Standard COVID Precautions

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I have some questions about how hospitals nationwide are handling COVID. Mainly curious about hotspots, but all answers appreciated. 

1) Do you wear N95s all day, outside of COVID+ rooms?
2) Is your hospital testing all patients, or only those who are symptomatic?
3) If you're wearing surgical masks, do you get a new one each day?
4) Do you have both COVID+ and COVID- patients on the same shift/same floor?
5) Do you feel it's inevitable that you and/or your family members will have COVID at some point and, if so, do you think it's because you're a healthcare worker?
6) Are your coworkers keeping the doors closed on COVID+ patients, PUIs, and those with aerosolizing treatments?

Thank you! 
 

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  1. No.  We only wear an N95 in the room with COVID positive patients or PUI.  Outside of these rooms we always wear a surgical mask.  We wear an N95 mask for all aerosolizing procedures, regardless of COVID status.  We are also required to wear eye protection at all times as well.
  2. All patients are screened on admission, unless they have a negative COVID screen within the past 7 days.  Personally, I disagree with this and think that all patients should be screened.
  3. Daily, and as needed when soiled.  Additionally, the mask is changed when we exit the room of a patient on isolation for any reason.
  4. Yes.
  5. No, I don’t think so.  While I realize there is a possibility that I might come in contact with an asymptomatic patient at work, I am very attentive to wearing PPE.
  6. Yes.  Ideally COVID positive patients and PUI are placed in a negative pressure room.  The doors to these rooms are always left closed and all persons entering and exiting the room do so through the anteroom.  If we have to use a non-negative pressure room the doors are kept closed as much as possible, and a portable HEPA filter is placed in these rooms.  
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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

1. Not outside of patient rooms. N95 masks are used inside the room of a patient who is COVID 19 positive, PUI's and pending COVID 19 results, and patients having any of the aerosol-generating procedures regardless of COVID 19 status.  At a minimum, N95 + face shield OR PAPR, gown, gloves are required.

2. Yes, all admissions must have a COVID test within the last 3-4 days which would include all elective surgical admissions to the hospital. All ED admissions are tested. Patients who are still in the hospital will be retested every 7 days for as long as they are in the hospital.

3. We have screening questionnaires for all staff and visitors that must be completed at the hospital entrance everyday.  This can be done on a smartphone app.  If we pass the questionnaire, we are handed a new surgical mask and allowed to enter.  If a staff member fails the questionnaire, they get referred for testing by employee health and can not work. Visitors are denied entry and asked to seek care. Surgical masks are required in all areas along with eye protection (we can bring our own PPI for eye protection as long as it's a style approved by the medical center).  Soiled or damaged surgical masks must be replaced immediately

4. Yes, COVID 19 patients are admitted in the MICU and the COVID19 unit (non-ICU) in 2 separate campuses within the medical center system.  Some COVID 19 patients are in the Cardiac ICU if on ECMO or being considered for ECMO.  COVID 19 positive OB ICU cases are admitted in a designated women's health ICU within the medical center.  Non-ICU COVID 19 OB patients stay in the L&D area in a private room.  Peds patients are admitted in various peds ICU's and peds units depending on their acuity.  There is a protocol for OR prep and transport for COVID 19 patients. 

5. Hope not if we all follow precautions to minimize risk.

6. Yes, the efficiency of the negative pressure vent in the rooms decreases when doors are open for a prolonged period of time.  You only open the door to allow you to get in and out of the room.  Because our buildings are older, not all negative pressure rooms have an ante-room but maintenance checks the efficiency of those rooms frequently.

-- Our state has the highest number of COVID 19 positive individuals in the US but our city is not considered a COVID 19 hotspot.  

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On 10/3/2020 at 1:12 PM, rooftop-yawp said:

I have some questions about how hospitals nationwide are handling COVID. Mainly curious about hotspots, but all answers appreciated. 

1) Do you wear N95s all day, outside of COVID+ rooms?
2) Is your hospital testing all patients, or only those who are symptomatic?
3) If you're wearing surgical masks, do you get a new one each day?
4) Do you have both COVID+ and COVID- patients on the same shift/same floor?
5) Do you feel it's inevitable that you and/or your family members will have COVID at some point and, if so, do you think it's because you're a healthcare worker?
6) Are your coworkers keeping the doors closed on COVID+ patients, PUIs, and those with aerosolizing treatments?

Thank you! 
 

1) When I am on a COVID unit, I wear my N95 mask the whole time. Some colleagues switch to surgical masks when they are outside the rooms.  I find I don't get a good tight seal if I take it off and reapply (because our straps stretch out but do not retract).

2) Our hospital does a rapid test for everyone who comes in, either through the ED or for scheduled surgery. Only those who meet risk criteria (COVID symptoms, cohabitation in a facility with known cases) will be given a PCR test if the rapid comes back negative. 

3) We get new surgical masks daily.  They were being rationed back in the Spring, but are now readily available. No problem to change when soiled.

4) I have had both COVID - and COVID + patients on the same shift/floor because when waiting for patients to rule out or rule in, it's inevitable that some will test positive and others negative.  Once they are ruled out, they go to a clean floor.  If they test +, they remain on the COVID unit.  

5) I do not feel it's inevitable that I will get COVID.  We've already had the first surge back in the Spring when there was a national PPE shortage and very little testing capabilities.  I didn't get it then, and see no reason it would be inevitable that I'd get it now that we have better testing and more PPE.  At the moment, our community spread is low, and has been for several months, but I realize that could change at any point. If community spread goes up, my chances of contracting COVID go up, too, but not because of my job.  

6) Of course, we keep the doors closed.  Why wouldn't we?  Additionally, our hospital policy is to wear N95 masks during any aerosolizing treatment, even if the patient has tested negative for COVID.  Those treatments can only take place in private rooms, and we are keeping a negative pressure room open on each floor so patients in double rooms can be brought there for their respiratory treatments.

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Specializes in Med-Surg.
On 10/3/2020 at 1:12 PM, rooftop-yawp said:

I have some questions about how hospitals nationwide are handling COVID. Mainly curious about hotspots, but all answers appreciated. 

1) Do you wear N95s all day, outside of COVID+ rooms?
2) Is your hospital testing all patients, or only those who are symptomatic?
3) If you're wearing surgical masks, do you get a new one each day?
4) Do you have both COVID+ and COVID- patients on the same shift/same floor?
5) Do you feel it's inevitable that you and/or your family members will have COVID at some point and, if so, do you think it's because you're a healthcare worker?
6) Are your coworkers keeping the doors closed on COVID+ patients, PUIs, and those with aerosolizing treatments?

Thank you! 
 

1). I'm not 100% what they are doing as I don't float there, but when it started they wore N95's and face shields all day, even outside of rooms.

2). All admissions are tested for covid and resulted prior to coming to the floor.

3). Yes a new mask everyday.  We also use new N95's every day as they are no longer in short supply.

4). No.  We have designated Covid floors for both critical and non-critical covid patients.  We have a couple of floors where PUI's can be mixed with general patients.  They've tested negative, but have either had an exposure or their symptoms are so suspicious that even if negative they will be on PUI isolation.  We also have "never covid" floors which is our trauma unit, and one of the med-surg units where the post-op patients go (this is the floor I work on by some dumb luck).

5).I have always thought it was inevitable that I get it, especially during our surge here in Florida back in July.   Our percent of positivity has risen some where I live and we're probably headed for a 2nd wave as I live in Florida where there are now no restrictions.  But since we were designated not to have covid or PUI on my floor I am feeling a bit better about it.  About a month ago I tested negative for antibiodies so apparently I was doing well up to that point even after three known exposures.

6). Yes, doors are shut for all three types of patients.  We are to wear N95's after someone gets a breathing treatment for 30 minutes and to keep the door shut.

 

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Specializes in Ortho-Neuro.

Background: The metropolitan area I live in has about 750,000 people. It has grown fast and the hospital systems here were already insufficient before COVID. Nursing shortage here is real, but the next metro over has a surplus of nurses. I wouldn't consider this a hotspot, but due to the number of people, we are seeing quite a bit of COVID. The local department of health announced this week that we are now in our 3rd wave of COVID, and it is different this time because it is higher than previous waves and it is sustained at the same level as the highest peak we have seen so far. My hospital started with pretty good isolation control and COVID cohorting, but we've since gone back to almost normal. Even with the 2nd and now 3rd waves, we have not returned to any previous level of precautions. 

1) Do you wear N95s all day, outside of COVID+ rooms?
No, and we never have. Even when we had a COVID+ cohorted floor, they did not wear masks outside patient rooms. We still wear the same N95 until it falls apart. In July, we started using a dry cleaning process, but the mask must have 50 hours use before eligible for cleaning. We keep them in paper bags that we keep with us. I believe these policies are in still place as cost-cutting measures rather than due to actual shortage.

2) Is your hospital testing all patients, or only those who are symptomatic?
Only symptomatic and patients with elective surgeries. We've had multiple instances where a trauma patient came in and was later found to be COVID+. Most ED admits are not tested.

3) If you're wearing surgical masks, do you get a new one each day?
We wear a new surgical mask each day, and it is the same surgical mask for the entire day. That mask goes in and out of all patient rooms and all public areas of the hospital. We do not change the mask between isolation rooms unless the isolation is droplet or airborne. We get 1 new one at the start of the day and it must be given out by charge nurse on the assigned unit. We wear a cloth mask from entry into hospital until start of shift at our unit. All non-patient contact staff wear cloth masks the entire shift.

4) Do you have both COVID+ and COVID- patients on the same shift/same floor?
Yes. We used to cohort patients on a dedicated floor, but this was discontinued. We have the same amount of COVID+ and COVID rule outs, but less mortality and overall less acuity, so we're actually seeing more COVID+ outside of ICU and Intermediate Care.
I'm on a post-surgical unit. Our surgeons used to tell patients that COVID+ patients were not allowed on or floor. This is not true and has never been true. When we have a known COVID+ or rule out, then we try to put a few rooms space between them and the fresh post-ops, but that isn't always possible. We get COVID patients rarely enough that we only have one or two on the floor at a time, so that nurse gets post-surgicals and med/surg patients too.

5) Do you feel it's inevitable that you and/or your family members will have COVID at some point and, if so, do you think it's because you're a healthcare worker?
Yup. Already have had COVID in late May and I have a known source from a patient at work. Patient was a trauma that went to emergency surgery and was on our floor for over a week. I was that patient's nurse 5 of the nights he was on our unit. Patient had chest tubes and was on continuous BIPAP. A family member was staying the night each night and tested positive. Then one of the docs realized the patient looked COVIDish and the patient tested positive too. I didn't know anything about all these tests, but I came down sick shortly after and tested inconclusive, but was diagnosed positive by symptoms alone. Another nurse in my unit that cared for this patient also tested positive. The hospital now has a policy to wear N95 in all rooms with CPAP or BIPAP, but at the time of exposure we were to wear surgical mask only, and only in patient rooms. Not convinced an N95 would have helped in this case since we still don't gown up with aerosolizing procedures.
My family all came down with symptoms but were milder and shorter than mine. I absolutely believe I gave it to them.

6) Are your coworkers keeping the doors closed on COVID+ patients, PUIs, and those with aerosolizing treatments?
Policy is always changing on this and my unit is having trouble keeping up. For the most part, we do above and beyond the policy and isolate more than strictly required because we recognize that our post-surgical patients are immune depressed and would have more difficulty with COVID due to their specific surgeries. The rest of the hospital is hit or miss. The current policy is door stays open with aerosolizing procedures if patient tests negative once.

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Specializes in Critical Care.

We stopped using the designation of "Aerosol Generating Procedures" some time ago because the premise that some procedures and interactions present a higher risk of COVID transmission due to the generation of aerosols appears to be false.  For instance, the same evidence that staff present during endotracheal intubation are at increased risk of getting infected also showed that being present during am EKG are at significantly higher risk of infection compared to intubation.  Unless there's something about an EKG that is thought to produce aerosols, it would appear that higher risk procedures / interactions aren't really based on the generation of aerosols, so how do your facilities determine what is higher risk and what isn't? 

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Specializes in Long term care.

It seems things are very different in a nursing home than in a hospital setting. 

We wear the same non fit tested KN 95 mask x 5 shifts regardless of which type of unit, covid positive or otherwise. Only just recently we have been required to wear face shields as well but, most don't actually wear them & no one enforces it! We also now have the option of wearing a new daily surgical mask on non positive unit but, again, I often see both CNAs & RNs with masks pulled under the nose in patient rooms!

We have a "clean unit", a "holding" unit for new admits, and a set of rooms for positive people. There are no pressurized rooms & doors are usually left open with PPE gowns hanging on the outside of doors...masks are not changed between patients on any unit, ever.

I had covid this past Spring along with everyone in my household despite the frantic efforts to not get it or pass it on. 

I'm convinced I will get it again if I continue to work in LTC. ( 1staff & 2 residents are currently on their 2nd bout of covid).

All staff & all residents were being tested weekly since May. We are now tested 2x a week because there is a new surge of staff & residents testing positive. ..... I wonder why.? (.....sarcasm).

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On 10/3/2020 at 1:12 PM, rooftop-yawp said:

I have some questions about how hospitals nationwide are handling COVID. Mainly curious about hotspots, but all answers appreciated. 

1) Do you wear N95s all day, outside of COVID+ rooms?

No.  Covid only.


2) Is your hospital testing all patients, or only those who are symptomatic?

Symptomatic


3) If you're wearing surgical masks, do you get a new one each day?

Ours are cheap, and often only last me a few hours before they rip, then I take a new one.


4) Do you have both COVID+ and COVID- patients on the same shift/same floor?

ER, so yes.


5) Do you feel it's inevitable that you and/or your family members will have COVID at some point and, if so, do you think it's because you're a healthcare worker?

It sees likely, though not inevitable.


6) Are your coworkers keeping the doors closed on COVID+ patients, PUIs, and those with aerosolizing treatments?

Yes


Thank you! 
 

You're welcome.

 

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On 10/14/2020 at 11:58 AM, Ioreth said:

1) Do you wear N95s all day, outside of COVID+ rooms?
No, and we never have. Even when we had a COVID+ cohorted floor, they did not wear masks outside patient rooms. We still wear the same N95 until it falls apart. In July, we started using a dry cleaning process, but the mask must have 50 hours use before eligible for cleaning. We keep them in paper bags that we keep with us. I believe these policies are in still place as cost-cutting measures rather than due to actual shortage.

2) Is your hospital testing all patients, or only those who are symptomatic?
Only symptomatic and patients with elective surgeries. We've had multiple instances where a trauma patient came in and was later found to be COVID+. Most ED admits are not tested.

4) Do you have both COVID+ and COVID- patients on the same shift/same floor?
The rest of the hospital is hit or miss. The current policy is door stays open with aerosolizing procedures if patient tests negative once.

1) That seems like a really long time to wear a single N95, and I'm curious about not wearing it outside of patient rooms.  Since you'd be going in/out of the + patients' rooms multiple times daily, that's a lot of donning/doffing. It seems like that much handling would increase the risk of infection.

2) Why not test ED admits?  Since we know the spread can be from asymptomatic or presymptomatic patients, it seems risky to create a situation where people must be in close proximity to them for days without knowing their COVID status.

4) Why not shut the door?  It seems like that's a really easy intervention to decrease risk that costs $0.

15 hours ago, MunoRN said:

We stopped using the designation of "Aerosol Generating Procedures" some time ago because the premise that some procedures and interactions present a higher risk of COVID transmission due to the generation of aerosols appears to be false.  For instance, the same evidence that staff present during endotracheal intubation are at increased risk of getting infected also showed that being present during am EKG are at significantly higher risk of infection compared to intubation.  Unless there's something about an EKG that is thought to produce aerosols, it would appear that higher risk procedures / interactions aren't really based on the generation of aerosols, so how do your facilities determine what is higher risk and what isn't? 

I haven't heard about aerosolizing risk vs EKG risk, and am curious about the study showing that.  What controls were in place for the study? How would you tie it back to just those procedures?  

If your facility has decided the risk for an EKG and an intubation are equal, does that mean they are not adding additional precautions for intubation or does that mean they are providing N95 and face shields to people who perform the EKGs?

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Specializes in Ortho-Neuro.
4 hours ago, turtlesRcool said:

1) That seems like a really long time to wear a single N95, and I'm curious about not wearing it outside of patient rooms.  Since you'd be going in/out of the + patients' rooms multiple times daily, that's a lot of donning/doffing. It seems like that much handling would increase the risk of infection.

2) Why not test ED admits?  Since we know the spread can be from asymptomatic or presymptomatic patients, it seems risky to create a situation where people must be in close proximity to them for days without knowing their COVID status.

4) Why not shut the door?  It seems like that's a really easy intervention to decrease risk that costs $0.

I completely agree with each of your points, but I don't make the policies. As I mentioned, the lack of testing admits has already led to problems on my floor. We do keep the doors shut with aerosolizing procedures on my floor, but we do go above and beyond.

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Specializes in Critical Care.
On 10/16/2020 at 6:16 AM, turtlesRcool said:

I haven't heard about aerosolizing risk vs EKG risk, and am curious about the study showing that.  What controls were in place for the study? How would you tie it back to just those procedures?  

If your facility has decided the risk for an EKG and an intubation are equal, does that mean they are not adding additional precautions for intubation or does that mean they are providing N95 and face shields to people who perform the EKGs?

I think people mistakenly assume that there is some level of evidence to support the premise of "aerosol generating procedures" given how commonly the phrase is used in the setting of COVID-19.

The presumption that some procedures and interactions are more likely to result in virus transmission to staff because they are more likely to generate aerosols is just a guess, and a bad one at that.  Many of these procedures have no mechanism that would produce an increased number of aerosols relative to things that we already know produces aerosols, like talking for instance.

What the data shows is that increase of viral transmission increases with exposure, specifically proximity and time.  When are at what the CDC defines as "crisis capacity", which is the only time they allow limiting respirators (N95s, PAPRs) to certain procedures/interactions, we prioritize based on these factors that have been shown to increase risk.  This will typically include the person performing an intubation, but not because intubation produces significant aerosols (there's no basis for thinking that might be true) but because of being in close proximity to the patient's exhaled respiratory secretions.

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