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Patients tend to take it for granted that their doctor's office will be clean and antiseptic - but if they see clues that
imply otherwise, it can spoil an otherwise good experience. And good experiences are what keep patients returning and
recommending your practice to others. Patients are not likely to tell the doctor or staff that their office is unclean;
it's too confrontational and socially rude. Conversely, patients who actually view proactive hygienic efforts first-hand
develop a feeling that everything in the practice is high quality.
Even if your office is clean, and even if any instrument that contacts the patient is disinfected via proper protocol, it's
a good idea to review office hygiene from the patient's point of view. Do they perceive the cleanliness? Do they see
evidence of it, or does all cleaning effort occur out of view?
A good example of proactive hygiene is having a technician routinely wipe the faceplate of the phoroptor with an alcohol
swab in front of the patient, before it is used on that patient. Do you currently do this? Is it really necessary before
every patient? I think so, even if the main point is to alleviate any concern that patients may have about putting their
face up to it. Many people have such concerns - and legitimately so. Your office serves the general public and the
phoroptor touches each person's face. People today are concerned about germs in public places. I know I'd like to see it
Optometrists often don't even see the patient's side of the phoroptor - but I'll bet we've all seen a residue of face
make-up from a prior female patient at some time. Patient's will see it too as it comes close to them, especially those
3.00 diopter myopes!
Many offices have an assistant get the exam room ready after each patient, and steps are taken then to clean instruments,
and that can work OK, but consider letting the next patient see her do it, instead. Use of tissues on chin rests is also
highly recommended, along with wiping the forehead rests in front of patients.
It's a good idea to check out the view from the patient's side of instruments frequently. This includes the table
supporting the pre-test instruments, the slit lamp, and the chair and stand. There can easily be an accumulation of dust,
bits of tissue and general grunge that the doctor can't see. It does not present a good example. Remember that computers
are dust magnets because the internal cooling fan pulls air. Exam room computers need attention, but so do the ones in the
business office, as patients look over the counter and see the side the staff misses.
Who should do it?
Of course, all technicians should be trained to perform the little cleaning details that can be done in front of patients,
and it's important to review this at staff meetings to be sure the procedures have not suffered from employee drift (the
gradual change in technique that occurs when no one is actually supervising it).
In my practice, we assign a side job to every employee so they each have an extra duty to manage when they are not doing
their primary job. One technician on our staff has the job of equipment hygiene. This hygiene officer is trained in the
proper cleaning technique for instruments, including lenses and mirrors, and she checks them on a daily basis and cleans as
needed. Our contracted general housekeeping staff is not trained to care for our medical instruments, and they are
instructed to never touch them. They clean the general office (which also must be kept meticulously clean), not the
It takes time to concentrate on the "little things" in a practice - and time is one thing we can all be short of. But those
things actually aren't so little; it's an accumulation of them that builds success.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
A Proud Supporter of
Send questions and comments to firstname.lastname@example.org.
Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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