There are four main routes for transmission, these are: 

1. physical contact, which can spread:
   • ophthalmic infections, such as bacterial and adenoviral conjunctivitis
   • skin infections, for example staphylococcus, herpes simplex or fungi
   • enteric infections, for example viral gastroenteritis
2. airborne particles, including respiratory infections, for example tuberculosis:
   • you are at a special risk of the transmission of airborne infection because of the proximity to the patient’s nose and mouth
   • potentially infectious respiratory aerosols are generated when an individual sneezes, coughs or talks. Particles over 5 microns in diameter do not normally travel more than 1m but smaller particles can travel longer distances and remain airborne for longer
3. contact with bodily fluids:
   • you are at extremely low risk of transmitting blood borne viruses, such as human immunodeficiency virus (HIV) and hepatitis B and C, in optometric practice
   • tears can contain infectious agents (including these viruses, and others that are much more contagious, such as adenovirus) which may be transmitted to yourself or to other patients if your hands are not properly cleaned after the clinical examination
   • all spillages of blood and body fluids should be cleaned up immediately using a product that contains a detergent and disinfectant. Do not use mops for this. Use disposable paper towels and dispose of them as clinical waste.¹⁷³
4. use of sharps: the main risk of transmission is associated with invasive procedures in which injury, for example needlestick, could result in blood from the infected individual entering open tissues of another person. If you suffer an injury from a sharp which may be contaminated, you should:
   • gently encourage the wound to bleed, if possible whilst holding it under running water
   • wash the wound using running water and plenty of soap
   • dry the wound and cover it with a waterproof plaster or dressing
   • seek urgent medical advice
   • report the injury to your employer.^{174 175}

You should not suck the wound or scrub it while you are washing it.

You must use adequate infection control measures to avoid transmitting infections.¹⁷⁶