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Infection control is a foundational competency for paraoptometric professionals. The optometric office involves close patient contact, shared instruments, and procedures near sensitive mucosal surfaces. Proper infection control protects patients from acquiring healthcare-associated infections, protects staff from occupational exposure, and is a regulatory requirement under OSHA standards. Both CPO and CPOA exams include infection control questions covering standard precautions, hand hygiene, instrument reprocessing, and PPE.
Standard Precautions treat all patient body fluids as potentially infectious—regardless of known diagnosis. In optometry, relevant body fluids include tears, ocular discharge, conjunctival secretions, and blood (rare but possible during foreign body removal).
| Instrument / Item | Level Required | Method |
|---|---|---|
| Slit lamp chin/forehead rest | Low-level disinfection | 70% isopropyl alcohol wipe; between every patient |
| Slit lamp eyepieces & joystick | Low-level disinfection | Lens-safe alcohol or disinfectant wipe |
| Goldmann tonometer tip | High-level disinfection | 3% hydrogen peroxide soak 10 min, OR sodium hypochlorite 1:10, OR 70% alcohol immersion per manufacturer |
| Gonioscopy lens | High-level disinfection | Clean with detergent, soak per manufacturer; often 70% isopropyl for 10 min |
| Pachymeter probe | Low to high-level | Alcohol wipe or manufacturer-specified disinfectant |
| Lacrimal dilator / irrigator | Sterilization required | Autoclave; device enters punctal lumen (sterile territory) |
| Diagnostic trial lens set | Low-level disinfection | Alcohol wipe between patients; avoid soaking plastic lenses unless approved |
| Reusable frame displayer | Low-level disinfection | Periodic disinfectant wipe; between patients for instruments near eyes |
The Goldmann applanation tonometer tip directly contacts the corneal epithelium. Adenovirus (epidemic keratoconjunctivitis/EKC) is a particularly hardy virus that survives on surfaces and is easily transmitted via inadequately disinfected tonometer tips. The WHO and CDC have specific guidance:
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Standard Precautions (formerly called Universal Precautions) assume that all patients' blood and body fluids—including tears, mucus, and ocular discharge—may be infectious. In optometry, this means: (1) Wash hands before and after every patient contact. (2) Wear gloves when contact with body fluids (tears, discharge) is likely. (3) Wear masks, eye protection, or face shields when splashing or spraying of body fluids is possible. (4) Dispose of sharps (syringe caps, needles from ophthalmic anesthetic vials) in approved sharps containers. (5) Properly clean and disinfect all instruments between patients. Standard Precautions apply regardless of the patient's known infection status.
Hand hygiene is the single most effective infection control measure. Two accepted methods: (1) Soap and water: wet hands, apply soap, lather for at least 20 seconds (including backs of hands, between fingers, under nails), rinse, and dry with a clean disposable towel. Required when hands are visibly soiled or contaminated with body fluids, before and after eating, and after using the restroom. (2) Alcohol-based hand sanitizer (ABHS): apply enough to cover all surfaces of hands and rub together until dry (approximately 15–20 seconds). Do NOT use ABHS when hands are visibly soiled or after contact with a patient with C. difficile (spores are alcohol-resistant). Timing: before patient contact, before any procedure, after patient contact, after touching contaminated surfaces.
The slit lamp is a high-contact instrument that requires thorough disinfection between patients. The chin rest and forehead rest should be wiped with a 70% isopropyl alcohol swab or an EPA-registered disinfectant wipe after each patient. Eyepieces can be cleaned with lens-safe disinfectant wipes or alcohol wipes. The slit lamp joystick (frequently handled) should also be wiped. Allow surfaces to air dry completely before the next patient—the brief contact time allows the disinfectant to work. In practices with high patient volume, disinfecting the slit lamp is often the paraoptometric's responsibility between exam room turns.
These are three distinct levels of decontamination: (1) Cleaning: physical removal of visible debris using soap/detergent and water. Required BEFORE disinfection or sterilization—organic material interferes with both processes. (2) Disinfection: kills most pathogens (bacteria, viruses, some fungi) but not necessarily bacterial spores. Most optometric instruments require high-level disinfection. (3) Sterilization: destroys ALL microorganisms including spores. Required for instruments that penetrate sterile tissue (e.g., surgical instruments, lacrimal dilators that enter the punctum). Most slit lamp accessories, tonometer tips, and gonioscopy lenses require disinfection; items that enter body cavities require sterilization.
PPE selection in optometry depends on the anticipated exposure: Gloves: when contact with tears, discharge, or mucous membranes is expected (e.g., foreign body removal, lacrimal irrigation, handling specimens). Masks and eye protection: when splashing or aerosol exposure is possible (e.g., removing a corneal foreign body with a burr, irrigating the eye). Lab coat or gown: when extensive body fluid contact is anticipated or to protect personal clothing. During respiratory illness outbreaks (e.g., COVID-19), respiratory precautions (masks, distancing, ventilation) become standard. Staff should always don (put on) PPE before exposure and doff (remove) carefully to avoid self-contamination.
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