Thursday, April 9, 2020

Face mask struggles

Why the $@&% do we, frontline healthcare providers, have to socially distance?

As healthcare providers, we've found ourselves exempt from many of the recommendations and closures related to the current pandemic.  Since we absolutely are essential in this response, we've had a bit more freedom than many of our non-HCW friends.  We've listened, admittedly annoyed, while our friends and family members complain about how bored they are just sitting at home, telling us that we're lucky because we get to go to work.  But, with that being said, we’ve been privy to actually having face-to-face interactions while the rest of the world is hunkering down.  It is this privilege that puts us at such great risk. 

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Ideally, you're social distancing since it's unlikely respiratory droplets disperse more than 6ft away with normal talking.  That’s not the case for a forceful cough; but, if you're coughing (or otherwise symptomatic), you shouldn't be at work. 

In our line of work, it can be tough to stay 6ft away from our coworkers.  We've got this covered with PPE on calls, but what about when we're at the station?  That's where masking comes in.  We truly should be wearing a mask anytime there’s potential for close contact (<6ft) with someone outside of our immediate home.  And, that includes the station.  This is exactly why the CDC changed its recommendations last week to include the use of a mask anytime social distancing may be difficult.  That's not to say that you need to wear a N95 to bed, but you should be covering your face so that you don't accidentally infect your partner as an asymptomatic transmitter.  This is the only situation where you should consider wearing a cloth mask at work!

Remember that old six degrees to Kevin Bacon game (also known as Bacon's Law)?  Well every time an infected person accidentally touches or exhales on an item, that item becomes a fomite just waiting for you to touch it and become infected.  You then easily take that home with you to your family.  All of a sudden, it's like your whole family was hugging that infected person.  The good news: when we wear appropriate PPE and DECON our truck, we break this cycle, never putting our loved ones at risk. 

But, how confident are you that someone with whom you work closely hasn't accidentally been contaminated or isn’t an asymptomatic carrier?  This post isn't meant to scare you, but to remind us that we can do a better job social distancing (even though we're still going to work), simply by following the CDC's recommendations for everyone.  This includes social distancing, wearing a mask anytime that you may come within close proximity of another person, washing your hands frequently (or using sanitizer when soap and water aren't available), etc.  

Take a look at this diagram from the New York Times:

Imagine if the person in red had worn a mask at work and didn’t touch their face.  Maybe they wouldn't have infected both their shift and relieving crew...

Some of our agencies are doing a fantastic job of protecting themselves, their partners and their families by making a few changes on shift.
- Limit the number of people in the station to ONLY those on duty
- Spread out sleeping arrangements
- Mask whenever you're not in a private room
- Disinfect boots and leave them in the bay, only wearing slippers in the station
- Wipe down any touched surfaces including door jams, the backs of kitchen table chairs, keyboards, radios, etc. at least 1x/shift
- Eat in rotations to limit the number of members at the kitchen table

Some of these changes are a big shift from our usual station culture.  But, please, be flexible.  The alternative may mean more than just a few days off work.

A few other things to consider:
- Limit the number of people in close proximity to high-risk patients
- Never write your VS on dirty gloves that you'll need to keep around to write your report
- Don’t spread the risk.  DECON early in patient rooms before moving into clean spaces.
- Make sure to wash your neck and wrists after DECON'ing as these areas are not covered by face shields and gowns
- Bring an extra uniform to change into before going home (and, if able, wash your dirty uniform at the station)

I'm not saying that you need to be these guys...

But take a look at how easily you can contaminate your surroundings, from the MythBusters

I pester because I care.  Please stay safe.

And, thank you.  Thank you so very much for your commitment to our team, patients and community.

Use of Cloth Face Coverings to Help Slow the Spread of COVID-19. CDC. Published online April 4, 2020.

Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. Published online February 21, 2020. doi:10.1001/jama.2020.2565.

Roberts, S. You Can Help Break the Chain of Transmission. New York Times. Published online March 19, 2020.  
white textile on brown wooden table 

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