COVID-19: The dos and donts as a Health Care Worker

INTRODUCTION

A lot has bee said about COVID-19 and you may have read a lot already. Lets keep the introduction short then.
SARTS-CoV2 – the virus that causes COVID-19 belong to a large family of viruses that cause illnesses ranging from common cold to more severe and even fatal diseases. CoVs are mainly zoonotic (transmitted from animals to humans with 4 known human (H)CoVs causing 10-30% of Upper respiratory tract infection in adults. Some members of the family are known to cause severe illness like the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

EPIDEMIOLOGY

The disease COVID-19 started in December in Wuhan, China. The World Health Organization was notified on the 31st December, 2019. The virus was named SARS-COV2 and the disease, COVID-19. WHO declared it pandemic on 12th March, 2020 and the attack rate is estimated to be 30-40%. The global estimation of cases can be found on the WHO and GHS websites.

TRANSMISSION

The risk of infection depends on exposure and is highest amongst close contact with infected persons. The risk can be categorized into High, Medium and Low.
Close contact for health care exposures can be defined as being within approximately 6 feet (2 meters) of a person with COVID-19 for a prolonged period of time (usually for or over 15minutes). Example, sitting within 6 feet of the patient in a healthcare waiting area or room. It can also be defined as having unprotected direct contact with infectious secretions or excretions of a COVID-19 patient. Example, being coughed on, touching used tissue with a bare hand.
Bodily fluids other than respiratory secretions has not been confirmed to transmit COVID-19 but we however know SARS-COV2 can infest its victims through mucus membranes, this means it will be wise to protect yourself from other non-respiratory fluids as well since they could potentially carry SARS-COV2.

HIGH-RISK EXPOSURE

A Health Care Worker (HCW) whose eyes, nose or mouth were no protected while performing or was present for procedures that generate aerosols and respiratory secretions were poorly controlled, example, CPM, nebulizer therapy, intubation etc on COVID-19 patients. It can also be categorized by prolonged contact of at least 15 minutes with a COVID-19 patient who wasn’t wearing a facemask and either – the HCW wasn’t on any Personal Protective Equipment (PPE) OR especially not wearing a medical mask or a respirator.

MEDIUM-RISK EXPOSURE

When a HCW has a prolonged close contact with a COVID-19 patient where mucus membranes were exposed to potentially infectious material. Example a HCW who had a close contact with a COVID-19 patient while the patient had a mask on but the HCW wasn’t wearing any PPE OR the HCW wasn’t on a medical mask or a respirator.

LOW-RISK EXPOSURE

Here, the HCW had brief interaction with the COVID-19 patient OR the HCW had prolonged close contact with a COVID-19 patient who was wearing a facemask and;

• The HCW was wearing a medical mask or respirator.
• The HCW was not wearing eye protection.
• The HCW was wearing all recommended PPE except that they were wearing a medical mask instead of a respirator.
  

OR the HCW had prolonged close contact with the COVID-19 patient who was not wearing a face mask while;

• The HCW was not wearing all gown or gloves (in this case, immediate hand washing is advised).
• The HCW was wearing all recommended PPE except that they were wearing a medical mask instead of a respirator.

SPREAD

COVID-19 is noted to be zoonotic but is now transmitted between humans via droplets (some people believe the virus can suspend in the air for a long time hence making it airborne) that is coughing and sneezing, close personal unprotected contact with an infected person i.e. touching, shaking hands, kissing etc. We cannot overlook the fact that transmission occurs through contamination fomites example PHONES, COMPUTERS, door handles and other surfaces. Most people have become addicted to their phones and computers (they sure will not admit) hence as soon as they wash their hands or sanitize, they go for their phone forgetting the protection from hand washing and hand sanitization doesn’t include the electronic gadget.PREVENTION Anything at all you do to stop SARS-COV2 from getting to any mucus membrane in your body can be called prevention. This include but not limited to :

• Avoiding unnecessary gatherings.
• This is where we have to limit patient visits.
• In some localities, the entire family brings just on person to the health facility (its real) please be bold enough to politely ask them to return leaving one or two key relatives behind.
• Check the number of people at your OPD and ensure there is enough space between them i.e. at least 6 feet.
  

• Being vigilant.
• You should avoid touching anything you don’t really need to touch including using your phone at work, picking things from your hand bag if you feel its necessary to take one with you to work.
• Avoid taking a hand bag with you to work as much as possible take yourself ONLY to work and little money you might need.
• Don’t wear the same uniform twice to work without washing it and if possible, get a basket at the entrance of your room where you can remove your uniform and discard before you enter into your room.
• Avoid touching patient and patient surroundings unnecessarily, be sure to wash your hands or sanitize afterwards.
• If there are HCW who just don’t care about their lives in your facility, avoid them. Example, HCW who playfully cough or sneeze on you or rob their hands on you because you asked them not to.
• Be each others keeper i.e. if your colleague is doing anything that could compromise their safety, alert them because you sure will be vigilant about your patients but you won’t exercise that same level of vigilance with your colleagues hence when they get infected, your health will be on the line as well.
  

• Practice social distancing.
• You should space up your ward, it would be great to leave at least 4 meters (just for safety because the patient might spend over 48hrs on the ward with others) between beds, some COVID-19 patients are asymptomatic but can spread the infection.
• Maintain at least 6 feet between you and your out patients especially those you have not screened.
  

• Follow Universal Precautions.
• Where available, use surgical or N-95 mask when attending to your patients and wash your hands before and after touching each patient.
• As much as it is very tempting, do not touch your eyes, nose, mouth or ears because you’ll be giving the virus a free lift to a mucus membrane. This is something I noticed from the few videos of patient recovering from COVID-19. They talk for a few seconds and their hands are roaming around their nose, that’s actually a sure way to get the infection.
• Cut your fingernails short in order to attain 100% protection from sanitizing and hand washing. Some people have made videos of how to wash your hands with long nails. Dear, just discard that idea because Nurses aren’t slay queens and its against the profession. The hand washing technique shown by those videos does not even conform with international IPC standard.
• Teach your patient to use tissue (a piece of cloth or T-roll) while sneezing or coughing and discard immediately but if they can’t afford it, teach them to do the sleeve sneeze.
• If available, use the infrared or non-touch thermometer instead of the digital or analogue type that require touching your client.
• Due to stigmatization, some patients will not provide accurate travel history, therefore, be observant and detect signs pertaining to COVID-19. About 70% of patients who have fever at home take anti pyrectics before visiting the hospital hence you should ask for history of fever and if possible check more than once.
  

Signs of COVID-19 include sneezing, dry cough, temperature of more than 38*C, difficulty in breathing (be careful not to mistaken asthma for this).

WHO IS SAFE?

Some research shows that the recovery from COVID-19 in children is almost 100% with no respiratory symptoms – but they still got infected anyway hence NO ONE is safe. Don’t think your immune system has a bullet proof, just take precautions and you’ll be good.

HOW SAFE ARE YOU?

• The majority of people who make about 81% of infected cases have uncomplicated or mild illness.
• Approximately 14% develop severe diseases that require hospitalization and oxygen support.
• About 5% require admission to an intensive care unit for treatment.
• Infection rates in males is said to be higher than that of females, Aged folk tend to have critical effects than the young, children are asymptomatic and have almost 100% recovery.
  

So what group do you belong to and how safe are you?
On the ward, we have HCW who belong to the “I don’t care” and “Only God Kills” groups, they care less about IPC and safety precautions but note this, your selfishness may cause some aged citizen their life and you’ll also end up infecting your co-workers. Note also that, when the virus hits your facility, you’ll go first, Just Mark It.

PRE-TRIAGE

There is a little change in the traditional healthcare process. When you visit the hospital, you are required to first speak with a HCW who will ask a few question on your signs and symptoms and travel history before you are allowed to join the other patients at the (Out-Patient Department (OPD). This is to reduce the potency of spreading the virus should you have it. The health care worker should at all times adhere to safty protocols regarding covid-19. The distance between the Pre-triage Nurse and client should be atleast 2 meters. Ensure you wear gloves or sanitize your hands regularly and also provide hand washing or sanitary venues for the clients who visit the hospital. The patient must wash or sanitize their hands before entering the health facility, they must also be in masks or have a sheild on.

FINAL VERDIT

Covid-19 has had a great impact on the world as a whole, thankfully, in August 2020 the world has seen some improvements in PPEs since face sheilds and masks are available to everyone who can afford them unlike the shortage that was experienced around March 2020. Therefore, as a health care worker, ALWAYS use PPEs when attending to your clients. Remember prevention is better than cure so donot do anything that you will regret later. A very big thank you to all health care workers, your sacrifices, big and small has kept the world going. We sympathize with all healhcare workers who has been greatly affected by the novel virus, Some have even died but no one has recognised your efforts. To every single one of you whether dead or alive, we say AYEKOO!

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