BHREI COVID-19 Guidance for Operational Safety

BHREI COVID-19 Guidance for Operational Safety 

Updated April 20, 2020

Black Hills Regional Eye Institute is committed to demonstrating responsible community leadership as we define and implement safe clinical operations for our patients, staff, and providers so that we may provide eye care services while respecting the ongoing needs for COVID mitigation in our society.  More than ever, we want to remain true to our core values of being friendly, compassionate and respectful to each person we interact with in the office.

Patient Screening and Safety

  • Each clinic should have a staff person at the entry to assist with screening and direction.
  • Patients should enter for their appointment by themselves or if they need assistance, bring only one person. If possible, drivers should remain outside or in their vehicle.
  • All staff, patients and caregivers will have their temperature taken on entry to the clinic.
  • Individuals with temperatures greater than 100.0 will not be allowed into the clinic. The physician will be notified of patients presenting with a high temperature.
  • All people entering the clinic are asked to wear their own facemask when coming into the clinic.
  • Those who fail to bring a mask will be given one to wear.
  • Signs should be posted at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette (Coronavirus Factsheets).
  • Clinic schedules should be controlled to allow for 6’ physical spacing in the waiting and testing areas.
  • All patients shall be questioned about pertinent symptoms per CDC guidelines on entry to the clinic.
    • In the last two weeks, have you been in contact with someone who was confirmed or suspected to have Cornonavirus/COVID 19?
    • “No”…Are you experiencing a fever, cough or shortness of breath?
  • Readily accessible supplies are available such as tissues, hand soap, waste receptacles, and alcohol-based hand sanitizer.
  • Patients should be coached to not speak when being closely examined or working with staff.

No Touch Greetings

Employees should use “No Touch” greetings.  A masked smile followed by a simple “Hello”, your name and regular explanations will suffice.  Do not hug patients.


Physical Distancing in the Clinic

  • Any necessary paperwork should be emailed to patients before their appointment via the patient portal.
  • Ask patients to maintain their distance if there is a wait to check-in.
  • Entry/exit doors and internal doors within clinics will either be open or maintained with appropriate cleaning intervals to allow minimal patient/staff potential contamination
  • Most check-in areas will have protective screens between staff and patients.
  • Counters and signature stylus should be frequently wiped down.
  • Seating will set to provide for appropriate spacing.
  • Testing equipment shall be spaced to allow for 6’ distancing between patients.

Designated Exam Lane for Sick Patients

  • All locations have a designated lane(s) closest to the check-in area for use for patients who answer affirmatively to screening questions. All staff should be aware of the lane to be used.
  • For patients believed to be potentially ill with the virus or who report having come into contact with an individual infected by the virus, providers and technicians will follow the CDC and American Academy of Ophthalmology procedures for gowns, gloves, masks and eye protection.
  • Any time a lane is used to care for a patient in need of isolation, it should be thoroughly wiped down.

Handwashing and Sanitizing – The Best Way to Not Get Sick

  • When caring for patients, visible hand sanitizing and surface cleaning will bring them peace of mind.
  • Proper handwashing technique signs are everywhere in the practice. Follow the rules.
  • Sanitize your hands or the gloves you are wearing often for at least 20 seconds each time.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Putting a tissue on a table contaminates the surface of the table with germs.
  • Avoid touching your eyes, nose and mouth.

Personal Protection

  • All staff members who interface with patients must wear a mask. Minimize mask removal and avoid touching your face.  Employees should try to use one mask each day.  Some masks may become contaminated and loose.  These need to be replaced.
  • Slit lamp protective shields are available in every clinic.
  • Best practices for examining patients include the use of a mask, gloves and eye protection. Goggles should be available for use in each clinic location.
  • Please read the reference below for CDC recommendation on facemasks.

  • Supervisors shall monitor the condition of masks worn by staff and provide replacements as indicated.
  • Staff wearing gloves during clinic operations should sanitize between patient encounters by washing or using hand sanitizer.
  • Gloves shall be replaced if breached or removed.

Lane Cleaning

  • Wipe surfaces that contact the patient’s face with alcohol wipes between each patient – chin rests, head bands, breath shields, occluders, handle bars and near-reading cards.
  • Each lane should be wiped down including the chair seat and arm rests at the end of each clinic session (twice daily) when rooms are “closed”.
  • Tonometer tip replacement/disinfection protocol should be followed very strictly. If Goldmann tips are used and are crazed (fine patina of cracks) these should be discarded and replaced with new ones.
  • Discontinue use of paper guards if currently using.
  • Technicians/scribes should periodically wipe down the keyboard and mouse in the exam lanes.
  • All toys and magazines should be removed from exam lanes and waiting areas.

Waiting Room Cleaning

  • Staff should wipe down waiting room chairs and tables at the close of the morning and afternoon sessions.
  • High touch areas such as door handles, counter tops, dispensing tables, etc. should be wiped down periodically through the day and immediately after assisting a patient demonstrating respiratory symptoms.

Patient Illness

If we become aware that a patient who has recently been in our office has tested positive for COVID-19, we will notify the patient’s known close contacts in the office.  All contacts can continue to work while wearing a mask, but they will be screened with temperature checks prior to work and will self-monitor for other signs of illness.

If You Are Sick

  • If when you come to work, it appears you have acute respiratory illness symptoms (i.e. cough, shortness of breath) or you become sick during the day you will be separated and sent home.
  • If you are sick with COVID-19 or suspect you are infected with the virus, contact your PCP to arrange for testing. Stay home except to get medical care.
  • If an ill employee tests positive for COVID-19, all contacts in the clinic may continue to work masked while monitoring for fever twice daily and watching for other signs of illness.
  • If an employee is able to obtain a negative test, they can return to work once fever resolves and respiratory symptoms start to improve.
  • Without testing, the employee can return to work the later of:
    • 72 hours after fever has resolved without the use of fever-reducing medication and respiratory symptoms have resolved.
    • 7 days have passed from the start of symptoms.
  • CDC link for what to do if you are sick…


If You Can’t Work

In the event of quarantine, illness, child-care shortage or school closures you may need to stay home to care for yourself or family members.  In addition to our regular leave policies, EI complies with the requirements of the Federal Families First Coronavirus Response Act (FFCRA).  The FFCRA provides employees with Emergency Paid Sick Leave and Emergency Paid Family and Medical Leave for those who are affected by the COVID-19 pandemic.  This Policy will be in effect from April 1, 2020 through December 31, 2020 other than the 8-week period of the PPP loan which is April 6-June 1st.

Stay Informed

  • The CDC Information on all things virus related can be found at

  • The Oregon Health Authority is a good source of current information and much of the information is presented in multiple languages.