The College of Optometrists

Methods of preventing infection transmission from person to person

Hand hygiene (refer to COVID-19 guidance)

B21
You must decontaminate your hands regularly and thoroughly to prevent the spread of infection, see paragraphs B31-B33.177  You can reduce the risk of transmitting infections such as methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile (C.diff) if you use fastidious hand hygiene.  
B22
There are a number of organisms present in healthy skin: some are resident organisms (skin commensals) and are mostly harmless, although some are known to cause mild eye infections. You can reduce the number of skin commensals left on your skin by washing with an antiseptic detergent preparation, instead of soap and water. 
B23
Other transient organisms can be deposited on the skin, including certain gram-negative bacteria which could lead to more serious corneal infections. You can remove most of these transient organisms by thoroughly washing with liquid soap and water (use warm water where available). 
B24
You must decontaminate your hands, as appropriate: 
  1. before every episode of direct patient contact or care
  2. after every episode of direct patient contact or care
  3. after any exposure to body fluids (including tears)
  4. after any other activity or contact with a patient’s surroundings that could potentially result in hands becoming contaminated
  5. after removal of gloves.
B25
You can use an antibacterial handrub between seeing patients during a clinic session. Alcohol is not a cleaning agent, so you should perform a proper handwash with soap and water at the beginning and completion of the clinic session, as well as after exposure to body fluids. Alternatively, you can wash your hands between patients.  
B26
You should also decontaminate your hands:  
  1. before (and after) contact lens insertion or removal
  2. after going to the toilet
  3. when hands are visibly dirty
  4. before (and after) contact with ocular surfaces and adnexae
  5. before (and after, if necessary) administering medication, for example eye drops
  6. after any possible microbial contamination, e.g. contact with body fluids, wounds, or clinical waste.
B27
You should use the following handwashing technique for most procedures you perform in the clinical setting: 
  1. wet hands under running water (use warm water where available)
  2. dispense liquid soap or antiseptic into cupped hand (bar soap should not be used)
  3. rub hands vigorously and thoroughly for at least 15 seconds without adding more water
  4. ensure all surfaces of the hands are covered
  5. rinse hands thoroughly under running water (use warm water where available)
  6. dry hands with a disposable paper towel. You should not use non-disposable towels.

See  Annex 3 World Health Organization guidance on handrubbing and handwashing techniques.

B28
Hand hygiene agents include: 
  1. liquid soap
  2. antiseptic
  3. antibacterial (alcohol-based) handrubs.178 
B29
Handwashing with soap and water is effective in removing most transient microorganisms and is usually all you need to prevent infection. In clinical areas, you should: 
  1. use liquid soap in disposable containers or containers that are washed and dried before refilling
  2. never top up the containers.
B30
Antiseptic agents are effective in reducing both transient and resident microorganisms. Chlorhexidine (4%) preparations have a residual effect against transient organisms influencing the survival time on hand surfaces.179 You should use an antiseptic agent: 
  1. before and after direct contact with patients in clinical settings, where there is an outbreak of antimicrobial resistant organisms (e.g. residential or nursing homes)
  2. where there is heavy microbial contamination
  3. before performing invasive procedures or minor operations.
B31
Antibacterial (alcohol-based) handrubs rapidly destroy microorganisms on the skin's surface. However, they are not a cleaning agent and you should not use them if hands are visibly dirty or contaminated with blood, bodily fluids or other potentially infectious agents. They are especially useful in situations where handwashing and drying facilities are inadequate e.g. domiciliary visits, or between patient contacts. 
B32
You should not use alcohol handrubs as a substitute for handwashing with soap and water, when these are available. You are strongly advised to wash your hands at the start and finish of a session. Alcohol handrubs are not effective against Clostridium difficile spores or norovirus (a cause of viral gastroenteritis), so you should use liquid soap and water in situations where there is potential for the spread of these organisms. 
B33
The standard for efficacy of hygienic handrubs uses a reference of 60% isopropyl alcohol. However, to be effective against staphylococci, including MRSA, handrubs must contain 70% of either ethyl or isopropyl alcohol. 
B34
Using an unperfumed alcohol-based handrub prior to contact lens insertion has been shown to have a negligible effect on ocular comfort, redness and lens wettability. You should ensure that the handrub has been allowed to dry on the hands as instructed by manufacturers (often 15 seconds). 

Maintain the integrity of your skin 

B35
To maintain the integrity of your skin, you should:
  1. cover cuts and abrasions to skin with waterproof dressings (preferably coloured)
  2. dry your skin properly with paper hand towels after washing
  3. use hand cream as appropriate; you should not share jars of hand cream with others.

Keep up to date with immunisation

B36
You should keep up to date with immunisation, including: 
  1. tetanus
  2. polio
  3. tuberculosis
  4. hepatitis B. 

Minimise the risk of airborne infection

B37
You should minimise the risk of airborne infection by:180
  1. covering your nose and mouth and using a tissue whilst coughing or sneezing
  2. disposing of used tissues in the nearest appropriate receptacle as soon as possible181 
  3. performing hand hygiene after coughing or sneezing
  4. not working in clinical practice if you have an acute upper respiratory tract infection, such as the common cold
  5. avoiding touching your mouth, eyes and nose unless you have performed hand hygiene. 

Protective clothing (refer to COVID-19 guidance)

B38
Wear protective clothing (refer to COVID-19 guidance):
  1. to protect against direct contact with body fluid
  2. while handling and cleaning decontaminated equipment. 

Masks

B39
You do not have to use a mask, unless there is a serious risk of respiratory infection or there is a public health requirement to wear one, such as during a pandemic. If you do need to use a face mask you should follow the relevant national or local public health guidance to ensure you are using the correct mask with the appropriate level of protection182 (refer to COVID-19 guidance).

Gloves (refer to COVID-19 guidance)

B40
You should wear gloves where you consider there is a risk from: 
  1. invasive procedures
  2. contact with:
    • non-intact skin
    • mucous membranes
  3. exposure to:
    • blood
    • bodily fluids, including tears
    • secretions
    • excretions
    • sharp or contaminated instruments
    • other contaminated material, for example dressings.
B41
You should consider the following factors when deciding to wear gloves (refer to COVID-19 guidance): 
  1. whether the patient has an overt infection, such as ulcerative blepharitis or acute viral or bacterial conjunctivitis
  2. the degree of contact with bodily fluids or infected tissue
  3. the consequences of infection.
B42
You do not have to wear gloves to (refer to COVID-19 guidance):
  1. carry out a normal eye examination
  2. perform minor procedures where there is no likelihood of cross-inoculation with bodily fluids
  3. fit contact lenses.
B43
You should practise thorough hand hygiene before wearing, and after removing, gloves, as they may not provide complete protection.
B44
You must dispose appropriately of gloves that you believe are contaminated.
B45
You can use non-sterile disposable examination gloves. However, if you undertake a procedure which requires a sterile environment, you must use sterile surgical gloves. You must not use polythene gloves for clinical interventions. If you choose to use latex gloves you should be aware that these might cause allergic reactions such as asthma in sensitised individuals183 184 (refer to COVID-19 guidance).

Appropriate sharps disposal

B46
You must only use sharps where necessary.185
B47
If you need to use sharps, you should use and dispose of them safely by: 186
  1. using equipment with safety devices
  2. using safe handling and disposal procedures.
B48
You should follow the NICE guidance on sharps containers.187 

References

177 National Institute for Health and Care Excellence (2017) Healthcare-associated infections: prevention and control in primary and community care. Clinical Guideline 139 [Accessed 20 Nov 2020]
178 British Standards Institute (2013) Chemical disinfectants and antiseptics. Hygienic handrub. Test method and requirements (phase 2/step 2). BS EN 1500:2013. College members can access British Standards Online via the College website [Accessed 20 Nov 2020]
179 Chlorhexidine is known to induce hypersensitivity, including generalised allergic reactions and anaphylactic shock. The prevalence of chlorhexidine hypersensitivity is unknown but is likely to be very rare. For further information see MHRA (2012) Chlorhexidine: reminder of potential for hypersensitivity [Accessed 20 Nov 2020].
180 NHS Choices. Catch it, Bin it, Kill it [Accessed 20 Nov 2020]
181 Health and Safety Executive: Pandemic Flu – Workplace guidance [Accessed 1 Dec 2020]
182 Pratt RJ, Pellowe CM, Wilson JA et al (2007) Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 65(S1) S1-S61, but see page S22
183 NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine (2008) Latex allergy: occupational aspects of management. A national guideline [Accessed 20 Nov 2020]
184 Health and Safety Executive. Latex allergies [Accessed 20 Nov 2020]
186 The Health and Safety (Sharp Instruments in Healthcare) Regulations SI 645 of 2013.
Health and Safety Executive (2013) Health and Safety (Sharp Instruments in Healthcare) Regulations 2013: Guidance for employers and employees [Accessed 20 Nov 2020]
187 National Institute for Health and Care Excellence (2017) Healthcare-associated infections: prevention and control in primary and community care. Clinical Guideline 139  [Accessed 1 Dec 2020]

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