Millennium Heights Medical Complex
COVID-19 STAFF HANDBOOK
CORONA VIRUS DISEASE (COVID-19) Corona Virus Disease (Covid-19) is an infectious disease caused by a newly discovered coronavirus. The Covid-19 virus spreads primarily through droplets of saliva or discharge from the nose of an infected person’s cough or sneeze. The best way to prevent and slow down transmission of this virus is to be well informed about the Covid-19 virus, the disease it causes, how it spreads, and how you can protect yourself and others (WHO 2020). What are some of the most common symptoms of the coronavirus disease? The most common symptoms of COVID-19 are fever, dry cough, and tiredness. Other symptoms that are less common and may affect some patients include loss of taste or smell, aches and pains, headache, sore throat, nasal congestion, red eyes, diarrhea, or a skin rash. We know this is a worrying time for staff and many of us will be feeling stressed out and anxious. This handbook is designed to give you some information which will help in supporting you as you do your work, and in your daily life.
Let us Stop CORONA VIRUS COVID-19
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A. SOME KEY AREAS IN THE MANAGEMENT OF COVID-19 1. Social Distancing It is important to follow social distancing guidelines where possible, to help limit the spread of the virus. Within the hospital, when teams are working together we understand that social distancing can be very difficult. However, it is vital that we do everything we can to stay apart whenever possible.
PLEASE KEEP SAFE
PHYSICAL DISTANCE
MINIMUM DISTANCE OF 2 METERs
STOP CORONAVIRUS COVID-19
Please be mindful of “professional distancing” in clinical and non-clinical areas, and setting a good example for our patients and the public. This means making sure that you clearly distance from colleagues, patients and visitors whether you are seeing patients, walking in corridors, having your break or queuing in the cafeteria. 2. Masks and PPE The hospital has made a huge effort in ensuring that staff working in the clinical areas have enough of the right PPE, and staff have been trained in the different types of PPE they should wear according to the tasks and clinical situation. The national protocol is that all staff regardless of whether they work in a clinical or non-clinical area, must wear a medical mask to help prevent the potential spread of infection. Visitors and outpatients are also required to wear face coverings. See the Do’s and Don’ts of wearing a mask in section B.
HEAD PROTECTOR GOGGLES
SURGICAL GLOVES
PROTECTIVE MASK
PROTECTIVE GOWN
SHOES
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A. SOME KEY AREAS IN THE MANAGEMENT OF COVID-19 3. Hygiene Wash your hands with soap and water often, for at least 20 seconds. Keep in mind that the presence of wrist watches, wrist jewelry and rings interfere with your ability to clean your hands. It is recommended that jewelry be limited to only what is essential or none at all. False nails/nail varnish may also interfere with your ability to wash your hands effectively. Use hand sanitizer if soap and water is not available. Cover your mouth and nose with a tissue or sleeve (not your hands) when you cough or sneeze. Put used tissues in a bin immediately and wash your hands afterwards. Avoid touching your eyes, nose and mouth with your hands. 4. Cleaning Our environment must be kept free from clutter to enable effective cleaning. Our cleaning staff have been trained on the approved methods and solutions for cleaning various surfaces, to include recommended bleach dilutions. Everyone should ensure that their work stations are cleaned regularly. Disinfectant wipes may be used as well as a paper roll with soapy water. Always wash your hands after cleaning any area. 5. Traveling to and from Work If you use public transportation, try to avoid over crowding by being flexible around journey times if you can. Maintain a safe distance from other passengers and wear a mask at all times. Wash or sanitize your hands as soon as you get off the bus. 6. Driving to Work If you have no option but to car-share, then you should try to consist- ently share with the same people and with minimum number of people at any one time, ensuring you all wear a face covering. Maintain good ventilation and wash hands or use hand sanitizer before entering and after getting out of the vehicle.
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A. SOME KEY AREAS IN THE MANAGEMENT OF COVID-19 7. Arriving at Work Your hands must be sanitized at the Security point on entry to the Hospital. Your temperature reading will also be taken. Any elevated temperature must be reported to your supervisor immediately. Please ensure you are wearing a face mask when entering the building and avoid crowding at entrances, corridors and stairwells. 8. At the Cafeteria Wash/sanitize your hands before entering or leaving the cafeteria. Avoid touching objects and surfaces where possible. Maintain social distancing when queuing and when seated to eat. When eating/drinking, clean your hands before and after you remove your mask. You may reuse your mask by storing it correctly as follows:
• Fold the mask and place it in a clean plastic bag. Do not place face masks on dinning tables or nearby surfaces
• If a clean mask is required, this should be taken with you in a clean plastic bag.
Once you have finished eating/drinking you should put on a mask to return to your work area. Sanitize your hands.
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B. FACE MASKS How to wear a Medical Mask safely
How to wear a Fabric Mask safely
DO’s
DO’s
• Wash hands before touching the mask
• Wash hands before touching the mask
• Inspect the mask for tears or holes. Find the top side where the metal piece or stiff edge is. Ensure the colored side faces outwards • Place the metal piece or stiff edge over your nose. Cover your nose, mouth and chin. Adjust the mask to your face without leaving gaps on the sides • Avoid touching the mask
• Remove the mask from behind the head or ears. Keep the mask away from you and surfaces while removing it
• Discard the mask immediately after use, preferably in a closed bin.
• Wash your hands after discarding the mask.
• Inspect the mask for damage or if dirty • Adjust the mask to your face without leaving gaps on the sides • Cover your mouth, nose, and chin • Avoid touching the mask
• Clean your hands before removing the mask • Remove the mask by the straps behind the ears or head • Pull the mask away from your face
• Store the mask in a clean plastic reusable bag if it is not dirty or wet or you plan to reuse it • Remove the mask by the straps when taking it out of the bag • Wash the mask in soap or detergent, preferably with hot water, at least once a day • Clean your hands after removing the mask
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B. FACE MASKS Don’ts (Fabric Mask): DON’Ts • Do not use a mask that looks damaged
• Do not use a mask that is difficult to breathe through
• Do not wear the mask under the nose
• Do not wear a dirty or wet mask
• Do not wear a loose mask
• Do not share your mask with others
• Do not remove the mask where there are people within 1 meter
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C. HEALTHCARE WORKER EXPOSURE TO A PERSON WITH COVID-19 Here’s some information on the pathways for staff members who have been exposed to someone with a confirmed diagnosis of Covid-19. Figure 1 indicates the steps to be taken and Figure 2 outlines the steps for assessment of the risk levels. In keeping with the Ministry of Health and Wellness SARS-Cov-2 Testing Guidelines, workplace contacts are sent in for testing as recommended by the contact tracing team once there is exposure to a confirmed case in the workplace. This is usually done at day 7 post exposure to the confirmed case. Figure 1: F lowchart for Management of Healthcare Workers with Exposure to a person with Covid-19 Contact with confirmed Covid-19 positive person within the last 14 days
Present with Respiratory Symptoms
YES
NO
Present to the Respiratory Hospital/Respiratory Clinic
Inform Supervisor/HoD who will inform Infection Control Nurse
Inform Supervisor/HoD
Assessment of Risk Levels (See Fig. 2)
HoD informs Infection Control Nurse and Senior Manaement Team
Low Risk
• No restriction from work • Self-monitoring for 14 days • Determination of need for/ timeline for swabbing
COVID-19 STAFF HANDBOOK
High Risk
• Restrict from work for 14 days (quarantine) • If symptoms develop present to Respiratory Hospital or Respiratory Clinic • Determination of timeline for swabbing
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C. HEALTHCARE WORKER EXPOSURE TO A PERSON WITH COVID-19 Figure 2: Assessment of Risk levels for Healthcare workers exposed to a positive Covid-19 person
Assessing Activity Did the HCW participate in any of the following scenarios with a patient with suspected or confirmed COVID-19? A. Direct physical care B. Face-to-face contact (within 1 metre for over 15 minutes) C. Performed or was present in the same room during any aerosol-generating procedure
NO
HCW can continue to work, adhere to infection control precautions and in accordance with local policy, monitor symptoms (see section 2.2).
Determining Exposure
Exposure Advice Low-Risk Event
YES
Did any of the following exposure events occur? A. Any type of contact with body fluids/respiratory secretions without the use of personal protective equipment (PPE) when interacting with a patient with suspected or confirmed COVID-19. Examples: • Splash of body fluids/ respiratory secretions into the eyes, mouth • Non-intact skin or any sharps injury OR B. Any major failure in practising appropriate precautions when providing direct care for a patient with suspected or confirmed COVID-19. Examples: • Not wearing appropriate PPE: - Not wearing medical mask - Not wearing eye prptection - Not wearing a respirator during aerosolgenerating procedures • Using or removing PPE incorrectly.
COVID-19 STAFF HANDBOOK
YES
NO
LOW RISK exposure advice: - HCW can continue to work and adhere to infection control precautions. - HCW should self-monitor for symptoms for 14 days (see section 2.2), including measuring body temperature twice daily. If symptoms develop, HCW should inform his or her manager/supervisor and refer to the management of symptomatic HCWs flowchart (Figure 2). - Provide ongoing psychosocial support to HCW and immediate family/loved ones regarding managing their mental health.
High-Risk Event HIGH-RISK exposure advice: Management of HCWs following a high-risk exposure event will depend upon national/local testing policy and the results of such laboratory testing: - All HCWs must immediately stop all interactions with patients and colleagues. - All HCWs should inform their manager/supervisor and provide contact information. - Provide ongoing psychosocial support to HCW and immediate family/loved ones regarding managing their mental health. ________________________ If tests positive: - Isolate HCW in the healthcare facility or designated setting and manage as per national/local policy. ________________________ If initial test negative OR If no-testing performed: - Quarantine HCW at a designated setting or at home. - E xclude HCW from the workplace. - Self-monitor for symptoms for 14 days, including body temperature twice daily (see section 2.2). If symptoms develop, HCW should inform his or her manager/supervisor and refer to the management of symptomatic HCWs flowchart (Figure 2).
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D. STAYING HEALTHY Let us discuss an issue that is important to everyone: YOU! Here are some recommenda- tions which can help to keep you Healthy. 1. Avoid Infectious pathogens During family get-togethers avoid physical contact even with the nearest and dearest. Express affection from a safe distance. Share the love, not the infection. 2. Re-orient your attitude towards self-care If you look at the big picture, taking care of yourself doesn’t have to mean avoiding things you enjoy. Instead, change your current habits to ones that makes you feel better long-term. Some examples: learn to prepare and enjoy more nutritious foods, getting regular sleep, exercising and seeking out activities that uplift your mood. 3. Fix your sleeping habits Instead of staying up late binge-watching Netflix or other net- works, get more regular sleep that will make your body feel better and help your immune system. 4. Manage what you eat Instead of eating sugary, fatty foods that are temporarily fun, eat nutritious foods that make your body feel better and boost your immune system.
Some Dietary Tips to assist you
hop Smart: Know your pocket and plan your budget. S Prepare a shopping list before hand of the items you absolutely need. Organize your shopping list according to the location in the store the items will be found.
Cook Smart: Plan your meals based on food you have. Clean and sanitize kitchen food surfaces. Continuously wash hands, surfaces and fresh fruits and vegetables throughout the cooking process. Ensure raw meat, poultry and seafood are handled separately from Ready- to-Eat foods. Eat Smart: Consume a very nutritious, balanced diet based on your specific nutritional needs: Daily, eat 2-3 servings of fruits, 2-4 servings of a variety of colorful vegetables, 1 serving legumes, 5-10 servings of whole grain and fiber rich carbs and 4- 6 oz lean animal meats 3-4 times per week. Keep well hydrated. Daily, drink sufficient water for your weight and height anywhere from 1.5 L to 3.5 L.
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D. STAYING HEALTHY 5. Engage in regular physical activity Physical activity has been proven to improve our health and general wellbeing. It can be fun and helps prevent diseases. It doesn’t matter how you move or how fit you are. When it comes to your health and well- being every move counts.
Key Facts on physical activity (WHO, 2018)
• Physical activity and Physical exercises can limit the negative effects of stress, depression, exhaustion, anxiety and irritability.
• Physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure.
• Physical activity has significant health benefits and contributes to the prevention of non-communicable diseases. • Exercise is a subcategory of physical activity that is planned, structured, repetitive, and aims to improve or maintain one or more components of physical fitness. • Adults should do at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorousintensity activity. • Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.
How to increase Physical Activity
• Include walking, cycling, sporting or recreational (e.g., dancing) activities in your daily routine.
• Incorporate physical activities of daily living in your daily routine.
• Utilize a structured exercise program (at home or a gym) using weights, aerobics or nautilus equipment.
Above all, find time to relax or use meditation, Yoga, Tai Chi, music or family time to achieve an additional sense of self care.
NB. P lease contact your doctor before embarking on any structured exercise program.
6. Lighten your mood Engage in fun activities that will keep you in a positive and upbeat frame of mind. Try a little more laughter!
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E. HAND HYGIENE Wash your hands to prevent the spread of Coronavirus. Here are five key moments:
Before touching a patient
Before and after engaging in cleaning/ antiseptic procedures
After touching a patient
After touching a patient’s environment
Before putting on/ taking off any PPE
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E. HAND HYGIENE How to wash your hands?
Wet hands with water
Apply soap
Rub hands palms to plams
Rub the back of each hands with fingers interlaced
Rub palms together with fingers interlaced
Rub with back of fingers to the opposing palms
Rub each thumb clasped in opposite hands
Rub the tips of fingers
Rub each wrist with different hands
Rinse with water
Dry thoroughly your hands
Your hands are now clean
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E. HAND HYGIENE How to sanitize your hands?
Apply a squirt of sanitizer in the palm of your hand
Rub your hands palm to palm
Rub the back of each hands with the palm of the other hand
Rub your palms together with your finger interlaced
Rub the back of your fingers with the opposite palms
Rotate your thumbs in the other hand
Do a circle on your palm with your fingers clasped
Once dry, your hands are safe
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F. MENTAL HEALTH AND RESILIENCY TIPS 1. Watch for signs of burnout and stress Signs can range from poor hygiene, de- pression, irritability, fatigue and frustration, to more serious signs of being worried too much or easily startled, and having nightmares.
2. Make time to unwind Take time every day to do things you enjoy.
3. Get support from team members You may want to set up a buddy system within your work area to share concerns, watch over each other’s safety and well-being, and to check that PPE is used the right way. 4. Stay connected to others, safely Use technology to talk with friends, family, and col- leagues. Share your experiences. Actively listen to others. 5. Develop healthy ways to cope with stress Take your break while at work, eat healthy foods, exercise, and socialize with friends and family, while maintaining social distancing protocols. Do not use drugs and alcohol as a way to cope. 6. Limit your news and social media time Repeated reports and posts about the pandemic can be upsetting. Take breaks. 7. Take care of your body Eat healthy, take some type of regular exercise, and get enough sleep. 8. Ask for help when you need it You may feel anxious, bored, angry, or lonely. Speak to your supervisor, colleague, friend. You can also call the national mental health hotline at 203 to speak to a professional who can help you.
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F. MENTAL HEALTH AND RESILIENCY TIPS
Let’s take care of ourselves...
...and each other...
...so we can deal with this Pandemic.
References: Hepacart (2019). 6 Tips to Keep Your Healthcare Workers Healthy. Retrieved from https://www.hepacart.com/blog/6-tips-to-keep-healthcare-workers-healthy Minnesota Department of Health (2020). Mental Health and Resiliency Tools for Healthcare Workers: Covid-19. Retrieved from https://www.health.state.mn.us/diseases/coronaviru/hcp/ mh.html Policymedical (2020). 10 Ways to Stay Healthy for Healthcare Workers. Retrieved from: https:// www.polymedical.com/10-ways-to-stay-health-for-healthcare-workers/ World Health Organization (WHO) (2020). Coronavirus disease (COVID-19). Retrieved from https:// www.who.int/emergencies/diseases/novel-coronavirus-2019/coronavirus-diseaseanswers? query=What+is+COVID19%3F World Health Organization (WHO) (2020). Coronavirus disease(Covid-19) advice for the public: When and how to use masks. Retrieved from https://www.who.int/emergencies/diseases/novelcoronavirus-2019/advice-fpr-the-public/when-and-how-to-use-masks
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Millennium Heights Medical Complex