We’ve all seen those “keep calm” signs and that rings true now more than ever. Working in any compacity in a clinic during a pandemic can be anything but calm for staff but fortunately there are steps that can help everyone feel a little less stressed.
First, a detailed and comprehensive protocol to keep staff and patients safe should be established by the physicians and management team prior to opening the clinic. These protocols will more than likely need tweaking as time passes which should be communicated easily and quickly to all staff. Open and clear communication is one of the best ways to keep everyone calm. Decide how management will communicate to staff whether it is by email, daily meetings, and/or posted instructions. Ensure that staff can check emails frequently.
Once an effective method of communication is established make sure a two-way conversation can take place so that staff can address their concerns. There are situations that undoubtedly will come up in clinic that need to be addressed immediately. For instance, a patient may demonstrate symptoms of COVID-19 during the work-up even though they were asked about symptoms over the phone and responded “no” to all the questions. If temperatures were checked at the door, this patient’s may have been in the normal range. Technicians need a clear way of communicating with their supervisors in order to solve these issues quickly and safely. Clinic managers and lead technicians should do their best to keep instructions and answers clear and concise.
All staff need to be properly trained on protocol such as proper face mask placement as they may have to instruct the patient’s on how to wear their mask safely while in clinic. Proper greetings and patient instructions should be given by the technician when the patient enters the building from their car. Technicians can also explain cleaning/disinfecting protocol to the patient to help them feel they are safe to proceed with their eye examination. Physicians and/or scribes can explain how protocol has changed in the exam room to the patient. Open communication between staff and patients can help everyone feel calm and safe about their clinic experience.
Technicians should be given a detailed list of protocols that review proper PPE, slit lamp and phoropter sneeze guards, cleaning their uniform/mask and how to disinfect equipment/exam rooms. Exam rooms including all touched surfaces, i.e. slit lamp knobs and countertops, should be disinfected between each patient with approved CDC cleaners such as bleach or alcohol solutions. Sneeze guards are available and encouraged for slit lamps and phoropters to minimize exposure to airborne pathogens.
Wearing contact lenses in clinic is discouraged. Instead staff should wear a face shield, goggles, or glasses. A mask should always be worn properly by staff and patients when in the facility. Unnecessary chairs should be removed from waiting areas or consider not using the waiting room at all. Instead patients can wait in their cars and the front desk will call the patient in when the technician is ready. Any chairs should be at least 6 feet apart and cleaned between each use.
Keeping patients in the same room for workups and examinations minimizes unnecessary exposure. If testing is to be performed all equipment, chairs, keyboards, countertops etc. need to be disinfected between each patient. Staff should wash hands frequently for at least 20 seconds with soap and water. Hand sanitizer needs to be available in all exam rooms and when possible, sterile cotton swabs should be used to instill drops as this prevents technicians from contacting the patient’s skin. If technicians do need to make contact with the patient’s skin gloves should be worn and disposed of immediately or a tissue used as barrier.
Uniforms should be worn once before washing; the cloth masks should also be washed at home . The N95 masks can be “baked” in the oven at home for 30 minutes to kill the coronavirus. Instructions on how to disinfect different types of masks can be found on the CDC website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
This is a time of unforeseen change in ophthalmology from the exam room to the operating room. This is the “new normal” for now and we can all get through this calmly together.