COVID-19 ICU, The 12 Commandments for Front Line Clinicians

[NickICU-RN, ADN, BSN]

I did not climb a mountain nor talk to God, but I did stare the devil in the face! As a New York Covid-19 ICU RN, I felt compelled to help my fellow clinicians in other states as they are now seeing spikes.

1. Assume Everybody is Covid-19 Positive

Do not let your guard down. You may find yourself in another area that is supposedly non-Covid-19 and people may tell you it is OK to only wear a surgical mask, but I am telling you, it is not wise. Since the onset of Covid-19 symptoms may be delayed 5-7 days, patients may be infected and not know it. I have seen Covid-19 positive patients test negative with swab tests a couple times in a row and then later become positive. The official healthcare word on the street is only to believe a negative swab test if it is 3 times negative. But always believe a positive, because there is no real way to fudge that.

2. Wear an N95 Mask with a Basic Surgical Mask on Top

According to the CDC, the N95 mask filters on average 95% of the particulate matter in the air (CDC, 2020a). According to 3M's Averaged Filtration Efficiency Chart, Coronaviridae may penetrate at a higher rate due to their small size (3M, 2020a). With Coronaviridae at roughly 1.25 microns in size, the particle penetration rate of the N95 can decrease down to 93-94% (3M, 2020a). This increases the safety risk to the frontline clinical staff and therefore I recommend wearing a surgical mask over your N95. Since you will be most likely reusing your N95, this may help to keep it slightly cleaner.

I personally have worn the same N95 mask for 1 week straight, four consecutive 13-hour shifts in COVID-19 ICU. By the second day the N95 mask already smelled bad so I was very concerned. Over my 19 years ICU RN experience as well as the CDC's protocol, clinicians are to throw away the N95 after each use. Because of the N95 mask shortage, our employer all of a sudden told us clinicians it was OK to wear the N95 mask for extended periods of time. I had never heard of this protocol, so I decided to research it.

Amid the Covid-19 crisis and N95 mask shortage, the CDC published its guidelines that conveniently allowed N95 usage past the intended shelf life in times of increased demand and decreased supply (CDC, 2020b). But the mask manufacturer 3M stated the potential exists that the N95 may not perform up to standard if used past intended use (3M, 2020b). Over time components of the N95 mask degrade and affect the quality and fit (3M, 2020b).

3. Wear Eye Protection, Goggles Preferably

Covid-19 can infect you through your eyes, just like the flu, so please cover your eyes with either a shield or preferably goggles. I prefer goggles because I was able to tighten them over the bridge of my nose to improve my upper seal on my N95 mask. I always felt a potential seal break would occur above the bridge of my nose. When you are wearing a mask all day long it gets hot and I would notice if I yawned or talked too much I could feel cool air coming in, so this is why I adapted this protocol. After I applied goggles, I never felt this cool air again.

***1 recommendation is to use Anti-Fog spray that one uses in scuba diving.

4. Don't Touch Your Face

Common Sense- Keep your hands away from your mouth and eyes. With various reports of the Coronavirus being able to stay alive for days on hard, inanimate surfaces, one could infect themselves by touching your eyes or mouth.

5. Don't Eat Lunch with your Coworkers

Assume everybody has Covid-19! A large percentage of the Covid-19 positive are healthcare workers and I imagine many spread it to each other in this manner. Eat by yourself! I'm sure it will be boring, but sometimes being a smart clinician does not always equate to being a fun clinician. I would also recommend never taking your mask off in a room unless you know nobody has been in there for at least 3 hours. There have been reports of Covid-19 staying in the air for 3 hours.

6. Develop a Bleach Wipe & Plastic Bag Routine

When you come into work, put your name on your workstation and chair and bleach wipe it off. Sharing is not caring in this situation; you never know where somebody else has been.

Disrobing is also an important routine that may require several garbage bags. Although wasteful, I recommend placing one garbage bag on top of either a table or garbage can in the bathroom. I would place my wallet, my phone; etc. on this bag after I bleach wiped them.

Then I would place another clean bag on the floor before I disrobed. I would step onto the floor bag with shoes off, take off my scrubs and place them directly in a bag and seal it. I would them change into a clean set of scrubs so I would feel safe sitting in my car to go home. Washing hands multiple times, basically any time I came in contact with anything unclean.

As soon as I got to my car, I would set my belonging in another clean bag and place it on the floor, then I would sanitize my hands and clean where I touched.

7. Get Buck-Naked at your Doorstep

Just as this virus probably escaped a Chinese lab on somebody's shoe, do not bring this home to your family. Shoes off at the door or even keep those nasty shoes in your car trunk. And more importantly get naked at the door and put all of your clothes in a plastic garbage bag! Gracefully tip toe naked directly to your hot shower. I would not do a bath... baths are dirty! Keep the laundry bag by your door and when you wash your clothes, make sure you use bleach or something else with virus killing power!

8. Shave your Beard, 5 O' Clock Shadow may not kill you, but Yasser Arafat length is too long!

This is all about not breaking the seal on your N95 mask. It is common sense, but in the time of beards being "in", this has to be said. If you have a beard for religious reasons, and absolutely cannot shave, then buy a PAPR hood. This offers much better protection at about 9.97 filtration vs. a N95 anyways, but the price is about $1300-$1800. The real issue is most PAPR's are out of stock, so very hard to find right now. Just shave the beard, it is not worth it!

9. Best Practice – Moonshine is Purell for your Mouth

I'm not trying to encourage drinking here; you could even swish it around and spit it out. But for serious safety precautions I would perform this best practice protocol after encountering severe situations just incase any virus got through my mask. For instance, if you have ever had a homeless Covid-19 person cough directly in your face for a 12-hour shift, this may prove beneficial. I cannot say for sure because I could not find anybody interested in being involved in my double blind clinical trial.

I personally prefer Climax Moonshine, from the famous History Channel moonshiner: Tim Smith. High enough proof alcohol can kill the Coronavirus. It is very, very strong stuff; so maybe just swish and spit it out so you don't burn your esophagus. Possibly anything like a strong vodka or mouthwash may be beneficial in killing any bugs in your mouth.

10. If you are not a meticulously detailed person, maybe you shouldn't come home

If you do not think you can follow a strict routine of disinfecting and disrobing with proper plastic bagging technique, then maybe you should not come home. Another option is to have anybody of vulnerable population leave and stay somewhere else for a while. Every Covid-19 patient that was in the hospital had an entire family at home that was Covid-19 positive. I personally did not see any family member escape it. It seemed if one person in the house had it, the whole house caught it. There was no visitation because of this and I talked to A LOT of families on the phone!

11. It's OK to cry and to take something to help you sleep at night

Your facility just turned into a warzone overnight... It is OK and totally normal to be upset. In my 19 years of ICU experience, I have never seen this much death in my life. It's unnerving and I had to talk to my doctor to get something to help me sleep at night. One would not be able to function at a high level without sleep.

YES, I cried and it is OK! I had the honor of taking care of one my friendly coworkers who passed away, so yes it is OK to cry. Totally normal when you go through such a traumatic event.

12. Never Trust the Narrative

It seemed as if nobody prepared for the Covid-19 crisis as it just steam rolled over New York. No testing kits or N95 masks available as if no hospital disaster plan had ever been thought out or planned for. I saw the narrative change multiple times to fit the agenda.

Narrative changed from: You do not need to be tested unless you are hospitalized, to everybody needs to be tested.

***This was due to a test shortage

Narrative changed from: Wash Your Hands- You Do Not Need a Mask, to everybody should be wearing N95 Mask

*** This was due to a Mask Shortage

Narrative changed from: You normally throw N95 masks out after each use, to now you can magically wear a N95 for an entire week, even though the manufacturer warns against the safety of this.

*** This was due to Mask Shortages and questions of how long it would take for the pandemic to be over

The narrative was continuously engineered to fit the agenda! Critically think about everything you hear and do not be a blind follower. Sometimes you have to go with your gut!

References

3M. (2020a, February). COVID-19 | 3M Personal Protective Equipment (PPE) Info. 3m.Com.
Respiratory Protection for Airborne Exposures to Biohazards

3M. (2020b, May). COVID-19 | 3M Personal Protective Equipment (PPE) Info. 3m.Com. Respirators Beyond Their Shelf Life – Considerations

CDC. (2020a). Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Surgical Mask N95 Respirator Testing and Approval. Understanding the Difference (Surgical Mask vs N95 Respirator)

CDC. (2020b, February 11). Strategies for Optimizing the Supply of N95 Respirators

[BSN-to-MSN, ADN, BSN, RN]

Some good info, thank you!

Some myth, too. How about that #9? Do you suggest gurgle with vodka immediately? Is the virus going to "wait" in your mouth and not infect until the shift is over? ?

I will add that the microbiologist would cry looking at some people's "disinfecting" practices and "preventive" measures.

[NormaSaline]

3 hours ago, NickICU-RN said:

Just as this virus probably escaped a Chinese lab on somebody’s shoe,

Pause, rewind, replay. Say what? (Otherwise, I'm enjoying reading this.)

[spotangel, DNP, RN, NP]

On point on routine after work. It is so important to walk into your home and family safely.

My routine when I park my car-

Call home-one family member opens the garage and all doors leading to the laundry and bathroom downstairs.

Come in and close the garage.

Strip on a plastic garbage bag. All clothes that I am wearing go into another bag. Shoes stay on top of plastic bag.

ID,PENS gets cleaned with wipes and are left in the garage.

Put clothes to wash, throw plastic bag.

Go buck naked to the bathroom and shower-head to toe.

Wear clothes left outside the bathroom and come upstairs to elbow hug family.

1 month inpt with pts and coworkers dying left and right.

PTSD and lots of praying.

COVID free so far!

Praise God!

[Trampledunderfoot, LPN]

It's horrible that you all had to go through that. I can't believe our country is in the horrible state that it is in right now. I can't believe we weren't more prepared. I can't believe it is getting worse, and the news seems to be pretending that it is not. Great advice from you all! I'm praying for you.

[NickICU-RN, ADN, BSN]

On 6/19/2020 at 9:11 AM, RN-to- BSN said:

Some good info, thank you!

Some myth, too. How about that #9? Do you suggest gurgle with vodka immediately? Is the virus going to "wait" in your mouth and not infect until the shift is over? ?

I will add that the microbiologist would cry looking at some people's "disinfecting" practices and "preventive" measures.

Who ever said to wait until your shift is over? haaaaaaa

On 6/20/2020 at 12:18 PM, spotangel said:

On point on routine after work. It is so important to walk into your home and family safely.

My routine when I park my car-

Call home-one family member opens the garage and all doors leading to the laundry and bathroom downstairs.

Come in and close the garage.

Strip on a plastic garbage bag. All clothes that I am wearing go into another bag. Shoes stay on top of plastic bag.

ID,PENS gets cleaned with wipes and are left in the garage.

Put clothes to wash, throw plastic bag.

Go buck naked to the bathroom and shower-head to toe.

Wear clothes left outside the bathroom and come upstairs to elbow hug family.

1 month inpt with pts and coworkers dying left and right.

PTSD and lots of praying.

COVID free so far!

Praise God!

Excellent advice! Stay Safe!!

[NickICU-RN, ADN, BSN]

On 6/19/2020 at 12:23 PM, NormaSaline said:

Pause, rewind, replay. Say what? (Otherwise, I'm enjoying reading this.)

Tell me one other virus or bacteria that causes advanced vascular disease, a.k.a. blood clots everywhere in the body? If you don't believe me, check out the research, I'm convinced this was man-made! This was probably meant to be dumped on a battle field as a form of biological warfare.

[NickICU-RN, ADN, BSN]

On 6/19/2020 at 9:11 AM, RN-to- BSN said:

Some good info, thank you!

Some myth, too. How about that #9? Do you suggest gurgle with vodka immediately? Is the virus going to "wait" in your mouth and not infect until the shift is over? ?

I will add that the microbiologist would cry looking at some people's "disinfecting" practices and "preventive" measures.

Also for the record, I never did use vodka, I used moonshine which is a much higher proof and most definitely kills everything. I mentioned vodka really as the next best thing, figuring some people may not have moonshine available. So if one did want to follow evidence-based-practice, one would have to use moonshine. ?

[macawake, MSN]

Quote

Tell me one other virus or bacteria that causes advanced vascular disease, a.k.a. blood clots everywhere in the body? If you don’t believe me, check out the research, I’m convinced this was man-made! This was probably meant to be dumped on a battle field as a form of biological warfare.

No. Mortality and serious morbidity of Covid-19 predominantly affects the elderly and those with preeexisting conditions. Not many octa- and nonagenarians in the army, or with cardiovascular disease etc. It would be an extremely poor weapon to use on the battlefield.

I don’t personally believe that the virus escaped a lab on someone’s shoe, but a virus escaping a lab is at least within the realm of possibility. The battlefield weapon in my opinion, simply isn’t.

I’m not sure of you’re serious about the moonshine? You can’t really count on ”killing” the virus hours after it entered your body by swishing moonshine in your mouth. You’d likely have to snort it too, the micro-second after you think your mask leaked (and I sure as heck do NOT recommend that). Anyway, it’d be my guess that once it’s inside your body, it’s too late).

Reading the precautions you list, I’m struck by one thing. I live and work as a nurse in a country where all scrubs are hospital laundered. You never, and I mean never, see a person outside of a hospital or care facility wearing scrubs. It’s not allowed for infection control purposes and hasn’t been in my lifetime. Is that something your employer could/would consider for the future?

So many of the steps you have to take, would become unnecessary if you were provided a clean set of scrubs daily and could just shower at work and change into your street clothes. And of course, have separate shoes for that stay in your locker. The separate shoes make sense, that way you won’t bring the inside ”out” or the outside ”in”.

Since this virus is widely spread in the community we’re not only at risk of infection when we’re at work, but at other times as well, I think your advice to not walk with your shoes on into your house is sound. In my opinion it’s not only medical professionals who should do this, everyone else in the household ought to do the same.

As you appear to be a New York ICU nurse I realize that you most likely have a gruelling couple of months behind you. So from a fellow nurse, thank you for making a difference in peoples’ lives! Take care and stay safe!

[NormaSaline]

18 hours ago, NickICU-RN said:

Tell me one other virus or bacteria that causes advanced vascular disease, a.k.a. blood clots everywhere in the body? If you don't believe me, check out the research, I'm convinced this was man-made! This was probably meant to be dumped on a battle field as a form of biological warfare.

A discussion worth having is whether this is a respiratory illness or a vascular one. I have been doing a lot of reading and research on Covid, but I'm not at the point yet where I could piece it all together.

There is definitely something "alien" about this illness, right?, but for now, I am sticking with what those who are smarter, have more education, and have spent far more time, meaningfully, researching this than I have.

[NurseBlaq]

23 minutes ago, NormaSaline said:

A discussion worth having is whether this is a respiratory illness or a vascular one. I have been doing a lot of reading and research on Covid, but I'm not at the point yet where I could piece it all together.

There is definitely something "alien" about this illness, right?, but for now, I am sticking with what those who are smarter, have more education, and have spent far more time, meaningfully, researching this than I have.

I personally think it's both but it affects each person differently based on their susceptibility and preexisting conditions. Just my $0.02. Whatever the case, I hope they get it under control soon because I'm super high risk.

Shout out to all the covid nurses, I appreciate y'all!

[NickICU-RN, ADN, BSN]

On 6/22/2020 at 7:17 AM, NurseBlaq said:

I personally think it's both but it affects each person differently based on their susceptibility and preexisting conditions. Just my $0.02. Whatever the case, I hope they get it under control soon because I'm super high risk.

Shout out to all the covid nurses, I appreciate y'all!

Many of the research studying groups of autopsy reports have shown clots throughout the body, heavy on the lungs, kidneys, with sometimes brain. Current protocol is to put Covid positive patients on blood thinners as a preventative measure.