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4 Wash hands thoroughly using bactericidal soap and water or alcohol handrub, then dry hands. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

Procedure

5 Always treat the uninfected or uninflamed eye first. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

6 Always bathe lids with the eyes closed first. To reduce the risk of damaging the cornea and to remove any crusted discharge. E

7 Ask the patient to look up and, using a slightly moistened swab, gently swab the lower lid from the inner canthus outwards. Use an aseptic technique for the damaged or postoperative eye. If the swab is too wet, the solution will run down the patient’s cheek. This increases the risk of cross-infection and causes the patient discomfort. Swabbing from the nasal corner outwards avoids the risk of swabbing discharge into the lacrimal punctum, or even across the bridge of the nose into the other eye. Aseptic technique reduces the risk of cross-infection (Fraise and Bradley 2009, E).

8 Ensure that the edge of the swab is not above the lid margin. To avoid touching the sensitive cornea. E

9 Using a new swab each time, repeat the procedure until all the discharge has been removed. To reduce risk of cross-infection (Fraise and Bradley 2009, E).

10 Gently swab the upper lid by slightly everting the lid margin and asking the patient to look down. Swab from the nasal corner outwards and use a new swab each time until all discharge has been removed. To effectively remove any foreign material from the eye. E

To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

11 Once both eyelids have been cleaned and dried, make the patient comfortable. To ensure patient comfort. E

12 Remove and dispose of equipment. To keep area clean and reduce risk of cross-infection (Fraise and Bradley 2009, E).

13 Wash hands. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

Postprocedure

14 Discuss with the patient any changes post procedure; report any adverse effects to the patient’s doctor. Record the procedure in the appropriate documents. To monitor effectiveness of procedure, trends and fluctuations (NMC 2009, C).

Procedure guideline 9.3 Eye irrigation

Essential equipment

Sterile dressing pack

Sterile water for irrigation (in an emergency, tap water may be used)

Receiver

Towel

Plastic cape

Irrigating flask

Warm water in a bowl to warm irrigating fluid to tepid temperature

Low-linting or lint-free swabs

Light source

Optional equipment

Anaesthetic drops

Sterile/non-sterile powder-free gloves

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. Ask the patient to explain how their eyes feel, if they are able to. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).

To have a baseline understanding of current problems or changes the patient is experiencing. E

2 Instil anaesthetic drops if required. To avoid any discomfort (Marsden 2006, R5).

3 Prepare the irrigation fluid to the appropriate temperature by placing in bowl of water until warmed. Tepid fluid will be more comfortable for the patient. The solution should be poured across the inner aspect of the nurse’s wrist to test the temperature. E

4 Assist the patient into the appropriate position, with their head comfortably supported with chin almost horizontal and the head inclined to the side of the eye to be treated. To avoid the solution running either over the nose into the other eye, to avoid cross-infection, or out of the affected eye and down the side of the cheek (Fraise and Bradley 2009, E).

To reduce risk of cross-infection (Fraise and Bradley 2009, E).

To prevent washing the discharge down the lacrimal duct or across the cheek. E

5 Wash hands using bactericidal soap and water or alcohol handrub, and dry. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).

Procedure

6 If possible, remove any contact lens (see Procedure guideline 9.4 and 9.5. To ensure no reservoir