To Our Heroes: Healthcare Workers

Here is how to take care of yourself while caring for others with coronavirus.

By Benjamin Schwartz, MD, FAAOS, fellowship-trained Adult Reconstruction Orthopedic Surgeon with an interest in healthcare technology and shifting paradigms of care delivery

The coronavirus pandemic has impacted people from every walk of life across the globe. But perhaps none more than healthcare workers.

We are on the frontlines delivering care, working tirelessly, exposing ourselves to increased risk, and banding together to help address this crisis head-on. The worldwide response of the medical community makes me proud to be in healthcare—as I’m sure is the case for the majority of you as well.

There is so much information about COVID-19. And it is coming out at a dizzying pace. We want to do our part with our COVID-19 primer for healthcare workers. We hope you all continue to stay safe.

Prevent Infection Spread

We aren’t going to tell you to wash your hands, wear PPE, or avoid contact with others. We know that you already know this. But we will tell you that it is believed that COVID-19 has both droplet and airborne transmission, so that you can be mindful of this with each patient encounter. And do your best to practice standard protocols for the prevention of infection spread.

  • Assess and triage patients with acute respiratory symptoms and possible exposure by having them wear a face mask. Isolate them in a closed-door room when appropriate and possible.
  • Practice routine cleaning and disinfecting procedures using products that are EPA-approved for emerging viral pathogens.
  • If you think you may have had unprotected exposure, contact your supervisor or occupational health department.
  • Whenever you are not feeling well, especially with possible signs for COVID-19 (fever, cough, trouble breathing), contact your employer. Strongly consider not going to work, if possible.

Personal Protective Equipment (PPE)

This list is—in an ideal world—what healthcare workers should have available to protect themselves from contamination by transmissible diseases.

  • N95 masks—in cases with risk of exposure to infected droplets.
  • Face mask.
  • Eye protection like goggles, face shields, covers. Glasses or contacts don’t count.
  • Gown (cloth or disposable).
  • Gloves.

Almost as soon as COVID-19 started spreading, there have been warnings about PPE shortages. There have even been reports of hospitals limiting PPE use to make sure supplies are available later on for treating the sickest patients. But PPE is crucial for healthcare workers, who are at the highest risk of becoming infected with COVID-19.

Can PPE be reused?

While the CDC has issued limited guidelines regarding the extended use or reuse of PPE, each healthcare facility may have its own protocols.

  • In general, all PPE should be discarded if it becomes soiled, wet, worn, or loses its shape.
  • Isolation gowns (cloth or disposable) may be used for an extended period as long by one person for only one shift.
  • Cloth gowns should be placed in appropriate bins and washed after every shift.
  • Eyewear may be used by the same person for multiple shifts as long as they are correctly stored. (Usually in a labeled paper bag and away from areas of possible contamination.) Discard if they seem worn.

N95 Masks

Always check to make sure N95 masks are maintaining a proper seal and have not become deformed by repeated use. A regular face mask is an acceptable alternative until more are available.

  • N95 masks should be used by only one person.
  • If you have the option, leave on your N95 between seeing patients—extended use. This is preferable to taking on and off each time you see a new patient.
  • Store in a labeled paper bag between uses.
  • Never reuse if it has blood or other bodily fluids from a patient.

Recommendations for EMS Workers

Emergency Medical Service (EMS) workers may be required to answer calls for those confirmed or suspected—persons under investigation (PUIs)—to be infected with COVID-19.

Before addressing potential symptoms of coronavirus, EMS workers should follow standard protocols for anyone with possible life-threatening issues. When appropriate, callers should be screened for COVID-19 symptoms and risk factors. EMS clinicians should notify the facility in advance about a possible PUI for COVID-19.

If a potential coronavirus infection is suspected:

  • Wear all appropriate PPE—whatever is available—before entering the scene. Use appropriate droplet and airborne precautions when responding to any patient with possible COVID-19.
  • Whenever possible, put a mask on a patient prior to your assessment.
  • Minimize contact before and during transport.
  • Isolate the driver of the transport vehicle—no one should sit in the front passenger seat.
  • Open outside air vents in the driver area and turn rear exhaust ventilation to the highest setting.
  • Limit the number of providers in the patient compartment.
  • The CDC says that no one who has had contact with a possible COVID-19 patient should be in the transport vehicles. If anyone does ride with them, they should wear a face mask.
  • After delivering a suspected or confirmed COVID-19 patient, make sure the vehicle is cleaned per CDC guidance.

Coping with Stress

Healthcare workers are on the frontlines of the battle against this pandemic. They are also at the highest risk for stress and burnout from the COVID-19 pandemic. Sources of stress include the physical demands of maintaining biosecurity measures when caring for COVID-19 patients. Having to minimize the risk of transmission and practicing infection control measures. Balancing work life and home life. And doing your best to protect your family, friends, and neighbors from COVID-19.

We realize you may not be able to follow some, or even all, of these recommendations. But if or when you can, try some of these strategies to minimize the impact of stress.

  • Schedule regular check-ins with family and friends.
  • Work in teams—try not to work too long in isolation.
  • Take regular breaks. Do your best to keep the length and frequency of shifts as reasonable as possible. So you can rest and care for yourself, too.
  • Focus on what you can control—like handwashing and other simple safety measures.
  • Remember, it’s natural to have concerns about your safety and the safety of loved ones. But don’t let these concerns cause even more fear or panic.
  • Don’t ignore your self-care needs. Eat healthy meals, get at least 8 hours of sleep, and limit alcohol. If there were ever a time to stop smoking, it would definitely be now.

It can be difficult to “turn off” after a prolonged period of caring for COVID-19 patients. Take advantage of all social support mechanisms. If you begin to feel that your stress level is unmanageable or interfering with your ability to function in any way, please speak to a mental health professional. You don’t need to do this alone.

Your contributions and efforts are greatly appreciated in this time of crisis. Healthcare workers across the country have united to address this pandemic on the frontlines. You deserve recognition for your tireless support of patients and their families.

Resources

WHO Mythbusters

WHO general facts

Home care for patients with mild symptoms

WHO Occupational Safety

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