Keep Yourself and Your Family Safe
How to protect yourself — including proper use of PPE — and tips for how to protect your family when you return home after your shift.
The American Nurses Association (ANA) supports all nurses responding to COVID-19, caring for infected individuals and impacted communities, and preventing the spread of the coronavirus within their health care facilities, communities, and families. Your work on the frontlines increases your vulnerability and the risk of your family’s exposure, and it is imperative to continue learning about this new virus and speaking out if your feel your personal safety is at risk.
How to protect Yourself from COVID-19
Everyday measures to protect yourself from the virus include frequent hand hygiene, physical distancing when in public, wearing a cloth face mask, and most importantly, stay home. If you are at higher risk for severe illness, additional information is found here. If you are health care personnel:
- Adhere to the standards for donning and doffing PPE when caring for COVID-19 patients.
- Avoid touching your N95 respirator, facemask, eye goggles, and face shield if wearing during extended use.
- Wash your hands before donning all PPE. When doffing PPE, wash your hands before doffing your goggles, N95 respirator, and face shield, and again after all PPE is doffed.
- Wash your hands frequently with soap and warm water.
- Doff PPE before breaking for meals and taking trips to the restroom.
- Practice hand hygiene before and after going to the restroom and before eating.
- Eat meals in non-clinical areas.
- Disinfect your cell phone frequently, place your cellphone in a clear sealable bag that serves as a barrier, discard of the bag before going home, disinfect your cell phone before entering your home.
- Change your scrubs and shoes if possible before returning home.
N95 Respirator Fit Testing
Fit testing is still required by OSHA. Fit testing ensures the N95 respirator forms a seal around the mouth and nose. If you have not been fit tested for an N95 respirator, your organization or infection control department must provide “just-in-time” fit testing to ensure the N95 respirator is worn properly. Contact your facility’s occupational health department or infection control personnel for your organization’s fit testing requirements.
Reuse of N95 Respirators
The National Institute for Occupational Safety and Health (NIOSH) has outlined several recommendations for the extended use and limited reuse of N-95 respirators. Visit NIOSH's website for special considerations and recommendations for the implementation of N95 respirator re-use or extended use strategies.
Decontamination of N95 Respirators
The FDA has issued two Emergency Use Authorizations for the use of vaporized hydrogen peroxide for the decontamination and reuse of N95 respirators. According to the CDC, “Decontamination and subsequent reuse of FFRs should only be practiced as a crisis capacity strategy. At present, FFRs are considered one-time use and there are no manufacturer authorized methods for FFR decontamination prior to reuse.” Consideration must be given to whether the manufacturer has provided information regarding decontamination and the impact on respirator performance. Additionally, per the CDC, “given the uncertainties on the impact of decontamination on respirator performance, these FFRs should not be worn by HCPs when performing or present for an aerosol-generating procedure.” Following the release of the FDA’s EUA and recommendations from the CDC, on April 3, 2020, the Occupational Safety and Health Administration (OSHA) released the interim Enforcement Guidance for Respiratory Protection and the N95 Shortage Due to the Coronavirus Disease 2019 (COVID-19) Pandemic. This guidance was issued with respect to the extended use and reuse of respirators, as well as the use of respirators that are beyond their manufacturer’s recommended shelf life. Before reuse of a decontaminated N95 respirator, discuss with your employer or infection control team the decontamination method used and associated safety risks and safeguards to ensure proper fit and seal of the N95 respirator.
The Use of Cloth Masks
Within the health care setting, ANA maintains that all personnel have access to the highest level of respiratory protection to minimize exposure risk to COVID-19. This includes the use of the N95 respirator (or medical facemask with face shield if the N95 respirator is unavailable), face shield, or goggles for eye protection, gown, and gloves. A cloth mask alone does not provide enough respiratory protection from COVID-19 within a medical setting.
Recently, recommendations for the use of cloth masks by the general public changed. The CDC announced that the general public should wear a homemade cloth facemask when in public during outings to pick up essential items. The use of the homemade cloth facemask serves as a method of source control for those who carry COVID-19 with the potential of spreading the virus in the absence of symptoms. The use of a cloth mask is to be done in conjunction with other preventative measures including physical/social distancing, frequent hand washing, and staying home.
How to Keep Your Family Safe When You go Home After Your Shift
COVID-19 is primarily spread through respiratory droplets from coughs and sneezes and droplets exhaled when talking. The virus is also contracted by touching an infected surface and then touching the face, eyes, nose, or mouth. Therefore, cleaning hands and wiping down frequently touched objects, such as a cell phone or tablet, that are commonly transported between home and work is an important step to take prior to returning home. The U.S. Environmental Protection Agency (EPA) has developed a list of products suitable for use against COVID-19.
Additional tips include:
- Remove scrubs and shoes worn while providing care before entry into the home. If possible, wear hospital provided scrubs or carry a change of clothes to work including shoes.
- Remove shoes before entering into the home.
- Keep scrubs contained in a disposable bag, wash in hot water with detergent separately from other laundry items. Dispose of the bag in a lined trashcan once emptied into the washer. Wash your hands.
- Disinfect your cellphone frequently while on the unit and again just before leaving. Consider storing your cellphone in a clear sealable bag as a barrier.
- Leave high touch objects that are not essential for home on your unit, such as pens and clipboards used during your shift, disinfect frequently during the course of your shift.
- If using a personal stethoscope, leave on the unit in a locker, and disinfect before and after use with every patient.
- Wash hands with soap and water upon leaving the unit and again upon entry into the home.
It's also important that your family members understand what COVID-19 is, the symptoms, and the importance of preventative measures such as hand hygiene and physical distancing. This along with the recommendation to limit time away from home to solely work if essential and essential visits to the grocery store, pharmacy, or to your medical provider when scheduled or if you seek emergency medical care.
Guidelines have changed during the course of the pandemic.
If family members must leave home, emphasize the importance of wearing a cloth face mask along with physical distancing which is remaining a distance of 6 feet between yourself and others. Continued frequent hand hygiene is essential. Wash your hands upon returning home with soap and water for at least 20 seconds. When out in public and soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol content. Avoid touching your face, particularly your mouth, nose, and eyes. When you touch surfaces that may be contaminated and then touch your face you can easily infect yourself. Disinfect your cellphone frequently because it is a high touch surface where germs and viruses can live. Consider those around you who are elderly or who fall within the category of a vulnerable population when running errands and offer to pick up items to they can further limit their time away from home.
Reassignment of Health Care Workers Within a Vulnerable Population
Individuals over the age of 65 and with chronic underlying medical conditions are at increased risk of severe morbidity and mortality as a result of COVID-19. If you fall within this category, have a conversation with your employer about redeployment to support telehealth services, transfer to units without COVID-19 patients, or assignment to non-COVID-19 patients needing care. It is also crucial to have access to the appropriate PPE to minimize the risk of exposure.
What to Do If You Are Pregnant
A statement released by the Association of Women’s Health Obstetric and Neonatal Nursing (AWHONN) upholds “Normal physiologic and immunologic changes of pregnancy increase the pregnant woman’s susceptibility to infections. However, data specific to COVID-19 is limited. Pregnant women, their fetuses, and newborns may be at an increased risk for morbidity and mortality if COVID-19 is contracted during pregnancy.” In accordance with recommendations supported by AWHONN, ANA supports the CDC’s recommendation that health care facilities should consider limiting the exposure of pregnant health care personnel to patients with confirmed or suspected COVID-19 during high-risk procedures especially those with increased risk of aerosolization. If you are pregnant and are health care personnel, it is important to continue your routine prenatal care and inform your prenatal care clinician of your exposure risk at work along with any symptoms (including fever, cough, or difficulty breathing) associated with COVID-19.
Recommendations for Breastfeeding Mothers
Research on the risk of pregnant women and breastfeeding mothers associated with COVID-19 continues. The following guidelines are outlined by the CDC for breastfeeding mothers for the protection and prevention of spreading COVID-19 to their infants:
- Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.
- You, along with your family and health care providers, should decide whether and how to start or continue breastfeeding.
- In limited studies, COVID-19 has not been detected in breast milk; however, we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk.
- If you are sick and choose to direct breastfeed:
- Wear a facemask and wash your hands before each feeding.
- If you are sick and choose to express breast milk:
- Express breast milk to establish and maintain milk supply.
- A dedicated breast pump should be provided.
- Wash hands before touching any pump or bottle parts and before expressing breast milk.
- Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
- If possible, consider having someone who is well, feed the expressed breast milk to the infant.
For additional resources on breastfeeding and pregnancy visit the CDC’s Guidance on Pregnancy and Breastfeeding.
Guidance for Protection When Working in Home Health and Home Hospice Care Settings
- Connect with your patient or patient’s family in advance by telephone, text monitoring system, or video conference prior to home visits for temperature and symptom monitoring.
- If you must visit the home and the patient is suspected or confirmed to have COVID-19, wear the following PPE: Gown, gloves, eye protection (goggles or face shield), N95 filtering facepiece, or respirator (or medical facemask if not available). Always perform hand hygiene before donning PPE and after doffing PPE.
- Don and doff PPE outside of the home, dispose of PPE outside the home in a lined trash receptacle, do not travel with used PPE.
- The Centers for Medicare and Medicaid Services provides guidelines for home health care personnel along with detailed guidelines for home hospice care personnel.
Additional Information on Personal Protective Equipment (PPE)
Following the correct sequence of donning and doffing PPE is essential in the prevention of self-inoculation of COVID-19. Below are several links to review the proper sequence along with vital information related to respirator use.
- Sequence for Putting on Personal Protective Equipment (PPE)
- Three Key Factors Required for a Respirator to be Effective
- Important Steps for Using NIOSH-Approved N95 Filtering Facepiece Respirators
- Frequently Asked Questions about Respirators and their Use
Additional Information on Infection Control
For additional information on infection control measures to take within your facility, visit: the Infection Control and Prevention of our site.