Infection Control Guidelines for Ophthalmology Clinic Infection Prevention in Ophthalmology Clinic Dr. NAHLA ABDEL KADERوMD, PhD. INFECTION CONTROL CONSULTANT, MOH INFECTION CONTROL CBAHI SURVEYOR Infection Control Director, KKH.

1. ١
KING KHALID HOSPITAL
INFECTION PREVENTION
AND
CONTROL MANUAL
OPHTHALMOLOGY CLINIC
Dr. Nahla Abdel Kader, MD, PhD.
Infection Control Consultant, MOH
Infection Control CBAHI Surveyor
Infection Prevention Control Director
KKH.

2. ٢
DEFINITION
To provide clear guidelines for the appropriate methods of disinfection
of those ophthalmologic instruments for which sterilization is not
recommended and to provide guidelines on the use and storage of
multidose vials.
COMMENTS
Outbreaks can occur in the ophthalmology setting resulting from cross
contamination of Tonometer tips and multidose vials.
Outbreaks of epidemic keratoconjunctivitis due to adenovirus type 8
have been documented in ophthalmology clinics, and linked to
inadequately disinfected Tonometer tips.

3. ٣
• General Recommendations
A
B
C
• Medication Including Mulitdose vials
(MDV’S)
• Disinfection of Ophthalmological
instruments for which steam
sterilization is not recommended

4. ٤
PROCEDUR
A. General Recommendations
1. There should be a hand hygiene facility in each patient care
area used exclusively for hand hygiene.
2. Cleaning of items in preparation for disinfection/
sterilization should take place at a separate sink to that
used for hand hygiene.
3. It is the responsibility of all Health Care Workers (HCW) to
observe Standard Precautions to the wearing of personal
protective equipment (PPE) when exposure to blood or
body substances is anticipated.
4. Adequate PPE should be available to meet clinical
requirements at all times.
5. Clean and sterile items may be stored in the same area.

5. ٥
PROCEDUR
A. General Recommendations
6. Personal effects eg. bags, books, magazines should be stored in staff
lockers and not in any other area of the clinic.
7. All horizontal surfaces should be cleaned daily before work begins,
with a hospital approved (tuberculocidal) disinfectant, and
thereafter between patients. Visible soiling should be removed
first with a hospital approved detergent with water and friction
before disinfection.
8. A hospital approved sharps disposal container should be available
at point of use in all patient care areas.
9. A program for fridge cleaning and temperature monitoring should
be established, with record keeping.
10. Medication and food items should not be stored together.
11. Food and drink should only be consumed in a designated area for
this purpose.

6. ٦
PROCEDUR
B. Medication Including Mulitdose vials
(MDV’S)
1. Medication intended for internal or external use should be labeled
accordingly and stored separately.
2. MDV’s should be labeled with the opening date.
3. MDV’s should be used according to manufacturers’ instructions.
4. MDV’s should be discarded when:
1. Empty.
2. The expiration date is reached.
3. Contamination of the vial is known or suspected.
5. MDV’s should be accessed with a sterile needle each time, and
the needle removed on completion. The needle should not be left as
permanent access, as it will provide a portal of entry for microorganisms.
6. The rubber stopper of MDV’s should be wiped with Isopropyl Alcohol
70%, and allowed to air dry before needle insertion.
7. Eye medications ( drops, ointments) intended for single patient
use only should be discarded once treatment is completed.
8. Applicators of eye medications intended for single use should not
come in contact with the eye or periobital area. A separate
applicator should be used for each eye, and labeled accordingly.

7. ٧
PROCEDUR
C. Disinfection of Ophthalmological instruments for
which steam sterilization is not recommended
1. General Recommendations
1. Instruments that are visibly soiled should be washed with
a hospital – approved detergent and water with friction
prior to disinfection.
2. The presence of blood or proteinous material may
inactivate the disinfectant.
2. Tonometer Tips
In a busy ophthalmology clinic a fast and effective method of
disinfection is recommended:
a. The tonometer tip should be cleaned and disinfected
immediately after use.
b. The tonometer tip may be disinfected by one of the two
following methods:
1. Isopropyl Alcohol 70% .
a. The tonometer tip should be wiped clean and then disinfected
with 70% Isopropyl Alcohol.
b. Apply Isopropyl Alcohol 70% to all surfaces of the tonometer
tip, ensuring the entire surface is treated container.

8. ٨
PROCEDUR
C. Disinfection of Ophthalmological instruments for
which steam sterilization is not recommended
c. Apply friction to clean the surfaces. The mechanical wiping action
contributes to the effective removal of viruses.
d. The Alcohol should be allowed to completely air dry to promote
effective disinfection through adequate contact time of the alcohol,
and to ensure that no residual alcohol is transferred to the ocular
surface.
2. Hydrogen peroxide 3%.
a. The tonometer tip should be wiped clean and then disinfected with 3%
Hydrogen peroxide.
b. Apply hydrogen peroxide 3% to all surfaces of the tonometer tip,
ensuring the entire surface is treated.
c. Using a hydrogen peroxide soaked sponge apply friction to clean all
surfaces of the tonometer tip.
d. The hydrogen peroxide should be in contact with the tonometer
surface for at least 5 minutes.
e. Rinse the tonometer thoroughly with distilled water to ensure
removal of the hydrogen peroxide.
f. Dry the tonometer with a disposable clean tissue following the wash
disinfection process.

9. ٩
PROCEDUR
C. Disinfection of Ophthalmological instruments
for which steam sterilization is not recommended
3. Laser Lenses
Before cleaning, disconnect the power plug.
1. Cleaning of optical surfaces (Lenses):
 The lens should be cleaned and disinfected immediately after use.
 Wash lens thoroughly with soap and water.
 Rinse lens.
 Dry with a paper towel.
 Apply isopropyl alcohol 70% to all surfaces of the lens. Allow to air
dry.
 Replace lens in box.
2. Cleaning of painted surfaces:
Never use aggressive or abrasive cleaning agents, always use the
disinfectants approved by (the product evaluation committee) the
hospital.
• Clean and disinfect the device case as well as foot switch,
chin rest and forehead strap by wiping.
• In cleaning and disinfecting the equipment, make sure that
no moisture gets into the device and the foot switch.

10. ١٠