A Letter from Imran Rahman
Here is a letter from Imran Rahman MB BS FRCOphth, CEO and Consultant Ophthalmologist
Dear Optometry colleagues
I hope you are well and keeping safe. I would just wish to start that my communication comes from a medical viewpoint not optometry. Please therefore, understand that we look after medical patients but as healthcare providers the principles of best practice should apply to all of us, but to a degree designated by NHSE and Public Health England (PHE).
Firstly on a positive note, the NHS seems to be coping with the Covid influx, so planning, however delayed we may personally feel this is, does seem to be working.
You will have heard as a consequence that the UK Government are releasing guidance n the coming weeks to relax lockdown in a sensible and staged approach. Whilst I do not have full details, there is potential a RAG rating scale that will be implemented. Much of the below is my own thoughts after reading and discussions with NHSE and nothing is yet finalised. It will however, provide a flavour of potential discussions. When actual guidance is available I will forward this in a condensed form if and when available.
The next stage for us all is to get ready for restart. There will be a demand that is in need and it is important we can all manage this in a safe and controlled way to prevent infection spread. The goal is not only to keep patients/customers safe but also our staff. The last thing we want is our staff to be off self-isolating with symptoms for 2 weeks and having to close up once again. For this reason we are planning restart in a staged manner.
Whilst each practice is different, I have instigated several important aspects to limit the risk of our staff being infected and keeping the environment clean as possible.
Pre-booking of patients. Our ophthalmology services work different to high street optometry but a sensible approach to pre-booked patients is important. This is what we are doing:
Admin staff to ask on phone if the patient has the following symptoms currently:
i. Dry cough
ii. High temperature
iii. Member of house self-isolating
iv. Only allow patients symptom free to enter the practice. Inform patient if things change, to not attend and to contact our admin to rebook
i. Mark out seats and floor at 2m intervals and designate patients to the seat on arrival.
ii. No relatives allowed unless absolutely necessary and even then limited to 1 member who has no symptoms.
iii. Check temp with non contact thermometer. If greater than 37.8 degrees patients are asked to go home and contact 111. If less than 37.8 and no other symptoms asked at arrival, patients are allowed in after using hand gel and provided with a 3ply face mask for the duration.
iv. Make sure rooms are ventilated well, windows open if possible as poor ventilation allows the virus to circulate and settle within the immediate area.
v. Rooms are allocated for potential high risk patients and those at low risk, with extra precautions and cleaning for high risk patients
vi. After the patient has left, a clean down of the room and equipment with disinfectant/bleach/Dettol around equipment is important and ensure hand washing and cleaning of door handles and seats.
Who is high risk?
The DoH has designated the following as high risk and should be shielded are as follows. When relaxing of lockdown, this list will change but acts as a good guide.
In a nutshell, these are patients with:
1. Solid organ transplant recipients.
2. People with specific cancers:
· people with cancer who are undergoing active chemotherapy
· people with lung cancer who are undergoing radical radiotherapy
· people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
· people having immunotherapy or other continuing antibody treatments for cancer
· people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
· people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe combined immunodeficiency (SCID), homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.
It is likely after lockdown that over 70’s will be asked to shield. As such, we will add extra precaution by only offering evening clinics with longer appointments. The rational is to ensure they have the least exposure from leaving home, transport, at the clinic and on the way home, rather than at busy periods. This will limit the risk to elderly and patients asked to shield if they do need to attend.
This is crucially important. In a healthcare setting, PPE is a must before seeing a patient. Our guidance to our staff (note: this is what we are recommending to our clinical staff within our hospitals) internally is as follows (as guided by PHE). The goal is to keep you, your staff and your patients safe.
Wear fluid resistance 3ply face mask for the session
Face shield (CHEC guidance to our internal staff)
Alcohol gel between each patient
Alcohol or wash hands on entering and leaving an area
Fluid resistant face masks
Desks to be 2m apart
Direct clinical care
Try to remain 2 meters apart
Use sterile disposable gloves and changed between patients
Disposable apron between patients and changed
Fluid resistant face masks or better still KN95 ventilation masks
Goggles (CHEC guidance)
Alcohol gel or wash hands for 20 seconds between patients
Most PPE is available on Ebay for ordering and will be delivered fairly quickly.
As previously stated our accredited/referring practices will be issued with slit lamp guards and 2 KN95 ventilation masks. This will only happen when we have the ability to have engagement officers to attend limited practices. Most will be to independents as multiples seem to be well supplied. Please do note however, stocks are limited so is not available to everyone. It is until stocks last.
Imran Rahman MB BS FRCOphth
CEO and Consultant Ophthalmologist