Instrument Disinfection Between Patients with a Torn Contact Lens Case
You are assisting in a busy clinic. Between patients, you notice that the Goldmann tonometer prism was wiped with an alcohol swab and immediately reused on the next patient without drying. The same patient's records show a history of herpes simplex keratitis in the left eye 2 years ago. The clinic's written policy says tonometer prisms must be disinfected with a 10-minute soak in a recommended disinfectant or use of a disposable tip, and that alcohol wipes are acceptable only if the manufacturer specifies and the surface is allowed to dry. A box of disposable tips is available but the physician is running 20 minutes behind.
1. What is the infection-control problem, and what should you do right now?
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Problem: an alcohol wipe followed by immediate reuse does not meet the clinic's policy and may not achieve adequate disinfection, especially against herpes simplex, and residual alcohol on the prism can injure the cornea. Reusing a prism on a patient with a history of HSV keratitis raises cross-contamination risk for subsequent patients.
Immediate action: stop the reuse, remove the prism from service, and switch to a disposable tip for the next patient. Inform the physician and the office manager of the breach. Clean and disinfect the prism per policy (soak in the recommended disinfectant for the specified time) or discard if the manufacturer requires. Document the event per clinic protocol. Do not improvise a shorter soak to save time.
2. The physician says "just use the alcohol wipe, it's fine." How do you respond professionally, and what would you document?
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Respond respectfully but clearly: the clinic's written policy and the manufacturer's instructions require either a 10-minute soak or a disposable tip, and alcohol alone with immediate reuse does not meet that standard and risks corneal exposure to residual alcohol. Offer the disposable tip as the fast solution that keeps the schedule moving. If the physician still directs otherwise, escalate to the office manager or infection-control lead rather than silently complying.
Document: the time, the prism involved, the disinfectant used, the patient identifiers, the physician's instruction, the action taken (disposable tip used), and any escalation. Documentation should be factual and contemporaneous, not editorializing.
3. What preventive step would you recommend to avoid this in the future?
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Keep disposable tips stocked at every lane so the fast option is always available; post the disinfection policy at each station; build a short soak-and-dry step into the workflow with a timer; and include the policy in staff orientation and periodic refreshers. A brief huddle note or log of disinfection times can make compliance visible. The goal is to make the compliant path the easiest path so time pressure does not drive shortcuts.