COVID-19 guidelines
Tan Tock Seng Hospital (TTSH) is the national screening centre and main site for management of COVID-19 patients in Singapore. In a recent article published online on April 21 in Graefe’s Archive for Clinical and Experimental Ophthalmology,
https://link.springer.com/article/10.1007/s00417-020-04682-z Louis W. Lim MD and colleagues from the TTSH Eye Centre discussed the strategies and guidelines they developed to maintain a sustainable ophthalmology practice during the pandemic.
The group from the ophthalmology department took a systematic approach to creating solutions that are designed to enhance detection of infected patients and minimise risk of infection transmission. They began by enumerating the challenges affecting ophthalmic practice as they pertain to overall infection control, outpatient care, inpatient care, surgery and protecting the safety and well-being of healthcare workers.
Based on review of antiseptic-disinfectant activity against coronaviruses, they developed recommendations for handwashing and surface cleaning. In addition, they recommend avoiding puff tonometry because of the potential to aerosolise virus from the tear film.
Patients presenting for outpatient services and individuals accompanying them are carefully screened for possible infection based on three criteria and triaged according to the findings. Anyone identified as being at high-risk for COVID-19 is sent for further screening to the national screening centre. Entry is allowed for patients meeting one of the screening criteria if the attending doctor deems the visit is necessary, but the patients are given a surgical mask and brought to an isolation room.
The records of patients with upcoming visits are reviewed by senior ophthalmologists to identify those whose appointment can be safely rescheduled. Patients who miss an appointment in a subspecialty clinic are contacted to reschedule the visit so as to prevent them from incurring a sight-threatening event.
Examination of hospitalised patients needing ophthalmic care aims to maintain interaction at the bedside. If access is needed to equipment that is available only in the outpatient clinic, only patients who are not suspects for COVID-19 can be examined. Ophthalmology inpatients and patients hospitalised for other reasons needing assessment in the outpatient area are seen at separate time slots.
Elective surgeries are being postponed, and surgical patients undergo careful screening for COVID-19. Surgery for patients with COVID-19 is performed with universal precaution measures, including use of goggles and N95 masks for all staff.
Logistics and manpower plans have also been designed that take into account expected demands for personal protective equipment and the possibility that ophthalmologists may need to serve in other departments.
Finally, the group did not neglect the psychosocial toll that the situation could have on staff. Therefore, measures to support mental and social well-being are also being implemented.
