Quick facts
- A chart, occluder or pinhole disc that touches only intact skin is noncritical equipment under the Spaulding classification, which Public Health Ontario's provincial guidance pairs with cleaning followed by low-level disinfection, and in some cases cleaning alone (PIDAC table 1, page read 2026-10-21).
- A tonometer is listed in the same table as semicritical, because it contacts the cornea; that is why the tonometer prism and the occluder cannot share a cleaning procedure.
- Paper and card charts cannot be disinfected in any meaningful sense: they absorb the wipe, the ink lifts, and the surface that the next patient touches is the one that was never wet.
- The practitioner's own page is the weakest link: the AAO's guidance for the eye clinic puts hand hygiene and surface cleaning in the same routine, and a chart handled straight after a patient's face has been in the chin rest is a surface.
- ISO 17664-1:2021 requires the device manufacturer to supply processing information, so a chart or occluder bought without cleaning instructions is a purchasing gap, not an operator problem.
- Pages were read on 2026-10-21; the Public Health Ontario PDF, the AAO infection control page and the ISO catalogue entry returned 200.
The chart on the wall is handled more often than the tonometer and cleaned less often than the door handle. It is also the item that clinics find hardest to put a number on, because paper cannot be wiped and laminated cards look clean after a dry wipe whether or not anything was killed. This article sets out what the Spaulding classification actually asks of charts, occluders, pinhole discs and trial frames, how often each should be cleaned or replaced, and what belongs on the record when a surveyor asks. The chart set we stock is the CliniEco eye test chart set with Snellen, Amsler and near-vision cards, and the schedule below is written so that it can be applied to any set a practice already owns.
What does the Spaulding classification ask of an eye chart?
Public Health Ontario's provincial guidance reproduces Spaulding's classification as a three-row table. Critical equipment enters sterile tissue, including the vascular system, and requires cleaning followed by sterilisation; the examples include eye and dental equipment. Semicritical equipment contacts non-intact skin or mucous membranes without penetrating them, and requires cleaning followed by high-level disinfection at a minimum, with sterilisation preferred; the examples include the tonometer. Noncritical equipment touches only intact skin and not mucous membranes, or does not touch the patient at all, and requires cleaning followed by low-level disinfection, with cleaning alone acceptable in some cases.
A wall chart that the patient never touches, an occluder held against the orbit, a pinhole disc held in front of the eye, and a trial frame that rests on the nose and ears are all in the third row. They are not sterile items and they are not semicritical items, and treating them as either produces a procedure nobody follows. What the row asks for is cleaning followed by low-level disinfection, with the frequency set by how often the item is used and by whether it has been visibly contaminated.
The classification is also the reason a clinic should separate the items on the shelf from the items on the slit lamp. A tonometer prism that touches the cornea is semicritical and needs high-level disinfection or a single-use cover; an occluder that touches the orbital rim does not. Writing one procedure for "eye clinic equipment" collapses the distinction and usually ends with the tonometer being cleaned to the standard of the occluder.
| Item | Spaulding class | Minimum processing | Practical frequency in a lane |
|---|---|---|---|
| Wall chart, unmounted card | Noncritical (no patient contact) | Cleaning; low-level disinfection if handled | Daily surface clean; replace when marked or faded |
| Hand-held occluder | Noncritical (intact skin) | Cleaning + low-level disinfection | Between patients |
| Pinhole disc | Noncritical (intact skin) | Cleaning + low-level disinfection | Between patients; replace when the hole is burred |
| Trial frame | Noncritical (intact skin) | Cleaning + low-level disinfection | Between patients; weekly check of nose pads |
| Tonometer prism | Semicritical (cornea) | High-level disinfection or single-use cover | Per patient, per manufacturer instructions |
Why can a paper chart not simply be wiped?
A low-level disinfectant works by wetting the surface for a stated contact time. Paper fails that requirement twice: it absorbs the liquid so the surface is no longer wet for the contact time, and it swells, cockles and lifts ink, which changes the optotype sizes that the chart exists to present. A card that has been wiped twenty times is no longer the chart that was calibrated.
Laminated and coated charts are a different case, because the surface can be wet. They still have two limits. The first is mechanical: repeated wiping with an alcohol or quaternary product leaves a haze that reduces contrast, and contrast is the variable the test depends on. The second is documentary: if the chart carries a scale that the practice relies on, cleaning has to leave the print legible at the same dimensions.
The practical resolution is to separate the chart that is displayed from the chart that is handled. A wall chart that no patient touches needs a daily surface clean and a replacement cycle. The near-vision card that is passed from hand to hand needs either a laminated surface that is disinfected between patients, or a supply of single-patient cards that are given away, which often costs less than the labour of cleaning.
How often should occluders and pinhole discs be cleaned?
Between patients, every time. The occluder is held against the orbit and the bridge of the nose, which is intact skin but is also the part of the face that a previous patient's hands have just touched. The pinhole disc is held closer still, and it is small enough that a patient will hold it by the aperture. Neither item is expensive enough to justify a schedule that skips a patient.
The method matters as much as the frequency. A wipe that is squeezed dry leaves the surface damp for a second and wet for none of the contact time; a wipe that is dripping puts liquid into the hinge of a trial frame. Follow the disinfectant's label for contact time, clean the item first if it is visibly soiled, and let it dry before it goes back on the stand. For items with hinges and screws, a spray-and-wipe is usually easier to control than a bucket soak.
Replacement intervals are separate from cleaning intervals. An occluder with a cracked cup, a pinhole disc whose aperture has been enlarged by cleaning, and a trial frame whose nose pads have hardened all need replacing rather than cleaning, and none of those defects shows up on a cleaning log. A quarterly inspection with a named owner is the least expensive control.
What about trial frames and the lenses that go in them?
A trial frame is noncritical equipment by contact, but it is a compound device: the frame touches the face, the lens rings are handled by the practitioner, and the lenses themselves are handled by both. The frame and the rings can be cleaned and low-level disinfected between patients. The lenses need the care that optical surfaces need — a lens cloth and a lens cleaner, not a disinfectant wipe that leaves residue on the coating.
The operating rule that works in a busy lane is to treat the frame as a patient-contact item and the lenses as optical items. Clean the frame between patients, keep the lenses in the case until they are needed, and handle them by the edge. Where a practice uses a trial frame for paediatric patients who cannot hold still, the frame spends longer in contact with skin and the cleaning interval shortens rather than lengthens.
Storage is part of the same procedure. A trial frame left on a window sill collects dust and ultraviolet; a frame closed in its case after cleaning stays clean until the next patient. The same applies to the occluder and the pinhole disc: a drawer with a lid is a cleaning control, and an open tray on the sill is not.
How should the cleaning schedule be written and recorded?
Write it as a table with four columns: item, method, frequency, and the person responsible. Then add a fifth column for the replacement trigger, because most of the failures a surveyor finds are items that were cleaned correctly and should have been thrown away. A schedule that says "clean between patients" without naming the product, the contact time and the drying step is a schedule that will be interpreted three ways in three lanes.
Record only what you will actually maintain. A per-patient tick for every occluder is realistic in a single-lane practice and unrealistic in a five-lane clinic without a dedicated assistant; in the latter case the record is usually a daily line confirming that the lane was reset, with the per-patient cleaning written into the procedure rather than into the log. What matters is that the record and the procedure describe the same practice.
The record should also capture the exceptions: an item that was visibly contaminated, a patient with an active infection or a suspected adenoviral conjunctivitis, and any item that was removed from service. Those entries are what turn a cleaning log into an infection control record, and they are the first thing a reviewer reads.
| Record field | What it proves | Where it lives |
|---|---|---|
| Date and lane | That the schedule ran on that day | Daily reset sheet |
| Items cleaned | Which chart, occluders, discs, frames | Daily reset sheet |
| Product and contact time | That the method matched the label | Procedure, referenced on the sheet |
| Replacement or removal | That a defective item left service | Equipment note plus work order |
| Exception entry | That a contaminated or infectious case was handled | Incident or IPC note |
Does the same rule apply to the chart in a screening van or a shared clinic?
It applies more strictly, because a shared or mobile lane has less control over the previous patient. A screening van that runs 40 patients in a day has 40 faces against the same chin rest and 40 hands on the same occluder. The schedule that works is the one built around a reset between patients rather than around an end-of-day clean.
The material choice follows. In a van, laminated cards that can be wiped are worth the cost over paper cards that cannot, and a supply of single-patient near cards removes the cleaning step for the item that is hardest to clean. Where the van carries a trial frame, a second frame costs less than the delay of cleaning one between patients.
The same logic applies to a clinic that shares a lane between optometry and ophthalmology, or between a primary care physician and a visiting optometrist. The item that crosses the boundary is the one nobody owns, and the schedule should name an owner for it in writing.
A lane reset is a stock event as well as a cleaning event: charts, occluders and the wipes that clean them are replaced on the same cycle. Order through the wholesale programme for case pricing and an account, or become a distributor for resale. The Snellen and Amsler chart set sits in the same catalogue.
Sources
- Public Health Ontario, provincial guidance for cleaning, disinfection and sterilization in health care settings
- Public Health Ontario, infection prevention and control
- CDC, summary of infection prevention recommendations
- American Academy of Ophthalmology, infection control in the eye clinic
- American Academy of Ophthalmology, eye exam
- College of Optometrists of Ontario, infection control
- Canadian Association of Optometrists
- Canadian Ophthalmological Society
- ISO 17664-1:2021, processing of health care products
- ISO 8596:2017, visual acuity testing — optotypes and their presentation
- ISO 13485:2016, medical devices quality management
- ISO 14971:2019, application of risk management to medical devices
- Health Canada, medical devices
- Medical Devices Regulations, SOR/98-282
- Canadian Centre for Occupational Health and Safety, OSH answers
- CliniEco Medical, Snellen and Amsler chart set
Put the schedule on paper the lane can actually keep. The compliance log centre has a free printable room-reset sheet with columns for the chart, the occluders, the pinhole disc and the trial frame, plus a line for the replacement trigger. It prints on one page and needs no account and no sign-up.
For a lane that logs on a screen, the sterilization log generator on the same page produces a dated reset sheet with the item list already in place, which is faster to fill than a blank grid and easier to file with the room's other records.
Ask a compliance specialist — written answer specific to your equipment and province, with the regulation or standard it is based on cited: sterilization compliance consultation.
Related reading
- Eye chart in Canada vs the US: which optotype standard applies
- Snellen chart and eye test charts in Canada vs the US: which scale is used
- Amsler grid home monitoring programme: instruction, recall and record keeping
CliniEco Medical supplies eye test charts and clinic consumables in Canada under MDEL #35334.
Frequently Asked Questions
How often should an occluder be cleaned?
Between every patient. An occluder touches intact skin around the orbit and the bridge of the nose, which makes it noncritical equipment under the Spaulding classification: clean it, then apply low-level disinfection with a product that is allowed the labelled contact time, and let it dry before it goes back on the stand.
Can paper eye charts be disinfected?
Not in any meaningful sense. A low-level disinfectant has to keep the surface wet for the labelled contact time, and paper absorbs the liquid and lifts its ink. Paper charts should be cleaned only as a dry surface, replaced when marked or faded, and supplemented by laminated or single-patient cards where the chart is handled.
Is a trial frame cleaned the same way as a tonometer?
No. A tonometer prism contacts the cornea and is semicritical equipment, which requires high-level disinfection at a minimum or a single-use cover. A trial frame contacts intact skin and is noncritical, which requires cleaning followed by low-level disinfection. One procedure cannot cover both items.
Do eye charts need to be replaced on a schedule?
Yes, even when they look intact. Repeated wiping leaves a haze that reduces contrast, and a coated card that has been cleaned for a year no longer presents the same contrast as a new one. Set a replacement interval in the procedure and record the date the current chart went into service.
What should a cleaning log for a lane contain?
Date and lane, the items cleaned, the product and contact time referenced, any item replaced or removed from service, and any exception such as a patient with an active infection. A daily reset line with a per-patient procedure behind it is more honest than a per-patient tick nobody maintains.
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