Coronavirus: Clear up misperceptions and protect patients, yourselves

Infection control experts admit that there’s miscommunication about how nurses can protect themselves and others from transmission of the 2019 Novel Coronavirus (2019-nCoV).

So we asked two such experts to set the record straight.

Nancymarie Phillips, PhD, RN, is professor emeritus of Lakeland Community College in Kirtland, Ohio, and the author of “Berry and Kohn’s Operating Room Technique,” which is in its 14th edition, and’s continuing education course “Keep It Clean: Hand Hygiene and Skin Antisepsis.”

Luci Perri, MSN, MPH, CIC, FAPIC, owns the consulting company Infection Control Results and authored the CE course “Emerging Infectious Diseases.”

About the coronavirus

The CDC has identified seven types of coronavirus that affect humans. “Most of them have had some type of animal origin,” Phillips said.

MERS-CoV, the beta coronavirus that causes Middle East Respiratory Syndrome (MERS), came from camels. SARS-CoV, the beta coronavirus that causes severe acute respiratory syndrome (SARS), came from a type of cat. The 2019-nCoV, a virus that originated in Wuhan, China, has been traced to animals such as bats, according to Phillips.

coronavirus - Nancymarie Phillips, PhD, RN

Nancymarie Phillips, RN

“Coronavirus, as a broad category, is responsible for things like the common cold, laryngitis and pneumonia,” she said.

Viruses are obligate parasites. They can’t replicate by themselves, according to Phillips. “The coronavirus, by itself, is an RNA-based virus, and it has to have a host to finish its complement of DNA,” she said. “That’s how it can replicate.”

Handwashing is No. 1, but that’s not all

Handwashing with soap and water for a minimum of 20 seconds is the most important form of protection against the coronavirus. The soap doesn’t even have to be antibacterial, according to Phillips.

“Viruses are not bacteria,” she said. “They’re different critters. All of these things are physical entities. And removing them has to be mechanical and chemical.”

Handwashing mechanically rinses off the virus.

“The soap decreases the surface tension of the skin, and the physical entity of the contamination is removed,” Phillips explained. “Once you have removed (these viruses) from the place they want to be, you’ve changed their living conditions by exposing them to the soap. They don’t like soap. It ruins their cell membrane and kills them.”

Coughing or sneezing into your elbow?

Many people think they are less likely to spread coronavirus and other respiratory illnesses by coughing or sneezing into their elbows. Not true, according to Phillips.

“When somebody coughs or sneezes, it should be into a tissue,” she said. “I take exception with people who have been sneezing into their elbows. You’re impregnating [the virus] into your clothing. What’s the first thing we do when we pick up our kids? We cradle them in our arms. How often do you wash your coat or sweater?”

Even the right gloves are not 100% safe

The recommendation, according to Phillips, is not to wear sterile gloves. Rather, wear exam gloves for virus protection. They’re not sterile, but they are protective, she said.

“Gloves are never 100% impervious,” Phillips said. “I might be able to fill them up with water and they’re not going to leak, but water molecules are bigger than viral particles. Anytime you use exam gloves, upon removing them, wash hands again.”

Always wash your hands with soap and water before putting gloves on and right after taking them off. Hand sanitizers fall short of killing viruses, so it’s better to use soap and water, according to Phillips.

Getting the most from masks

Media coverage of the 2019-nCoV shows a lot of people wearing masks. Many are wearing them incorrectly, according to Phillips, who says typical surgical masks or any variety of rectangular mask are not adequate to filter a virus.

Viruses are tiny compared to other things nurses wear masks to protect against, such as splashes.

“Once the masks get wet, either from the inside from your breath or the outside from contamination, they are ineffective and have to be discarded immediately,” Phillips said.

Most of the recommended N95 respirators filter very small particles. But the coronavirus is smaller than the typical virus and even those masks are limited in their ability to protect wearers, according to Phillips.

To get the most out of the N95 respirator, nurses and others should wear them snug against the nose, cheeks and chin. The masks must be fitted, Phillips said.

PPE best practices

Healthcare providers, according to Perri, are notorious for not removing personal protective equipment correctly.

coronavirus - Luci Perri, RN

Luci Perri, MSN

“I would caution everybody that prior to putting on PPE, make sure your hands are clean, so you’re not contaminating yourself as you’re putting on your PPE,” Perri said. “When you go to take it off, make sure you take it off in the right order.

“We go from dirtiest to cleanest,” she continued. “So, your gloves would come off first, then your gown, then your eye protection if you’re wearing goggles, and then your mask. Wash your hands as soon as you get your PPE off. If you take off your gloves and you feel like your hands could be contaminated, before you take anything else off, clean your hands and then remove the rest of your PPE. Then, clean your hands again.”

Not protecting the eyes leaves you vulnerable. Eyewear is important because the eyes have mucus membranes, which have a blood supply.

If a contagious component gets into the eye from a cough, for example, it can enter the blood supply and infect the person.

Take precautions in every setting

Because of the heightened flu season and threat of coronavirus, inpatient facilities should have systems in place to protect patients and staff, according to Perri. This includes screening visitors to make sure no one is bringing any illness in, she said.

Novel coronavirus symptoms are similar to many other respiratory illnesses.

“There are always circumstances where visitors must get in to see the patient, if the patient is in intensive care or is dying,” Perri said. “In that case, you want to make sure they’re masked if they have upper respiratory symptoms.”

Nurses who suspect someone could have the novel coronavirus should mask the patient and keep those masks on as the patient enters airborne isolation, which is a negative pressure room.

“The mask should stay on the patient until they’re in negative pressure and the room is functioning properly,” Perri said.

In ambulatory settings, it’s important to display signage about respiratory etiquette. Front desk staff should be comfortable talking to patients, asking them to wear a mask and explaining respiratory etiquette, Perri said.

Emergency department and ambulatory settings should have a triage set up, so patients with coronavirus symptoms are separated from others or taken to a treatment room right away, according to Perri. Regardless of the setting type, nurses should educate patients, visitors and fellow healthcare workers about not touching their eyes, nose or mouth.

“If they must touch those areas, they should clean their hands first,” Perri said.

Finally, if a nurse thinks he or she could have been exposed to the novel coronavirus, that nurse should report the potential exposure to a manager and the occupational health or employee health department, Perri said.

Coronavirus resources

The Centers for Disease Control and Prevention provides many good resources on the coronavirus and protecting yourself and patients, including:

  • Novel coronavirus situation update, signs/symptoms, transmission
  • Putting PPE on and taking it off
  • Protecting Healthcare Personnel guidelines
  • Interim guidance for healthcare professionals on human infections with 2019 novel coronavirus (2019-nCoV)

Take these courses to learn more about infectious diseases and prevention:

Middle East Respiratory Syndrome (MERS)
(1 contact hr)
Middle East respiratory syndrome (MERS) is a lethal pulmonary disease caused by a newly emerged coronavirus. It is believed to have originated in bats before it was transmitted to camels. Since human contact with bats is limited, evidence (serological and molecular) suggests that camels are the likely animal reservoir for MERS and the primary zoonotic source for human infection. MERS coronavirus (MERS-CoV) was first identified in Saudi Arabia in 2012. As of October 2018, there have been 2,266 lab confirmed cases of MERS with 804 deaths. The virus has been found in 27 countries.

Emerging Infectious Diseases
(1 contact hr)
Emerging infectious diseases have become a global phenomenon. There are many causal factors for the presence of these diseases, including evolution and adaptation as viruses learn to evolve and recombine, and increased international travel and exportation. As these factors combine, a dangerous situation emerges. This activity will address West Nile virus, Ebola virus, and Zika virus.

Keep It Clean: Hand Hygiene and Skin Antisepsis
(1 contact hr)
Whether at the surgical site or on the hands of the healthcare provider, skin is laden inherently with resident and transient flora. Inadequate hand hygiene allows opportunistic pathogens in varying life stages to transfer between patients and other surfaces during everyday activities. Yet many healthcare workers across various disciplines continue to have poor hand hygiene despite best-practice evidence about microbial transfer between people. Proper preoperative patient skin antisepsis and hand hygiene can minimize surgical site infections, and healthcare professionals across disciplines should collaborate to enhance adherence.

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