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Letter to the Editor
Do we correctly comply with prevention protocols in ophthalmology? About the latest coronavirus epidemic
¿Cumplimos correctamente los protocolos de prevención en oftalmología?: a propósito de la última epidemia por coronavirus
M. García Lorentea,
Corresponding author
glorentemaria@gmail.com

Corresponding author.
, F. Zamorano Martína, F. Soler-Ferrándezb, C. Rocha de Lossadaa,c
a Servicio de Oftalmología, Hospital Regional Universitario de Málaga, Málaga, Spain
b Innova Ocular Clínica Dr. Soler, Elche, Alicante, Spain
c Servicio de Oftalmología, Hospital Clinic Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At the time of writing&#44; the epidemic caused by the new coronavirus known as COVID-19 has already affected over 68&#44;000 patients and caused 1600 confirmed deaths in China&#46; In addition&#44; over 680 cases have been diagnosed in 25 countries in Southeast Asia&#44; Europe&#44; North America&#44; Australia and the Middle East&#46; Of all infections&#44; approximately 1700 were health professionals with a total of 6 dead<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> including Li Wenliang&#44; a young ophthalmologist who became known for being the first to report the appearance of this new virus&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This coronavirus is a threat for ophthalmological practice for several reasons&#58; in the first place&#44; due to contact and proximity to the patient during slit lamp examinations&#46; Even though the transmission pathways of COVID-19 are yet being studied&#44; if we compare with other coronavirus &#40;SARS and MERS&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> contagion occurs through direct contact and through respiratory secretions when establishing contact with the oral&#44; nasal and conjunctival mucosa&#46; It is also a threat for ophthalmological practices due to the shared use of instruments and equipments for patients&#46; During the SARS-Cov epidemic&#44; it was proposed that tears could be a transmission pathway after finding viral RNA in the tears of infected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In the third place&#44; the literature describes conjunctivitis cases caused by other human coronavirus &#40;HcoV-NL63&#41;&#44; so that this ocular disease could be the clinic presentation of a COVID-19 infection&#44; although at this time it has not been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the epidemic and the growing number of health professionals affected by the coronavirus&#44; a number of recommendations have been established including thorough washing of hands&#44; protection through spectacles and face masks&#44; and in-depth anamnesis with questions about travel history&#44; systemic symptoms and familial antecedents&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The current epidemic prompts physicians and ophthalmologists to ponder whether we carry out adequate measures to prevent nosocomial infections in our daily clinic practice&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Existing research on hygiene and prevention in ophthalmological clinics has focused on the propagation of adenovirus<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> involved in several epidemic outbreaks&#46; The transmission of adenovirus has been associated to a broad range of ophthalmological instruments including&#44; tonometers&#44; lenses&#44; ophthalmoscopes and eyedrops&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> All these forms of transmission have brought about the development of preventive measures such as handwashing&#44; disinfection of slit lamps&#44; lenses and tonometers&#44; disposing of tonometer disposable tips or use of single-dose eyedrops&#46; However&#44; do we have standardized protocols for prevention&#63;</p><p id="par0035" class="elsevierStylePara elsevierViewall">According to the most recent guidelines of disease control and prevention centers for hand hygiene&#44; it is recommended to wash hands when they are visibly dirty&#44; after direct contact with patients&#44; bodily fluids and medical instruments and equipment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In this regard&#44; ophthalmologists are facing several challenges to achieve excellent hygiene for the hands&#44; involving the multiplicity of instruments used in an examination and the number of patients that can be seen in a practice&#46; According to a study&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> a busy ophthalmological practice could involve over 100 opportunities for hand hygiene per day&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In what concerns instruments and equipment&#44; even though it has been reported that adequate cleaning could diminish the risk of propagation of nosocomial infections&#44; there is a lack of protocolized methods for disinfecting slit lamps&#44; lenses&#44; tonometers to name a few&#46; The ideal hygiene for a tonometer has been studied in greater depth and the guidelines remain unclear due to the absence of a completely effective disinfectation method&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">By way of summary&#44; it can be said that just as for the rest of specialties&#44; the cleanliness of hands and disinfection of instruments are key factors in ophthalmological clinic practice&#46; The coronavirus epidemic has made us aware of the importance of conducting preventive measures and continuing research to definitely establish effective and standardized guidelines for disinfection and prevention of disease transmission&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors state that they have not received funding for this paper&#46;</p></span></span>"
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Article information
ISSN: 21735794
Original language: English
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es en pt

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