Residency Handbook

Baltimore VA Medical Center

Optometry Residency Handbook

Table of Contents:

Mission Statement                                                          Page 2

Program Goals and Objectives                                   Page 2

Selection Procedure                                                       Page 4

Duration of the Residency                                            Page 5

Salary and Benefits                                                         Page 5

Academic Calendar                                                          Page 6

Clinical Practice Protocols                                             Page 7

Resident’s Weekly Schedule                                Page 9

Requirements for Residency Completion               Page 11

Remediation and Dismissal                                           Page 12

Grievance Procedure                                                     Page 13

Clinic Policies                                                                     Page 13

Appendix                                                                            Page 17

Mission Statement:

                Mission:

The mission of the VA Maryland Health Care System, Baltimore VA Optometry Residency program is to provide didactic and clinical training that will enable the resident to diagnose and manage patients with a variety of ocular disease conditions.  High quality eye/vision care will be provided to all patients while adhering to residency supervision guidelines.  Residents will have the opportunity to interact with patients with multiple medical problems.  The program will provide the learning resources to expand upon the didactic base and enable residents to apply this knowledge to clinical care, career-long learning, and the future advancement of optometry.

Program Goals and Objectives: update the rest of goals and objectives

Goal and Objectives:

Goal 1.  To improve the resident’s clinical proficiency, competency and confidence in the diagnosis and management of ocular diseases including glaucoma, diabetic retinopathy, macular degeneration, vaso-occlusive disease, cataract, refractive surgery, and anterior segment disease.

Objective 1.  The resident will be the primary provider, within residency supervision guidelines, for patients exhibiting a variety of ocular disease to include diabetic retinopathy, glaucoma, cataracts, acute red eyes, vaso-occlusive disease, and macular degeneration. The resident will participate in Specialty Clinics, such as Retina, Glaucoma, Cornea, Plastics and Neuro-Ocular Disease.  The resident will also rotate in sub-specialty external rotations in Cornea, Photo-Refractive Surgery, Specialty Contact Lens, Neuro-ophthalmology, Glaucoma and Vitreoretinal Disease.  The resident will be able to observe laser and surgical procedures.

Goal 2.  To develop the resident’s ability to function as a primary care member of the health care team through participation in a multidisciplinary health delivery system which provides the resident with the opportunity to work with patients exhibiting multiple medical problems.

Objective 2.  The resident will have the ability to refer patients for laboratory testing, diagnostic imaging, and specialty consultation within the hospital.  In addition, the resident will see patients referred from other specialists within the hospital for eye consultation

Goal 3.  To increase the resident’s ophthalmic knowledge base and enhance their ability to apply it clinically. 

Objective 3.  The resident will attend weekly Grand Rounds lectures at Wilmer Eye Institute of the Johns Hopkins Hospital. The resident will participate in weekly Baltimore VA Eye Clinic Friday Afternoon Conference, where they will have an opportunity to present Grand Rounds style cases to their peers and attending doctors.  The resident will also participate in a weekly journal club where both landmark and new literature will be critically reviewed. The resident will attend a National Optometry Meeting during the residency year (usually the American Academy of Optometry’s national meeting).

Goal 4.  To develop and enhance the resident's special diagnostic skills including the use of gonioscopy, scleral depression, ocular photography/videography, optical coherence tomography, ultrasonography, fluorescein angiography and other diagnostic imaging  devices.

Objective 4.  The resident will participate in specialty workshops in gonioscopy, automated perimetry, scleral depression, ocular photography, ultrasonography, fluorescein angiograph, OCT,  and corneal pachymetry.  The resident after proper training will perform these tests and procedures routinely in the clinic.

Goal 5.  To develop the communication skills for lecturing and medical publication.

Objective 5. The resident will participate in weekly Eye Clinic Friday Afternoon Conference, present one lecture every other month, and run conference in the winter quarter (during incoming resident interviews). The resident will present a formal lecture at the Pennsylvania College of Optometry at Salus University (PCO) Grand Rounds Program in the springtime.  The resident is encouraged to present a poster or abstract at a National Meeting or submit a paper for publication of original research project, literature review or case report in a medical or optometric journal.  The resident is encouraged to participate in a staff research project when available.

Goal 6. To provide the resident with the necessary academic knowledge and clinical expertise to become a leader in the profession in academics, research, or clinical teaching.

Objective 6.  The residents are encouraged to seek employment opportunities in the VA, academics, co-management centers or multidisciplinary settings to take advantage of the clinical and academic training they received from the residency.  The residents are encouraged to develop teaching programs to future educate optometry students and residents.

Goal 7. To maintain an academic affiliation with a college of optometry and receive and maintain accreditation from the Accreditation Council for Optometric Education (ACOE) of the American Optometric Association

Objective 7. The Baltimore VA will maintain an academic affiliation with PCO and maintain accreditation with the ACOE.

Selection Procedure:

The Baltimore VA Medical Center participates in the Optometric Residency Match (ORMatch) program administered through the National Matching Services (NMS). Therefore, applicants must submit the materials requested by ORMatch to be considered for the residency.  These materials include a copy of the ORMatch application form, curriculum vitae, National Board of Examiners in Optometry (NBEO) scores, optometry school transcripts, three letters of recommendation and a statement of interest.  Candidates can go to the Baltimore VA residency website for further information about the program at:

www.baltimorevaoptometry.com 

Specific requirements the applicant must meet for residency consideration include the following:

                1.  The applicant must have earned an O.D. degree or will have earned such a degree from an ACOE accredited School or College of Optometry prior to the starting date of the program.

                2.  The applicant must successfully complete Parts I, II and III of the NBEO examinations, including Treatment and Management of Ocular Disease (TMOD). At this time there is no requirement to have passed Injections Skill Examination (ISE) or Laser and Surgical Procedures Examination (LSPE).

                3.  Residency applicants will be evaluated without regard to sex, race, religion, age, national origin, or disability.

                4.  Residency applicants must be citizens of the United States to be considered for a VA funded residency position.

                5.  Qualified candidates are asked to visit the facility and interview for the residency position.  Under special circumstances, a telephone or virtual video interview may be granted.

After all the candidates have been interviewed and their supporting material reviewed, the current attending doctors collectively rank the candidates and submit rankings into the ORMatch online system.  If major discrepancies exist, the final ranking is at the discretion of the Residency Program supervisor. Once the program has been notified as to the outcome of the matching process, a letter of appointment is sent to the matched applicant.  The letter confirms the applicant’s acceptance of the position and provides information regarding the duration of the program, hours of attendance, compensation, health insurance availability and benefits. 

Duration of the residency:

The residency begins at the start of the federal pay period immediately preceding July 1 and is completed on June 30 of the following year.  The start date may vary from year to year but will always be within two weeks of July 1 and will be clearly communicated to incoming resident well in advance of the residency. This allows time for mandatory VA and eye clinic specific orientation before patient care begins.  On the first day, the resident will receive a formal orientation from Human Resource Management Service to the Baltimore VA Medical Center. Following the first day, the resident will learn clinic specific protocols and will be trained in the use the computerized record system and diagnostic equipment. The resident will be introduced to their attendings doctors, staff, and external faculty (when possible).  

During orientation, the incoming resident will observe the previous years’ residents to gain a better understanding of clinic flow and procedures.  Time will be spent reviewing an information packet, which is mailed to the incoming resident approximately two months before the start of the residency.  The packet[1] contains detailed information on ocular disease conditions and clinic protocols pertinent to the residency.  The resident is expected to review and understand the information in the packet before the start of the residency. Any outstanding onboarding paperwork will be addressed at this time as well.

Salary and Benefits:

The stipend for the 2024-2025 academic year is $50,582 which is set by the Office of Academic Affairs at VA Headquarters.  This stipend is not contingent upon resident productivity.  Residents are paid on a biweekly basis.

Additionally, residents may participate in a VA-sponsored health insurance plan.  Any health plan premiums will be deducted directly from the resident’s paycheck.  Professional liability insurance is provided through the Federal Tort Claims Act and the Federal Employees Liability Reform and Tort Compensation Act.  This covers both duties performed within the VA Maryland Health Care System as well as duties performed while on external rotations.

The resident accrues both annual leave and sick leave at a rate of one-half day (four-hour equivalent) per pay period.  Sufficient advanced notice for annual leave must be given to allow time for clinic adjustments.  All requests for leave must be submitted in writing and approval is at the discretion of the residency supervisor. Sick leave of greater than two consecutive days requires a note from a physician.  Special authorized absence is granted for attendance at professional meetings, such as the American Academy of Optometry, and will not count against the resident’s annual leave balance.  

All residents are covered by Workers’ Compensation for injuries or illnesses incurred in the performance of duty at the VA Medical Center, provided they have been properly processed as an employee.  If a resident is injured or incurs a job-related illness while on duty at the Medical Center, the resident should seek immediate medical attention from the Personnel Health Clinic.  The resident must report the episode to his/her Service Chief and complete within 24 hours either a CA-1 Form for a traumatic injury, or a CA-2 Form for an occupational disease or illness.

Academic Calendar:

Prospective residents should apply to ORMatch by February 1 of the match year.  Interviews for qualified candidates are generally held in January and February, preferably on Fridays.  The match deadline is dictated by ORMatch and usually falls in March. 

●        June 20, 2023 (June 17, 2024):  Orientation begins

●        July 1: Residency begins

●        August 15, 2023: Abstract for American Academy of Optometry Residents Program due

●        September 30:  Fall resident evaluation due

●        October 1: Topic for PCO at Salus University presentation and written publication due

●        Dec 31:  Midterm resident and faculty and resident program evaluations due

●        Jan 1:  Publishable paper title, outline & abstract due.  PCO presentation completed

●        March 1: Rough draft of written publication due

●        April 15: - First draft of written publication due

●        April/May --- PCO at Salus University Grand Rounds lecture

●        June 1:  Final draft of written publication due

●        June 30: Final evaluation and resident evaluation of program/coordinator

●        June 30:  Residency ends

●        ***Note:  The date of the final presentation given at PCO at Salus University is variable but will be determined several months in advance.  

No clinics are scheduled on the following federal holidays and residents are not expected to be in clinic on these days, unless external rotation is open and performing patient care:

                                Fourth of July                                 New Year’s Day 

                                Labor Day                                         Martin Luther King’s Birthday  

                                Columbus Day                                Presidents’ Day

                                Veteran’s Day                                  Memorial Day

                                Thanksgiving Day                          Juneteenth

                                                             Christmas

Clinical Practice Protocols:

The resident spends [2] four days a week participating in direct patient care at the Baltimore VA.  At a minimum, 1000-1200 patient encounters are required to successfully complete the program.   The resident will be exposed to a large variety of ocular disease patients at the Baltimore VA.  These include glaucoma, diabetic eye disease, macular degeneration, vaso-occlusive disease, neuro-ophthalmic disease, cataracts, uveitis, and other anterior segment abnormalities.   The resident will become proficient in advanced ophthalmic techniques, including, but not limited to, corneal foreign body removal, punctual plug insertion, gonioscopy and fundus contact lens evaluation, scleral depression, and ocular imaging such as B-scan ultrasonography, optical coherence tomography, Optos and digital fundus photography. 

In addition, the resident will spend one day per week outside of the VA at one of six external rotations. Residents will rotate approximately 8 weeks at each location throughout the year. In addition to the external rotations, residents will work directly in VA Retina Attending clinic on Wednesday afternoons. The current external rotations are listed below:

Monday

Elliott Myrowitz, OD, MPH

Wilmer Eye Institute at Greenspring Station

Specialty Contact Lenses and Primary Care Optometry

Tuesday

Eric Suan, MD, FACS

Retina Care Center

Vitreoretinal Disease

Wednesday (alternating)

Roma Desai, OD

Select Eye Care

OD/MD referral practice with surgical observation

Wednesday (alternating)

Esen Akpek, MD

Wilmer Eye Institute

Cornea, Uveitis, Anterior Segment Disease, Ocular Immunology

Thursday

Esen Akpek, MD

Wilmer Eye Institute

Cornea, Uveitis, Anterior Segment Disease, Ocular Immunology

Friday

Amanda Henderson, MD

Wilmer Eye Institute

Neuro-ophthalmology

Friday

Ramya Swamy, MD, MPH

Baltimore VA Medical Center

Glaucoma

Resident’s Weekly Schedule at Baltimore VA:    

Monday               8:00 AM                

                                AM clinic                     Optometry patient care

                                PM clinic                     Optometry patient care

Tuesday               8:00 AM                 

                                 AM clinic                     Optometry patient care

                                 PM clinic                        Optometry patient care

Wednesday        8:00 AM

  AM clinic                    Optometry patient care

                                 PM clinic                    Retina Attending or Optometry patient care

Thursday             7:30-8:45 AM                         Wilmer Grand Round Lecture (virtual)

                                AM clinic                         Optometry patient care

                                PM clinic                     Optometry patient care

Friday                   8:00 AM

 AM clinic                     Optometry patient care

                                PM clinic                     No clinic. Friday Afternoon Conference

WILMER LECTURES:

Residents are required to attend Thursday Grand round lectures at the Wilmer Institute of Johns Hopkins Hospital.  Lecture schedule is available at https://events.hopkinsmedicine.org/wilmer-grand-rounds/.

FRIDAY AFTERNOON CONFERENCE:

FAC is held every Friday afternoon at the Baltimore VA.  Attendance is mandatory. Residents are responsible for management of both the resident and student lecture schedule. The residency supervisor is responsible for management of the attending lecture schedule. The schedule is to be set up on a rotating basis to allow for equal distribution of opportunity for each resident and student to be able to present. During the winter quarter, the residents will lead conference, as the attending doctors will be participating in residency interviews.  Topics and lecture dates should be posted well in advance to allow for appropriate preparation and avoidance of redundant topics.  In addition to lecture, journal club will be held during FAC. The articles selected will range from landmark trials to current and evolving topics. The article will be selected by the attending running FAC and disseminated to the residents and students in the days preceding journal club. If there is an article of particular interest to a resident, they may suggest it be included at the attending doctor’s discretion.

CLINIC SCHEDULE  

It is important to try to see patients as close to their scheduled times as possible, hopefully within 15 minutes of their scheduled appointment.  To accomplish this, it is imperative that the clinics begin on time.  You should be at clinic 15 minutes prior to the first patient to allow time to log into your workstation and prepare the first patient’s chart. On Thursdays you are expected to report to clinic immediately following Wilmer Grand Rounds (if held in person), or to attend Grand Rounds on an eye clinic computer (if held virtually). Except for Thursdays, clinic begins at 8:00AM.  One-half hour is provided for lunch.  The clinic day is over after the last patient is seen.  The clinic is scheduled to end around 4:30PM but may end later depending on the patient load.  The residents are not on scheduled call and there are no weekend or evening clinic hours.

EXTERNAL ROTATIONS:

The resident will rotate outside the VA clinic in subspecialty areas as outlined previously. The resident will be assigned one subspecialty approximately every eight (8) weeks. The residents are supervised by the directors of the subspecialty clinics.  External rotations generally begin 6 weeks after the start of the residency program and continue until the end of the program.

SUPPLIES/MEDICATIONS:

You are responsible for keeping your exam room functional and stocked with the necessary supplies.  You are not to take items from another exam room.  If you identify a missing supply or piece of equipment, immediately notify an attending doctor, so that it can be replaced. It is your responsibility to report any broken or malfunctional equipment to an attending doctor immediately if noticed.

Medications are stored securely in the Omnicell in the hallway. Ask an attending or a technician to obtain needed diagnostic or therapeutic medications.

MAINTENANCE AND REPAIR:

The clinic equipment is maintained and repaired by Biomedical Engineering.  If repair or maintenance is indicated, please alert an attending doctor so a work order for repair can be placed.  Non-technical repairs such as plumbing, lighting, painting, etc. are handled by Engineering Service.  An attending doctor can enter a work order request in the computer or phone Engineering directly if it is an emergency.

Requirements for Residency Completion:

To successfully complete the residency program and receive a residency certificate from the Pennsylvania College of Optometry at Salus University, the resident will:

●        Attend and complete all assigned clinic sessions in a professional manner and remain in clinic until all patients are cared for or the clinic preceptor states otherwise

●        Maintain patient care log in Meditrek as assigned (with a minimum of 1200 patient encounters)

●        Attend and document all other assigned activities, including external rotations, didactic, and scholarly activities

●        Complete the required manuscript of publishable quality

●        Present a Grand Rounds at PCOSU, as well as periodic lectures at Friday Afternoon Conference

●        Achieve satisfactory performance evaluations

●        Complete all assigned evaluations of the residency program and faculty

Upon termination of the appointment as a VA paid resident, the resident must complete “Employee’s Clearance from Indebtedness” Form 3248.  This form is available from the Residency Supervisor.  As part of this clearance procedure, all medical records must be completed and all property of the Medical Center must be returned, including keys, uniforms, library books, parking passes, and photo-identification badge.  Final paychecks will not be released until the clearance procedure and the form is fully completed.  

Remediation and Dismissal:

Any rating of “below expected levels” on the resident’s evaluation in any of the categories of Clinical Skills, Interpersonal Skills, or Ethics and Professionalism, as well as any patient encounter where care is deemed to be seriously inadequate or dangerous, necessitates remediation.  The remediation plan will be developed by the Program Supervisor and approved by the Program Director, and should include specific “benchmark” goals (e.g. performance of gonioscopy with accurate findings documented on four patients, examination of ten diabetic patients with accurate findings confirmed by attending, etc.), and specific activities to reach these goals, such as supervised workshop in procedures, selected assigned readings, etc.  The plan must specify a completion date, at which time the Program Supervior will evaluate and notify the resident as to whether remediation was satisfactorily completed.

Failure to complete a remediation program may be grounds for dismissal.  Violations of residency, VA, or affiliate policy may also be grounds for dismissal.  Certain violations such as endangering a patient or patient abuse will be grounds for immediate dismissal.  In other cases, such as repeated failure to complete clinic assignments, the resident would generally be counseled verbally after the first occurrence, notified of a subsequent violation in writing, and finally dismissed if the violation is repeated.  Copies of written notifications of violations would be sent to the Program Director and the Chief of the Optometry Section.

CONDUCT VIOLATION:

Each resident is expected to abide by the Department of Veterans Affairs’ regulations and policies so that the highest possible standards of conduct, honest, integrity, impartiality, and ethical behavior are always maintained.  When these standards are not met, prompt and just corrective action will be taken by the Residency Supervisot and reviewed by the Residency Director and the Chief of the Optometry Section.

DISCIPLINARY ACTION/TERMINATION:

Action taken may include closer supervision and counseling, formal written censure, or dismissal based on, and in proportion to, the severity of the infraction.  Progressive discipline will be used for repeated minor offenses and may result in dismissal from the residency program.  In all cases, the resident will be specifically informed of the charges and given an opportunity to respond to them.  If the resident feels that the action taken by the Residency Supervisor is inappropriate or unwarranted, a review by the Chief of the Optometry Section may be requested.  If the matter remains unresolved, the resident may request a review by the Chief of Staff.  This request must be made in writing giving the specific reasons why the resident feels that the action is unjust and must be filed within seven days of their notification of the action.  The information provided by the resident and all other information pertinent to the case will be reviewed by the Chief of Staff and a final decision will be made.  This decision will be provided to the resident in writing.

Grievance Procedure:

A grievance is a specific complaint by a resident that the established policies and procedures pertaining to employment conditions and disciplinary actions are not being properly applied in his/her situation.  A grievance is not a minor irritation or gripe that can and should be tolerated, nor is it a complaint that the established benefits, policies, or procedures are unsatisfactory.  This grievance procedure is available to all full-time residents and fellows who are paid by the VA Maryland Health Care System. 

A resident who believes he/she is being treated unfairly may raise a question in the form of a grievance and will receive an answer from management.  Whenever possible, informed resolution of complaints at a level as close to the source of the problem as possible should be attempted.  The Residency Supervisor is always available for advice, discussion, or consultation on any matter a resident considers pertinent.  If the nature of the grievance is such that the resident feels the matter cannot be taken up with his/her first-level supervisor, it may be presented to the appropriate person at the next higher supervisory level.

Grievances should be initiated and discussed with the immediate supervisor within fifteen days of the date of the incident.  The basis of the grievance and the corrective action desired should be carefully presented and discussed.  If the matter cannot be resolved, the resident will be advised to present his/her grievance progressively to the next higher level until the Chief of Staff has given it consideration.  The resident should receive an answer within five workdays after consideration of the grievance by the Chief of Staff.  If it cannot be satisfactorily resolved by the Chief of Staff, the resident may then present the grievance, in writing, to the Medical Center Director for a decision.  The Director will render a decision to the resident within fifteen calendar days.  The Medical Center Director’s decision is binding, and the resident has no further appeal action.  The Residency Supervisor will maintain written records of receiving, adjudicating, and resolving any resident complaints.

Clinic Policies:

Optometry Resident Supervision Policy for all in house clinics

1. The Department of Veterans Affairs mandates that all residents receiving training at a VA hospital be supervised by an attending staff doctor who must be physically present in the clinic.  Residents will complete full examinations for each patient and present the case to one of the attending doctors in the clinic.  The level of supervision will change during the residency year, as the staff doctors become more confident in the resident’s clinical and management skills.

2. The resident will start and complete a chart note for each patient they examine.  The resident will sign the chart note after completion of the examination and discussing the case with one of the staff attendings.  The staff attending is required to co-sign all resident’s chart notes.

3. There will be four levels of supervision:

   1. Level 1 – This will be the entry level for all residents.  At this level, residents will perform ocular examinations of patients and formulate diagnosis and treatment plans.  The attending doctor will verify clinical findings by physically examining the same patient and assessing the accuracy of the diagnosis and treatment plan. 

   2. Level 2 – This level of supervision allows the resident to discuss routine cases without physical examination of the patient by the staff attending. More complex cases require the staff attending to also examine the patient.  Minor invasive procedures (foreign body removal, punctal plug insertion) are performed with an attending in the examination room. This level of supervision also allows the resident to rotate outside of the VA clinic in the external rotation clinics.   

   3. Level 3 – The residents are granted therapeutic prescription privileges for uncomplicated cases with staff consultation.  If the diagnosis or management is in question, or if the condition is refractory to treatment, consultation with or referral to an appropriate subspecialist will be obtained with proper documentation in the patient's chart. 

   4. Level 4 – At the nine-month interval, with approval of the program director, the residents may be permitted to supervise 4th year optometry students.  The case must be reviewed with one of the staff attendings and the patient record must be co-signed by the staff attending per VA supervision guidelines. 

4. It is expected that the resident will have Level 1 supervision for the 1st six weeks of the residency program with Level 2 supervision for the next 3-6 months.  At six months, the resident will generally receive Level 3 supervision, and Level 4 supervision will be obtained at nine months.  The residency program director will have final say on the level of supervision depending on the individual competency of each resident. 

Infection control:

                All health care workers in direct patient contact areas must:

●        Use an alcohol-based hand rub or antimicrobial soap and water to routinely decontaminate their hands before and after having direct contact with patient

●        Put gloves on when contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin could occur. Remove gloves after caring for patient. Do not wear the same pair gloves for the care of more than one patient, and do not wash gloves between uses with different patients. 

●        Use an alcohol-based hand rub or antimicrobial soap and water to decontaminate hands before and after removing gloves 

●        Wash hand with non-antimicrobial or antimicrobial soap and water whenever hands are visibly soiled or contaminated with body fluids, before eating, and after using the restroom. 

●        Use an alcohol-based hand rub or antimicrobial soap and water after contact with a patient's intact skin (as in taking a pulse or blood pressure, or lifting a patient). 

●        Use an alcohol-based hand rub if moving from a contaminated body site to a clean site doing patient care. 

                Additionally, all health care workers who provide direct, hands-on care to patients shall not wear artificial fingernails or extenders.  Natural nail tips will be kept less than 1/4 inch in length. Nail polish, if worn, must be in good repair with no cracks or chips. 

                Contaminated needles and other sharps are not bent, recapped, or removed unless: 

●        It can be demonstrated that there is no feasible alternative. 

●        The action is required by specific medical/dental procedures. 

●        In the two situations above, the recapping or needle removal are accomplished through the use of a medical device or one-handed technique.  (This technique involves placing the cap on a flat surface where it will not roll.  The resident holds the syringe in one hand and places the other hand behind his or her back.  The syringe is slid into the cap.  Once accomplished, the other hand may be used to secure the cap in place.)

                Contaminated sharps will be placed in rigid puncture-resistant containers designed for sharp disposal.  Other contaminated instruments will be placed immediately in a puncture-resistant, leak-proof container labeled with a biohazard warning, and then transported to Supply, Processing, and Distribution Section (SPD).

                Personal protective equipment is provided by the VA.  Gloves are worn for anticipated contact with blood, pus, feces, urine, or oral secretions.  Employees with dermatitis, cuts, open areas, etc., should wear gloves when there is risk of drainage.  Alternative gloves are available to employees who are allergic to the gloves normally used. Surgical Masks are not currently required for patient care unless the patient requests the provider wear one or in cases where droplet precautions are indicated.

                Routine cleaning and disinfection of environmental surfaces (especially frequently touched surfaces) is required.  Diagnostic equipment that contacts a patient’s eye must be properly disinfected or disposed of in a safe manner.    

●        Tonometry:  Using aseptic technique, apply a new tonometer tip to the holder before measuring intraocular pressure.  Dispose of the tip in a regular garbage bag immediately after the procedure.

●        Gonioscopy/Fundus contact lens:  Using aseptic technique, remove the gonioscopy lens from the sterile, autoclaved bags.  After the procedure, dispose of the lens in a regular garbage bag.

Facility safety:

●        Accidents/Injuries:  If you are injured, immediately notify your supervisor.

●        Electrical safety:  Inspect all electrically powered equipment before use.  Do not use equipment with frayed cords or broken plugs.  Report defective equipment to your supervisor.  

●        Equipment safety:  Know how to use equipment properly and inspect for defects prior to use.  Remove any defective/inoperative equipment from use and report it to your supervisor.

●        Fire:  Upon discovering or suspecting a fire in the area, perform RACE: 1) Rescue anyone in danger from the fire, 2) Activate the nearest fire alarm pull station and have someone call the fire department  3) Confine fire spread by closing all doors, and 4) Extinguish if the fire is small and you are properly trained.

●        Hazardous materials:  Become familiar with the hazards associated with the chemicals you use before you use them.  Ensure all containers are properly labeled with the name of the product, manufacturer’s name and address, and appropriate hazard warnings.  Know the location of your chemical inventory and material safety data sheets (MSDS).  In the event of a chemical spill, notify the fire department.

Additional infection control and facility safety policies are always available on the VA Maryland Health Care System intranet at: http://vaww.vamhcs.med.va.gov/Departments/InfectionControl/WhatWeDo/Policies.htm 

http://vaww.vamhcs.med.va.gov/Departments/engineering/Safety/Safety.htm

Appendix: available upon request