Redeployed to ICU

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airpods123

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Hey there, attending in another specialty. Will be getting redeployed to ICU to help out/basically do intern type work. I have a couple of basic questions for you guys doing this regularly

1) Fit testing - just got fit tested ... one of those quantitative ones (PortaCount) where they hook at tube up to a N95 mask. Given ton of people have been getting fitted recently , one after the other, isn't this risky.. same machine/tubing etc..? I'm not sure how the test works but don't they basically attempt to flood your face with particles?

2) N95 masks - we get one a week... Doesn't this seem inadequate? Won't be in individual rooms but isn't the virus floating around the ICU? Any words of advice?

3) Living situation - living with/taking care of older people. Are you guys staying in a hotel?

Thanks

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Hey there, attending in another specialty. Will be getting redeployed to ICU to help out/basically do intern type work. I have a couple of basic questions for you guys doing this regularly

1) Fit testing - just got fit tested ... one of those quantitative ones (PortaCount) where they hook at tube up to a N95 mask. Given ton of people have been getting fitted recently , one after the other, isn't this risky.. same machine/tubing etc..? I'm not sure how the test works but don't they basically attempt to flood your face with particles?

2) N95 masks - we get one a week... Doesn't this seem inadequate? Won't be in individual rooms but isn't the virus floating around the ICU? Any words of advice?

3) Living situation - living with/taking care of older people. Are you guys staying in a hotel?

Thanks

1) dunno, I’m not familiar with the fit testing equipment I’ve only done old school way


2) it isn’t. But it’s better than none. I’d ask if they have uv decontamination. That’s what we’re doing. Depending on the style, I doubt some designs last a whole week and good luck finding respirators on your own now unless you want to pay 200% mark up on eBay. For the moment we seem to be doing better than other countries a protecting ourselves. Physicians' Risk From COVID-19: A Reassuring Statistic

3) Im essentially in a hotel, I’m not living with elderly but if my wife gets sick it will take me out as I won’t have child care. It sucks but it is what it is.
 
Hey there, attending in another specialty. Will be getting redeployed to ICU to help out/basically do intern type work. I have a couple of basic questions for you guys doing this regularly

1) Fit testing - just got fit tested ... one of those quantitative ones (PortaCount) where they hook at tube up to a N95 mask. Given ton of people have been getting fitted recently , one after the other, isn't this risky.. same machine/tubing etc..? I'm not sure how the test works but don't they basically attempt to flood your face with particles?

2) N95 masks - we get one a week... Doesn't this seem inadequate? Won't be in individual rooms but isn't the virus floating around the ICU? Any words of advice?

3) Living situation - living with/taking care of older people. Are you guys staying in a hotel?

Thanks

1) We use a portacount or similar device. I honestly don't know what their cleaning process is between individuals. I know we throw the mask away, but if they exchange the tubing or use some sort of disinfectant between HCP's... I would hope so

2) If you're that short on N95's you should be using a surgical mask for routine care and saving your N95 for events at risk of aerosolization. That said, we're very strapped for PPE and to my understanding are generally still providing 5 to individuals providing routine COVID care with plans to cycle through them and use time as a decontamination procedure

3) n/a for me, but I would.
 
1. I've seen them flush the machine/tube between people but you might ask your industrial hygienist for more details.

2. Depending on your ICU set-up it may well be floating around and coating a lot of surfaces. Aerosol generating events (intubations, mask nebulizers, high flow nasal cannulas) should be done in negative pressure rooms only, especially if not everyone in the unit is wearing N95s all the time. If you're re-using the mask for the week I would wear a surgical mask over the top of the N95 to reduce the fomites. Look for Youtube videos on how to doff an N95 into a tupperware container as the outside is considered contaminated. If they are not providing eye protection bring your own faceshield, onion goggles, lab goggles, etc. Consider getting a headband for the surgical mask, the nurses likely already have them and they have 2 buttons sewn to the sides so you don't have to use your ears. Obviously these need to be washed daily so you'll need at least two.

Use every hand sanitizer dispenser you walk past while in the ICU, usually this is also less caustic on your hands because most of the hospital sanitizers contain some moisturizer. Wash your hands before and after going to the bathroom and before and after eating. Don't touch your face. Wear at least a surgical mask 100% of the time while in the hospital unless you're actively eating or drinking something. Sanitize your hands frequently, no seriously. Unless you're being exposed to a lot of high risk aerosol events your hands are the most likely vector.

Watch either your hospital's, the CDC's or a random Youtube video you like on how to don and doff PPE. Watch it over and over until you're sick of it and then watch it some more. Doffing is the most dangerous part as you're now likely covered in covid. Use a buddy if you can. The nurses will likely be able to help you as they've probably been doing it more than you. Once you're comfortable donning/doffing, forget that you're comfortable. Familiarity breeds contempt and that's risky.

For codes full PPE goes on (N95, full faceshield, hair/head cover, isolation/surgical gown, double glove, booties if available) and only then do you go into the room and only if you're actually going to physically do something. This is an absolute.

3. If your hospital is providing hotel rooms (some are) you could consider it. Wear scrubs/clothes to work, change into hospital scrubs for work including covid shoes that stay in the hospital. Zip lock baggie your phone, dispose of this bag as you are exiting the hospital. Change your scrubs before leaving the hospital. Carry as little as possible into the hospital and bring as little as possible into the house (phone, house + car key, license, credit card). Shoes stay outside. Strip before entering the house if feasible. Go immediately to your own shower. Use bags to bring clothes to the washer directly and dispose of those bags outside the house right away. Wash everything in hot water. Wipe anything you brought to the hospital down with bleach wipes and try to leave it in your "hot" zone by your door. Sleep in a separate room, don't share food or bathrooms and take your temperature morning and evening if you're staying with older people.
 
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