4 Protecting yourself from COVID-19

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Contents

• Objectives
• How to protect yourself
• Personal protective equipment
• Wearing a cloth mask in public
• Emotional challenges for health workers
• Case studies

Objectives

Once you have finished this chapter you should be able to:

1. Explain how health workers can protect themselves against COVID-19.
2. Describe personal protective equipment.
3. Use and wash a non-medical cloth face mask correctly.
4. Recognise and manage work-related stress.

How to protect yourself

4-1 Are health workers at increased risk of coronavirus infection?

Yes. Anyone who is in close in contact with someone who has COVID-19 or is suspected of having coronavirus infection is at increased risk. They therefore need to take extra care.

4-2 What can health workers do to protect themselves?

They should:

• Practise handwashing and social distancing both at home and at work.
• Make sure everyone wears a cloth face mask when near other people.
• Use personal protective equipment (PPE) correctly.
• Follow all hospital or clinic protocols correctly.
• Not touch their face with their hands or gloves.
• Support each other during this stressful time.

Personal protective equipment

4-3 What is personal protective equipment?

Personal protective equipment (PPE) is the equipment needed to protect health workers from becoming infected with coronavirus. It is especially important that health workers protect themselves when looking after COVID-19 patients and people who are suspected of having coronavirus infection. The most appropriate and effective PPE should be used in each circumstance.

Community health workers doing COVID-19 screening in the community should keep a personal distance of at least 1 metre and wear a medical mask.

Basic personal protective equipment (PPE) for close patient contact, such as taking nasal swabs, is:

• A plastic apron or a non-sterile long-sleeved gown
• Non-sterile gloves
• Medical mask
• Eye protection such as goggles or a face shield.

For health workers performing aerosol-generating procedures, any procedure that causes the patient to produce droplets, a well-fitting N95 respirator should be used.

Donning (putting on) and doffing (taking off) full PPE is a skill that needs practice and must be done properly to avoid being contaminated with coronavirus.

Personal protective equipment must be made available for all health workers caring for COVID-19 patients.

4-4 What personal protective equipment should be used when speaking to people?

When speaking to people or handing out educational material do not stand closer than 1 metre. A medical mask is all that is needed. Wash your hands well and often.

4-5 Can personal protective equipment be re-used?

Gloves and aprons must be changed between patients. Medical masks can be worn for 8 hours if not contaminated, wet or torn. Usually PPE is not re-used. However, if PPE is very scarce, reuse is still preferable to having no PPE when supplies are extremely limited.

4-6 How should you handle your uniform or work clothes?

If possible, remove your work clothes at the workplace and place them in a plastic bag. If removed at home, place them in a washing basket immediately. Wash your hands well after removing your clothes. Wash the clothes in hot water if possible (60℃). Remember to also clean your glasses and to wipe down your cellphone and any pens with an alcohol-based sanitiser.

4-7 What should be used to clean and disinfect surfaces and equipment?

Clean the surfaces around the patient or where you are working at least twice daily with soap and water followed by a 0.1% bleach solution (25 ml liquid bleach in 1 litre of water) or a cup (250 ml) of Jik in 1 litre of water. Disinfect equipment such as stethoscopes with a 70% alcohol sanitiser after each use.

Wearing a cloth mask in public

4-8 Is it helpful to wear a non-medical cloth mask in public when not working?

It is always important to protect yourself and your family when out in public. A cloth face mask helps prevent the spread of droplets that may contain coronavirus. However, face masks must be used correctly. It is helpful if this information is shared with friends, family, and colleagues:

• A good mask is made of three layers of non-stretch cotton material.
• It should cover from above the nose to below the chin and back to the ears.
• Two straps to tie behind the head is better than straps or elastic bands behind the ears.
• Wash your hands before putting on the clean mask.
• Do not touch your face or the cloth part of the mask.
• Hold the mask by the straps and pull the mask over your face making sure your nose and mouth are covered.
• Tie the straps with one set above your ears and the other set around your neck.
• Touch only the straps when removing the mask.
• Place the mask in a container until you wash it.
• Wash your hands well.
• Do not re-use the mask without washing it.
• It is best to have two or more masks (at least one to wear and one to wash).
• Never share masks.

4-9 How should a cloth mask be cleaned?

Cleaning a cloth mask correctly is important:

• Hold the mask by the straps.
• Wash with soap and hot water.
• Allow to dry well, preferably in the sun.
• Iron the dry mask.
• Wash your hands.

Emotional challenges for health workers

4-10 What are the emotional challenges of being a health worker in the time of COVID-19?

Health workers are at the frontline of protecting the public and caring for people infected with coronavirus. This is stressful as they are at risk of becoming infected and spreading coronavirus to their family. Caring for sick and frightened patients is also difficult. Some people will die, leaving family and friends sad. Colleagues may also get sick and die.

As the coronavirus spreads, there will be overcrowding in health facilities. Many health workers may also be away in isolation because they have come into contact with infected people or are infected themselves. This results in staff shortages. The demands of training and supporting inexperienced staff or volunteers may be an additional burden.

The stigma of working with COVID-19 patients is also a problem.

4-11 What are the symptoms of stress?

It is important to recognise and acknowledge when you are stressed. Common symptoms of stress include:

• Worry
• Anger
• Restlessness
• Being short-tempered
• Feeling sad and helpless
• Having a racing mind
• Not being able to sleep.

Being stressed is normal under these circumstances. You are not alone. Many others are also stressed. Some symptoms of stress and panic can feel similar to the symptoms of COVID-19, such as headache, shortness of breath, feeling feverish and sweating. This can feel very frightening.

4-12 What can be done to help and support stressed health workers?

It is important to speak to a trusted family member, friend, colleague, or supervisor. Ask for help if you are not managing. Tell them how you are feeling. Do not be shy to ask for support.

There are several simple things that can be done to help manage stress:

• Get the correct information about COVID-19 and ignore sensational or fake news.
• Take time out to be mindful, pray or just relax for a few minutes.
• Take a few deep breaths.
• Give yourself time to think about and process what has happened.
• Do something you enjoy like cooking, gardening, reading, doing puzzles, watching online movies, or dancing to distract yourself.
• Try to stick to a regular daily routine.
• Eat regular, healthy meals.
• Keep well hydrated.
• Get enough rest and sleep.
• Spend time outside every day.
• Keep fit by doing some form of exercise, such as following an exercise class online or on television.
• Use your phone to keep in contact with friends.
• Help others who might also be stressed.
• Understand that everyone is struggling – their struggles may be different, but you are not the only one who is feeling confused or frightened.
• Give yourself the same kindness you would give a close friend.
• Explain to children what is happening at their level of understanding, as your children may be frightened, behave badly, or be fearful about your increased risk.

It is important to look after your own mental health for your own wellbeing and so that you will be strong to help others.

Case study 1

Lindiwe is a health worker who meets patients with COVID-19 every day. Most days she just sits with them to give support and listen to their stories as visits from friends are not allowed. She is anxious to learn more about how to protect herself from infection.

1. What would she need when listening to patients?

She should wear a medical mask and encourage the patients to wear a cloth mask. She should not touch patients and must wash her hands often. It is also important that she learn not to touch her face unless her hands are washed.

2. What she should use to wipe down the plastic chair that she uses?

She should wipe down the chair with soapy water and then disinfect it with a bleach solution.

3. A few friends suggest that they should make cloth masks for patients to wear when she is counselling them. What advice would you give them?

A simple cloth face mask can be made from three layers of cotton material such as an old sheet or pillowcase. The mask must be wide enough to cover both the nose and the chin. Either material straps or elastic bands can be used to fasten the mask around the face.

4. How should a mask be used?

Only use a clean mask. When putting the mask on or taking it off, do not touch the material that covers the face. Do not fiddle with the mask and do not keep taking it on and off. After using a mask, it should be cleaned. Wash your hands well before and after handling a mask.

5. How should a cloth mask be cleaned?

Cloth masks should be washed with soap and hot water. If possible, let the mask dry in the sun and then iron it. This will kill any coronavirus. It is best to have two masks so that you always have a clean one ready to use.

Case study 2

A young health worker is becoming extremely stressed after a week of screening people in an informal settlement. She tells a friend that she wants to resign.

1. Is this an unusual response?

No. Health workers find it especially stressful to see frightened and angry people who do not want to be screened. Many people are frightened of the stigma and risk to themselves and their families if they are positive.

2. What symptoms of stress may she be experiencing?

Common symptoms of stress are restlessness, feeling sad or helpless, not being able to sleep and having a racing mind with thoughts of the many things that are going wrong.

3. What advice would you give her?

She should share her anxiety with a trusted friend or family member. It may help to know that many of her colleagues are also stressed. Each day she should make time to exercise, relax for a while in the open air, or find some activity that she enjoys to distract her from her worrying thoughts.