Precautions in ophthalmic practice in a hospital with the risk of COVID-19: experience from China.

Editor,

The coronavirus disease (COVID‐19) was first found in December, 2019 in Wuhan, China. It swept through China and worldwide. It can cause severe acute respiratory infection with an incubation period of 1–14 days (Chen et al. 2020; Huang et al. 2020), and mainly spread by respiratory droplets, although spreading by discharges, faeces, aerosol, conjunctiva, etc. was also suspected (Li et al. 2020). Ophthalmologists often contact with patients closely and are exposed to risk of cross infection. It is important that the ophthalmologists get acquaintance with strategy of protection during clinical practice.

Personal protection of ophthalmologists: since the safe distance of droplets transmission is ≥1.5 m, we suggest ophthalmologists taking different levels of protection according to clinical practices (Table 1). Management of hand hygiene should always be strictly complied with.

Table 1

Personal protective equipments

Level of risk	Procedures	Protective equipments
Low risk	Indirect contact with suspected patients, consultation, inspection without examinations or performance procedures	Gown, surgical mask, disposable cap
Moderate risk	Examination with slit lamp, funduscope, gonioscope, ophthalmic ultrasound, UBM, fluorescence angiography, puncture, injection and laser therapy	Water repellent gown, barrier apparel, surgical mask or N95 respirator, disposable cap, gloves, goggle or face shield, shoe covers
High risk	Specimen collection from the eye, intraocular surgery	Water repellent gown, barrier apparel, N95 respirator, disposable cap, double gloves, goggle or face shield, shoe covers

Disinfection of inspection equipments: SARS‐CoV‐2 is sensitive to UV and heat. It can be inactivated at 56°C for 30 min or by lipid solvent such as ether, 75% ethanol, chlorine disinfectant, peracetic acid and chloroform. A shield plate should be installed on the slit lamp to prevent droplets transmission. Slit lamp, automatic refractor, corneal topography, OCT, fundus camera and fluorescein angiography should be cleaned with 75% ethanol or 3% hydrogen peroxide tampon. Appliances directly contacting with patients’ ocular surface, such as Goldmann applanation tonometer, gonioscope, specular microscope, ultrasound probe and UBM probe, should be soaked by 2% alkaline glutaraldehyde, washed by flowing water and then cleaned by 75% ethanol or 3% hydrogen peroxide tampon (Rutala 1996). Since microaerosol might be formed due to tear film dehiscence, the non‐contact ‘air‐puff’ tonometry should be placed in ventilated place, and the probe should be well disinfected every time after use (Britt et al. 1991).

Outpatient care: a triage system should be run by experienced nurses. The nurse should measure body temperature and inquire contact history of all the patients. Patients with fever or contact history of COVID‐19 patients within 14 days were guided to the fever clinic for further evaluations. Only patients without fever or contact history are allowed to enter the eye clinic. The patients should put on masks as well. The clinic should be well ventilated, disinfected with UV of 250–270 nm for 30–60 min. The staff are encouraged to follow the precautions listed above and discard gloves, wash or alcohol‐rub the hands and then put on new gloves in‐between case.

In‐patient care: during the epidemic period, diseases admitted to the eye ward should be arranged accordingly. Only ocular emergencies such as eye traumas, acute glaucoma, rhegmatogenous retinal detachment and central retinal artery occlusion are considered for admission. The patients of new admission should be arranged one person in one room and be monitored attentively.

Ophthalmic operation care: non‐urgent interventions such as barrier laser, YAG: Nd laser capsulotomy, pan‐retinal photocoagulation, incision and curettage should be suspended or performed only when necessary. While ruptured eyeball, intraocular foreign body, acute glaucoma, rheugmatogenous retinal detachment and central retinal artery occlusion could be arranged for operation. Operation should be performed in well‐ventilated or negative pressure environment. The operating room is regarded as a high‐risk area, and universal precaution measures with barrier apparels should be strictly taken.

The SARS‐CoV‐2 is one of the viruses against which we need protection in ophthalmic setting. The measures we mentioned here may help protect from COVID‐19 and reduce the risk of its further spreading within hospital.