How to instill eye drops and avoid contamination
Correct procedure is critical for your patients’ best care
Patient drop instillation
We now know how to handle instillation of eye drops in our offices, but what about the patient?
Provide written detailed instructions with simplified language to patients.
Give an in-office drop instillation demo, then ask the patient to give it a try and offer feedback. If a family member accompanied the patient to the visit, suggest the family member try instilling the drops. An actual demonstration to instruct the patient on drop usage is especially critical if there is a language barrier between technician and patient.
One report shows that over 30 percent of patients miss the mark by placing drops on their eyelids or cheeks, over 70 percent touch the tip of the bottle to eyelashes, and only 25 percent comply with closing their eyes for a few moments after instillation. In addition, many patients squeeze out up to eight drops instead of one with each instillation.1
Be cognizant of any physical impairments that could impact patient compliance such as tremors or arthritis.
Contamination and hygiene
Drops contain preservatives to prevent bacterial growth during use. But preservatives cover only certain microorganisms. Good hygiene is required to prevent contaminated drops.
One study showed contamination in 44 percent of residues of eyedrops.2 Single-use containers have the advantage of continuous sterility, but they cost more than stocking larger sizes.
If contamination is suspected, err on the side of caution and discard the bottle.
Don’t forget to routinely check all drops for expiration date. Follow the expiration date on the label if the bottle is unopened. Manufacturers usually advise discarding open bottles 30 days after opening. Train your team to write on the bottle label the date it was opened.
Poor hygiene practices can lead to contaminated medication in the office as well as many illness, such as such as Salmonella, Campylobacter, methicillin-resistant Staphylococcus aureus (MRSA), flu, diarrhea, common cold, and impetigo.
Hand hygiene is a generic term that applies to handwashing, antiseptic hand wash, alcohol-based hand rub or surgical hand hygiene. Specific indications for hand hygiene are simple: Follow hygiene recommendations before and after patient contact to protect the patient and yourself.
Plain soap is good at reducing bacterial counts, but antimicrobial soap is better, and alcohol-based hand rubs are the best.3
Alcohol-based hand rubs may be a better option than handwashing with soap—less time because rubs act faster, less hand irritation, and less flow time. You don’t need to walk to a sink before taking care of the next patient. The time required can end up being a deterrent to frequent or proper handwashing.
The best hand rub technique is to apply the rub to the palm of one hand, and rub hands together covering all surface until dry. Make sure you allow the rub to dry.
Think about all you touch every day: doorknobs, toilet seats, animals, other people’s hands via handshake, and more. Germs live on almost everything. Handwashing is the most important act to help stop the spread of disease.
Evaluate your clinic to improve hygiene best practices by placing hand rubs at entrance to patient lanes and in clinic hallways for easy access. Provide staff with individual pocket sized containers as well.
1. Gupta R, Patil B, Shah BM, Bali SJ, Mishra SK, Dada T. Evaluating eye drop instillation technique in glaucoma patients. J Glaucoma. 2012 Mar;21(3):189-92.
2. Harte VJ, O’Hanrahan MT, Timoney RF. Microbial contamination in residues of ophthalmic preparations. Intern J Pharmaceutics. 1978(1):165-171.
3. Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR. 2002 Oct 25;51.