Michigan Optometric Association Guidelines For Re-Opening Michigan Optometric Practices
Following are a set of guidelines by which Michigan’s optometric practices can be expanded beyond their provision of emergent and essential services in order to give Michigan citizens access to needed routine preventive eye and vision care services while providing for the safety of both patients and office/clinic personnel. As a part of the Healthcare Critical Infrastructure Sector, the expansion of Michigan’s optometric practices must be approached on a basis of a gradual transition back to a normal governed by a risk-based, regional approach with a high priority on safety. Optometric offices in low incidence/low risk counties of Michigan must be treated differently than offices in the high incidence/high risk counties.
In cooperation with the DHHS Director and department, as well as, all other appropriate public health resources, the State of Michigan must develop a method of grading or classifying Michigan counties based on current regional risk-based data points. Based on available COVID-19 incidence information, including each county’s statistical history of COVID-19 disease incidence, mitigation and management, counties then may be categorized into three tiers (HIGH RISK, MODERATE RISK, and LOW RISK) that would more accurately identify each county’s current level of risk. Further, a defined process should be developed by which counties can effectively be reassigned from tier to tier based on weekly reporting of the incidence of disease and the effectiveness of disease management.
In view of health safety, granting patients access to routine preventive eye care, and reenergizing the economy, it would make sense to start to re-open optometric practices after May 1, 2020 in counties that are designated within Tiers MODERATE RISK and LOW RISK while utilizing the CDC safety recommendations and measures that are outlined below.
LEVEL OF OPTOMETRIC PATIENT INTERACTION:
Optometric eye and vision care would include routine preventive comprehensive eye health and refractive examinations, emergency treatment and management of ocular infections and injuries, and management of chronic ocular disease processes. It would also include the fitting or refitting of contact lenses and the prescription of eyeglasses. This work requires direct physical contact with patients which would include touching the patient’s face and eyelids, as well as coming into contact with mucous membranes of the conjunctiva, the corneal surface and with bodily fluids such as tears and mucous discharge.
PROTECTION OF EMPLOYEES:
• Services will be provided by appointment only; no walk-in patients except for prearranged emergency services or treatment • Signs will be posted on the office entrances stating that any patient who has a fever, cough or flu-like symptoms must reschedule their appointment • If a patient has tested positive for COVID-19, refer to CDC guidelines prior to rescheduling appointment • Before initiating professional services, all patients/companions will be screened: (1) body temperature will be verified; (2) asked if they have experienced any recent cold/flu symptoms; (3) been in contact with someone diagnosed with COVID-19; or (4) are awaiting test results for COVID-19 • Patients will be required to wear a PPE facemask. They may wear one of their own or will be supplied one by the office/clinic. If PPE supplies are not available, patients must follow applicable CDC PPE guidelines • Number of persons allowed into the office will be limited to one person per doctor, technician or optician (patients who are minors or have special needs may bring one companion with them) • No persons, other than the patient, will be allowed to wait within the building • All employees will maintain CDC recommended social distancing measures within the building • Optical stations must maintain proper social-distancing guidelines. Patients in optical stations should be separated by at least six (6) feet; or, if optical furniture cannot be physically moved, optical station rotation patterns should be adjusted to ensure CDC guidelines of social-distancing • All employees and doctors interacting with the public and/or each other will use appropriate PPE (face masks, disposable gloves, etc) • All employees will use CDC hand washing, office disinfection, and other infection control guidelines • Employees will conduct as much administrative work and patient data collection as possible electronically to limit patient contact time and time spent in the office/clinic
COMMUNICATION OF EMPLOYEE SAFETY INFORMATION
• Owners/Office Managers will meet with all employees and communicate all safety measures and directives both verbally and in writing • All employees will be required to physically sign a statement acknowledging that they understand and will comply to all safety measures and directives
• The Michigan Optometric Association and/or the Michigan College of Optometry at Ferris State University will offer an optometric employee safety training webinar, if needed
OTHER MATTERS OF EMPLOYEE SAFETY AND CONCERN
• Sanitizing and disinfection cleaning of examination equipment, work stations, counter tops and entrance doors and handles will be required to reopen • Protective face masks are required for patients, office employees and doctors; screens at office check-in and check-out points are recommended but not required • These measures will not require the sanitization of all incoming stock, component parts, raw materials or materials from normal supply chains but will require the disinfection and sanitizing of all examination equipment, chin rests, and examination chairs prior to each new patient • These measures do require all office/clinic personnel to use PPE, such as facemasks and disposable gloves. One facemask can be used throughout the day, but gloves must be disposed of after each patient encounter
PATIENT PROTECTION MEASURES
• All office/clinic employees will be medically screened prior to each business day including the measurement of body temperature and presence of any flu-like symptoms • No employee or doctor with a fever, cough or flu-like symptoms will provide services to any patient • The number of patients permitted in the office/clinic will be one per doctor, technician or optician • Consider separate operating hours for the most vulnerable populations • Triaging and categorizing patient visits to address urgent patient concerns first, and to facilitate safety in patient flow • Requiring patients to call or text the office/clinic upon arrival so entrance to and movement through the office/clinic can be safely coordinated by staff • No accompanying persons will be allowed to wait for patients in office/clinic waiting areas • Establishment of an appropriate timeframe between patients appointments to avoid congestion or overcrowding • Patient flow procedures will encourage maintenance of CDC recommended social distancing practices within the office/clinic except where examination procedures make it impossible to do so • Optical stations must maintain proper social-distancing guidelines. Patients in optical stations should be separated by at least six (6) feet; or, if optical furniture cannot be physically moved, optical station rotation patterns should be adjusted to ensure CDC guidelines of social-distancing
• Consider offering telehealth services when appropriate • All employees and doctors will wear protective face masks and protective gloves and/or follow CDC “Hand Hygiene in Healthcare Settings Guidelines” if they have physical contact of the patient • All examination equipment will be disinfected and sanitized between patients • Offices will not provide books, magazines or any other reading material for patients during their visit • All office space and surfaces (check in/check out stations, counters, desk tops, restrooms) will be cleaned and disinfected according to CDC safety guidelines • In addition to being posted on all entrance doors for patients to read prior to entering an office/clinic, safety measures and guidelines must be communicated to patients including any or all of the following methods: Facebook, Instagram, text, email and/or on the professional practice website if available • Safety measures and guidelines must be posted on all entrance doors for patients to read prior to entering your office/clinic
OTHER MATTERS OF PATIENT SAFETY AND CONCERN
• None of the safety measures require your business to get an updated building occupancy fire code in order to determine the percentage of occupancy allowed by local code. • None of the cleaning/sanitization mandates require any particular or required cleaning or sanitization products other than those used must be labeled effective in killing both bacteria and viruses • None of these safety measures or requirements require the installation of special equipment or markings such as tape on the floor to mark safe separation unless it is necessary to maintain CDC recommended standards on social distancing • None of these safety measures require any office/clinic physical restructuring or reconfiguration unless CDC recommended social distancing cannot be maintained otherwise. • Each employee is required to monitor themselves in regard to their personal responsibility of treating or caring for only one patient at a time and to be responsible for keeping their own work space/area clean and sanitized. • Offices will sanitize and disinfect doors and handles at their entrances once each hour.