You can download a printable version of this checklist to take to work here.
As more large gatherings are canceled and more people in the U.S. elect to self-quarantine or practice social distancing measures, it’s clear the outbreak of novel coronavirus and the disease it causes, COVID-19, isn’t slowing down.
To make matters more stressful, many healthcare workers feel underprepared to fight the epidemic, should it come to their workplace. In fact, according a recent survey by National Nurses United, less than half of nurses (44 percent) said their employers had provided them with info on COVID-19, and only 29 percent reported that their employers had a plan to isolate patients with possible infection. Only 65 percent said they were trained on safely donning and doffing personal protective equipment with the past year.
In an effort to make up for this lack of consistent information, here is a compilation of practices that you should follow every day at your facility during this outbreak. This information comes from both the Centers for Disease Control and Prevention, as well as several infectious disease experts: Aaron Glatt, MD, Mount Sinai South; Stephen Joseph Scholand, MD, MidState Medical Center; Richard Beers, MD, SUNY Upstate Medical Center; Maria A. Erbin-Roesemann, PhD, RN, Texas State University; and Brandon Brown, MPH, PhD, University of California, Riverside.
Before the visit
- If a patient is requesting an appointment for respiratory symptoms, assess whether the patient can be treated remotely.
- If the patient must come in, request they call ahead of time to remind staff.
- Upon entry, give patients with respiratory symptoms a mask, and instruct them to wear it for the entire visit unless told otherwise.
- At check-in, ask ALL patients about: symptoms of a respiratory infection; history of travel to areas experiencing transmission of COVID-19; and contact with possible COVID-19 patients.
- Keep patients with possible COVID-19 symptoms in a separate waiting room.
- Know the criteria for a person under investigation (PUI) for COVID-19.
- Perform triage and isolate patients with symptoms of suspected COVID-19 or respiratory infection (ex. fever, cough) in an exam room with the door closed as quickly as possible.
- If hospitalization isn’t medically necessary, recommend home care.
- Place admitted patients with suspected or known COVID-19 in single rooms with dedicated bathrooms. Place patients requiring aerosol-generating procedures in airborne infection isolation rooms (AIIRs).
During the stay
- Ask COVID-19 patients not to leave their room. They should only do so if it’s medically necessary.
- Avoid performing procedures that could generate coughing. If they’re medically necessary, then: do it in an AIIR; wear an N95 or higher-level respirator, eye protection, gloves and a gown; and make sure surfaces in the room are disinfected ASAP.
- Ask all admitted patients daily about whether they’ve developed respiratory symptoms.
- Limit visitors for suspected COVID-19 patients. Encourage video calls, phone calls, etc. instead.
- Before the visitor enters the patient’s room, provide instruction about PPE, hand hygiene, cough etiquette and limiting touching surfaces.
- Visitors should only go to the patient’s room.
Your own protection
- Perform hand hygiene before and after all patient interactions, and after touching high-touch surfaces, like your stethoscope, door knobs, your phone or electronic equipment. Use sanitizer with 60-95 percent alcohol or antibacterial, liquid soap for 20 seconds.
- If an unprotected exposure takes place, contact your facility’s occupational health department.
- Avoid touching your eyes, nose or mouth.
Personal protective equipment
- Perform hand hygiene before putting on PPE and after taking it off.
- All PPE should be put on upon entering the care area EXCEPT for respirators and face masks, which you should put on right before entering.
- Remove all PPE right before leaving the care area except the respirator.
- Follow CDC recommendations for safely removing and discarding PPE.
Respirators and face masks
- Put it on before entering the care area. For N95s, make sure there’s a strong seal around the nose, cheeks and chin.
- Wear a respirator for aerosol-generating procedures.
- Discard disposable face masks/respirators after leaving the care area and closing the door.
- Make sure reusable equipment is cleaned properly prior to reuse.
- Don’t touch your respirator or face mask during the visit.
- Put on goggles or a disposable face shield that covers the front and sides of the face upon entering the care area. (Note that eyeglasses and contact lenses aren’t sufficient protection.)
- Remove eye protection right before leaving the care area.
- Make sure reusable goggles or shields are disinfected properly.
- Don’t touch your eye protection during the visit.
- Put on clean, non-sterile gloves upon entering the care area.
- Change gloves if they become torn or heavily contaminated during the visit. Practice hand hygiene after removing them.
- Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.
- Put on a clean gown upon entering the care area.
- Change the gown if it becomes soiled during the visit.
- If it’s disposable, remove and discard it before leaving the care area.
If there’s a shortage…
- Prioritize gowns for aerosol-generating procedures, activities where splashes or sprays are anticipated, and high-contact activities (ex. dressing, bathing, changing linens).
- Prioritize respirators for procedures that are likely to generate respiratory aerosols.
- If necessary, use respirators beyond the manufacturer-designated shelf life.
- Implement limited re-use of N95 respirators for patients with COVID-19, measles and varicella.
Additional healthcare setting policies
- Train all staff members on best practices for COVID-19 infection prevention.
- Post signage throughout the facility, especially at entry points, that explains how to minimize spread of COVID-19 (ex. hand hygiene, covering your cough, wearing masks).
- Minimize entry points to the facility.
- Establish a separate “respiratory virus evaluation center” where patients with fever or respiratory symptoms can seek evaluation and care.
- Establish dedicated personnel for treating these patients to minimize possible exposure for other staff and patients.
- Cancel group healthcare activities (ex. group therapy, recreational activities).
- Postpone elective procedures, surgeries and non-urgent outpatient visits.
Home care settings
- Before making a home visit, speak with the patient by phone.
- If the symptoms are indicative of COVID-19, call the county health department and ask about getting a test.
- For such patients, recommend the patient stay in a separate bedroom and that the patient, family and caregivers have access to PPE, especially gloves and face masks.
- During home visits with no suspected COVID-19, follow regular safety precautions, especially hand-washing.
- Tell any coughing or sneezing patients to wear a mask.
- Make sure there is a container of alcohol-based hand sanitizer at the door of the office and reception desk.
- Ask patients with symptoms of respiratory infection to wait separately, ideally in a well-ventilated space more than six feet from other patients.
- Contact patients via phone when it’s their turn.
On your own time
- Monitor the CDC guidelines regularly.
- If you become sick, stay at home and notify your employer’s occupational health services. Do not go to work.
- Take care of yourself! Get enough sleep, eat right, you know the drill…
Additional COVID-19 resources from Florence Health: