As a frontline health care worker, I’m as scared shitless as any of you over this coronavirus pandemic, particularly now that there is increasing community spread of COVID-19. That being said, I am grateful for a steady pay check when so many have lost their jobs. I am also thankful for the moments of grace, compassion and humour that bind us all together.
There have been umpteen articles, news reports, instructional videos and personal testimonies on what to wear for PPE (personal protection equipment) whether you are a health care worker preparing for battle or a citizen trying to get your groceries done at the local supermarket.
If it were only a matter of having an adequate supply of PPE at our disposal we’d be all set but alas, there is a specific method to donning and doffing in health care so that you do not contaminate either your client or yourself on the way in and on the way out. Nurses are the ultimate pros (I bow to them) at this but as you have heard reported in the media, there are many who have fallen ill from the coronavirus despite the use of PPE. It is definitely not foolproof.
Let me clarify that as a physiotherapist I have donned and doffed many times in my 35 year career. Never have the stakes been so high though.
Last week I had the opportunity to practice my PPE technique when I did a home visit for a client who was in quarantine with symptoms. Social distancing, my eye. There is no way to examine a wound or reassure an anxious client from 2 meters away. By the time I left, I had managed to contaminate just about everything I touched from the cell phone I took pictures of the wound with, to the pen I used to write down recommendations, to the small bottle of standard issue, flip-top hand sanitizer I used between donning and doffing.
Folks, it ain’t nothing like in the instructional video where everything you need is at arms length like the hand sanitizer dispenser on the wall or in the case of the ever handy garbage can, a foot pump away.
I vowed to do better next time and this past Friday I had my chance: my client had a doctor’s appointment on Monday and I was asked to practice stair training with her. Before leaving for the home visit, I reviewed the PPE procedure in my head and again out loud with my office mates as they nodded encouragingly. You’ve got this, Sharon, they said.
Once I arrived at the client’s, I left everything in my car except my car keys which I placed in the right hand pocket of my coat, my hand sanitizer which I placed in my left pocket and a brown paper bag that held mask, gloves and gown.
As I entered the house, my client appeared on the landing above. She was upset because us workers were leaving our discarded PPE in her entranceway and they were accumulating. I explained that we could not transport them back to the office as they were considered contaminated. Irate, she asked if I could at least throw it in her garbage can outside. I agreed to do so on my way out making a mental note to use my hand sanitizer immediately after.
Here are my donning and doffing procedures in detail.
Donning: hang coat in closet, reach in right pocket of jacket and feel car keys (oops), reach in left pocket for hand sanitizer, practice hand hygiene for recommended 20-40 seconds as client looks on, put on gown, note in hallway mirror that gown is too décolleté and shirt is sticking out, attempt to re-tie gown and note that shirt is still showing but less so, place procedure mask over mouth and nose as glasses steam up, put on rubber gloves pulling them up over arms of gown.
Intervention: reassure anxious client while looking over steamed up glasses, discuss exit plan for Monday’s doctor’s appointment and decide that client will go out front door rather than garage, realize that we will have to practice outside stairs while I am fully doffed for neighbours to ogle at, successfully practice indoor stairs with client who is thrilled, client does even better with outside stairs (hurrah!), client checks up on garbage cans by garage door and notices one is tipped over, client asks me to place it upright, as I put it upright my be-gloved right hand lands in mushy, food stuff that some animal has rummaged through, I silently scream ewww as I retain outward professional decorum and make mental note not to touch anything with right hand, escort client back upstairs and into house, ask client if there is anything I can do for her before I go— As a matter of fact, client says, can you please spray my roots for me with that magic root concealer spray on the dining room table? Spray client’s roots with left hand keeping dirty, garbage-contaminated right hand behind back while client holds stockingnette against forehead, wipe excess brown dye from client’s forehead and attempt to wipe away large, brown age spot that is permanent and matches hair dye, client checks hair in bathroom mirror and gives me thumbs up with her good hand.
Doffing: remove really gross right glove first, remove left glove with magic root concealer on it, reach into right hand pocket of coat to find car keys, reach into left hand pocket to get hand sanitizer, practice recommended hand hygiene for 20-40 seconds, lean head forward to remove mask, realize with horror that mask is stuck on something so pull harder and steamed up glasses go flying across landing as client watches, forget what to do when this happens as it wasn’t covered in instructional video so put glasses on and silently hope for the best, remove gown after untying knot that has formed at the neck and got caught in hair, reach in left pocket of coat for hand sanitizer to practice hand hygiene for recommended time, leave client while promising to take out garbage next visit.
In car: take out hand sanitizer and practice vigorous hand hygiene for five minutes, remove antiseptic wipe from baggie in knapsack on passenger car seat and wipe outside of hand sanitizer bottle, glasses, keys, door handles, radio knobs, steering wheel, bottom of boots and hands again.
Conclusion: it is harder than it looks to don and doff and so much more stressful under present circumstances. Trust me, even with PPE, it is easy to contaminate. I bow again before the nurses who do this so much better than me.
Stay safe everyone. We’ll get through this. ❤️🙏