COVID-19 Update: new webinar and masks advice updated (April 2)

By Optometry Australia

We encourage you to review the free CCLSA webcast which was live-streamed on Monday 30 March. The webcast contains extensive information on understanding epidemiology, patient care and practice safety in our COVID-19 environment that is applicable to all optometry practise, not just contact lenses. Presenters include leading Sydney epidemiologist, Assoc Professor Gordon Doig and Luke Arundel as Optometry Australia’s Chief Clinical Optometrist.

As per our previous advice from the Department of Health, we recommend using your clinical judgement to determine if appointments can be postponed without undue risk to patient health or wellbeing and that you should begin working within that framework. We have released guides to assist you and staff in this area.

FACE MASKS AND PPE

Advice on wearing face masks for general consulting in non-COVID suspicious patients remains conflicting and is constantly changing, which makes it difficult for us to provide you with a definitive recommendation. We do however, suggest that you regularly check the Department of Health’s website for up-to-date information on face masks and our more detailed exploration of mask and PPE use on our resources page.

Please note that at this stage advice on masks is changing DAILY. The following is a collection of the most recent information on this topic from around the world to assist you in making a decision for what to do in your clinical practice.

The World Health Organization states the following in its document: ‘Advice on the use of masks in the community during home care and in healthcare settings in the context of the novel coronavirus’ published 19 March 2020:

‘Wearing medical masks when not indicated may result in unnecessary costs and procurement burdens and create a false sense of security that can lead to the neglect of other essential measures, such as hand hygiene practices. Further, using a mask incorrectly may hamper its effectiveness in reducing the risk of transmission. Health care workers should wear a medical mask when entering a room where patients with suspected or confirmed COVID-19 are admitted’.

The updated advice from organisations in the eye sector seems to be that whilst the use of masks in non-suspicious patients has no specific evidence, optometric practitioners may wish to use one given their close proximity to patients.

The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) released this update today, 2 April:

‘Where practical, doctors, staff and patients should wear masks. This may be very difficult given the limited availability of masks. Doctors and staff should use gloves when seeing patients’.

The Royal College of Ophthalmologists UK released on 1 April, ‘The Royal College of Ophthalmologists guidance to ophthalmologists’, which states that the College is advising the following approach to the use of PPE
‘Patients with no respiratory symptoms and no COVID-19 risk factors:

• Clinicians should wear standard surgical masks, when examining or treating patients at the slit lamp. Gowns and gloves are not recommended
• Plastic breath shields attached to slit lamps provide some protection but must be disinfected between patients because studies show that the COVID-19 virus is viable for up to 72 hours on plastic surfaces
• Avoid speaking at slit lamp’.

And further: ‘Wear a surgical mask when examining or treating patients at the slit lamp. The same surgical mask may be worn for examining multiple patients, but you must be fastidious to avoid transmitting the virus on the front of the mask via your hands or your clothes. Do not take the mask on and off between patients and do not allow it to dangle on your chest.’

Finally, the American Academy of Ophthalmology also released a statement on 31 of March: describing that

‘US hospital guidance has varied from forbidding physicians from wearing masks except in high-risk interactions, presumably for fear of shortages, to mandating all hospital staff wear surgical or N-95 masks. The Academy relies on expert guidance from the CDC with regards to indications for extended mask wear and reuse. The use of masks during ophthalmic examinations is a rapidly evolving issue.’

The Academy has suggested in the setting of an asymptomatic patient during an eye exam:

• ‘Standard precautions.
• Added precaution of not speaking during slit-lamp biomicroscopic examinations is appropriate.
• In the setting of adequate PPE supplies, use of surgical mask and eye protection for the clinician as well as surgical mask for the patient may reduce asymptomatic and presymptomatic transmission.’

We also encourage Australian optometrists to review the Australian Department of Health’s “Interim advice on non-inpatient care of persons with suspected or confirmed Coronavirus disease (COVID19), including use of personal protective equipment (PPE)”, updated 5 March.

Advice from the Australian Department of Health is currently only being provided for suspect and confirmed cases:

‘Suspect case:
A suspect case is a patient whom has any one of the following;

• Recent travel to, including transit though, another country
• Close or casual contact within the last 14 days with a confirmed case of COVID-19
• Respiratory illness symptoms.’

Patients whom are suspect cases should defer any non-emergent optometric care until post the 14 days of quarantine. If they present to a practice; ‘Immediately give the patient a surgical mask and ensure they put it on correctly. Direct them to a single room, whether or not respiratory symptoms are present. If this is the first contact with a health care provider, contact the local public health unit or state/territory communicable disease branch for advice if you are uncertain about the need for testing. All staff and practitioners should wear a mask’.

Where possible Optometry Australia is recommending confirmed cases requiring urgent eyecare are referred to your closest facility which is equipped for infection control in this setting.

Let your patients know if you are open

It is important that you let your patients know if you are open, if you are taking only emergency-care or if you can provide telehealth services. We also encourage you to update your membership profile to highlight what services your practice is prepared to provide during this crisis – including telehealth and/or urgent or emergency face-to-face care. This is necessary for patients to find your practice and contact details under the Find an optometrist function on both optometry.org.au and goodvisionforlife.com.au.

We have a range of patient communications material that you can use in your practice and on your website and other digital channels. We will continue to grow this library of patient resources.

If you need further advice or assistance, our Member Support Team are available to provide you with personal and confidential assistance. Details are listed below.

Looking after your mental health and that of others

• Optometry NSW/ACT has released its latest podcast today and news story on this topic. We have also added a mental health tile to the COVID-19 resources page which links to new Government resources in this area. Optometry Australia has a mental health first aid webinar scheduled for April 22 to help you assist and triage patients who may present with various mental health issues.
• Reach out to Beyond Blue and Lifeline for further support, including if you are experiencing heightened concern due to a coronavirus diagnosis, or increased stress or anxiety due to employment changes, business closure, financial difficulties, family pressures or other challenges.