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! 
 

On 10/16/2020 at 12:53 AM, Missingyou said:

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).

Admittedly our knowledge about the SARS-CoV-2 is still limited and we are constantly gaining new information. But three reinfections in a single facility sounds unlikely to me. We have almost 40 millions cases of Covid-19 infections so far globally and to date there have only been a handful confirmed reinfections worldwide.

Are the cases in your facility laboratory confirmed on both the first and the second instances of infection and has whole genome sequencing been done to ascertain that it’s indeed reinfections and not just long-term positives/viral shedders?

I have no doubt that we will se more reinfections as time passes but considering the large amount of people who’ve had the infection since the pandemic started, so far we haven’t seen a substantial number.

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30764-7/fulltext

https://www.ecdc.europa.eu/sites/default/files/documents/Re-infection-and-viral-shedding-threat-assessment-brief.pdf

 

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On 10/16/2020 at 9:16 AM, turtlesRcool said:

I haven't heard about aerosolizing risk vs EKG risk, and am curious about the study showing that.  

This is not meant to be a well-researched intellectual comment ? but some of the talk about AGPs and especially associating them with intubation didn't strike me as being very commonsense right from the get-go. After all, a patient who is down and ready to be intubated (in my area that would be due to RSI) already a lot lower risk to everyone around than they were even in the minutes just preceding the moment when someone was standing at the HOB to intubate them. Now it totally makes sense that those at the HOB are in a high risk situation - but, at that point it is due to sheer proximity. All the minutes and hours leading up to that moment probably should've been considered more high risk than they were, since this same covid+ patient has been putting "aerosols" into the air the entire time--those being their breath, their coughs, etc.

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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 neglected to answer the part about what evidence the idea of AGP risk is based on.  First, there are no RCTs on the subject, they simply looked retrospectively at the procedures that HCWs who contracted a virus had taken part in (this comes mainly from the SARS outbreak).  There was an assumption that procedures which increased HCW risk of becoming infected posed a higher risk because they produce an increase in aerosols, even though there was no apparent basis to assume this, particularly since most of the procedures that showed a higher risk to HCWs have no apparent mechanism of producing aerosols.  One of the meta-analyses this was based on even specifically pointed out that the significantly higher risk of procedures like a 12 lead EKG compared to intubation suggested that aerosol generation was not the variable that produced the increase risk.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0010717

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263217/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338532/#!po=72.2222

The conspiracy theory to attempt to explain how it is that supposedly intelligent medical and scientific professionals have made this assumption is that the procedures singled out as being higher risk due to aerosol generation are overwhelmingly procedures performed by Physicians, whereas the procedures shown to be of equal or even higher risk but yet aren't included in lists of procedures that justify the use of respirators are predominately performed by staff who are lower on the totem pole, so to speak.  

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47 minutes ago, MunoRN said:

The conspiracy theory to attempt to explain how it is that supposedly intelligent medical and scientific professionals have made this assumption is that the procedures singled out as being higher risk due to aerosol generation are overwhelmingly procedures performed by Physicians, whereas the procedures shown to be of equal or even higher risk but yet aren't included in lists of procedures that justify the use of respirators are predominately performed by staff who are lower on the totem pole, so to speak. 

I always kind of thought it also (maybe moreso) had to do with the fact that business is in even bigger trouble with PPE if anyone dares admit that the coughing and the breathing generate aerosols.

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On 10/15/2020 at 6:53 PM, Missingyou said:

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).

I work in a nursing home as well, and I can relate. I honestly lost all hope when I see nursing staff pulling their masks down to talk to each other or on the phone. 

Pretty much everything you said applies to where I work, except we have to buy our own KN 95 if we want to wear anything more than a surgical mask (on non Covid units). 

*sighs*

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Specializes in Emergency Room, CEN, TCRN.

we wear a mask at all times on shift, we're supposed to wear safety glasses but those are kind of short in supply. In covid/presumptive rooms we're supposed to wear gown, gloves, mask, glasses, and face shield.

No more N95s or PAPRS unless its an aerosolized procedure

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Specializes in Ortho-Neuro.

I just checked my work email and my hospital has updated PPE policy as we enter our 3rd wave in my state.

We will no longer wear N95/PAPR for confirmed or PUI Covid+ patients routinely. We will wear surgical masks unless they are having an aerosolizing procedure and then we will use N95/PAPR. We will continue to reuse the N95 until they fall apart. They will be eligible for cleaning after 50 hours of use, which will be tracked on the paper bag we store the mask in.

1 surgical mask per staff member per shift to be worn the whole shift. We are to be ready to reuse masks over multiple shifts, so we have been encouraged to keep old masks that are still usable.

Right now we are not reusing gowns, but starting on Wednesday we will be reusing gowns for all patients except C-diff patients. This will consist of hanging the gown on a hook inside the patients room and reusing the gown for the shift.

Face shields to be used with all patients. They do not take the place of a mask. We will bleach the face shield between patients and continue to use until cannot read text through the face shield. We've already been doing this for a while, and this particularly stinks because they start fogging up immediately.

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Specializes in ECC.

Emergency department

Symptomatic resus - Full gear
Asymptomatic - surgical mask
Majors 1 - Surgical mask
Majors 2 Confirmed covids - full gear.
Walk in triage - surgical mask
Ambulance triage - surgical mask

Quite a number of times people I have nursed in majors 1 tested positive for covid so now I make a habit of wearing N95 or my fitted mask. I'd wear goggles/visor as well but they fog up as I get really warm although it is a habit I'm trying to get into. 

Personally I think full PPE should be worn because you cant diagnose covid by eyeballing patients as they come in. 

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Specializes in CRNA.

n95 is the standard at our hospital

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Specializes in Private Duty Pediatrics.
20 hours ago, Ioreth said:

Face shields to be used with all patients. They do not take the place of a mask. We will bleach the face shield between patients and continue to use until cannot read text through the face shield. We've already been doing this for a while, and this particularly stinks because they start fogging up immediately.

Why not simply wash the plastic on the face shield with soap & water? Soap kills the virus and water washes it away. And neither will fog up the shield.

Am I missing something here? Perhaps it takes too long, and it makes more sense to quickly wipe it down?

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