Health care workers, first responders and persons handling consignments, without being told, are at the forefront of the fight against the dreaded coronavirus. Hence, the need to comply with occupational safety procedures such as proper use of Personal Protective Equipment (PPE) cannot be overemphasized.
Based on the presented evidence, the COVID-19 virus is passed on between people through close contact and droplets, not by airborne transmission even though droplets can be suspended in the air for a few seconds. The people most at risk of infection are those who – are in close contact with a COVID-19 patient, care for COVID-19 patients or handle goods from impacted countries, that is, countries with a good number of already established cases.
The coronavirus outbreak has become a horror show and as you may have noticed, TV sets cease to be an entertaining distraction. Rather, a live broadcast of what looks like scenes from apocalyptic movies keep surfacing.
In addition to this, sneezing in public does not attract the usual and friendly ‘God bless you’! Instead, people cast you away with their stares as they scramble for their sanitizers.
Recently, a patient presented at our facility and going by history, the patient had just collapsed, body temperature was 38.6 °C, breathing was wheezy and shivering started afterward. Right then a quick thought flashed through my mind ‘OMG! What if this person has it?’
I tried to silence that thought immediately!
But, wait a sec! What about these other five persons who conveyed the patient to the hospital?
Then it hit me that the only protection I had on was a face mask and a pair of latex gloves. Physically, I was exposed and mentally unprepared to receive a probable case of COVID-19. My thoughts were running wild but I tried hard to remain calm. It wasn’t long after, the laboratory results revealed that acute malaria was the culprit.
Pheeww! I was relieved!
However, one thing I learned from that experience!? ‘Do not treat this pandemic as a normal emergency!’
‘Try your best to be calm’.
Don’t ever rush in to handle any case without being properly dressed in your PPE. As a health worker, to avoid becoming the end-user of your medical care and consequently increasing the disease burden, you have to protect yourself at all times and at all costs during the outbreak.
Are you still wondering why you cannot afford to be sick? Well, aside from your job being taken by someone probably less qualified, your team would be further exposed. With one man down, they are more prone to errors. By that time, you’re technically not on the list of people to run to for expertise anymore. It’ll really be difficult saving another person when you’re fighting for your own wellness.
In view of this, today’s post seeks to provide up-to-date information on hospital infection control. This includes tips on the effective use of Personal Protective Equipment (PPE), your rights, roles, and responsibilities as a health worker during this outbreak and much more.
What is Personal Protective Equipment Procedure?
The use of Personal Protective Equipment (PPE) is not entirely a new thing in healthcare, only that one has to pay more attention this time, take it a little more seriously and use at least ten minutes to inspect before use as it helps protect against health and safety risks especially during this outbreak.
In some regions, the government may bar private facilities from treating established cases of COVID-19 except the facility is capable of handling the infection control. Nevertheless, health facilities have to be prepared to receive patients presenting an unfamiliar range of symptoms and pay close attention to those with underlying medical conditions that exhibit similar signs and symptoms too.
Be smart enough to understand that your employers have duties concerning the provision of personal protective equipment (PPE) and you have a responsibility to use it properly.
Your employer should at least be able to provide
- eye protection
- isolation gowns
- face masks
- N95 Respirators
Other standard recommendations to prevent the spread of COVID-19
- Frequent cleaning of hands using alcohol-based hand rub
- Washing your hands for at least 20 seconds with soap and water.
- Covering your nose and mouth with a flexed elbow/ disposable tissue when coughing and sneezing.
- Dispose of tissue immediately and safely.
- Avoiding close contact with anyone that has a fever and cough.
Why is PPE important?
Personal Protective Equipment (PPE) exists as a preventative measure even for the industrial environment known to be more hazardous, like manufacturing and mining.
Agreed, complete protection is a far cry during an outbreak; nonetheless, PPE is designed to protect its user against any physical harm or hazard within a specific workplace environment.
With the onset of the coronavirus pandemic which has its roots in Wuhan, China, self-isolation and social distancing have become the order of the day owing to the absence of readily available treatment or vaccine. This option is not open to health workers as the reverse is the case, depending on the disease burden in one’s country.
There may need to put in more hours and the demanding nature of the outbreak can further compromise immunity and stress level. In times like this, not paying attention to personal protective equipment can further dampen your safety.
You may want to be more vigilant if you notice the following
The common signs and symptoms are;
- shortness of breath
In more severe cases;
- Severe acute respiratory syndrome and sometimes death.
What are the minimum safety measures?
As a health worker caring for a COVID-19 patient, an extra effort is required to protect yourself and prevent transmission in your facility. According to the World Health Organization (WHO), here are simple precautions to be implemented:
Personal Protective Equipment (PPE) includes:
- Goggles or a face shield
- Medical masks
- Respirators (i.e. N95 or FFP2 standard or equivalent)
Other measures include:
- Avoid touching your eyes, nose, and mouth.
- Maintain social distance (a minimum of 1 meter i.e. 3ft) from persons with respiratory symptoms.
- Perform hand hygiene frequently with an alcohol-based hand rub (augment with handwashing)
- Practice respiratory hygiene by coughing or sneezing into a bent elbow or tissue and then immediately disposing of the tissue.
- Select proper PPE.
- Train your colleagues on how to put on, remove, and dispose of it.
- Wear a medical mask if you have respiratory symptoms and performing hand hygiene after disposing of the mask.
Why is it important to check the equipment before use?
It is very important to take at least 10minutes to inspect and ensure that every equipment is safe before use. Of course, the primary purpose of wearing it is for your safety and well-being.
Besides this, other reasons are:
- Nosocomial infection lower productivity due to lost work time.
- In certain regions, hospital-acquired injuries could result in costly worker’s compensation claims.
- A routine, properly conducted inspection would provide liability protection and due diligence especially at a time like this.
- It may be unlawful if you fail to conduct equipment inspections as required, which may attract fines and extreme liability exposure.
What item is donned first?
Now that you’re ready to save the world, it is absolutely important to be cautious while wearing or removing your PPE. The orifices (eyes, mouth, and nose) of your body are the common pathways for infections and of course, this includes the COVID-19 virus.
- hand hygiene — proper donning begins with washing your hands
- Use and removal of gloves — do not expose your arms. They are your most valuable tool.
- Gown, mask, eye protection or face shield.
Also required is the proper handling of equipment or items in the patient’s environment.
Important things to note:
- Wear gloves during direct patient contact.
- Ensure your gloves do not have holes while handling heavily soiled equipment.
- Clean and properly disinfect or sterilize reusable equipment before using it on another patient.
- Keep hands away from the face.
- Work from clean to dirty.
- Limit surfaces touched.
- Change PPE when torn or heavily contaminated.
Personal Protective Equipment recommended donning sequence is as follows:
To don a gown:
- Select the appropriate type and size.
- With the opening in the back, secure the gown at the neck and waist.
- If the gown is too small for full coverage, use two; the first with the opening in the front, and the second-placed over it with the opening in the back.
To don a mask:
- Place it over the nose, mouth, and chin.
- Fit the bendable nose piece over the bridge of the nose.
- Secure it on the head with ties or elastic.
- Fine-tune it to fit.
If the mask has two elastic headbands, these should be separated. With the mask over the nose, mouth, and chin, stretch the bands over the head and secure them comfortably – one on the upper back of the head and one below the ears at the base of the neck.
To don goggles and face shield:
- Position goggles over the eyes and secure to the head using the earpieces or headband.
- Station the face shield over the face and secure on the brow with the headband.
- Adjust for coziness.
Putting on a particulate respirator (like an N95, N99 or N100) is similar to donning a preformed mask with elastic headbands. Check manufacturer’s instructions for any model-specific precautions and fit testing requirements.
To don gloves:
Gloves are the last component of PPE to be applied.
- Spread out the hands into the gloves and extend the gloves to cover the wrist of the isolation gown.
- Tuck the cuffs of the gown firmly under each glove.
- Fine-tune for comfort and handiness.
Basic removal of Personal Protective Equipment
Once you’re done handling patients, carefully remove PPE and discard it in the receptacles, followed by immediate hand hygiene. While removing your PPE, the goal is to avoid contamination of the self or the environment with the contaminated equipment.
Usually, the outer front and sleeves of a gown, the outside front of face protection and the outside of gloves are considered contaminated regardless of the appearance of visible soil.
The location for removing Personal Protective Equipment will depend on the amount and type of PPE worn as well as the category of patient isolation. For instance, if only gloves are worn, they may be removed and discarded in the patient room.
When a gown or full PPE is worn, PPE should be removed at the doorway to a patient room or in an anteroom. Respirators should always be taken off outside a patient room, once the door is closed.
To remove a gown:
• Unfasten the ties.
• Peel the gown away from the neck and shoulder.
• Turn the contaminated side (the outside) toward the inside.
• Fold or roll the gown into a bundle.
• Discard in the designated receptacle.
To remove a mask, note that the front is considered contaminated and should not be touched. Follow these steps:
• First untie the bottom, then the top tie.
• Lift the mask away from the face.
• Discard in the designated receptacle.
To remove a respirator:
• Lift the bottom elastic over the head first.
• Lift the top elastic slowly to avoid “snapping.”
• Discard in the designated receptacle.
To remove gloves:
• Grasp the outside edge near the wrist of one hand
• Peel the glove away from the hand, turning the glove inside out. Hold it in the opposite gloved hand.
• Slide an ungloved finger under the wrist of the remaining glove, then peel it off from the inside, creating a “bag” for both used gloves.
• Discard in the designated receptacle.
Again, remember to perform hand hygiene after using and discarding PPE.
Compliance with the basics of safety, including proper donning and removal of Personal Protective Equipment, can significantly impact your ability as a healthcare professional to reduce the risk of hospital-acquired infection.
You should examine yourself during this pandemic; are you doing all you can to create and advocate for a culture of safety in your workplace? Is your facility’s infection control program doing all it should to engage employees in training, provide proper PPE and encourage adherence?
Not every hero wears capes but many heroes wear PPE.