By Christopher Cheney
As the novel coronavirus (COVID-19) spreads in the United States and globally, measures must be taken to protect and support healthcare workers and their families, a new journal article says.
In China, where the COVID-19 outbreak started in December, nearly 3,400 healthcare workers have been infected, with 22 deaths, the National Health Commission of the People’s Republic of China has reported.
Although routes of COVID-19 transmission have not been thoroughly researched, the spread of the viral disease is believed to be mainly through person-to-person contact, such as by respiratory droplets from infected individuals who cough and sneeze, the Centers for Disease Control and Prevention reports. Transmission of the virus may also be possible from contaminated surfaces and objects, according to the CDC.
The COVID-19 pandemic is straining healthcare workers worldwide, according to the new journal article, which was published last week by the Journal of the American Medical Association. “The pressure on the global healthcare workforce continues to intensify. This pressure takes two forms. The first is the potentially overwhelming burden of illnesses that stresses health system capacity and the second is the adverse effects on healthcare workers, including the risk of infection,” the article co-authors wrote.
They say six kinds of measures can protect and support healthcare workers and their families.
1. Infection prevention: Protective gear is essential to prevent healthcare worker infection when treating COVID-19 patients, the article co-authors wrote. “The CDC recommends the use of personal protective equipment including a gown, gloves, and either an N95 respirator plus a face shield/goggles or a powered, air-purifying respirator (PAPR).”
If N95 respirators or PAPR are not available such as in many outpatient settings, medical masks could be effective protection, the article co-authors wrote. “In a study of outpatient healthcare personnel in diverse ambulatory practices, medical masks applied to both patient and caregiver provided effectively similar protection as N95 masks in the incidence of laboratory-confirmed influenza among caregivers who were routinely exposed to patients with respiratory viruses.”
2. Emergency department protocols: EDs are on the front line of the coronavirus pandemic and crowding is a concern for person-to-person contact among patients with respiratory symptoms, the article co-authors wrote. “Placing a facemask on the patient at arrival, supplying tissues, promoting cough etiquette, and providing for hand hygiene and surface decontamination are all important steps.”
They say urgent actions should be taken for patients who present at EDs with COVID-19 symptoms, which are primarily fever, cough, and shortness of breath. Those steps include rapid triage and placing the patient in a well-ventilated space away from other patients until an isolation room is available.
3. Hand hygiene and surface decontamination: Hand hygiene is critically important for healthcare workers during the COVID-19 pandemic, the article co-authors wrote. “Healthcare personnel must focus on meticulous hand hygiene, avoiding contaminating workspaces.”
The COVID-19 virus has been shown to live on surfaces for hours or days, so healthcare workers should disinfect personal items and workspaces such as cell phones and keyboards. “It is sensible for environmental services workers to increase the frequency of cleaning of commonly touched surfaces such as light switches, countertops, chair arms, escalator railings, elevator buttons, doorknobs, and handles,” the article co-authors wrote.
4. Healthcare worker precautions: With community spread of COVID-19 reported in many states, U.S. healthcare workers are at high risk of exposure to the virus, the article co-authors wrote. “Healthcare workers must self-monitor, report signs of illness, and not engage in patient care while exhibiting infectious symptoms.”
Just like elderly members of the general public, some healthcare workers can be at risk for severe outcomes from the COVID-19 outbreak, they wrote. “Many healthcare workers have conditions that elevate risk for severe infection or death if they become infected with COVID-19, so organizations will need to decide whether such workers, including physicians, should be redeployed away from the highest risk sites.”
They wrote that healthcare organizations should consider restricting the travel of healthcare workers to reduce the risk of exposure and to keep clinical staff close to work and available.
5. Protecting family members: “For front-line caregivers, the concerns about transmitting the virus to family members will need to be addressed,” the article co-authors wrote.
They wrote these concerns can be eased through communication with healthcare workers about ways to protect family members, including separation of living spaces and protocols for infection control after shifts such as removing and washing clothing at home. “The focus should be on supportive conversations, clear guidance when recommendations exist, attempts to minimize misinformation, and efforts to reduce anxiety.”
6. Leadership: With the COVID-19 crisis likely to stretch over weeks or months, the leaders of healthcare organizations should engage healthcare workers to address their concerns, the article co-authors wrote.
“Transparent and thoughtful communication could contribute to trust and a sense of control. Ensuring that workers feel they get adequate rest, are able to tend to critical personal needs (such as care of an older family member), and are supported both as healthcare professionals and as individuals will help maintain individual and team performance over the long run.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.