Being Mindfully Hygienic

Introduction

There is good scientific evidence that the virus responsible for causing COVID-19 can survive on various surfaces for quite some time. A study published in the New England Journal Of Medicine found SARS-CoV-2 could survive for up to three days on plastics, two days on stainless steel, 24 hours on cardboard, and four hours on copper.

Given this information, we must be keenly aware of the surfaces that we come into contact with as well as those carried with us while serving in the healthcare setting. Think of how many items we carry with us every day in the hospital: white coats, stethoscopes, shoes, badges, glasses, pens, pagers, cell phones--the list goes on. One way we can help ourselves, our patients, and those who live with us stay safe is by remaining diligent in reducing our exposure to contaminated surfaces through mindful hygiene practices. Many of the suggestions made below may require some difficult changes in behaviors, but keep in mind the substantial impact that these small changes in your behavior can have on the safety of those around you and ultimately in reducing the spread of COVID19.

Thought question

• What are some surfaces with which you often come into contact (or carry with you) in the clinical setting?

The Many Potential Surfaces for Exposure

ID Badge, Stethoscope, White coat (other clothes), Pens/Pencils- Pager/Phone, Glasses, Watches, Rings, Shoes, Hands, Hair

Upon Arrival to Your Workspace (Every time)

As a student serving during this time, your workspace will certainly vary and you must take the nuances of your specific environment into account. This section will provide you with some essential tips for properly preparing your new workspace.

Plan ahead

Before coming to work, there are a few things you can do to limit the unnecessary exposure of the surfaces you carry with you.

• Leave accessories at home (jewelry, unneeded sun or reading glasses, etc.)

• Keep all essential items in a designated bag (hospital badge, stethoscope, hand sanitizer, etc.)

• Other: keep your designated pair of shoes in one area, limit hair exposure, cut nails short

Clean, clean, clean!

When first arriving at your new workspace, take the opportunity to disinfect all the surfaces that you will come into contact with. Wash your hands and don a pair of gloves before grabbing an EPA approved disinfectant and disinfecting your workspace. For a typical clinical workspace, this may include your: desk, badge, printer, phones, pager, and chair. See the infographic from BWH ED hygiene initiatives below:

(Adapted directly from BWH ED Infographic Protocol)

Continuous caution & avoiding old bad habits

As you progress through your workday, you will also come into contact with various surfaces outside of your workspace. In addition to the previously discussed importance of wearing appropriate PPE and regular hand washing, work to avoid the following habits that could put yourself and others at risk of exposure.

• Shaking hands (or anything that breaks social distancing rules discussed above)

• Touching your face

• Touching your cell phone with PPE

Some tips for breaking these habits/avoiding inadvertent exposure in this way are:

• Keep your phone and other items in a ziplock bag

• Put a sticker over your phone screen to remind you to remove PPE/disinfect hands prior to use

Contaminated surfaces to be cognizant of:

• Doors/door handles

• Patient beds

• IV poles

• Supplies carts

• Over bed tables

• Patient gowns, other linens

Hand Washing/Sanitizing

As you are well aware by now, hand washing or sanitizing is essential, especially with the following instances:

• Before and after donning/removing any PPE

• Blowing nose, coughing, sneezing,

• Before/after eating

• With visibly dirty hands

According to the CDC, the most effective way to do this is:

• Soap-Based: Lather hands with soap and scrub for 20 seconds before rinsing

• Hand Sanitizers: Spread sanitizer over all surfaces of of hand and allow to dry completely (effective alcohol-based hand sanitizers must have greater than or equal to 60% alcohol)

Thought question:

• What are the unique surfaces you may come into contact with in your clinical setting and how will you reduce your risk of contact/exposure?

Hygiene At Home

One of the most important times to be aware of your hygiene is when returning back to your home from the clinical setting. This is especially important for those who live with others, as we certainly do not want to expose others, but it is also key in limiting exposure for ourselves.

The basics

When it comes to keeping our living environments safe and clean, there are two key points to keep in mind: cleaning and disinfecting. Cleaning refers to the removal of microbes, while disinfecting refers to the killing of microbes. With awareness that a specific concentration of viral particles (IC50) is required to cause infection, both of these methods are essential in reducing that risk. When you clean a surface (use a non-microbe killing solution) you are reducing the amount of microbes but not killing them. The key is to do both! In general, soap, detergent, bleach, or >70% alcohol based cleaner will cause enough damage to the viral membrane to kill it--though it is preferred to clean the surface first with soap or detergent and then disinfect with bleach or >70% alcohol based solutions (or other approved disinfecting agents). To be sure you have products that are recognized by the CDC to be effective at killing COVID19, see the EPA-registered disinfectants webpage. All surfaces you come into contact with after returning from the hospital could potentially be exposed, so follow these brief guidelines to ensure the safety of yourself and those who live with you.

Cleaning Hard (nonporous) Surfaces

Start by washing your hands and donning gloves if you can. The CDC recommends that any surface should first be cleaned (detergent/soap) prior to disinfecting, so clean exposed hard surfaces before disinfecting with bleach, >70% alcohol-based or other EPA-approved products. Be sure to let bleach solutions sit for at least one minute and ensure adequate ventilation and take note of manufacturing directions and precautions.

Soft (Porous) Surfaces

When it comes to soft surfaces like rugs and carpets, the recommendation from the CDC is to follow manufacturers’ instructions while using the warmest possible water setting.

Laundry

It is recommended that you keep a separate hamper (preferably with a disposable or washable liner) for your work clothes and wash them in detergent on the warmest possible setting. Try keeping this in an area close to the entrance you come in at so you can reduce the areas exposed. Remember that the virus can survive in the air for hours, so be careful not to shake the bag. Be sure to wash your hands before and after (as you should with all of these cleaning methods).

Electronics

The main item here to be cognizant of is your cell phone. It is preferred that you buy a wipeable case or covering that can be safely cleaned and disinfected in advance, so you don't risk damaging your phone with repeated cleanings. For any electronic, start with following manufacturer directions if available. For most electronic and touchable screens, >70% alcohol wipes or sprays are sufficient. Ensure that you allow all surfaces to dry or manually dry to avoid pooling.

Other General Tips

• If possible, use a separate, low traffic door for going to and from the clinical setting

• Have a designated area wear you keep your shoes, dirty clothes and other items for cleaning/disinfecting after working

• Designated trash and laundry bin in isolated location if possible

• If possible/applicable, put on and remove scrubs in the clinical setting (in designated locker/changing room)

Thought question:

• What can you do to protect the people you live with from being exposed to COVID19?