'COVID fatigue' and infection control practices

Has 'COVID fatigue' set in with your infection control practices?

We hear you. There’s pressure from all angles right now. Pressure to keep up with the latest updates, pressure to keep you, your staff AND your patients safe and happy. It’s not easy to stay on top of it all with a smile on your face.

As COVID-19 ‘fatigue’ sets in, even with the best intentions and safety plans, shortcuts can creep in. A procedural step may be skipped – or even abandoned.

Most practices are aware by now that reducing the risk of COVID-19 transmission requires much more than staff and patients simply wearing a mask.

Over the next few weeks, we’re collaborating with Marg Jennings, Infection Prevention and Control Educator and Consultant to look at some common issues related to COVID-19 transmission in your practice that can be simply avoided.  

If you missed our webinar with Marg on 17 September, you can view the recording here

You can also sign up to our daily COVID email update, check our regularly updated COVID-19 webpage for health professionals and follow us on Facebook, Twitter and LinkedIn.   


Masks + Business As Usual = OK?

The issue: You might think that if your staff and patients are wearing masks, this is all the protection you need. However, a mask is not nearly as protective as physical distancing plus a mask. 

Solution: Both wearing a mask and physical distancing is needed to reduce the risk of COVID-19 transmission. Masks decrease the risk when you cannot distance, but do step back as soon as you can.

Masks offer around 65% protection if one person wears one, and 85% if both people wear one. Encourage your patients to bring their own. 

So, treat a mask as being additional to physical distancing, not instead of physical distancing. Watch Marg’s video about masks https://youtu.be/vYx8ZAD5vlk.

As always, refer to DHHS’ latest PPE advice Guide to the conventional use of PPE (Word).


Staff tea rooms

The issue: Staff tea rooms are a high-risk area for COVID-19 transmission. They are full of high-touch surfaces, including fridge handles, taps, kettles and microwave touchpads.

There will be saliva on cups, cutlery and dishes left in the sink, no masks being worn while eating/drinking and high potential for more than one person to be present.

Solutions: The best option to reduce the risk of COVID-19 transmission is to either close your tearoom to staff or make it a quick stop to make a cuppa or heat up food, for staff to immediately consume elsewhere on their own or outside.

Alternatives to the tearoom include bringing a thermos from home to leave in your car, sitting/standing outside 1.5 metres away from others or taking a walk with your cuppa.

If you can, set-up a pleasant area outside (with an umbrella for shade). Breaks are essential for mental health, too. 


Face shields and goggles  

The issue: Receptor sites for SARS-CoV-2 are found on the eyes (conjunctivae), throat (pharynx) and lungs (alveol). 

Solution: When within 1.5 metres of a patient, both eye protection and masks need to be worn. Use face shields (where practical) or safety glasses/goggles. Reusable face shields should be chosen over single-use face shields, where possible. For reusable face shields, a process needs to be in place to ensure appropriate decontamination and storage between uses (i.e. meal breaks) and at the end of a shift/use. As always, refer to DHHS’ latest PPE advice Guide to the conventional use of PPE (Word).


Gloves are good, but not perfect

The issue: The more PPE you wear unnecessarily, the greater the chance you will self-contaminate. In fact, PPE users self-contaminate 30-40% of the time. This is usually during removal e.g. incorrect glove removal or incorrect order. Gloves don’t replace hand hygiene! Around 30% of the time you use them, there is exchange of microorganisms between you and the patient - especially if your gloves are not removed correctly. This is why hand hygiene is so important after glove removal. 

Solution: 

Only use the PPE that’s necessary. Rely much more on distancing and hand hygiene. 

Watch Marg’s video on the correct technique for glove removal here 

Watch Marg’s hand hygiene video here 

Refer to DHHS’ latest PPE advice Guide to the conventional use of PPE (Word).


Don’t use your waiting room unless you have to

The issue: Most patients wear masks incorrectly and they continually touch them or pull them down. Also, many patients are lonely, so they are more likely to seek you out for a chat! 

Solution: Ask your patients to wait outside in their car. Call them on their phone when the doctor is ready, and walk them straight through to the consulting/treatment room. Use sanitiser on their way in and out. Payment can be arranged to be no touch and receipts emailed.


Reduce everyone’s time inside

The issue: We’re so used to being inside, especially during cold weather. It’s convenient and comfortable for patients and staff, and we’ve always done it. Can’t we just wear a mask and keep apart a bit when we can? The fact is that being inside, even with a mask, increases the risk of COVID-19 transmission because there is limited air exchange (ventilation). 

Solutions – Ask your patients to wait in their cars instead of the waiting room. As the weather improves, put chairs outside for your patients and have a packet of hand wipes and sanitizer outside for cleaning. GPs can continue conversations with their patients after examinations either by phone, when they have returned to their car, or outside. 

If you must be inside or next to a colleague (at least 1.5 metres apart), make it as short as possible. Use a mask and face shield and have windows/doors open for air exchange to occur. If you can, place one staff member in a room of their own to do phone calls and take calls, and a single receptionist to manage patients coming in. 


 Look after staff well being 

The issue: It’s tempting to delay breaks, neglect our self-care and revert to old habits when we’re under pressure.

Solutions: As the weather improves, it’s a great idea to set-up a nice table and chair outside for staff breaks. Providing a few weekly coffee vouchers is a great way to show your appreciation, get staff out of the tearoom and walking in the fresh air, and supporting local cafes. Remember, all staff working onsite need to go through the COVID-19 symptom checklist every day, not just temperature-checked. For staff in south eastern Melbourne who are feeling stressed or worried, SEMPHN is still offering four free support sessions via SEMPHN's Employee Access Program (EAP). 

Read more on how to book a confidential appointment. Note, all appointments are via video or phone.


Cleaning

The issue: Coronaviruses can remain infective on some surfaces longer than others e.g. a few hours for porous surfaces like fabric but a day or so for smooth surfaces such as glass, plastic and metal. However, a person touching such a contaminated surface would need to bring an ‘infectious dose’ to the mouth or eyes - the evidence does not support this as a main means of transmission. The material that contains the virus on a contaminated surface is easily removed by cleaning. After cleaning, remaining infectious particles can be inactivated by common household disinfectants as long as the correct concentration and contact time are observed.

Solution: Take care to clean/disinfect surfaces in areas that patients have directly in contact with or have been exposed to respiratory droplets. Clean and disinfect frequently touched surfaces e.g. door handles with detergent and disinfectant wipe/solution and between each episode of patient contact (according to normal infection prevention and control practice).

See the fact sheet Environmental cleaning and disinfection principles for health and residential care facilities for cleaning after a potentially infectious patient.

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