Eye care - Infection prevention

Section

Recommendation statement

Grade of recommendation

13.

Clinicians are to undertake a risk assessment to identity the risk of contamination and mucosal or conjunctival splash injuries when caring for patients PPE (including goggles/face shield/gloves and gown/apron) as per NSW 2007 Infection Prevention control policy should be worn according to the risk assessment.

PD2007_036

14.

Clinicians are to adhere to the Five Moments of Hand Hygiene (13).

PD2010_058

15.

Equipment for eye care must be kept in its own container separate from other patient hygiene equipment. These containers should be passed through ward cleaning procedures on a regular basis.

D

Hand hygiene

The NSW Health Hand Hygiene Policy (PD2010_058) states that all staff must perform hand hygiene as per the Five Moments for Hand Hygiene; hand hygiene must occur before touching the patient; prior to a procedure; after a procedure or body fluid exposure risk; after touching a patient; after touching a patient’s surroundings. Hand hygiene can be performed using appropriate soap solutions and water or ABHR (alcohol-based hand rub). Soap and water must be used when hands are visibly soiled.

Before touching a patient, before a procedure, after procedure, after touching a patient, after touching a patient's surroundings

Based on the 'My 5 moments for Hand Hygiene', © World Health Organization 2009. All rights reserved.

NSW Ministry of Health policies

Prevention of infection is an important aspect of any clinical practice guideline. Users are directed to the following policy directives covering infection control. Local policy must also be consulted.

  1. Infection Control Policy (PD2007_036)
  2. Infection Control Policy: prevention & management of multi-resistant organisms (MRO) (PD2007_084)
  3. Hand Hygiene Policy (PD2010_058)

Other relevant policies and standards

  1. Australian Guidelines for the Prevention and Control of Infection in Health Care

Personal protective equipment

The Australian Guidelines for the Prevention and Control of Infection in Health Care and the NSW Infection Control Policy (PD2007_036) state that all procedures that generate or have the potential to generate secretions or excretions require that either a face shield or a mask with protective goggles be worn.

Therefore, the use of personal protective equipment (PPE) to prevent mucosal or conjunctival splash injury is mandatory while suctioning the patient (both open and closed suction). This must include mask and goggles or face shield; gloves and gown/apron.

Critically ill patients are at increased risk of eye infections due to impaired mechanisms such as eyelid closure and reduced tear film (2-5). Regular eye hygiene is an integral component of eye care interventions provided for critically ill patients and should routinely pre-empt eye treatment.

Eye care equipment should be kept in containers separate from other hygiene equipment. Additionally, medications including eye lubricants must be for single patient use only, and must be kept in locations and disposed of as indicated by the manufacturer. Critically ill patients are also at risk of ocular infections due to exposure to respiratory pathogens during suction procedures (3, 6-8). Accordingly, clinicians should consider interventions to limit this exposure including:

  • use of eye covers
  • methods of limiting aerolisation of secretions (such as closed tracheal suction systems)
  • ensuring suction catheters are not passed over or near patient’s eyes.

Grading of recommendations

Grade of recommendation Description

A

Body of evidence can be trusted to guide evidence

B

Body of evidence can be trusted to guide practice in most situations

C

Body of evidence provides some support for recommendation/s but care should be taken in its application

D

Body of evidence is weak and recommendation must be applied with caution

Consensus

Consensus was set as a median of ≥ 7

Grades A–D are based on NHMRC grades (9)

References

  1. Clinical Safety QaG. Hand Hygiene Policy. In: Health Do, editor. Sydney: NSW Department of Health; 2010.
  2. Marshall A, Elliott R, Rolls K, Schacht S, Boyle M. Eyecare in the critically ill: Clinical practice guideline. ACCCN (Australian College of Critical Care Nurses). 2008;21:97-109.
  3. Yi WY. Evidence-based Eye Protocol for ICU Patients with Altered Level of Consciousness: University of Hong Kong; 2009.
  4. Sandring S. The orbit and accessory visual apparatus.  Grays Anatomy. 40 ed. Edinburgh: Churchill Livingstone; 2008. p. 655-97.
  5. Kam K, Hayes M, Joshi N. Ocular Care and complications in the critically ill. Trends in Anaesthesia and Critical Care. 2011 (1):257-62.
  6. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: Narrative review and meta-analysis. Crit Care. 2008;36(12):3151-5.
  7. Ramirez F, Ibarra S, Varon J, Tang R. The Neglected Eye: Ophthalmological Issues in the Intensive Care Unit. Crit Care & Shock. 2008;11:72-82.
  8. Hilton E, Adams AA, Uliss A, Lesser ML, Samuels S, Lowy FD. Nosocomial bacterial eye infections in intensive care units*. The Lancet. 1983 (June 11,1983).
  9. Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011;11:23. PubMed PMID: 21356039.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.