Christopher Friese: Health care workers must protect themselves even if employers won’t

Christopher Friese, the Elizabeth Tone Hosmer Professor of Nursing at the School of Nursing and professor of health management and policy at the School of Public Health, leads a research team focused on health care delivery in high-risk settings. He discusses the importance of health care worker safety while treating coronavirus.

Your research has shown that health care workers often don’t receive the equipment and training they need or they use the equipment improperly. How can they protect themselves?

Friese: To me, the strategy for any health care worker is first take care of yourself. It’s the old analogy, when you’re on the airplane put your own mask on first. Take the time to study up on this problem. There’s good resources at the CDC website to learn about this virus, how it spreads and what you can do to protect yourself.

The second step is to practice these skills yourself. Don’t wait for your employer to roll out training, as this virus may be in your communities right now. We know from our work that despite training, nurses do not apply and remove their protective equipment as recommended, even during routine care. They’re subject to contamination. Health care workers need to practice this. They can’t assume they will do it right when the urgent matter arises.

Health care workers should have the conversation with their employer to make sure the supplies are present and the staff are trained on their correct use. One thing that happened with H1N1 about 10 years ago is that many hospitals supplied different masks than the staff were used to, and this led to failures because the staff didn’t know how to wear them properly.

I think it’s important to stay connected to the CDC and WHO. We may learn over time that the guidance may change like it did with Ebola—the initial information was updated but it’s not clear all health care workers were updated with that new information. My strong recommendation is before each shift to take five minutes and check the CDC website to see if there have been changes. That may seem like a lot but we’re in uncertain territory, and personal, up-to-date knowledge is the best defense right now.

The public has been asked to save masks for health care workers. Why do health care workers need masks but the public has been told they’re not helpful?

There are no data to suggest that for regular people who are not sick, wearing a mask in public will do anything to reduce exposure to the virus. But, for health care workers, we need this workforce to stay healthy and prevent transmission to other, vulnerable patients. There are already reports of potential shortages in particular areas, so we have to be really thoughtful about how we use the supply that we have. The best use right now is for health care workers who have to go patient-to-patient and who, in the long run, will have to care for sick patients for months and months.

What about workers and patients in home health care, nursing homes and outpatient clinics?

The problem in places like home health, nursing homes, and EMS is they’re under-resourced (in training and equipment). Workers in these settings are often part-time and work in multiple agencies or facilities, which allows the spread to happen more rapidly. Also, these environments are not designed to isolate patients; nursing homes often have two beds to a room, home health workers go house-to-house and EMS teams pick up dozens of patients a day—how do you clean and disinfect those spaces? All places that treat patients, particularly vulnerable patients, will need equipment and procedures to isolate patients and clean and disinfect surfaces.

What kind of equipment keeps health care workers safe?

The most important thing is to wash your hands thoroughly with soap and water. Use a hand gel with 60% or higher alcohol concentration if soap and water aren’t available. For appropriate respiratory protection, the current recommendation from CDC is for health care workers to wear a gown, gloves, N-95 or higher-level respirator, and eye protection for patients with presumed or confirmed COVID-19. After removing the equipment carefully to avoid contamination, wash hands again. Unless you are told otherwise by the CDC, reusing personal protective equipment is not recommended.

How can patients safely interact with health care providers?

The most important thing a patient can do is alert the health care team they’re having respiratory symptoms immediately. The health care provider can put a mask on the patient, apply their own equipment, and alert the rest of the health care team.