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How to reduce cross-infections.

Dear Editor,

Through your columns may I make a few suggestions which may help to reduce in-practice cross infections during the present swine flu pandemic. These are as follows: * Do not go into work if you have Swine Flu (SF) or suspect Swine Flu (SSF). (Addendum I)

* Tell patients not to attend if they have SF or SSF

* All hard surfaces such as door handles and remote controls to be cleaned frequently with a normal cleansing agent (Addendum II)

* Catch it, bin it and kill it after sneezing (Addendum II)

* Wash your hands in front of patients before each examination (Addendum III)

* Disinfect with an alcohol swab all instruments which come into contact with patients eg. trial frame, visual fields equipment, NCT, retinal camera, slit lamp, optical coherence tomographers etc.

* Each time the slit lamp is used replace the disposable paper chin rest

* Use disposable probes with Perkins and Goldmann Tonometers

* If during the examination, you suspect patient may have SF: * Postpone direct ophthalmoscopy and re-book (Addendum V) or

* Use a face mask (Addendum IV) or

* Use an indirect ophthalmoscopy (Volk or BIO)

* Do not fit contact lenses to patients with SF or SSF and only fit disposable trial lens during the pandemic

* Do not touch lids, lashes or external eyes eg. when instilling drops or everting lids, with patients with SF or SSF, or use disposable gloves

* After choosing new frames clean the surfaces of sample frames

Whilst the highest standards of practice hygiene are a sine qua non, stringent antimicrobial procedures such as those outlined above are essential during a pandemic. At the time of writing there is still an official SF pandemic which, however, may have peaked and possibly reduced when this letter is published. It is this writer's hope that at least some of the precautions listed above may be of assistance to colleagues.

Addendum I If you have a fever or high temperature (over 38[degrees]c or 100.4[degrees]F) and have one or more of the following symptoms: unusual tiredness, headaches, runny nose, sore throat, shortness of breath, a cough, loss of appetite, aching muscles, diarrhoea, or vomiting you may have SF (source: National Pandemic Service, 2009).

Addendum II (Source: Patient Guide to Swine Flu, Holmes Chapel Health Centre, 2009)

Addendum III A comprehensive handwash should extend from the fingertips to the elbows and last at least 40 seconds The procedure should cover washing from palm to palm, palm to the back of the hand and reverse and also in between the fingers.

Addendum IV There is no specific proof that wearing a conventional face mask will in itself prevent catching the SF virus. However new and improved versions are now available which are designed to filter at least 99% of viral particles from entering the lungs by providing FFP3 particle filtration. (Source: P16, Optometry Today, Aug 21 2009 Vol 49i16)

Addendum V It could of course be argued that indirect ophthalmoscopy should become the norm whilst direct ophthalmoscopy is now arguably quickly becoming obsolete.

Donald F C Loran, Holmes Chapel, Crewe, Cheshire
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Title Annotation:LETTERS
Author:Loran, Donald F.C.
Publication:Optometry Today
Article Type:Letter to the editor
Geographic Code:4EUUK
Date:Sep 25, 2009
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