Practice Tip of the Week: Preparing for COVID-19
Tuesday, March 3, 2020
Posted by: Kanaka Sathasivan
By Kanaka Sathasivan, MPH
Updated March 4, 11:45 a.m.
As of today, cases of COVID-19 (formerly novel coronavirus) have appeared in over 60 countries and nurses are already responding to cases in San Antonio. The Centers for Disease Control and Prevention have provided recommendations for health care professionals, combining what is known about the virus so far with the best practices learned during the response to MERS and SARS, also coronaviruses. Researchers continue to study COVID-19 to learn more about its transmission, how long the virus lasts after leaving the body, and what the severity and fatality rates are.
Preliminary data from the Chinese Center for Disease Control and Prevention indicate a 2.3 percent overall mortality rate with mortality increasing with age and comorbidities. However, as this number is only based on confirmed cases, the estimate likely misses people who were infected but had only mild symptoms and did not get tested. As more research comes out, we can expect the mortality rate to lower. As with other viruses, older adults and those with existing medical conditions, like heart disease or a compromised immune system, are most at risk.
Your role in prevention
All nurses are trained in the basics of infection prevention and control and use of personal protective equipment, and IPC and PPE are still the first line of defense against COVID-19. If working with patients that have symptoms of COVID-19, health care workers should use masks, gloves, goggles and gowns in addition to frequently washing hands with soap and water or alcohol-based sanitizer. At this point, there is no indication that nurses need PPE that includes respirators or positive air pressure.
Your workplace may benefit from the CDC’s COVID-19 Risk Communication Package, which includes printable posters with IPC and PPE reminders. The package includes guidance on patient intake, nurse protection and communications guidelines. Good advice nurses can keep in mind is the “5 Moments for Hand Hygiene.”
Use alcohol-based hand rub or wash hands with soap and water:
- Before touching a patient
- Before engaging in clean/aseptic procedures
- After body fluid exposure risk
- After touching a patient
- After touching patient surroundings
Know your rights
Nurses and other frontline health care practitioners have the right to expect a safe work environment. Employers should ensure that preventative and protective measures are in place, including providing refresher training on IPC and PPE as well as adequate supplies for staff and patients. Employers should also “provide a blame-free environment” to allow staff to report incidents involving blood or bodily fluids and allow staff to remove themselves from any situation where they feel their health or life is in serious danger.
Using proper precautions takes time, so nurses should discuss any time concerns with their supervisors. Without adequate time for hand-washing built into their schedule, nurses may feel pressured to skip a step or rush through without the recommended 20-30 seconds of friction.
Employers should also make sure all health care practitioners know the protocol for evaluating and reporting suspected cases. Updated CDC guidelines now allow for broader testing, and more tests are expected to be available within the month.
Communicating with the public
Remind concerned patients and the general public to be prepared but not to panic. Consistently use the phrase “novel coronavirus” or “COVID-19” rather than “Wuhan flu” or “Chinese coronavirus” to avoid stigmatization. There have already been several violent incidents and cases of discrimination involving Asian-Americans by others afraid of COVID-19.
While public health professionals are working to stop the spread of the virus, most cases are not serious. Masks used in public will not stop the spread of the virus, and when non-health care workers buy up masks and gloves, it creates a shortage for practitioners. Food or water shortages are very unlikely in the US, but if you are in an at-risk community, it may be useful to store a few weeks’ worth of food so you can avoid crowds.
Everyone should practice proper handwashing with soap and water for 20-30 seconds — about the time it takes to sing Happy Birthday twice — or use alcohol-based sanitizer with 60-70% alcohol — any less will not kill the virus, any more will evaporate too quickly. Put preventive practices into use at home and work. Wipe down common areas (cabinets, door handles, grocery carts), sneeze into your elbow or a tissue (and discard the tissue), and avoid touching your face without washing your hands.
If you have been in contact with a confirmed case and have symptoms, call your health care practitioner to let them know before you go in for an exam and contact the local health board for information on testing. When possible, anyone with symptoms should stay home and avoid going to work or public places.
Finally, we can all reduce the burden on the health care system by getting flu shots. The flu has already killed at least 18,000 people in the US, with some estimates as high as 46,000. Also, by getting the shot, you can prevent the number of flu cases that may be mistaken for COVID-19.
Editor's note: An earlier version of this article mentioned nurses responding to cases of COVID-19 in Dallas. This error has been corrected. No cases have been reported in Dallas as of March 3, 2020.
Updated March 4: Previous CDC guidelines included both clinical features and epidemiological risk, such as close contact with a confirmed COVID-19 patient or travel to an affected geographic area.