Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Optometrists and staff, which also
includes assistants in the office of an optometrist, must comply with all the
applicable Standard Precautions.
(b) Standard Precautions combine the major
features of Universal Precautions and Body Substance Isolation and are based on
the principle that all blood, body fluids, secretions, excretions (except
sweat), non-intact skin, and mucus membranes may contain transmissible
infectious agents. All contact with these substances is treated as if known to
be infectious for Human Immunodeficiency Virus (HIV), Hepatitis, and other
transmissible infectious agents. Standard Precautions are also intended to
protect patients by ensuring that optometric staff do not carry infectious
agents to patients on their hands or via equipment used when providing
optometric services. Standard Precautions must be used in the care of all
patients, regardless of suspected or confirmed infection status, and in all
settings wherein optometric services are provided. Standard Precautions
include:
(1) Proper Hand Hygiene
(A) Each office shall have a hand washing
facility that is entirely within the confines of the premises or space occupied
by such office and not elsewhere, and which shall be for the exclusive use of
the optometrist or optometrists practicing in such office and his/her or their
assistants and patients and shall not be used by other persons.
(B) For the purpose of this section, a hand
washing facility is a facility affording, at minimum, the following:
1. A wash basin or sink with hot and cold
running water which complies with Title 24, California Administrative Code,
Part 5 (commencing with Section P100).
2. Liquid hand washing detergent in a
dispensing device.
3. Single
service sanitary towels in a dispensing device or a sanitary hot-air blower
hand drying apparatus.
(C) Hand washing facilities shall be
maintained in a condition of cleanliness and good repair.
(D) The optometrists and staff shall maintain
at all times a high standard of cleanliness and personal hygiene in order to
ensure proper patient care.
(E) The
optometrists and staff shall avoid unnecessary touching of face, nose, and
surfaces in close proximity to the patient to prevent both contamination of
clean hands from environmental surfaces and transmission of pathogens from
contaminated hands to surfaces, when providing optometric services.
(F) When hands are visibly soiled, hands
shall be washed with soap and water for a 20-second scrub and 10-second rinse
or an antimicrobial hand wash. If hands are not visibly soiled, an acceptable
alternative of hand decontamination is with an alcohol-based hand rub (except
in cases of spores, as described below).
(G) Hands shall be washed or decontaminated
as follows:
1. Before having direct contact
with any patient, immediately after a procedure (such as eye examinations or
other procedures involving contact with tears), and in between
patients.
2. After removing gloves,
ensure that hands will not carry potential infectious material that might have
penetrated through unrecognized cuts or lacerations in the gloves, or that
could contaminate the hands during glove removal.
3. Artificial fingernails or extenders shall
not be worn if duties include direct contact with patients at high risk for
infection and associated adverse outcomes.
(H) After each patient session ends, hands
must be washed with soap and water or an antimicrobial hand wash if contact
with spores (including but not limited to C. difficile or
Bacillus anthracis) is likely to have occurred. The physical
action of washing and rinsing hands in such circumstances is required because
alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor
activity against spores.
(I) If an
optometrist or staff member has exudative lesions or weeping dermatitis of the
hand, direct patient care and the handling of patient care equipment by the
person with the condition must stop until the condition
resolves.
(2) Use of
Personal Protective Equipment
(A) The
optometrists and staff must routinely use gloves to prevent skin exposure when
anticipating direct contact with blood or body fluids, mucous membranes,
nonintact skin, and other potentially infectious material or surfaces soiled
with such fluids.
(B) The
optometrists and staff shall discard gloves after contact with each patient to
prevent transmission of infectious material.
(C) The optometrists and staff shall change
gloves if patient interaction involves touching portable computer keyboards or
other mobile equipment that is transported from room to room.
(D) The optometrists and staff shall not
reuse gloves.
(E) The optometrists
and staff must wear masks, gloves and protective eye wear in situations where
blood, respiratory secretions, or contaminated fluids may be sprayed or
splashed into the eyes of an optometrist or staff member.
(F) The optometrists and staff must wear
masks, gloves and protective eye wear if the optometrist, staff or patient is
known or suspected to have a pathogen, which can be transmitted by airborne,
contact or droplet routes. If an optometrist or staff member is infected with a
pulmonary or other disease that is transmitted by airborne, contact or droplet
routes, then that optometrist or staff member must wear a mask, gloves and
protective eyewear to protect the patient.
(G) Protective eyewear must be washed and
disinfected between each patient or when visibly soiled.
(3) Handling of Sharp Instruments
(A) Precautions must be taken in order to
prevent injuries caused by needles, scalpels, and other sharp instruments or
devices when:
1. Performing procedures,
including but not limited to venipuncture;
2. Cleaning used instruments;
3. Disposing of used needles; and
4. Handling sharp instruments after
procedures.
(B) To
prevent needle stick injuries, optometrists and staff shall be instructed in
the proper handling of needles, including but not limited to when needles must
not be recapped, or purposely bent or broken by hand, removed from disposable
syringes, or otherwise manipulated by hand.
(C) Optometrists and staff must be instructed
to place disposable syringes and needles, scalpel blades and other sharp items
in puncture resistant containers following their use. Puncture resistant
containers shall be provided and shall be located as close as practical to the
area where needles and syringes are in use.
(D) Pursuant to Cal/OSHA's Bloodborne
Pathogens Standard, Title 8, Cal. Code Regs., Section
5193, employers governed by this
rule must establish, maintain, review and update at least annually and whenever
necessary their Exposure Control Plan to reflect changes in technology that
eliminate or reduce exposure to bloodborne pathogens, and establish and
maintain a Sharps Injury Log. This rule applies to all employers with employees
who have occupational exposure to blood or other potentially infectious
materials.
(E) Optometrists and
staff shall adhere to all federal and state requirements for handling of sharp
instruments (including but not limited to the Medical Waste Management Act,
California Health and Safety Code sections
117600-
118360).
(4) Disinfection Requirements
(A) Germicides and/or disinfectants must be
used in order to eliminate most of all pathogenic microorganisms from inanimate
objects, such as medical devices or equipment. If there are questions on how to
disinfect a particular medical device, the office may contact the manufacturer
of the product.
(B) Contact lenses
and carrying cases used in trial and follow-up fittings shall be handled in the
following manner:
1. Discarding the trial
contact lenses is recommended. This procedure however is inapplicable to rigid
gas permeable and non-disposable hydrogel trial contact lenses.
2. Disinfecting between each fitting by one
of the following regimens:
a. U.S. Food and
Drug Administration (FDA) approved chemical disinfection system appropriate for
the contact lens type.
b. Heat
disinfection.
(C) When using eye drops, optometrists and
assistants shall not permit the bottle tip to come into direct contact with the
patient's tears or conjunctiva. If the tip touches the patient, the bottle
shall be discarded.
(D)
Optometrists and staff shall follow employer-established policies and
procedures for routine and targeted cleaning of environmental surfaces as
indicated by the service-delivery setting, the level of patient contact, and
degree of soiling.
(E) Optometrists
and staff shall clean and disinfect surfaces that are likely to be contaminated
with pathogens, especially those in close proximity to the patient and
frequently touched surfaces in the patient care
environment.
(c) Optometrists and staff shall comply with
all minimum standards for infection control practices issued by local, state,
and federal governmental agencies in response to emergency health and safety
situations.
1. New Article
4 (Section
1520) filed 131-63; effective
thirtieth day thereafter (Register 64. No. 3).
2. Amendment of
subsection (d) filed 3-3-78; effective thirtieth day thereafter (Register 78,
No. 9.)
3. Amendment filed 12-1-83; effective thirtieth day
thereafter (Register 83, No. 49).
4. Amendment of section heading,
section and NOTE filed 12-20-2010; operative 1-19-2011 (Register 2010, No.
52).
Note: Authority cited: Sections
3010.1,
3025,
3025.5
and
3110,
Business and Professions Code. Reference: Sections
2544,
2564.5,
3025.5,
3025.6
and
3110,
Business and Professions Code.
