680. “There’s More to This Than Meets the Eye”: Opportunities for Infection Prevention in Optometry Clinics

BACKGROUND: Los Angeles County Department of Public Health (LAC-DPH) investigated an outbreak of epidemic keratoconjunctivitis secondary to adenovirus between June and July 2017, and all cases were linked to a single optometry clinic. The LAC-DPH aimed to determine whether sub-optimal infection prevention practices used in the implicated clinic were commonplace within other local optometry clinics. The objective of this study was to understand infection prevention practices in optometry clinics within Los Angeles County. METHODS: LAC-DPH conducted a survey consisting of 17 questions related to infection prevention practices among a sample of optometry providers in the county. The survey was administered online (SurveyMonkey) via emails sent to a local optometric society’s listserv and in-person at a local continuing education event for optometrists. The results were analyzed and are represented as percentages. RESULTS: There were 42 responses, 20 via the online survey (response rate 15%) and 22 via the in-person survey (response rate 22%). The majority worked in an optometry clinic: 77.5% (n = 31). More than half had no written hand-hygiene policy (58.5%, n = 24), 46.2% (n = 18) did not wear gloves while examining patients with eye drainage and about half (48.7%, n = 18) did not use droplet precautions for patients with respiratory symptoms. The vast majority used multi-dose eye-drop vials (92.5%, n = 37) but more than 40% (n = 21) did not discard the vial if the tip came into contact with conjunctiva. The majority (68.4%, n = 26) used alcohol wipes with 70% isopropyl alcohol to disinfect tonometers, while 47.4% (n = 18) used noncontact tonometers and 23.6% (n = 9) used disposable tips (options for this question were not mutually exclusive). CONCLUSION: Infection prevention practices in optometry clinics are sub-optimal and must be improved. All optometry clinics must have a hand-hygiene policy and discard multi-dose vials which come into contact with conjunctivae. While the evidence on the best disinfectant for tonometers is limited, commonly used disinfectants like 70% alcohol wipes or 3% hydrogen peroxide have been associated with adenovirus outbreaks. Current evidence suggests that infectious spread via tonometers can be prevented by using disposable covers or by disinfection with 1:10 diluted bleach. DISCLOSURES: All authors: No reported disclosures.