Advice from an epidemiologist: How to stay safe at work

Our workforce is the most valuable resource within the hospital, and in the midst of the COVID-19 outbreak, we need to do everything possible to ensure that we stay healthy.

By Mike Edmond, MD, MPH, MPA, MBA
Chief Quality Officer and Associate Chief Medical Officer, Associate Hospital Epidemiologist, Clinical Professor of Internal Medicine – Infectious Diseases, UI Health Care

Like other hospital epidemiologists, I spend a lot of time thinking about practical ways to reduce the risk of infection. So to that end, I want to offer some suggestions for reducing your risk of acquiring COVID-19 at work.

Personal infection prevention

I strongly recommend that everyone in clinical areas follow bare below the elbows. This means that there should be nothing on your forearms, including wrist jewelry and wrist watches. This prevents contamination of sleeves and allows you to perform good hand hygiene. Scrubs, doffed before going home, is optimal. We want to minimize clothing contamination, so I recommend not wearing white coats, cover jackets, or fleece jackets. Neckties are problematic because they frequently touch the patient/patient surroundings and are rarely cleaned. If you feel the need to wear a necktie, tuck it into your shirt. If you wear a long sleeve shirt, roll up the sleeves. Perform hand hygiene like never before (at least before and after every patient contact), and remember to wipe down tools such as a stethoscope after each use. Lastly, avoid touching your face.

Work rooms

Faculty and staff work rooms are often small, so we need to think about how to achieve social distancing in these small spaces. One way to do this is to do your documentation in another site to reduce the number of people in the work room. Also, it’s important to declutter these rooms so that housekeeping can come in to clean all the surfaces. It’s very difficult for them to do this when there is clutter everywhere. You should also wipe down your workspace before you use it. Avoid shared foods in work spaces.

Conservation of personal protective equipment

Supplies of PPE are tight because many of these products are manufactured in China and factories are closed. This means we really need to conserve these items so that we can safely care for COVID-19 patients for what may be an extended duration. We have modified contact precautions for non-COVID-19 patients to not include gowns, since gowns are particularly in short supply. We continue to wear gloves for patients in contact precautions. If you anticipate a splash or spray, wear a gown for any patient. One way to think about this is to ask yourself: Would I rather have this gown to care for a C diff patient today, or this gown to care for a COVID-19 patient six weeks from now?

I think this question puts the issue into perspective. Face masks and face shields marketed for medical use are in short supply, so we’re considering face shields from other industries. Here is an example of one. This particular model completely covers your face even laterally, provides good protection, and is comfortable. If you work in urgent care or the emergency department, where there are many patients with respiratory symptoms, I would consider wearing the shield the entire shift. Avoid touching the shield, and wipe it down after use. To reduce supplies used, reduce the number of persons entering the patient room to the minimum necessary.

Workflow

Again, we need to think about social distancing. In teaching hospitals, we tend to travel in packs, and this needs to stop. Consider asynchronous rounding (attending rounds with each intern separately) to avoid congregating in the hallways on rounds. You might also consider batching your duties to the degree that you can and doing more of your documentation at home. Avoid elevators, if possible.

What to do if you become ill

The most important thing is to not come to work if you have fever or new onset respiratory symptoms. If you begin to feel sick at work, remove yourself from patient care as soon as possible. If you don’t have a thermometer (I didn’t have one until a few days ago), please get one, so that you can check your temp at home should you feel febrile. You might also consider purchasing a pulse oximeter to keep at home for self-monitoring in case you become ill.

Please take care of yourself during this difficult time. Patients need us, so let’s do everything we can to stay healthy!

5 comments

  1. Mike,
    OR staff did not receive specific instructions re: Not wearing full sleeve jackets over scrubs. The current expectation is to wear full sleeved jackets covering up to wrists. Could you please clarify? Thank you!

    • The OR staff did receive that information a few weeks ago when we had our Tuesday morning meeting. We were told by Torrie,that we could have bare arms and that we did not have to wear a scrub jacket.

  2. We were told by management to wipe down our PAPR hoods with pdi wipes after use so that other staff may share them due to inadequate supply. What are your thoughts on this.

  3. Dr. Edmond, I work in office with others, Hospital Operator, and we have been wiping down our work station desk area, under our edges of drawers, tape dispensers, staplers, clipboards, pagers, printer, fax machine, alarm panels, keyboards, mouse, and attached cords, light switches, door handles, sink handles, fridge handles. Can you think of anything we might not be thinking of? I worry a little about coming in and out the same check point main entrance where patients and visitors come in and out, only because normally I have no patient/visitor contact daily, using the entrance across from ramp 1. Do you think this raises the risk for us?

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