What lies in store? A new practice design reality

Over the past month and a half, the unfolding pandemic has presented optometry with many new challenges which may alter the way we interact with patients forever.


If practices are to bounce back, it will be by establishing themselves as hygienic, safe havens. We will need to inspire confidence in patients who have become hyper-hygiene conscious and ensure operations continue as close to the new normal as possible should another event, or relapse, occur. 


What we have been given, is an opportunity to create practice environments that our patients perceive to be clean and hygienic, based on reinforced positive visible and olfactory cues.


Declutter and demark


Cluttered environments can negatively impact patient satisfaction. To patients, a cluttered environment can be perceived as unclean; also, an uncluttered surface is far easier to clean.


I'm sure you have already removed any leaflets and magazines from your practice and increased spacing between chairs in the waiting and dispensing areas, but have you considered curating your frame stock to reduce the number on display? The average practice stocks 500 to 800 frames. However, the average human being's short-term memory can only comfortably hold about seven items at any one time, so less really is more. When you moderate the amount of product on show, you can ensure it's kept sparklingly clean while providing the visual sensation of space, cleanliness and openness. 


Be conspicuous about cleaning


Studies show coronaviruses can remain viable or infectious on metal, glass, wood, fabric and plastic surfaces for several hours to a few days, irrespective of the surface looking dirty or clean. In the absence of being able to evaluate the environment as a clinician would, patients look for things that make them feel as though they are safe and that the quality of care is excellent. When patients see something that gives the impression the environment is not clean, they feel at risk. From a patient's perspective, finger marks, dust and grime indicate you are ineffective in keeping those surfaces clean and therefore they are more likely to be contaminated.


Cleaning should be used as a way to positively affect a patient's first impression, as well as subsequent ones. While removing pathogens from surfaces is an essential part of cleaning, it is invisible. Using products throughout the practice that visually communicate your commitment, such as alcohol wipes, hand sanitiser and signage describing your hygiene protocols, can create perceived value, letting people know there's more going on than a simple spray and wipe. 


What about the general appearance of your premises? Is the paintwork chipped, marked or scuffed? A simple freshen up using a paint product, such as Resene's Clinical Cote, which is easy to clean, designed to withstand glycol-containing hospital cleaners and contains anti-microbial silver, will give an instant air of fresh cleanliness. 


Another prominent way of promoting your commitment to hygiene could be to carry out your frame-cleaning protocol in plain sight. This could involve using a UVC sterilising unit, which is a very convenient way to disinfect several frames simultaneously1.


So, don't hide your cleaning processes, make them visible. Often patients don't see or understand what you're doing for them or understand the motivation behind it. If you communicate your decontamination protocol, it helps them see the value.


Take a deep breath


The aroma in your practice is another element you can use to support the perception that the premises are well sanitised. 


Inhale deeply - does your practice smell clean? Air-conditioning units tend to harbour stale smells. In the HVAC industry this is known as dirty sock syndrome, caused by the build-up of mould and bacteria on the evaporator coil. One solution, alongside regular filter replacement, is to install UVC lamps in the HVAC system, which decontaminate and deodorise the air before it is recirculated2.


Bibs, covers and guards


Patients often spend the majority of their visit in the optometrist's chair, resting their faces against several instruments. We have well-established protocols in place for cleaning the rests on our slit lamps and autorefractors, but what about the hydraulic chair itself? Beauticians and airlines have used disposable headrest covers for years and there are armrest covers available too. 


Alongside slit lamp spray guards, you could install an acrylic counter shield, similar to the ones we’ve become accustomed to at supermarket checkouts. Also, if your practice uses tablet-based dispensing apps, you could deploy similar screens at the dispensing desks.


In summary


Times are changing and with them, our priorities. The full impact of the Covid-19 pandemic on optometry practice design remains an unknown. However, clear signals are beginning to emerge; the most obvious being heightened attention to hygiene. Even when the curve flattens and lockdown restrictions end, it is likely people will feel more comfortable in spaces designed and promoted with health and cleanliness in mind.



  1. Ziegenfuss SJ, Helgerson AF, Matos B, Dombroski-Brokman AM. Ultraviolet light efficacy for decontamination of safety glasses. Appl Biosaf. 2018;23:242-48.
  2. Dietz L, Horve PF, Coil DA, Fretz M, Eisen JA, Van den Wymelenberg K. Novel coronavirus (Covid-19) pandemic: Built environment considerations to reduce transmission. mSystems. 2020;5:e00245-20.


Elaine Silk is a freelance designer and locum dispensing optician. She combines these skills to create practice designs that are visually engaging and clinically efficient.


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