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How do doctors keep themselves safe during the COVID-19 pandemic?

How do doctors keep themselves safe during the COVID-19 pandemic?
In a hospital, many aerosol-generating treatment procedures are carried out which increase the COVID-19 risk of healthcare professionals. @Shutterstock

Doctors and frontline healthcare workers are at a high risk of catching the COVID-19 infection. Here is a fool proof guide for them to safeguard themselves and their families from the novel coronavirus.

Written by Saswati Sarkar |Updated : August 3, 2020 12:41 PM IST

Globally, countless doctors have lost their lives to the deadly COVID-19 infection while helping others battle it. According to some estimates, in India alone, the pandemic has taken the lives of hundreds of doctors so far. Our health heroes risk their own lives while fighting hard to protect us from COVID-19. However, more than themselves, doctors and other healthcare workers (HCWs) are worried about infecting their kids and close family members. Watch this video to know how they safeguard themselves and their close ones from the COVID-19 infection. Top experts Dr. Randeep Guleria, Director, AIIMS, K Srinath Reddy, President, Public Health Foundation of India and Dr. Anoop Misra (Padma Shri), Chairman, Fortis C-Doc share their COVID-19 protection plan.

Why Are Doctors at High Risk of COVID-19 infection?

Commonly, chances of catching COVID-19 infection are high when you are in close proximity (within 2 metres) of a person who has tested positive for the condition. The transmission happens through virus-loaded droplets (measuring between 5-10 microns) emitted by COVID-19 patients when coughing, sneezing or talking. Doctors and other healthcare professionals have to stay close to them for treatments, procedures and support. This is what makes them vulnerable to this infection. Also, the novel coronavirus has been found to last on various surfaces for like steel or plastic for as long as two to three days. "In a hospital setting, these viruses linger on the beds of patients, mattresses, and other equipment too," says Dr. RK Mani, Director, Strategy and COVID-19 Management, Yashoda Super Speciality Hospitals. It's easy for healthcare workers to catch the virus if they put their hands on their mouth, nose and eyes after touching a contaminated surface.

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Apart from these, there is a third way of transmission, which is more likely in a hospital setting: Airborne transmission through aerosols. Aerosols are virus-loaded tiny droplets smaller than 5 microns, which stay suspended in the air for as long as 3 hours and can travel for more than 1 metre. "In a hospital, many aerosol-generating treatment procedures are carried out which increase the COVID-19 risk of healthcare professionals," says Dr. Mani. These include various oxygen and airway-related procedures like non-invasive ventilation (NIV), high flow nasal cannula (HFNC) and incubation among others. "In NIV, air is blown into the mouth of the patient through a mask and a hose pipe while for HFNC, high flow of air is mixed with heated oxygen through a humidifier. It goes through a thick cannula (tube) into his nose. Similarly, when you are incubating someone, you are introducing a pipe into his airway in order to connect it to a ventilator. The patients cough a lot during this procedure which generates contaminated phlegm. Additionally, the process of suctioning their body fluids and secretions generates a flush of aerosols. Surgical interventions and dental procedures using drills and jets also produce these airborne droplets," explains Dr. Mani.

Protective Measures for Doctors

When a healthcare worker is at risk of an infection like COVID-19, many people around him also become vulnerable to it. So, they need to be extremely cautious about safeguarding themselves. Personal Protection Equipment (PPE) that ensure zero skin exposure and a few hygiene measures can shield doctors and healthcare workers from the novel coronavirus. "However, it is crucial for any HCW to choose their PPE carefully. Pay attention to the quality and pick up the ones that are breathable, or else you won't be able to function properly," suggests Dr. Mani. Masks, goggles, gloves, face shields and caps are essential personal protection equipment for doctors and other frontline healthcare workers. Here is a guideline for them to keep the novel coronavirus at bay.

Wear the right face mask: Masks provide airway protection, which is very important especially in a hospital setting. N-95 respirator is the basic mask that HCWs should wear. "However, if they are involved in aerosol generating procedures, they need higher protection. While an N95 mask filters out up to 95 per cent viruses, FFP3 masks can protect them against 97-100 per cent viruses. Powered air purifying respirator (PARP) is another face mask that ensures even a higher level of protection. It covers your face and delivers a positive airway pressure with an air generator fixed to your back. The pressured air comes in between your face and the mask, so that there is no chance of any air from outside entering your system," explains Dr. Mani.

Wear two gloves: It is important to wear two of them. "This is because you need to remove the outer glove after touching one patient and moving on to the next. It minimises viral contact," says Dr. Mani. An alcohol-based sanitizer should be used to disinfect the inner gloves.

Maintain proper hand hygiene: Washing hands with soap and water is extremely essential. The duration of this process should ideally be40-60 seconds. While washing your hands, make sure that you use soap generously to cover all the surfaces and rub from palm to palm, interlacing and interlocking your fingers. Follow a rotational movement while rubbing. Rinse with water after rubbing well. Dry your hands with a single use towel and turn off the faucet with a tissue. Follow the same process while cleaning your hands or inner gloves with a sanitizer. According the WHO guidelines, the duration of sanitizing process can be 20 seconds.

Don't forget to wear goggles: They are also an important PPE. So, wearing goggles is a must. Make sure that your goggles are well-fitted," says Dr. Mani.

Opt for a face shield: It protects you from the flush of frequently generated aerosols, virus-loaded droplets and fluids from the patient's body.

Don a cap: Viral droplets can settle on your hair and enter your body. So, doctors and healthcare workers need to cover their whole body, including the head.

Stick to proper donning and doffing techniques: When doctors come in for their duty, they remove their usual clothes in the changing rooms, put on their scrub suits (clothes worn in an OT) and wear PPE. This process is known as donning. "There are certain techniques that one needs to adhere to during donning. Learn and stick to them," says Dr. Mani. Doffing is the process of taking off your PPE at the end of your duty. "Personal protection gear can be loaded with virus-loaded droplets. So, it is extremely essential for doctors and other HCWs to discard them safely and in a scientific manner in an area earmarked for doffing. If you are not cautious during doffing, you may risk yourself and your environment too. This process has to be followed by a bath," says Dr. Mani.

Safety Measures For Family

When you go back home from duty, take a bath. "Also, it is important to have a separate room and toilet for yourself at home. I have done it for myself. Maintain a 2-metre distance from every family member and make sure you use separate utensils and towels. Nobody else should share them," says Dr. Mani. However, if one doesn't have enough space at home, then he or she should stay away from family. "In many hospitals, doctors treating COVID-19 patients are on duty for 1 week and off for 2 weeks. They can stay outside during their on-duty week. The hospital can arrange their accommodation. At the end of their duty, they should go through a COVID-19 swab test. If they are negative, then their families are also safe. If they are symptomatic and test positive, they should also stay away from their families," suggests Dr. Mani.