MAJOR RISKS OF INFECTION

The periocular region is one that is inhabited by a wide diversity of microorganisms with the most common having been identified as staphylococcus aureus, coagulase-negative Staphylococcus spp., Propionibacterium acnes, and coryneform bacteria. Many of these species of bacteria, fungi and viruses that make up the diverse microbiome of the eye are in fact harmless, or have been shown to provide a level of protection against other more pathogenic organisms.

Identification of the more pathogenic types of organisms that are found in the periocular region, most particularly pathogenic bacteria, have been shown to contribute to the majority of eye infections found in optometric practice. Moreover, these bacteria are often found to be resistant to treatment of antibiotics, which makes them particularly difficult to control(1).

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In about 60-70% of cases of infection, the transmission is seen to have occurred in the tissues that make up the sinuses and sinus passages, where the pathogenic microorganisms then come to infect the eye. There are, however, other resultant infections that may occur as a result of direct injury, pre-existing conditions that affect the orbital region and haematogenous spread.

The most common infections that have been found to affect the periorbital region are those associated with: 

• Staphylococcus aureus and the resulting infection called bacterial conjunctivitis.

• Adenovirus, which is highly associated with the spread of viral conjunctivitis.

• Herpes simplex, varicella zoster, molluscum contagiosum, measles and mumps, all of which can cause conjunctivitis.

• Staphylococci and propionibacteria infections, which causes inflammation of the eyelids and is associated with a conditioncalled blepharitis.

When serious enough, and containment of the infection is not possible, consequences are dire and may result in loss of vision, which has been shown to occur in more than 10% of patients(2). Other serious consequences of eye infections are meningitis, intracranial abscess formation and death when infections are unable to be treated. 

In order to prevent the spread and risk of complications of orbital infections, it is essential to both contain the spread of the infection and appropriately manage them as early as possible. 

ADVANCES IN SOLUTIONS APPROPRIATE FOR THE MANAGEMENT OF EYE- AND WOUND CARE

Within the optometry practice, the risk of cross-transmission of eye infections is high as is the risk of community spread when an infected patient enters their home environment. Prevention starts in the optometry practise, which reduces the risk of community transmission of eye infections. 

Since its launch, the disinfectant hypochlorous acid (HOCl) solution Briotech, has been widely used in the healthcare setting, particularly in the wound care, dermatology and dentistry industry. It now shows a significant and important role in eye care with a gentle, yet highly effective approach to infection control(3). 

HOCl is a particularly special compound. It has the same active ingredient in bleach, but with one significant difference: it has a different chemical structure. 

This slight difference is what makes HCOl completely safe for direct contact with the skin and other sensitive mucous membranes such as those found in open wounds and in the ocular region. 

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Using bleach in these areas would cause serious and debilitating injury, while HOCll-containing Briotech has been found to becompletely safe.

The reason for its highly effective yet gentle action is because HOCl is a completely natural antimicrobial. In fact, it is a compound that is actually produced by the human body. The body makes and releases HOCl in response to an immune reaction, which has been shown to kill microorganisms and neutralize toxins on contact.

While extremely potent, HOCl-containing Briotech is a non-toxic and gentle solution that is suitable for daily use. This aloneoffers an appealing application to both infection control and treatment of eye infections in optometry, as well as the control andtreatment of related infectious diseases.

Additionally, Briotech has been shown to provide relief from dry eyes and hordeola, with the HOCl solution also being aneffective treatment option for the symptoms associated with blepharitis and meibomian gland dysfunction, or MGD, whereresearch has shown it to reduces bacterial load as well as promote secretions(4).

Often, surfactant cleaners have been used to treat infections in the optometry practice. Research on Briotech shows that it issafe to use alongside frequent surfactant cleaners, and additionally has been shown to improve outcomes of more severeconditions when the two are used in combination

CONTACT INFECTION A RISK FROM HEALTHCARE WORKERS

There are additional threats that pose the risk of infection in the optometry office, such as those of a healthcare worker. If a healthcare worker or technician has an infected or potentially infected lesion on their exposed skin, for example, recommendations are that it is to remain covered with an occlusive dressing. In order to further reduce the risk of cross-transmission between an infected healthcare worker and a patient, direct contact between the two has to be limited, which may compromise the therapy and interventions provided to the patient as is required in the optometry practice.

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With Briotech, there is a solution. HOCl offers an additional level of protection against the spread of potential infections from the site of the lesion. Briotech can be sprayed directly onto the wound, which kills microorganisms on contant. Additionally, it can be sprayed onto the wound dressing periodically or between patients, providing effective measures against cross-transmission of potential infections. 

Research into Briotech with its HCOl-containing solution, shows a decrease in bacterial load of more than 90%. There have been no detrimental effects or significant alterations to the normal microbial diversity of the human microbiome seen in experiments(5), which makes Briotech a safe, easy and effective solution for prevention of risk of cross-infection between healthcare workers and their patients in the optometry setting, without the risk of negative side effects of frequent use. 

DISINFECTING OBJECTS BETWEEN PATIENT VISITS

There are some optometric devices, such as tonometry tips, that may not not do well when exposed to traditional disinfection methods, still need to be regularly cleaned and disinfected to protect vulnerable patients and to prevent the spread of infections. 

With Briotech’s HOCl solution, these devices and instruments may also be quickly cleaned and disinfected, simply by spraying the device or object after use on one patient and before the use on the next. 

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AEROSOL CONTROL AND SURFACE DISINFECTION USING THE BRIOTECH SOLUTION

Any surface or inanimate object that is located in the environment of the optometry practice may become contaminated with microorganisms and become a source of transmission of infection. These surfaces and objects need to be regularly and thoroughly cleaned as a means to reduce the risk of infection to all of those who may enter the optometry practice, including healthcare workers, technicians, patients and their families. 

Aerosols, which are airborne particles that become contaminated by microorganisms, may settle onto surfaces and other inanimate objects and, depending on the type of microorganisms they contain, may survive for a significant period of time. The longer these particles are allowed to remain in the environment, the higher the risk of transmission of an infection. Persons going about their business within the environment may be easily contaminated, particularly by a person’s hands when they come into contact with them. 

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It is therefore essential to impose good hand hygiene practices and regular cleaning of surfaces and objects across the optometry practise. Implementing these guidelines may, however, pose a significant problem due to high foot traffic across the optometry practice, or hard-to-reach surfaces being left unattended to. 

With Briotech, it can be used to quickly disinfect the hands, be used as a disinfectant fog when sprayed into the environment, sprayed directly onto surfaces, and used to decontaminate any object that is used throughout the optometry practice. We have already shown that it not only effectively inactivated infectious microorganisms including bacteria, fungi, viruses and spores on contact, with it having a high safety profile for use on sensitive tissues, including being an effective disinfectant solution that can be used directly on mucous membranes, spraying it directly into the environment poses little threat to health, which is important should the solution accidentally come into contact with a physician/technician or patient’s eyes. 

Briotech offers more to disinfection and infection control than traditionally used alcohol wipes and solutions. 

Alcohol has more recently been advised against as the sole method of decontamination of high-touch surfaces or devices. Alcohol has been shown to fix proteins and their prions to smooth surfaces, potentially increasing the risk of cross-contamination and infection by increasing their viability on inert objects. 

The bottom line is that the implementation of effective infection control practices across the optometric environment is a critical part of every day operations. While threats of cross-transmission may not appear to be as high a risk as those seen in healthcare fields that perform exposure-prone or invasive procedures, other less obvious sources of contamination may pose significant infection-related risks to both the healthcare provider, their patients and families. Using a simple solution such as Briotech may have a profound and beneficial impact on decreasing the exposure to microorganisms that may be present in optometry practice and significantly reduce the risk of cross-contamination of infection. 

REFERENCES

1. Mohammed, A.A., Ali, M.M. & Zenebe, M.H. Bacterial etiology of ocular and periocular infections, antimicrobial susceptibility profile and associated factors among patients attending eye unit of Shashemene comprehensive specialized hospital, Shashemene, Ethiopia. BMC Ophthalmol 20, 124 (2020).

2. Tomaç S, Turgut S. Orbital cellulitis and irreversible visual loss owing to acute sinusitis. Ann Ophthalmol (Skokie). 2006 Summer; 38(2):131-3.

3. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. 2007;6:e5.

4. Harsch AG, Stout N, Lighthizer N. Beat the blepharitis blues. Rev Cornea Contact Lens. 2016;153(7):12-15.

5. Ono T, Yamashita K, Murayama T, Sato T. Microbicidal effect of weak acid hypochlorous solution on various microorganisms. Biocontrol Science. 2012;17(3):129-33.