Part 2 of a 3-Part Series on Reentry During COVID-19
By: Maureen Hillier
The Centers for Disease Control and Prevention (CDC, 2020) is our gold standard for evidence-based information on cleaning protocols and personal protective equipment (PPE) and much of this information comes from this source. Until a vaccine is universally available, nonpharmaceutical interventions must be implemented to protect faculty, staff, and students to reduce virus transmission. Key considerations for schools of nursing should center on PPE and cleaning protocols.
Items used to support in-class instruction include masks, low-density and social distancing, frequent hand hygiene, staying home when sick, and cleaning and disinfecting. In addition, those in higher education leadership must have an ongoing and heightened situational awareness regarding COVID-19 transmission and protocols within their respective states.
The simulation learning environment has the capacity to promote realism while living through a pandemic. The simulation prebriefing is an opportune time to remind learners about safety standards including PPE, cleaning protocols, and a program’s commitment to conserve resources. Students should be informed to expect a modified environment that will include plastic bed sheets, essential equipment only, and limited use of props.
After a prolonged shutdown and before students return, buildings should be assessed for mold and excess moisture. If present, these must be eradicated before student and faculty reentry. Although the coronavirus naturally dies in hours to days in typical indoor and outdoor environments, extra time for additional cleaning and an abundant supply of hand hygiene products with alcohol should be continually available. The CDC recommends using an alcohol hand-based rub (AHBR) with 60 percent to 95 percent alcohol in health care settings. High-touch surfaces such as doorknobs, light switches, phones, faucets, counters, and keyboards will require more frequent cleaning based on level of use.
While thorough cleaning should be done by the custodial staff, intermittent wipe downs by learners and faculty can also be done. It is important to keep in mind that routine cleaning with soap and water reduces the number of germs. However, powerful disinfection is required to kill germs. To properly disinfect, gloves and adequate ventilation are also needed.
Disinfectant products that meet Environmental Protection Agency (EPA, 2020) standards for use against SARs-CoV are listed on a newly created category called “List N.” As of this writing, the regularly updated list contains almost 500 disinfectant products accompanied by comprehensive instructions for dilution and application. Acceptable disinfectant agents are searchable by the first two parts of the product registration number. When EPA-approved disinfectants are not available, such as in low-resource settings, alternative disinfectants can be used (for example, 1/3 cup of bleach added to 1 gallon of water, or 70 percent alcohol solutions). To capture ultrafine air particles to further reduce chance of disease transmission, evidence now also supports the use of High Efficiency Particulate Air (HEPA) filters, which can be rented or purchased. The virus that causes COVID-19 is approximately 0.125 micron, which is within the particle size range of 0.01 micron that HEPA filters capture with efficiency (Christopherson, 2020).
Educational programs should be in place for faculty, students, and staff on how to properly don, use, and doff full PPE. For the general public, wearing gloves is not necessary; however, surgical masks and gloves are suggested when touching a manikin. To further reduce chance of disease transmission, a face shield or an N-95 mask may be worn. If an N-95 is indicated, then students and faculty will require fit testing. Some programs may indicate N-95 masks when the number of students in a simulation scenario approaches the limits of social distancing guidelines. If the debriefing room is larger, then N-95 masks can be removed and replaced with surgical masks.
It is critical for all students to wear masks and practice good hand hygiene because social exposures produce more secondary cases than family or workplace exposures. Research has demonstrated that COVID-19-positive individuals who were asymptomatic or presymptomatic carried similar viral loads and both groups were considered infectious (Lee, 2020).
When possible, the CDC encourages virtual education. COVID-19 is a new disease with limited data about its long-term impact on underlying medical conditions. Therefore, students and faculty with the following conditions should be considered at risk and should proceed cautiously when reentering the higher education environment: asthma, cerebrovascular disease, cystic fibrosis, hypertension, immunocompromised state, neurological conditions, liver disease, pregnancy, pulmonary fibrosis, history of smoking, thalassemia, and type I diabetes. Additional consideration and precautions should be provided for those from racial and ethnic minority groups, as well as those who are pregnant, breastfeeding, and living with disabilities or developmental, behavioral or substance use disorders (CDC, 2020).
As students and faculty prepare for reentry during COVID-19, schools of nursing must be reprogrammed to include close attention to detail on PPE and cleaning protocols. In addition, those in higher education leadership must have an ongoing and heightened situational awareness regarding COVID-19 transmission and protocols within their respective states.
Centers for Disease Control (CDC, 2020). Corona virus (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/index.html
Christopherson, D A., Yao, W. C., Lu, M., Vijayakumar, R., & Sedaghat, A. R. (2020). High-efficiency particulate air filters in the era of COVID-19: Function and efficacy. Otolaryngology-Head and Neck Surgery. https://journals.sagepub.com/doi/full/10.1177/0194599820941838 https://doi.org/10.1177/0194599820941838
Environmental Protection Agency. (2020). 6 steps for safe and effective disinfectant use. https://www.epa.gov/sites/production/files/2020-04/documents/disinfectants-onepager.pdf).
Lee, S., Kim, T., Lee, E., Lee, C., Kim, H., Rhee, H., Park, S. Y., Son, H. J., Yu, S., Park, J W., Choo, E..J., Park, S., Loeb, M., & Kim, T. H. (2020, August 6). Clinical course and molecular viral shedding among asymptomatic and symptomatic patients with SARS-CoV-2 infection in a community treatment center in the Republic of Korea. JAMA Internal Medicine, 180(11), 1447-1452. doi:10.1001/jamainternmed.2020.3862