Combating COVID-19: Best Practices That Clinicians Need to Know

As the variety of
international circumstances of coronavirus illness 2019 (COVID-19) rises, it’s crucial
that healthcare suppliers keep knowledgeable and ready with the perfect medical
practices to fight the SARS-CoV-2 virus. Following applicable tips and
working towards correct method will profit each sufferers and clinicians and
higher forestall the additional unfold of the virus.

It has been established that the virus principally spreads from individual to individual through shut contact or respiratory droplets. The Centers for Disease Control and Prevention (CDC) defines shut contact with a affected person with COVID-19 as being inside 6 toes for an prolonged time frame or having direct contact with the affected person’s bodily fluids (ie, sputum, blood, respiratory droplets).1 When treating sufferers in such shut proximity, it’s particularly necessary to make use of private protecting tools (PPE), which might help to cut back the chance of buying the virus.

PPE and Isolation Precautions

In a podcast interview,
Betsey Todd, MPH, RN, a nurse epidemiologist and medical editor of American Journal of Nursing, famous the
significance of correct PPE and the way it varies relying on the Four classes of
isolation precautions: normal, contact, droplet, and airborne precautions.2


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Unlike normal precaution, contact, droplet, and airborne precautions are all kinds of transmission precautions that Ms Todd notes could also be utilized in mixture. While contact precautions embody using gloves and robes to deal with situations corresponding to methicillin-resistant Staphylococcus aureus, different situations corresponding to influenza infections or tuberculosis could require extra PPE, corresponding to a face masks or protect (droplet precautions) or an N95 respirator and adverse stress rooms (airborne precautions), respectively.2

When discussing the remedy of sufferers with suspected or
confirmed COVID-19, Ms Todd famous that there’s relative certainty that the
virus spreads by droplets, which could recommend the necessity for a masks and face
cowl. However, she notes that as a result of the virus remains to be so new, “the CDC
recommends for sufferers which are suspected of getting or have confirmed COVID-19,
that [health care providers] go forward and use, not droplet, however airborne
precautions, and place the affected person in a adverse stress room if accessible.”

Ms Todd went on to notice that “regular surgical-type masks are made for containing droplets from [a clinician’s] own mouth…whereas N95 respirators or other kinds of particulate respirators are made to protect what [clinicians are] breathing in.” Therefore, she suggests using airborne precaution method.

Proper PPE wouldn’t be as efficient if not worn accurately. When
carrying a masks, be sure to fit-test by taking a second to guarantee that the
masks suits appropriately. Take just a few deep breaths to make sure there is no such thing as a leakage
round or close to the masks.2

When requested who ought to be carrying the N95 masks, Ms Todd replied, “the CDC and World Health Organization are really trying to strongly push back against the idea that everybody should go around wearing any kind of mask… . People think that it will protect them out in public, but the fact is that N95s are not appropriate for wearing long periods of time.”

The World Health Organization famous earlier this month in a information launch that the “shortages [in PPE] are leaving doctors, nurses, and other frontline workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons.”3

Practices for Healthcare
Providers and Patients

Amy Fuller, DNP, director of the Master’s Nurse Program at Endicott College in Beverly, Massachusetts, described steps nurse practitioners (NPs) and doctor assistants (PAs) can take to make sure the perfect prevention and remedy strategies.

Because the 2019 coronavirus outbreak has overlapped with the
present influenza season, Dr Fuller famous that “it’s arduous to distinguish
as a result of they each have the identical type of signs. But the incidence and
prevalence for the flu is a lot higher than for the coronavirus.” For
nurses, NPs, and PAs, she famous that it ought to be “common sense” that if a
affected person is “coughing or sneezing, put a mask on.”

She continued by noting that each healthcare suppliers and sufferers ought to be “realistic” and that the SARS-CoV-2 virus will “be here with more of a presence than it is currently.” Healthcare suppliers ought to inform their sufferers to “avoid crowded places” and “avoid close contact with people who are sick,” along with avoiding cruise journey and nonessential air journey and staying at residence as a lot as attainable to additional scale back the chance of publicity.4

Another
suggestion was for healthcare suppliers to be conscious of the sufferers who
current to their practices and ensure to triage them instantly. It is
necessary to be conscious of their symptomology, their contact with others, and
their journey historical past.

Both clinicians and sufferers ought to keep away from touching their face, nostril, and eyes; you should definitely wash their palms typically with cleaning soap and water (for a minimum of 20 seconds) or with a minimum of 60% alcohol-containing hand sanitizer if cleaning soap and water usually are not accessible; and to wash and disinfect frequent floor areas within the residence.4

When requested
whether or not a affected person ought to be self-quarantined or seen in a medical apply, Dr
Fuller famous that it depends upon the case. “I would definitely suggest
self-quarantine if they’ve the chance components…if [patient] signs are delicate,
and most circumstances are delicate, [the patients] don’t require any type of
hospitalization.”

If a affected person
presents with signs, “the caveat could possibly be that the nurse, NP, or PA can
examine on the affected person in 12 hours and see how they’re doing or instruct them to
name again if their signs worsen. But if they simply have cold-like signs
with no fever, I’m not totally invested in sending them to the hospital.”

There is
at the moment no vaccine or antiviral to deal with this an infection. Current therapies
could embody fever-reducing drugs however “the very last thing we need to do is
have an enormous rush of individuals to the hospital who solely have delicate, cold-like
signs.”

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Risks and Symptoms to Look
Out For

According to the CDC, it’s important for healthcare suppliers to concentrate to signs corresponding to fever, cough, and shortness of breath.4 While human coronaviruses could cause illness just like a standard chilly, extra extreme circumstances could cause pneumonia, extreme acute respiratory syndrome, and even demise.5 Individuals with a better risk for COVID-19 embody older adults and people with continual medical situations corresponding to coronary heart illness, diabetes, and lung illness. Emergency warning indicators that require rapid medical consideration embody problem respiratory or shortness of breath, persistent ache or stress within the chest, new confusion or lack of ability to arouse, and/or bluish lips or face. Although these usually are not all inclusive, the CDC urges adults with these signs to contact their medical suppliers. 

Conclusion

Healthcare suppliers are on the forefront, caring for contaminated
sufferers and growing their very own threat of publicity to the virus. The
data surrounding COVID-19 is consistently being up to date as we study extra
in regards to the virus, the diseases it causes, and who’s in danger.

It is crucial that clinicians proceed to learn new data and keep up to date, apply beneficial hygiene, put on the suitable PPE, and guarantee that their sufferers are educated. Following the suitable steps will assist to cut back the unfold of the virus and hopefully forestall additional publicity in uninfected people.

Reference

  1. What healthcare personnel should know about caring for patients with confirmed or possible COVID-19 infection. Centers for Disease Control and Prevention.  Updated February 29, 2020.
  2. Bonsall L, Todd B. COVID-19: what nurses need to know about personal protective equipment (PPE). Lippincott Nurs Cent. March 6, 2020. Accessed March 10, 2020.
  3. Shortage of personal protective equipment endangering health workers worldwide. World Health Organization. March 3, 2020. Accessed March 11, 2020.
  4. People at risk for serious illness from COVID-19.Centers for Disease Control and Prevention. Updated March 9, 2020. Accessed March 11, 2020.
  5. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health. World Health Organization. Accessed March 11, 2020.

This article initially appeared on Clinical Advisor

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