Optometry: moving to level 2

The Ministry of Health (MoH) has issued guidance to the allied health sector which covers optometrists and dispensing opticians. As indicated in our earlier communication, Alert Level 2 will look a lot different to Alert Level 3. It will be a “return to work” as long as measures are taken to protect the health and safety of the public. The MoH issued the following statement:

“Telehealth and virtual appointments are still the preferred option in Alert Level 2. Please exercise extra caution when treating vulnerable groups.”

Clinicians will be able to see patients face-to-face if the following processes are in place:

• Screening for Covid-19 symptoms prior to face-to-face appointment
• Physical distancing measures
• Infection prevention control measures including PPE where required

In addition, the MoH said clinicians will be able to travel within and to neighbouring regions to provide care to patients and receive training.

While practices can reopen for routine face-to-face consultations/dispensing under Alert Level 2, protocols must be implemented to maximise patient safety, including ongoing risk assessment and appropriate infection prevention control procedures.

Screening

Screening or risk assessment of patients/customers and any support persons for risk of Covid-19 prior to entering your practice is mandatory. If there is any risk identified, do not allow them into your practice or see them in the community until they have medical clearance.

Risk screening should be based on the Covid-19 case definition - www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-resources-health-professionals/case-definition-covid-19-infection

The Board recommends you follow the same Covid-19 screening protocols as you have during Alert level 4 and Alert Level 3 - www.odob.health.nz/wp-content/uploads/2020/04/Optometry-Essential-Services-during-the-lockdown-period-in-New-Zealand-1.pdf

Employers are responsible for conducting risk assessments for staff moving back into work premises during Alert Level 2. This may include individual discussions with each staff member prior to returning to work.

Physical distancing

Physical distancing must occur and you must ensure that the practice environment allows for this, including controlled entry and exit. Under Alert Level 2 in a controlled environment, 1m physical distancing is required.

A controlled environment (as defined by Work Safe NZ) is where you can:

• Reasonably require hand sanitising/cleaning
• Clean frequently, including between occupancy by different groups
• Manage distancing of people
• Keep groups contained and not mix groups
• Inquire about the health of users and refuse access if necessary
• Keep a record - name, phone and physical address - of people who are present to facilitate contact tracing if necessary

Infection prevention control measures and PPE

You must continue to have a high level of vigilance to ensure hygiene protocols are maintained. The best defence against Covid-19 are basic hygiene measures, including:

• Coughing or sneezing into your elbow or by covering your mouth and nose with tissues
• Putting used tissues in the bin or a bag immediately
• Washing your hands with soap and water often (for at least 20 seconds)
• Avoiding touching your eyes, nose or mouth
• Cleaning surfaces regularly

During Alert Level 2, the risk of community transmission is low or minimal. Your risk assessment should consider this when you are determining the correct level of PPE.

In general, MoH advice is that if a patient has been screened, as indicated above, is not symptomatic and you are not undertaking an aerosol generating procedure, and there is no exposure to bodily fluids, then optometrists and dispensing opticians are not required to wear PPE. Optometrists and dispensing opticians or patients, may still choose to wear PPE if they wish. However, if after risk assessment you identify there is a risk and it's not possible to maintain physical distancing then you should wear a mask. A risk includes customers/patients who are at a higher risk of severe illness from Covid-19 or part of a vulnerable group. If there is uncertainty, you should wear a mask.

We would advise keeping a small supply of PPE on hand, however generally optometrists and dispensing opticians at Alert Level 2 should not need to order large amounts. The MoH has asked practices and clinics not to stockpile. According to MoH, if you cannot get PPE from your usual supplier, contact the emergency management officer at your local district health board (DHB).

We understand there are still challenges for many trying to source PPE from DHBs. We suggest where possible, contacting local suppliers.

- For further information on guidelines for PPE use in a health care setting - www.health.govt.nz/system/files/documents/pages/hp7366-guidelines-for-ppe-use-in-healthcare-poster-25-april2020.pdf

- For further infection control information - www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-information-specific-audiences/covid-19-personal-protective-equipment-workers

Contact tracing

You must continue with contact tracing, recording patients/customers, employees and any other members of the public entering your practice - https://covid19.govt.nz/covid-19/about-covid-19/contact-tracing-for-covid-19/.

Working with vulnerable people

The government guidance for Alert Level 2 states, “People at high risk of severe illness, such as older people and those with existing medical conditions, are encouraged to stay at home where possible and take additional precautions when leaving home. They may choose to work”.

Practitioners must carefully weigh up the risks and benefits of seeing patients who may have vulnerabilities to Covid-19 for face-to-face consultations/dispensing. You must discuss the risks and benefits with the customer/patient and/or carer. If it is decided a face-to-face consultation is appropriate, screening and the use of a mask is required, as stated above.

Fitness to practice

As a registered health practitioner, you have an obligation to ensure you are fit and safe to practice. Please refer to previous Board communications for more on this.

If you or staff member, patient or visitor becomes a confirmed or probable Covid-19 case and has been at your practice while potentially infectious then you must adhere to the following MoH - www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-information-specific-audiences/covid-19-advice-workplaces/guidance-workplaces-have-case-covid-19

SOVS, University of Auckland practicum (placements and externship)

As we move to Alert Level 2, some of you may also be involved in hosting a student for their practicum. In making sure you are fit to practice, you will also need to ensure that both you and the student follow all the protocols mentioned above and that you take all the necessary steps to protect the health and safety of the public.

For the time being you should:

• Continue to follow Alert Level 3 requirements until Alert Level 2 officially commences
• Continue to work collaboratively with your DHBs
• Stay in contact with your professional body, including NZAO and ADONZ

As always, the Board will advise you of any further updates.

Noho ora mai / stay well

Jayesh Chouhan, ODOB Board chair, and Antony McFelin, registrar