COVID-19 is likely to be around for a long time and while it is vital we keep ourselves safe, the health system also needs to manage its supplies wisely. None of want to see health care workers suffering from the disease, nor do we want to see homemade PPE in ICUs.
There is much debate about the role of PPE when seeing asymptomatic patients, and much variation in the way it is being used in primary care. This is totally understandable, the evidence supporting any particular approach is emerging.
With this complexity in the background we suggest practices adhere to the guidelines set by the Ministry of Health.
These decisions are not easy, but the Ministry advice is based on expert opinion that carefully considers the evidence of benefit, and the potential harms of inappropriate use.
We will continue to collaborate with others across the sector, monitor the evidence, and advocate for change where needed.
The advice itself is causing confusion, but we hope the following helps.
For consultations that may involve exposure to blood, body fluids, secretions, excretions, touching oral or other mucosa, taking blood, vaginal swabs, performing a cervical smear or medication assistance.
We need to avoid consultations that will involve being in "close contact" with a patient whether they are symptomatic or not (i.e. face to face within 2 meters for greater than 15 minutes.) Taking a history by phone, preparing for an intervention or examination in advance, and limiting interventions to only those things that are absolutely necessary is vital, defer if it is possible.
If you HAVE to "burst the bubble" in this way (for you and the patient) the use of droplet PPE is recommended - fluid resistant gown or plastic apron, gloves, eye protection and surgical mask.
As an essential worker you are playing a vital and much appreciated role in keeping New Zealand running during our response to COVID-19 - thank you!
The Ministry of Health has provided advice about using Personal Protective Equipment (PPE) in order to keep yourself safe during this time. You'll may also be wanting to know what to do to protect those in your bubble when you return home.
In a healthcare setting, the guidelines for the use of PPE are more specific.
Also please note the Guidelines for the use of personal protective equipment for frontline health care workers (PDF) was updated 7 April.
Protective eyewear is a re-usable product and Lakes DHB's Infection Control staff have issued instructions around cleaning of re-usable products. Please remember protective eyewear is a precious resource. Please make sure you don't discard protective eyewear after a single use, clean and reuse, according to these instructions (PDF).
All patients should be dealt with by virtual medicine if possible.
There should be a system in place to ensure patients with respiratory infection symptoms are not unexpectedly appearing in your clinical space - telephone triage, triage in the car park, triage at the door.
Triage is best done limbic system to limbic system, you cannot rely on people reading or taking any notice of signs - although the public health message should be getting through to people by now.
"COVID-19 transmission is similar to that of the influenza virus and it is recommended that standard droplet and contact precautions are used when managing patients with suspect COVID-19 infection and those with respiratory and influenza-like illness." (Ministry of Health - 28/03/2020.)
People with respiratory infection symptoms need to be separated from the rest of your clients. These people need to be assessed and treated by people in a minimum of droplet PPE (gown, mask, gloves and eye protection).
Some clinical staff may want to protect their normal clothes from any potential exposure and many clinicians are concerned about bringing infection into the family home.
If a person needs to be seen face to face (a unilateral hot red swollen joint that could be gout could be septic arthritis for example) and they have no respiratory symptoms the risk of infection is VERY LOW - the clinician DOES NOT NEED to be in any PPE.
Remember good hand hygiene practices before and after you have seen patient. If you choose to wear gloves, wash your hands before and after changing gloves, and change gloves with every patient.
In some situations, staff may wish to protect their normal day clothes, depending on supplies it may be possible to provide them with a gown to protect clothes, "surgical scrubs" or an equivalent uniform to wear.
The MOH recommend that if wearing a gown in low risk circumstances it does not need to be changed in between every patient, but should be removed, before entering staff room for breaks, using the bathroom and at the end of the shift. Some staff may wish to bring a change of clothes in to change into at the end of the day.
Hand washing is vital and should be performed before and after touching a patient, before and after performing a procedure, before and after donning and doffing any PPE, before eating and after using the lavatory (as if you needed reminding of that!).
When a clinician gets home, regardless of their use of PPE I recommend (if only for a sense of safety) the days clothes are put into the wash, a shower is taken, evening clothes are put on and the family (in your bubble) are given a big hug. They probably deserve it, and having done all that so do you.