COVID-19: A Cough Is a Cough… Until it’s Not
Unless you live under a rock or on top of a mountain, chances are that you've heard of the latest public health crisis, 2019 coronavirus, or its fancy official name, COVID-19. Similar to other recent viral respiratory illnesses such as SARS or MERS, COVID-19 is transmitted through droplets in coughs, sneezes, or close contact. Although the majority of cases are located in China, every new day presents more infected patients across the globe, including many confirmed cases in the U.S. So, for that patient sitting in your waiting room, when is a cough just a cough? The answer is simple - never.
The World Health Organization recently listed COVID-19 to the level of a pandemic and community-based infections (those not directly related to a known infected region or person) are emerging each day and are currently on every continent but Antarctica and nearly every country. Healthcare workers are always at higher risk of exposure for contracting infectious illnesses, so keeping ahead of the emerging disease du-jour is the only way to protect ourselves and our families.
While I would love to take the credit for your big "AHA!" moment of universal precautions, these standards are not new by any means. Yes, we tend to get serious and more disciplined in following them when there's an international health crisis, but these are RULES that we, as nurses and healthcare personnel, should be following every day:
- Wash. Your. Hands. People. Seriously? Do I really need to say/write this? Unfortunately, most hand hygiene audits at many organizations STILL report low compliance in hand washing or using degerming agents.
- Avoid touching your face/eyes. Since we've already established that your hands are not clean, introducing germs and viruses to your open orifices is never a good idea.
- Free mask giveaway to all coughing patients. Most patients are willing to put on a mask when presented in a positive light, such as "For your safety and the safety of those around you, here is a FREE mask for you to wear." This is the first step in the isolation process for infectious patients, especially when a fever is present. Next, the patient needs to be escorted to a private room as soon as possible or be at least six feet from other people.
- Protect yourself with a respirator. Can you really tell if the patient's cough is from allergies, a cold, TB, or the latest coronavirus? Does it really matter? This is why cough is never just a cough. If a patient reports a cough that could be infectious, is there any harm in popping on your N95?
Now, let's talk about what employers should be doing:
- Stay current with CDC guidelines and update your policies and protocols accordingly.
- Educate your staff and provide a venue where staff can easily access the organization's protocols
- Take inventory of the PPE stock and plan to restock.
- Educate staff on when, where, and how to don PPE. More isn't always better, especially when supplies are low.
- Stay ahead of the hype, provide factual information from the CDC, and listen to the concerns and ideas from the staff. I've said it before - the people who do the work have the answers. Listen and address accordingly as they probably have concerns that no one in the C-Suite has considered.
- Create a contingency plan that not only addresses staffing levels but how to manage staff who may become infected and cannot work. As this is an international outbreak (community outbreak in many areas of the U.S.), having an HR policy that addresses communicable diseases as it relates to an excused or unexcused absence, and possible pay for such illness.
Over 6,500 nurses responded to a recent survey by the National Nurses United regarding their employers' handling of COVID-19. Here are some notable responses:
- 44% report their employer-provided COVID-19 education
- 58% report they screen patients for fever, cough and recent travel
- 30% report they have sufficient PPE
- 65% report they have been trained in the past year on how to don/doff PPE
- 19% report that their employer has the policy to address staff who may be infected
Now, let's be real for a moment and acknowledge that many of these employers have plans, PPE, and protocols. Yet, just like the tree falling in the woods with no one to hear it, if nurses aren't educated on the plans, PPE location, and protocols, do they still exist?
Experts have stated that frequent newly emerging viruses are not a matter of if, but a matter of when. As we move from one norovirus to the next, having a solid plan to protect yourself, your patients, and our communities are the best way to keep ahead of the hype. Organizations need to stay in front of this outbreak not just from the infectious disease side, but also from the perspective of the most precious resource in healthcare - human capital. Staff needs to feel that supervisors, managers, directors, and the Head Honcho care about their well-being.
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