PPE observers?

[LibraNurse27, BSN, RN]

Quick question! We have a lot of rule out covid19 patients (so far only one positive!) and our system is to have one nurse who goes in and out of the room (donning and doffing of course) and an "observer" who watches anyone who goes in the room don and doff and lets them know if there is anything they need to do differently. This person is in the anteroom in the PPE.

The observer can also call for items that the nurse in the room needs and hand them in to them but has to stay in the anteroom, take off the PPE and wash hands before they come out. If the patient is total care both nurses can go in and watch each other don and doff. No nurses that go in a rule out covid room can go in other patient's rooms. But, other staff (MDs, lab, etc) go into covid rooms and also other rooms. Just wondering if this is standard, and if not what other hospitals are doing?

[Pepper The Cat, BSN, RN]

I had a pt in airborne precautions today. I had to have an observer every time I went on and again when I went out. They had a checklist to follow. Massive PITA.

Went in with a doctor and we each had a person watch us. He was quite OK with it and waited for the observer .

I was lucky that my pt was alert and oriented. I called her on the phone before going in saying “ I am coming in with Xyz, do yiu need anything else”

But having someone watch me made me feel like a student again

[LibraNurse27, BSN, RN]

Thanks for your reply! So I guess that is the standard then to have observation. I agree about feeling like a student! Luckily I didn't get any negative feedback about my donning and doffing. But I received no training about being the observer, and the nurse I was working with didn't either so he went in the room unobserved and another coworker screamed at us... not fun. Luckily the patient is negative! So stressful

[Pepper The Cat, BSN, RN]

For sure stressful! Just remember, we are trying to keep everyone safe during an uncertain time.

[RNperdiem, RN]

So where are they getting staff to cover the observer position? Our staffing has been tight for months that we rely heavily on float pool and nurses working overtimeto stay fully staffed. There is no surplus here.

[LibraNurse27, BSN, RN]

Yes we are getting to that point now that we have so many rule out cases... not sure how long we can keep the observer thing going. Guess they will have to trust that we know how to use the PPE correctly? I don’t really know a good solution. What have they been doing at your facility?

[nursej22, MSN, RN]

We are using an observer, but we are a local health department collecting many of the specimens so we get up close and have the potential to trigger a sneeze or cough. The observer actually accepts the specimen in a clean manner to prevent spread of infectious material, and then completes packaging for shipping to the lab.

[Coffeenurse1]

This is exactly what we are doing too. We are going down from ratio of 4 or 5 pts to one RN to 2:1. All of ours are rule outs so far! They are limiting staff to go in these rooms as much as possible and some staff absolutely cannot go in these rooms (even the anteroom) for example, all of our meal trays are going to be disposable and dietary will give it to the nurse outside the anteroom. We also have certain rules for house keeping too. Good luck out there, very stressful times!

[SummitRN, BSN, RN]

We are using observers.

Just contact or just airborne, it's not to hard to get it exactly right every time.

Contact+Airborne+Eyepro the opportunity to self-contaminate during doffing goes up exponentially.

You need to get it right every time. We know there are about 2000 sick healthcare workers in Italy. One of my colleagues is vented right now after a work exposure. You need to get it right every time. The studies show that perfect adherence means no acquired infections from work.

You need to get it right every time.

Take it seriously and hone your technique. In a little while there will not be the luxury of observers.

[LibraNurse27, BSN, RN]

8 hours ago, SummitRN said:

We are using observers.

Just contact or just airborne, it's not to hard to get it exactly right every time.

Contact+Airborne+Eyepro the opportunity to self-contaminate during doffing goes up exponentially.

You need to get it right every time. We know there are about 2000 sick healthcare workers in Italy. One of my colleagues is vented right now after a work exposure. You need to get it right every time. The studies show that perfect adherence means no acquired infections from work.

You need to get it right every time.

Take it seriously and hone your technique. In a little while there will not be the luxury of observers.

That is so scary. I am so sorry for your colleague and I hope they will recover. And the situation in Italy is crazy. I agree with needing to get it right every time! I'm so glad my first two rule out patients were negative as I was not yet comfortable with the observer role.

I asked not to do that role again because it is so important and stresses me out. I am fine with taking care of the rule out patients and being observed. And I am fine with taking a hard assignment instead of being observer. Many colleagues like doing it because they don't have to do pt care and they feel confident in the role so it works out! Teamwork

[InnovativeRN, BSN, RN]

From my understanding this is mandated by our state health department. Just remember it is for the safety of you and everyone else. Their job is to observe and monitor PPE donning and doffing for potential breaches thus preventing unnecessary spread of the virus. They are NOT there to critique or comment on your clinical interventions.

[LibraNurse27, BSN, RN]

I don't take it as a critique in any way. I am glad we are doing it for our own protection, and I am so sad about all the healthcare workers who have been infected in Italy. The Italian news said it is likely most of them were infected during the doffing sequence.

I wish my hospital had given every nurse training on the observer role and the role of the nurse in the room instead of last-minute training when it's your turn. I let administration know and so did other nurses, but still no formal all staff training. I know they are overwhelmed but this is important. People are getting infected. I am now comfortable with the role and understand it's function, and I am grateful. Stay safe everyone, and I hope you have enough staff and supplies to do so ❤️