of their appointment.
o Inform patients and visitors in advance that they should wear their own mask or cloth face covering upon arrival at the facility. If they present without a mask or face covering, provide them with a mask to be worn in the facility if the patient is physically able to do so.
o Masks and cloth face coverings should not be placed on young children under the age of two, anyone with breathing difficulties, or anyone who is unable to remove the mask without assistance.

Core Principle 2: Physical Distancing Measures

• Individuals should maintain six feet of distance between each other when practical. Consider using signage, tape, or roping lines to direct patients to appropriate locations. Reconfiguration or removal of some waiting room and exam room seating may be appropriate.
• Request that patients call or text the office upon arrival so entrance to and movement through the facility can be coordinated by staff.
• Instruct patients that companions should remain outside the facility and not accompany the patient inside the facility, unless they are a parent/guardian or caregiver.
• Consider separate operating hours for elderly patients, patients with mobility issues, and other vulnerable populations.
• Establish a longer timeframe in between patient appointment slots.
• Implement curbside dispensing of eyewear when possible.
• Limit the number of patients and staff members within the optical dispensary area at any one time.
• Continue to offer telehealth services when appropriate.
• Clerical staff should conduct administrative work via remote methods when possible.
• All paperwork, including patient registration and history forms, should be made accessible to patients for completion prior to appointments through appropriate methods:
o Mailing forms to patients
o Providing a link on the facility website with a fillable and printable PDF, or
o Obtaining information over the phone.
• Facilities may utilize mobile apps that can scan documents provided the information shared via smartphones or other devices is transferred securely.

Core Principle 3: Infection Control and Disinfection Practices

• Make hand sanitizer and other sanitary products readily available for patients and staff throughout the facility.
• Use germicidal wipes to clean exam chairs and all equipment after every patient encounter.
• Facilities should routinely perform enhanced environmental cleaning of commonly touched surfaces, such as workstations, counters, railings, door handles, clipboards, pens, chairs, and other public area surfaces.
• Take care in the handling of eyeglass frames and other products to limit opportunities for virus transfer.
o A staff member can assist a patient in obtaining frames from the selection available and transport them with a tray or other receptacle to the fitting area.
o Once a patient has completed the selection process, the staff member shall clean each pair in an appropriate manner before replacing the frames on display.
• Offices should consider posting signage from the CDC with information regarding appropriate safety practices.
• Register and collect contact information for all patients and visitors entering the facility.
o This can be done electronically or recorded manually by a staff member.
o This information can be used for contact tracing in the event of a COVID-19 flare-up.

Core Principle 4: Protective Measures

• Doctors and Clinical Staff:
o All doctors and clinical staff should wear masks when interacting with patients.
o Eye protection and disposable gloves should be considered when clinically appropriate.
o A barrier shield may also be used around testing equipment due to close contact.
o Doctors and clinical staff members should wash hands before and after every patient encounter.
• Facilities shall:
o Provide training about when, how, and where cloth face coverings can be used.
▪ Frequency of laundering, when to replace, when they can and should be worn in the facility, etc. ▪ Prevent self-contamination by changing face coverings if they become soiled, damp, or hard to breathe through.
▪ Hand hygiene shall be performed immediately before and after any contact with the cloth face covering.
o Provide training regarding patient and staff protective measures.
o Provide training on infection control, cleaning and sanitation of supplies, equipment, chin rests, chairs, and facility.

It is important for all healthcare professionals to continually monitor recommendations and directives from government agencies.

Resources for Optometrists:
Indiana State Department of Health: https://www.coronavirus.in.gov/
CDC Guidance for Healthcare Professionals COVID-19: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
CMS: https://www.cms.gov/medicare/quality-safety-oversight-general-information/coronavirus
Indiana Optometric Association: http://www.ioa.org/
American Optometric Association COVID-19 Resources: https://www.aoa.org/coronavirus