You must decontaminate your hands regularly and thoroughly to prevent the spread of infection.¹⁹⁰  You can reduce the risk of transmitting infections such as methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile (C.diff) if you use fastidious hand hygiene.  

There are a number of organisms present in healthy skin: some are resident organisms (skin commensals) and are mostly harmless, although some are known to cause mild eye infections. You can reduce the number of skin commensals left on your skin by washing with an antiseptic detergent preparation, instead of soap and water. 

Other transient organisms can be deposited on the skin, including certain gram-negative bacteria which could lead to more serious corneal infections. You can remove most of these transient organisms by thoroughly washing with liquid soap and water (use warm water where available).

You must decontaminate your hands, as appropriate: 

1. before every episode of direct patient contact or care
2. after every episode of direct patient contact or care
3. after any exposure to body fluids (including tears)
4. after any other activity or contact with a patient’s surroundings that could potentially result in hands becoming contaminated
5. before putting on and after removing gloves.

You can use an antibacterial handrub between seeing patients during a clinic session. Alcohol is not a cleaning agent, so you should perform a proper handwash with soap and water at the beginning and completion of the clinic session, as well as after exposure to body fluids or if your hands are visibly soiled or dirty. Alternatively, you can wash your hands between patients.

You should also decontaminate your hands:  

1. before (and after) contact lens insertion or removal
2. after going to the toilet
3. when hands are visibly dirty
4. before (and after) contact with ocular surfaces and adnexae
5. before (and after, if necessary) administering medication, for example eye drops
6. after any possible microbial contamination, e.g. contact with body fluids, wounds, or clinical waste.

You must ensure you follow the correct procedure for hand washing as set out in each nation's infection prevention control manual (NIPCM). You should ensure you and your team receive regular handwashing training.  

• NHS England » National infection prevention and control manual (NIPCM) for England 
• National Infection Prevention and Control Manual: Home (scot.nhs.uk) 
• About the Manual - Public Health Wales (nhs.wales) 
• PHA Infection Control | (niinfectioncontrolmanual.net) 

Hand hygiene agents include: 

1. liquid soap
2. antiseptic
3. antibacterial (alcohol-based) handrubs.¹⁹¹

Handwashing with soap and water is effective in removing most transient microorganisms and is usually all you need to prevent infection. In clinical areas, you should: 

1. use liquid soap in disposable containers or containers that are washed and dried before refilling
2. never top up the containers.

Antiseptic agents are effective in reducing both transient and resident microorganisms. Chlorhexidine (4%) preparations have a residual effect against transient organisms influencing the survival time on hand surfaces.¹⁹² You should use an antiseptic agent: 

1. before and after direct contact with patients in clinical settings, where there is an outbreak of antimicrobial resistant organisms (e.g. residential or nursing homes)
2. where there is heavy microbial contamination
3. before performing invasive procedures or minor operations.

Antibacterial (alcohol-based) handrubs rapidly destroy microorganisms on the skin's surface. However, they are not a cleaning agent and you should not use them if hands are visibly dirty or contaminated with blood, bodily fluids or other potentially infectious agents. They are especially useful in situations where handwashing and drying facilities are inadequate e.g. domiciliary visits, or between patient contacts.

You should not use alcohol handrubs as a substitute for handwashing with soap and water, when these are available. You are strongly advised to wash your hands at the start and finish of a session. Alcohol handrubs are not effective against Clostridium difficile spores or norovirus (a cause of viral gastroenteritis), so you should use liquid soap and water in situations where there is potential for the spread of these organisms.

The standard for efficacy of hygienic handrubs uses a reference of 60% isopropyl alcohol. However, to be effective against staphylococci, including MRSA, handrubs must contain 70% of either ethyl or isopropyl alcohol.

Using an unperfumed alcohol-based handrub prior to contact lens insertion has been shown to have a negligible effect on ocular comfort, redness and lens wettability. You should ensure that the handrub has been allowed to dry on the hands as instructed by manufacturers (often 15 seconds). 

To maintain the integrity of your skin, you should:

1. cover cuts and abrasions to skin with waterproof dressings (preferably coloured)
2. dry your skin properly with paper hand towels after washing
3. use hand cream as appropriate; you should not share jars of hand cream with others.

You should keep up to date with immunisation, including: 

1. tetanus
2. polio
3. tuberculosis
4. hepatitis B. 

You should minimise the risk of airborne infection by:¹⁹³

1. covering your nose and mouth and using a tissue whilst coughing or sneezing
2. disposing of used tissues in the nearest appropriate receptacle as soon as possible¹⁹⁴ 
3. performing hand hygiene after coughing or sneezing
4. not working in clinical practice if you have an acute upper respiratory tract infection, such as the common cold
5. avoiding touching your mouth, eyes and nose unless you have performed hand hygiene
6. attach a breath guard or shield where appropriate, such as to the slit lamp or keratometer 
7. you must comply with appropriate health and safety measures for adequate ventilation throughout the practice.

You should risk assess whether to wear personal protective equipment (PPE) 

1. where you anticipate exposure to protect against direct contact with blood, body fluids or non-intact skin

2. while handling and cleaning decontaminated equipment 

All PPE should be: 

3. located close to the point of use 

4. single-use only items, unless specified by the manufacturer or public health body. Reusable PPE items, must be decontaminated according to the manufacturer’s recommendations

5. stored appropriately 

6. disposed of after use into the correct waste stream.

You should wear a fluid resistant surgical face mask (FRSM Type IIR) when 

1. Performing procedures when in close proximity to the patient  

2. You consider there is a risk of respiratory infection  

3. There is a public health requirement to wear one, such as during a pandemic, Unless the relevant national or local public health guidance recommends an alternative specification and level of protection.¹⁹⁵

You should wear gloves, and apron as appropriate, where you consider there is a risk from: 

1. invasive procedures
2. contact with:
   • non-intact skin
   • mucous membranes
3. exposure to:
   • blood
   • bodily fluids, including tears
   • secretions
   • excretions
   • sharp or contaminated instruments
   • other contaminated material, for example dressings.

You should consider the following factors when deciding to wear gloves and aprons: 

1. whether the patient has an overt infection, such as ulcerative blepharitis or acute viral or bacterial conjunctivitis
2. the degree of contact with bodily fluids or infected tissue
3. the consequences of infection.

You do not have to wear gloves or aprons to:

1. carry out a normal eye examination
2. perform minor procedures where there is no likelihood of cross-inoculation with bodily fluids
3. fit contact lenses.

You should practise thorough hand hygiene before wearing, and after removing, gloves, as they may not provide complete protection.

You must dispose appropriately of gloves and aprons that you believe are contaminated.

You can use non-sterile disposable examination gloves. However, if you undertake a procedure which requires a sterile environment, you must use sterile surgical gloves. You must not use polythene gloves for clinical interventions. If you choose to use latex gloves you should be aware that these might cause allergic reactions such as asthma in sensitised individuals^196, 197.

You must only use sharps where necessary.¹⁹⁸

If you need to use sharps, you should use and dispose of them safely by: ¹⁹⁹

1. using equipment with safety devices
2. using safe handling and disposal procedures.

You should follow the NICE guidance on sharps containers.²⁰⁰