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Detection of Coronavirus Disease 2019 Viral Material on Environmental Surfaces of an Ophthalmology Examination Room

Educational Objective
To understand how to prepare for the risks patients who are asymptomatic carriers for COVID-19 may pose in ophthalmology examination rooms
1 Credit CME
Key Points

Question  Do ophthalmologists run the risk of encountering individuals who are asymptomatically carrying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when maintaining elective examinations during the coronavirus disease 2019 pandemic?

Finding  In this quality improvement study of samples from 1 examination room, slitlamp breath shield and phoropter surface samples were analyzed by real-time polymerase chain reaction. In 2 of 7 postexamination samples, SARS-CoV-2 viral material was found.

Meaning  Despite triage systems to exclude patients with coronavirus disease 2019, viral material was found on ophthalmology examination room surfaces; however, the infectivity of the virus samples was unknown.


Importance  The new coronavirus disease 2019 (COVID-19) pandemic poses a particular threat to health care professionals; however, there appear to be no objective data that demonstrate the risks of encountering individuals carrying the virus asymptomatically in the case of maintained elective examinations.

Objective  To investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the environmental surfaces of an ophthalmology examination room after visits by patients who were asymptomatic and had passed COVID-19 triage.

Design, Setting, and Participants  This is a quality improvement study conducted 1 week after the first officially confirmed COVID-19 case in İzmir Tepecik Training and Research Hospital, İzmir, Turkey, on March 20, 2020. A triage system was used to determine the risk of COVID-19 from patients who were asymptomatic and presented for examination in an ophthalmology clinic. Real-time polymerase chain reaction testing was used to detect the presence of viral RNA material in samples from the biomicroscope stage, slitlamp breath shield, phoropter, tonometer, and door handles. The first group of samples was taken before the beginning of the examinations, and the second group of the samples was taken after the last patient had left the room.

Main Outcomes and Measures  The main outcome was the presence of viral material on surfaces in 5 circular zones with a diameter of 1 m each around where the patients sat.

Results  Thirty-one persons visited the room, of whom 22 underwent ophthalmic examination and 9 were companions. The mean (SD) examination time was 9 (4) minutes (range, 5-13 minutes). Seven samples were taken before examinations and 7 after examinations. Two samples that were taken after examinations were found to be positive for COVID-19, 1 from the slitlamp breath shield and 1 from the phoropter.

Conclusions and Relevance  This study showed the presence of COVID-19 viral material in a circle 1 m in diameter around where the patients sat. However, real-time polymerase chain reaction could only detect viral material, not the infectivity of these virus samples.

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Article Information

Accepted for Publication: June 28, 2020.

Corresponding Author: Hasan Aytoğan, MD, Department of Ophthalmology, İzmir Tepecik Training and Research Hospital, Yenişehir, Gaziler Cad. No. 468, Konak, İzmir 35020, Turkey (hasan_aytogan@hotmail.com).

Published Online: August 3, 2020. doi:10.1001/jamaophthalmol.2020.3154

Author Contributions: Dr Aytoğan had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Aytoğan, Ayıntap, and Özkalay Yılmaz contributed equally.

Concept and design: Aytoğan.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Aytoğan.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: All authors.

Supervision: Ayıntap, Özkalay Yılmaz.

Conflict of Interest Disclosures: None reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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