Provider Wellness Podcast

An Ebola Nurse Discusses COVID-19

April 08, 2020 Matthew Zinder, CRNA Season 1 Episode 6
Provider Wellness Podcast
An Ebola Nurse Discusses COVID-19
Show Notes Transcript

In this episode, Matthew speaks to Jason Slabach, a Nurse Anesthetist who took care of ebola patients at Emory University when he was an ICU nurse.  He shares his experiences taking care of these patients and compares and contrasts the lessons learned with the current COVID-19 pandemic.  He also details the proper procedures for putting on and taking off personal protective equipment. 

After we finished recording, Jason mentioned a website that he highly recommends for information regarding PPE, safety, and up to the minute information on COVID-19.  There is a huge host of information that can be useful to healthcare providers or anyone who wishes to learn more.  It is The National Emerging Special Pathogen Training and Education Center (NETEC). 

https://repository.netecweb.org/exhibits/show/ncov/ncov

Be sure to read and download the transcripts to this episode. Click on the tab above.

Check back often for more episodes pertaining to health and wellness and issues concerning the COVID-19 pandemic.

Please send your questions to goingviralpodcast@gmail.com

Website:  https://goingviral.buzzsprout.com/

Thanks for listening and please share this episode.

spk_1:   0:05
Hello and welcome to the going viral podcast. I'm Matthew's Ender, a certified registered nurse anaesthetist. I'm in Advanced Practice Nurse that specializes in the practice of anesthesia. Scope of this podcast will explore health and wellness from the broad to the specific. My aim is to educate while offering a unique perspective. Thank you for joining me today and let's get right to the show. So today I have a discussion with a nurse anaesthetist who, as an RN, worked in an icy you at Emory and took care of Ebola patients that were airlifted into the United States. He shares some very fascinating information about what he learned in that experience and then how he is applying that information to the current cove it 19 pandemic. He will also give a very informative and important talk on how to properly put on and take off personal protective equipment and some of the pitfalls that surround that, like where to do it, how to do it safely. Who was around you whether or not you have a buddy to do it with you were observe you doing it properly, so he gives some very important pieces of information relating to that as well. Now I've mentioned this before, but I am trying different platforms to record these episodes on, and today's episode was recorded on Skype. And as most people know, Skype is not a perfect platform, so you will hear some audio distortion every once in a while and also again. We're doing these at home by remote Internet video chat, so you will hear some background noise every once in a while as well, because, as you can well imagine, neither one of us is doing this from a professional recording studio. So I appreciate it. If you could bear with us on that as well. So please continue to share these episodes if you feel that any of this information is helpful to people. Ah, and if you wish, go to going viral dot buzz sprout dot com to see all of the episodes, and there's also a player there as well. And if you want to email me with any constructive comments or questions, you can go to going viral podcast at gmail dot com. Thank you very much again to any of the listeners who have given feedback. It has helped me form questions and topics for future episodes. And again, stay tuned because again, next week I will be talking to an arrow biologist who will talk about the concept of aerosols opposed to droplet and a very interesting invention that she has, along with her university, which is Texas A and M regarding how to test for covert 19 and then also be talking to a C or an A and an anesthesiologist who are on their way teams at their respective hospitals. So please stay tuned. So without further delay, here is my talk with nurse anaesthetist Jason Slay Ba, who is out of Wake Forest Baptist Medical Center. OK, so Jason, thanks again very much for joining me today and giving of your free time Thio, talk about your experiences and how you've applied those experiences to what we're going through today. So I usually just ask people in the beginning to get a little bit of a background, and then we can kind of get into Ah, a little bit of those experiences.

spk_0:   3:44
Cool. Yes. So I, um, I guess my first experience in health care was originally practices a paramedic in Virginia and then later went to nursing school. Um, that my wife is a nurse, and I went to nursing school at Emory University and then worked there in their CV. I see you for three years. Um, during that time was where I was asked to join a bio containment team that was going to take care of the first Ebola patients. Or or, as we like to say, patients with Ebola virus disease. Um, that we're going to come to the U. S. So I was on that team for about a year before I moved. Um, probably about six months of that was pretty active having patients, kind of that being my main job. Um And then I did some travel nursing for a while with my wife and applied and got in to see her in a school at Wake Forest. And I just finished there and graduated this past August. So now I am working there full time as a sierra and the impatient side.

spk_1:   4:57
Okay, well, that's Ah, that is great. Your brand new CR and they would Ah, what an interesting time. Thio, start your anesthesia career.

spk_0:   5:07
I mean, I think that the transition was great. Um, I'm glad that I have finished in all guess and started working instead of people that are, you know, just graduated in January and our testing now trying to hit the job market. That would be a just from a practicality, a lot harder to find a job. Right now,

spk_1:   5:26
I'm actually part of a program that helps people pass their boards. I come in, uh, it's two of us, and my partner does the academic side, and I do the stress management side Thio to deal with the pressure that is placed on a person when all those years of training come down to one day. But all of those people have had their tests cancelled. So now they're in limbo, so they can't practice as S r n a A C or a days or anything right now, even if there are jobs, depending on what part of the country they live in, I'm sure people that live close to the East Coast or or even closer to New York or probably helping as our ends at this point. But but back to your Orin experiences, uh, how many Ebola patients did you end up taking care of?

spk_0:   6:16
So we cared at Emory for four patients with confirmed cases of Ebola virus disease. We had many rule outs as well, pretty much at that time because of the turnaround. To get someone from Africa t the United States for care and because occasionally people would have when they first developed symptoms would test negative their 1st 1 or two days of symptoms. If you had a fever and you're an American citizen during that time, you got evacuated because it just wasn't worth the risk of waiting several days to get, maybe get a test back. And then it be at that point, you know, another 48 hours so you could be in a hospital here. So we wait four confirmed on. We were, um, one of the primary centers that cared for these patients. Some of the other major ones would have been the university Nebraska. We kind of were mostly paired with them, alternating who would get a patient and then later, through the process, the N I H. Was involved. Bellevue was involved in that led to a federal grant called me Tech Any T. C. The National Ebola Training Education Center. I think it's called and They kind of, um now have transformed. I think there are at least 10 facilities across the U. S that are prepared thio care for, um, patients at that level. Now,

spk_1:   7:44
what kind of symptoms did you observe? When When you were taking care of these

spk_0:   7:47
pages. So my my prior knowledge of Ebola before I joined this team was probably what a lot of people knew. Maybe you read a book, you'd read the hot zone or watched, you know, a movie with it. So I assumed that they would be bleeding from every orifice of their body. I would say they looked like someone who, um from hemorrhagic standpoint. They looked like someone who would have a really high a CT, someone who's on ECMO so they would choose from any ivy central line access around the gums in their mouth around their eyes. It would be bloodshot. Um, the biggest symptoms we saw were all gastro intestinal. They obviously had a very high fevers. And so people would have riders with that, um, hallucinations, possibly even neighbors. Maybe some siege like activity with fevers. 104 degrees. The G I symptoms were catastrophic. I know some estimates would be that a patient could lose 10 liters a day from diarrhea. Um, not as much. Vomiting Maur, just constant diarrhea. And that's what makes it so hard from a bio containment standpoint of staying safe is how to handle that much waste. So we learned that if you think about it, if a patient soils themselves and the bed, they can't make it to the toilet. Now you have a blanket that's covered in live virus that's wet, and you can't wash it. You have to burn it. So it's just becomes so much weight of trash every single day because anything that would enter the room would have to be incinerated when it would leave. So we had a lot of issues with how to transport it, even with, uh, dut standards. Um, the normal hazardous waste companies either wouldn't not, or we're not allowed to transfer. Report the waste. We had a lot of a lot of details like that to work out, but the biggest symptoms, definitely high fever and then the G I symptoms were massive. So we you know there's no treatment for Ebola virus. At the time we were doing a lot of experimental stuff similar to what we're hearing today with, you know, bringing old drugs back, or some antivirals or anti malaria treatments. And so we trialed a lot of things that were cleared by the FDA for compassionate use. So I was a part of that which is interesting scene, some drugs that you think are helping them, but it might be in a total or other drugs that, you see are, you know, getting worse. But predominantly, what we could we could do is offer supportive care. So obviously fluid replacement. We can draw labs and replace electrolytes as needed. We could give specific blood products as needed. Those are things that really are all first world things. That a lot off. A lot of people in, um, countries in West Africa that have a lot fewer resource is they're pretty much they had some access, some ivy's very little labs and a lot of them were mostly focused on accrued. Think they would call it aural rehydration therapy, which would be kind of a homemade Gatorade. They would just try to get everyone to constantly drink, because a lot to my understanding, a lot of the deaths would be from eventual, uh, cardiac admiral and generalities from electrolyte imbalances from all the diarrhea.

spk_1:   11:22
You know, it's amazing because, you know, this is all new to many of the people of the United States dealing with what we're dealing with now. But for those, like you took care of such a terrible disease, I mean, I know that the comparison from what I've read was 40% mortality rate. If if someone came down with Ebola, as opposed to right now, it's too early to tell what Corona virus or covert 19 is going to be a ce faras. The rate is concerned, but they're talking anywhere from 1 to 3% when it's all over. But to have to think about things like not only taking care of a patient who is critically ill, but you also have to think about yourself and your safety and dealing with what you mentioned. You're the soiled bed sheets and and how to not get contaminated yourself. Now, what kind of protection was given to you when you were there taking care of these patients?

spk_0:   12:23
So, uh, it was a very different time in 2014 because the whole world was not faced with this pandemic. So there was obviously West Africa was hit hard. But in terms of in the United States, we had unlimited peopie. So we really had that wasn't issues. We were full. Um, people call, like, you know, bunny suits the full tie that white suits. Um, we had that came with built in foot cover beauties as like, a onesie. We wore an extra set of duty's over that we had an inter pair of gloves that were tapes. We had an outer pair of gloves that were a different color and were extended cuff that extended up her arms. We had an apron on the front of us that covered over the zipper and also just was an extra splash guard. And then we wore Max Air papers that where the filter is on the top knot on your belts. We were actually fully enclosed. Um, there wasn't anything to decontaminate when we came out that actually had been exposed to the patient. Um, and the interesting thing through this, like you said, I think those were pretty accurate stats from I think the 2014 outbreak was about a 40% mortality rate. And that's for my knowledge. I think the best, uh, stats we've ever had with a now break some of the operates previously and maybe even been 80%. And so, even though it has such a high mortality rate cove, it is actually kind of more scary, in my opinion, to take care of because it's so much harder to control. While Ebola is very highly infectious, we knew from multiple studies for multiple decades that if someone was not displaying symptoms, they were not contagious. We were not a, you know, asymptomatic carriers. We were monitored, um, buying employees hell team a minimum of twice a day with our symptoms and documenting our temperature. So we felt very safe going in doing our job and knowing that, you know, if we were to have been exposed and to become contagious, we would become symptomatic first. And so the problem the problem with with Covert is we're finding that there's so many asymptomatic carriers. Oh, it's harder to control because people are normally, uh, you know, historically, through a lot of the outbreaks, it would burn its way out. It would kill so quickly that, um, you know a whole village might die, but it didn't take over the world. And so if if it got to a certain a certain area, you could you could just lock it down for 21 days and it would be over while Cove it. We can't really do that because it's It's the perfect storm. If you were going to create a plague where it's contagious but doesn't have really a lot of symptoms in a lot of the population, so it spreads unknowingly, Um, you know, through the world. And then because of that, we have this huge lack of peopie now worldwide because everyone needs it

spk_1:   15:29
right. And that's one of the things I even brought up with the infectious disease physician was how different this is from all other viruses that we know of. And why is it that we are seeing so many people walking around asymptomatic or getting only mild symptoms or getting sick but able to stay home or going to the hospital and getting treated and then going to the hospital getting on event, then dying? Every single one of those mentioned is a different group of people? Yeah, Then we have a group of people that have recovered, So there's literally like six or seven different groups of people that are being affected by this virus. And his answer was, as all other answers given, including douchey I don't know, because it's too soon

spk_0:   16:17
to years from now.

spk_1:   16:18
You're exactly right. And another expert I spoke about spoke to said that exact thing MERS SARS all h one n one. They got their information and put it out a good two or three years after it had passed because that's how long it takes to learn about these types of things. So we're in it now, and we're kind of learning as we go. But that's that is the scary part. I

spk_0:   16:41
think I'm not, you know, an epidemiologist or but from my understanding, it's very interesting that we didn't really do anything different with, you know, the H one, n one. The SAR is the MERS outbreaks. The world didn't really pay and they kind of petered out eventually. And this is one that obviously is different and took us by surprise because we have looking back now. It's obvious we could have done so many things months ago, but these things have happened before in other countries where there's a small outbreak that happens and it doesn't actually ever take over the world, you know, since probably 1912 with the Spanish flu,

spk_1:   17:21
right? Right. That's why they keep making that comparison. Now, with your experience with those four patients, did anyone in your unit become infected?

spk_0:   17:33
We never did. We always save. We had a room saved for any of our staff. Um, that would become infected. We only ever cared for two confirmed patients at a time on DDE. I think the success of our group what I'm most proud of. But I'm very proud that, you know, all of our patients were able to survive and make full recoveries. I'm really proud of how well our teamwork together to keep us safe.

spk_1:   18:02
Obviously, I would consider you now an expert on P p e from your experiences. Now, first of all, do you have any covert 19 patients in your hospital? Currently

spk_0:   18:14
we d'oh

spk_1:   18:14
you, don't

spk_0:   18:15
we? Yes, We, um we have several cove it in our one of our icy use. Um, we're a health system. So we have several hospitals in that system in the majority of them have coma patients confirm positives. And, um, multiple persons under investigation awaiting test results,

spk_1:   18:35
which is one of the other problems is a testing. Are you are are you having issues in your area or in your hospital with testing?

spk_0:   18:43
Yeah, I think, um, I think nationwide, the only places that aren't having issues with testing are where the hospital has been able to develop a test for themselves. Um, kind of From what I've read and heard, we are able Thio send some out kind of an unlimited amount out through the standard private sector testing things, but it might take days to get back. And I think we're working on her own tests. We don't have it up and running yet, And we are able, with another facility department with sending a specific, smaller number. We can send every day and get a result back in 24 hours. So we're obviously prioritizing getting those results back. We might need to might need an operation or something like that. So we can not waste precious pee pee on someone who is actually negative.

spk_1:   19:33
And how is your pee pees situation or your stockpile? There

spk_0:   19:38
I think we're like a lot of the rest of the country. We're really trying to ration it. The problem with this is that, um there's there's so much unknown and so specifically in the operating room, we know that inter baiting is dangerous for you. Community spread at this point. So we're you know, we've been trying Thio, you know, we're in a 95 mask for that were very limited on the amount of masks we have. We're limited on, um, the mouth surgical masks we have. We're limited on gowns, you know, cleaning products just like most of the rest of the country. And I mean, so far, we still have have the supplies we need, but we are, um it's very obvious to everyone in the in the hospital that we are taking extreme measures to ration, which is which is something we're not used to you here, but we're on ah medical missions trip a little bit. Having to reuse things are where the same in 95 mask all day for multiple patients. Kind of how you would if you were in ah, third World country. But because of our lack of peopie, that's kind of what we have to do, because what we don't want to do is where hospitals have made the mistake of burning through six months of supplies in the first week. Um, when they haven't really gotten hit yet. And that's that's kind of the attention we're feeling

spk_1:   20:59
right? And who would have thought. I mean, we're in the United States. It's one of the richest countries in the world on, and it's kind of unfortunately showing that we were unprepared for this. And there have been a lot of comparisons to the Third World country experience and a medical mission experience, which no one would have ever thought. Anyone would say This is such a surreal experience right now, whether they're stuck at home or whether you're working in a hospital or doing an essential job, it is it's odds, to say the least. I think we'll look back on this with many different feelings, that's for sure. Now, have you taken care of any covert patient yourself?

spk_0:   21:37
I have not personally taking care of a confirmed positive patient. I am, um, part of a team that, um is performing all of the airways in the hospital and I I, uh, help this. Last week I was a safety buddy. We're always having a buddy that's outside the room. That's ableto hand equipment through and also most most importantly, to help with donning and doffing to read a checklist and being accountability person. And so I was that person outside in an I c u an attending anesthesiologist. I was with Wen and intubated a patient

spk_1:   22:12
with with that type of a situation, you're still in full p p e or no?

spk_0:   22:18
Yes, so there's different. There's different levels of this situation. I was in full pp the person I was with it not, uh was the first time they had performed an airway on a positive cove. Impatient. So there's a lot of complex is that going to that? So I was in full pee pee outside in case something would be, you know, there was further assistant needed. Um, and then we were also in, and I see that wasn't, um it doesn't have a lot of experience yet with Kobe's patients, you know, hospitals in general, every unit is figuring out how to handle that safely. So part of that also was for my own safety as well to just be in pee pee while I was up there.

spk_1:   22:57
Well, of course. I mean, if it's if it's available and it's possible everyone needs to be in it. I mean, one of the things that's concerning me right now is you know, you're seeing all the stock footage on these 24 hour news cycles and the stock footage, and mainly in Manhattan or one of the New York hospitals, whether whatever New York City Hospital and you're seeing all of these health care providers with a regular surgical mask and a face, you and they're wearing a gown, which is totally inadequate for the situation that they're working in. And even, you know, it's these drive up testing sites with the tents. They're wearing surgical masks and face shields, totally open environment to a airborne virus. It's completely inadequate, which is is part of, I think, part of the spread, especially the people doing the testing there, sticking a swab down a person who knows that person's gonna call on them, you know, I mean a really difficult situation, so it's it's very concerning. So now I'm gonna I keep going back to this if you listen to any of the previous episodes, I I talked to a hazardous materials expert on and talk to him about the concept of decontamination after a shift. Is that on your radar at all, or any of your co workers?

spk_0:   24:17
Yeah. So, um, definitely, uh, my wife's a nurse's. Well, we're, you know, we're trying, you know, to be be careful. In general, we are because of our risk exposure, especially my a c. Renee. We're trying first and foremost to really socially distance ourselves to try to limit our exposure to the community as well. So kind of our our plan is it is nice and anesthesia or anyone in the o r that we are provided scraps of the hospital where, which is a blessing that, you know, the d e d. And I see you really are the front lines of this. It's not the O. R. And so I, you know, have my hat off to them. Um, so I try to in my locker to make sure when I hang my clothes up that I'm wearing in that they're they're hung up and not touching the floor. I try to keep a clean area in my locker in a dirty area because I don't want my O. R. Shoes, too, for there to be live virus on them and then my close touch them. But still, a soon as I tryto use good hand hygiene and most importantly, what I'm in there in the hospital. I try to not touch my face. I try to keep my phone clean. That's a big weakness for everyone, or phones are Petri dishes in general, so I try to not having out of my pocket when I am using. I tried to hand sale on the ties before I take it out. I know a lot of people you are putting their phones and Ziploc bags. I think that's that's fine. If you want to do that as well as soon as I get home, I, um we don't have any kids. This is easy for me. But I stripped down right at the door or washing machines right by our where we come in our house. Put all of my clothes that I have only been warned, you know, just to the hospital to get changed, I put those directly in the washing machine so that I don't have to handle them later. And then I set my wallet, my keys and my phone on a specific part On the end of our counter. We have some wipes that I wiped down my phone and let it dry and my keys and my wallet. And then I washed my hands and then I go shower. That's kind of what what we're doing and to speak to you know what you were saying about the pee pee thing? I We do have a lot of inadequate BP and obviously the first my opinions, obviously, Earl, reflect me and not any of my employers or past employers. So in in reflecting on what is appropriate from a P p standpoint, it definitely is obvious to even, you know, the lay person that the CDC is. Standards have changed on the recommendation based on our lack of adequate PP. And I think that became obvious when you know they're memo came out well, if if you need to, you might have to wear a bandanna. That's the general phrasing they had. So from what I am used to in PP, I am obviously very insecure. And what I'm wearing at this hospital, which is what everyone is wearing it. Even if you look at you, look at pictures of what intubation teams and even I seeyou teams are war in China. What they wore in Italy, what they weren't France. And then you look what we're wearing, You see way more exposed skin with us. Ah, lot of you can see scrubs showing you can see exposed Knapp exposed backs and those air all areas where a virus, especially when you're performing in their size and procedure, could could lane attach on. And we could be taking that, you know, all over the hospital and home. So I think the frustrating thing for all health care workers is that we've I always assumed that we would have what we need. And I think with this starting in in in China, a country that makes a lot of our peopie, um and so when they use it up and their factories aren't able to work because they're locked down and then it hits Europe and then it hits us. Um, it make sense with why we're in the situation we're in, and I definitely think going forward we will, um, not as relying on one specific country in general will be a little more diversified in our how we acquire PEOPIE will probably make a lot of it here. We'll have more stockpiles. Um, And I'm hoping, though even will be some standards with, uh, Jaco that are changed. I personally think that's contributed to it with arbitrary expiration dates on things when we could just be storing these things for a pandemic,

spk_1:   28:47
you know, 100%. I mean, I think that there is going to be a new normal. Ah, lot of people are using that phrase the new normal on. And as with 9 11 they're calling it, You know, this situation, this generation's 9 11 and or and then the other phrases this is a slow 9 11 because of how long it has taken to roll out on. It just keeps getting worse every day. Hopefully, we are reaching that peak. But there will definitely be major changes at the end of this when we come out the other end, just like there were with 9 11 the question is what will happen and hopefully they will be proactive and it starts with having the proper equipment that health care providers need to take care of this leg of a situation. It is it is very scary. Unfortunately, people are being asked to quite literally risk their lives, you know, and and the other comparison has been made. We're asking soldiers to go to the front lines with no bullets in their guns, and it's it's it is unfortunate.

spk_0:   29:48
Yeah, And I think like I said, the E d and the ice, you are really the front lines on this and they're they're the ones that I feel really bad with an act with peopIe. And also they don't traditionally get scrubs issued by the by the hospital. So they're they're working in an I. C. U room with a positive patient and with just a gown where the top of their scrubs are exposed, the back of their scrubs exposed, the bottom legs of their scrubs are exposed, and then they're not leaving those. They're there. Um, I doubt many have a an option of showering at the hospital or changing their clothes so they quite literally are bringing it in their car, bringing it home.

spk_1:   30:28
Now, our mutual friend Dr McCutchen told me that you have been teaching people how to work with P p e. You know, putting it on, taking it off. Are you able to just kind of give me a verbal walkthrough of what you've been teaching people?

spk_0:   30:47
Yes. So I've kind of helped. Um, I guess tweak some of the protocols that are infection control department put out with some of my experience from working at Emory in the S C T U. So we, well, our have pretty much the same peopie that other places have. And so there's a lot of variation in order of putting on peopie. Some of it doesn't matter. Some of it, um I kind of like from a muscle memory standpoint. Um, but doffing are taking off. Your pee pee is by far the most crucial part of that. And so, um, were mostly what we do have access Thio a few papers that were mostly using just to perform intubation on positive patients throughout the whole hospital. But the majority of our staff would only haven't in 95 so we would have a important thing Would be thio removing everything out of your pockets. Your phone, your stethoscope. You shouldn't be wearing jewelry with PEOPIE. This isn't a time to wear a cute cloth hat. Anything you're having on your person could be contaminated. No pens, watches things like that because they can all fall out in the room. Or they could damage your pee pee. And so, just with the basic, there's multiple ways of doing. It's the way that I've kind of been teaching would be to perform hand hygiene and then put on a contact down that has some holes. And then we would put a set of gloves over top of that. Those thumb over top of the gown and then we're actually with anesthesia were actually double gloving, and so were we. Ah, lightly tape, uh, just the edge of the gown to the glove. The holy around circumferential e very light. Loosely tapes because eventually you would will be doffing those taped wrists. Offer your wrist. So if you're there, take too tight. You want to get this off and we're, ah, putting on and 95 mask and then we have face shields or goggles. The goggles are very hot, even when you have a sealed and 95 just from your heat, and they're they're they're easy to fog. We also have facials there. They provide really good coverage around your entire face that are pretty close. The almost the whole way pasture here. I'm personally just gonna wear a face shield because of the fact of, um, I understand there's an airborne risk, but I due to my inability to be able to see through the goggles long term, I would end up touching my face more readjusting them and so that that's a risk factor in itself. And then, um, we have extended extended cuffed, uh, outer gloves were wearing their different color that go about halfway up her arm. And we also have, um, beauties we can wear. So, um, from a muscle memory thing, that's good. If you're wearing double gloves to treat your inner gloves like they're your skin. So we never touch anything with our inner gloves. If we need to change our outer gloves in the case, we would take her out of gloves off very carefully. There's, ah, there's a method I like called the beak method, where you're you're grabbing the outer part of your gloves with both sides using the inside portion of of of one hand of your gloves so you're not actually scooping your finger underneath your glove. Contaminate yourself. There's videos online about that. You could Google it, but the other thing I I like, uh, with our bare with our inner gloves. We would only use hand sanitizer and then a new pair outer gloves who never touched anything with that, and so were also wearing booties. And I prefer not to put my beauties on to the very end when I have when I have double gloves on. And it's just a muscle memory thing that I'm touching my beauties the floor with two pairs of gloves, basically. So it's important that your buddy is watching you, making sure you don't have a rip or tear in your pee pee, that there's not a large exposed portion that you have everything on appropriately and then on important thing. When you're in the room, I don't maintain a sterile environment as possible. So, um, one thing I never did is a nice universe. That I did with Ebola constantly was anytime I wouldn't touch something in the room with gloves on, I would hand sanitizers gloves, and that's something that's not really the culture. A lot of places. We change our gloves constantly, but you can hand sanitizer gloves. It doesn't deteriorate the structure of them. Um, I feel like I've definitely worn the same pair of gloves for at least four hours before without changing them, and I never saw any discoloration or anything with them. So I routinely is part of our practice in the operating room, where a pair of gloves and constantly hand sanitizer. So if I'm going thio, perform an airway, or when I'm done with anything I could that's highly contagious. I could changed my gloves. I can also take wipes. Wipe down my peopie white down my sleeves, the front of my gown. I could wipe down my arms. Um, I could wipe down my anesthesia machine. I can write down the chair I want to sit in. I can confidently wipe down my computer, and then also, when you're about to leave the room, it's important that you wipe down all of your pee pee so that if you a lot of these things are continued, sees for understanding that you might make a mistake and dolphin So if your pee pee is as clean as possible when you'd off, if you were to make a mistake, you have decreased the risk you're putting on yourself on DSO. We want our people to be as clean as possible and we have a checklist written inside our rooms and someone's can look through the window and watch you, Dauphin because a lot of this is it's a stressful environment and we want to take a lot of the thinking process out of it. So what our current protocol in the operating room would be Someone's going to be leaving the room. They would make sure their pee pees clean. They would hand sanitize their outer gloves. They would take off each one of their beauties and then hand sanitizer, put the beauties in a trash can and then hand sanitizer gloves again. We also kind of have a clean area that they're gonna be stepping onto will probably out like a caviar Sandy wiped down that they can put their bare shoes on so that we're not actually tracking the cove it out of the room. So then they would hand sanitizer. We're gonna remove our outer gloves And then we're going Thio, come out of our gown at that point. So now we just have inner gloves that are taped. Thio are gown and we have our and 95 mask on and we have goggles or a face shield. So, um, important way of taking off PP is that you do it very methodically and very, uh, everything needs to be strategic and thought out We don't want someone ripping off their peopie. We don't want a lot of commotion with the pee pee wee want it very controlled and slow so that we're not just throwing droplets all over the room. So with most gowns, it's important, Morton, they're tied behind you and you could break out of them. But your catch points around your neck and then around your waist. So you want to grab on our shoulders and pull straight outs so that you can pop it to break it. You're not taking it off that way, and then you want to be really careful that you're not actually touching above your gown and touching your scrubs or your neck, and then we're also going to reach to the side. It's not the front of you. The front would probably consider one of the more contaminated areas, but you can grab the size right off your waist and pull straight forward and break their to sear popping out. Your shoulder's popping at your waist, and now your gown should be somewhat free of, um, you're you're not or whatever was tied, and then you want to slowly pull it inside out, down and getting all the loose pieces and strings that were used to tie up. You kind of want to work it all into a tiny ball, kind of leaning forward, bending over to keep it off of your body. If you're taking your gown off and you're constantly the outside has been touching your scrubs, you kind of defeat the purpose of wearing a gown to start with. You really want to keep the dirty side out, slowly rolling it up into a ball, Um, and then we at the very end can take our gloves or taped to them. So as we come off, our wrists are gloves and everything will come off into the ball as well. We're gonna drop it into the trash can. We're gonna hand sanitizer and then we have our buddy who's been watching is a runner outside. They would open the door and we would come out of the room with our and 95 on and our face shield. So it's really important. I think, from a safety standpoint, for whatever your protocols are at your hospital that if you if you're able to be of an anteroom, it's perfect. But even if you're in a room, it's important to doff your gown inside the room so that you're not dolphin that gallon outside, where no one's wearing P P cause that would really could spread a virus outside. And the order of coming out is important because your face shone and 95 need to be on after your gown comes off because that's protecting your face in your eyes in your airway. So now they were outside. Um, we have clean hands and you're staying in there with just a and 95 a face. Shoulder goggles are protocols are our buddy hands you a new pair of gloves and you put new gloves on you hand sanitize them and even other clean. We want to make sure they're clean and these hand sanitizer after every step is a muscle memory tactic. Then we're gonna pull our goggles or face showed off. And, um, because we're on a medical mission trip to Africa right now, we have to re use everything. So we have a bin that says dirty. We're dropping the facial goggles in that bin, we're gonna hand sanitizer again, and then we're taking her and 95 off. And we currently have enough and 95 that we our policy is If if it is worn in a patient's room with known covert, we were able to throw those away and get a new mask New and 95 mask. I know some places that is not the situation. And so they might at that point have to put there in 95 in some form of storage container or ah ah, paper bag of some sort or away if they can get their decontaminated with, uh, they pressed hard and peroxide or whatever their protocol is. So at that point, you would hand sanitizer one more time, and you would remove your outer glove your inner gloves, and then you would go wash your hands with soap and water. It's kind of our our basic, uh, protocol for

spk_1:   41:02
for dolphin basic. That's Ah, that sounds pretty elaborate, but I'd certainly hope that that other facilities are following at least something similar to that because it is, it is that elaborate. Actually, the first thing that popped into my head was the concern that the recommendation is to take most of the personal protective equipment off in the room, even though it's an airway virus or an airborne virus. But then you said, you still keep your and 95 in your face shield on outside or getting to get out of the room, so that makes sense. But, um, there are There

spk_0:   41:45
are there are some something places, um, even when it within our facility do not feel comfortable with that. And so they have been doffing outside in the hallway. The perfect scenario would be every patient with Cove it is taking care of in a negative pressure room that has an answer. Um, it's attached to it, but that's not the situation we're living in. And so the options are. Either you're going to take the gallon off in the room where, then you are standing exposed without pee pee on now or you're taking out in the hallway where no one else is wearing all of the P. P. S o from a risk assessment. I think the way we're doing it is the safest way. We also are doing some some other things important that, um, for instance, if we have a specific room in the operating Bennett, that is negative pressure that we haven't. We have a separate intubation team from a team that's going to take care of the patient. And so we are staying in the room before moving the patient out after an intubation before a set amount of time for the specific O. R for the mountain air turnovers we have. And so we also are utilizing a um, you've seen the like the plexi glass boxes for intubation we have. We have kind of a version of that that has a clear screen on the front, but it has slits where you can place your arms around it. That's has a clear bag that's going to actually stay with the patient at all times. So if we were intimating a patient in the I C. U that box would be placed around the patient's head. We would transfer that box with the patient to the operating room for a procedure on DSO. Even though this this is mostly it mostly is a droplet spread disease and then definitely airborne with, uh, extra risk with certain procedures. So, um, if someone is in I c. U, and they can stand as far away as possible from the patient facing away from the patient facing the clear glass, I see you door. My personal opinion is that that it's safer to doff your gown inside there, come directly out with your facial and 95 on and then off the rest of the rest of that outside. Um, compared to the the counter option of coming out of a known hot room and dolphin your gown in a clean hallway where there's, ah, unit secretary, you know, 20 feet away with no Pete. Those are things that have brought me great concern.

spk_1:   44:15
Sure, that makes sense. That makes perfect sense, and it's such a difficult decision to make Well, Jason, I really appreciate the time that you have given. Do you have anything else that you would want to add or any points that you might want to get across before we finish up.

spk_0:   44:34
I think you just encourage everyone thio. We're We're in a scary time right now and I think it's important for for us, too, to recognize that. And almost in a way, if we accept the situation we're in, it's it's more bearable if we accept. Hey, we're in a situation where we don't have enough peopIe are hospitals have not protected us. It's almost easier to go to battle. And once we just realized the dire situation we're in,

spk_1:   45:02
I think we're gonna be seeing a lot of changes in not just the the area of National Stockpile. But I think we're gonna be seeing things all the way down to individual facilities and how they treated or how they were able to treat their workers. And hopefully a whole lot of negativity doesn't come out because there is also a lot of positivity that's happening. Where's your literal people? Literally, people are putting their lives on the line to take care of others on DDE. That is the very definition of a hero, So but But we are a captive audience at this point. But this this won't be over, probably for probably a few years to come when it comes to the changes. And and then also what kind of stories come out of it all? Well, again, I really appreciate your time. You should be very proud of what you're doing. Could your or one of the people that are going in and putting yourself at risk? So thank you very much from one health care provider to another. And again stay safe out there and and, you know, just as well as everybody. You gotta take the necessary precautions when you can, but hopefully you'll be able to continue doing that.

spk_0:   46:15
Sure. Thank you very much.

spk_1:   46:17
All right, well, then, thanks. And, uh, we will be in touch. I'd like to get some updates for me to see how you got your colleagues are doing.

spk_0:   46:25
Sure. Sure thing, man.

spk_1:   46:27
All right, well, thanks. So that'll do it for this episode. I hope to see you with the next one. This is Matthew's ender and the going viral podcast. Please stay safe and stay well,