What are some best practices for healthcare providers upon coming home?
March 22, 2020 5:42 PM   Subscribe

DrMsEld's practice (PhD, not MD) is still operating, with much increased telehealth options both for the therapists working under her (two of which are in quarantine but not sick per se) and clients, and she is still going into the office to provide in-person intakes and evaluations for cases that aren't feasible for telehealth sessions per her ethical/professional opinion. That means she comes home after seeing a non-zero number of the public and I'd rather limit the potential for infection here at home.

She could come in via the backdoor, strip down, toss clothes in the (new, fancy, with sanitize cycle) washer/dryer, sprint to the shower and hose off thoroughly but beyond that I feel like anything else that doesn't leave me single parenting our two kiddos is pointless. For example, if she actually catches it and presents as asymptomatic for any duration of time then I doubt any amount of cleaning / best practices here at home will be enough. Should I sleep in a separate room? Should we not eat together?

My reading of similar situations for MDs currently on the frontlines with families at home is that they are avoiding those things for risk of their family's health but, well, DrMsEld isn't in an ICU or hospital ward or swabbing anyone either, thank heavens.

We're both mid 30s and fairly healthy if a bit heavy. I have a lung issue (meeting most criteria for Aspergillus / ABPA but with a diagnosis that basically identifies lung nodules that are 95% likely to not be cancerous) and severe allergy driven asthma that is mostly under control via rescue inhaler and periodic maintenance inhaler. This whole intubating/respirator scenario, nay shortage, has me very, very twitchy.

She's currently not wearing an impromptu surgical mask at work and my read is that, unlike handwashing and distance maintenance which she is doing, if she did so it'd mostly be security theater or, at best, serve as protection for others which... may well be worth it I suppose but increasing anxiety of some of the people she sees is less than ideal to say the least.

Thanks, citation driven and anecdotal replies welcome.
posted by RolandOfEld to Health & Fitness (7 answers total) 3 users marked this as a favorite
I was unclear, sorry, the two therapists in her employ that are home quarantined are not showing strong symptoms but they have had COVID-19 tests ordered and are awaiting the, likely still days away, results of the same.
posted by RolandOfEld at 5:45 PM on March 22

I think the other part of the equation is to arrange her work setting so that even if a client is carrying the virus, she is unlikely to be infected. So, arrange chairs so the clients are sitting 6 feet away. Greet clients at a distance and don't shake hands. Open and close doors herself rather than letting clients touch them. Keep pens, tissues etc that clients need near the client (no reaching or sharing). Limit handling paperwork that client has handled (not sure what that one would look like). And then wash her hands with soap and water after every session, if at all possible. If not, then use hand sanitizer (if she can find it). There is a lot that she can do to keep herself safer even if she can't control who walks in the door.
posted by metahawk at 6:16 PM on March 22

The most important thing your partner can do is avoid becoming an asymptomatic carrier. Regardless of what she does when she gets home, even if she doesn't change clothes and does nothing more than rash her hands, the risk of transmission from contaminated materials is likely about 2-3 orders of magnitude less than the risk of sharing a home with an asymptomatic carrier.

That means being very strict on regular hand-washing at work, avoiding being less than six feet away from clients and screening clients for fever or respiratory symptoms.

Currently the opinion at our hospital and number of other hospitals is masks are unnecessary for contact with patients who are not under suspicion of infection, and experiences from early epidemiological surveys of unprotected contact with COVID cases in the EDs of Seattle and San Francisco is that, if not in close contact or performing a procedure, transmission even without a mask is unlikely or extremely rare.

But if regularly shaking hands, eating meals where patients are, in close contact with patients for more the 15-30 minutes, her risk of becoming a carrier is high. Then keeping from transmission at home becomes a lot trickier.

Atul Gawande has a great New Yorker piece that sums up some of the experience so far. The risk of fomites and aersolized droplets from a client in her office transferring to a surface in her office, then to her clothes, then surviving on clothes until she got home and then transferring to a mucosal surface on you is probably not zero, but it's probably not significantly far from zero. The survival rate on porous materials like clothes is such that clothes that have been in a hamper for a day are not going to infect you.
posted by midmarch snowman at 6:18 PM on March 22 [1 favorite]

posted by metahawk

These are all in place already. Good points all.

midmarch, thanks for the information. That's all good to hear. It still leaves life to the dice roll however as she's following all of those criteria / behaviors (well, except for the 15-30 minute rule since evaluations can run into the hours for various tests/evals). So, I guess the transmission vectors are all she can do and what she can focus on. Her office is already wiping down like mad and being very careful on the personal behavior front. I guess we'll see. Thanks for helping me tone down the porous material risk / concern a bit.

Now we wait to see if it sneaks past her work defenses.
posted by RolandOfEld at 7:00 PM on March 22

I read that in China inter-family transmission was 80% She should likely stay somehwere else if possible for now or you should rethink the working conditions
posted by fshgrl at 8:56 PM on March 22

I am a social worker currently working in a healthcare setting. At my hospital everybody is wearing masks while being treated or working (but not N95 unless it is suspected or confirmed case). We are reducing face to face contact in all situations where it is possible .

Reducing contact with patients reduces patient risk. I, along with the other healthcare providers that people are seeing, are likely to have the most contact out of anyone they interact with especially in areas with shelter in place orders. It's for their safety as well that we are reducing contact.

It's important to really anaylize if the work is absolutely necessary right now. Not just for you, but for the people she is seeing, whose health risks she may not know. There are some hard choices. Some Domestic Violence agencies around here have stopped doing intakes in person period. It's complicated. There are people with very very real needs but, those people may be more vulnerable if they get sick on top of their other needs. There are definately people I am seeing in person right now, where clinically I've felt the need of immediate in person assessment ourwieghed the risk of person to person contact.

In terms of family life, for me not much has changed. We've assumed that we are getting sick as a family though if I have it. This isn't without risks, but it is an assumption that makes our normal lives feel more controlled and keeps me from obsessively sanatizing everything over and over when it's a rabbit hole that might not be effective and may not have been useful. I could just not see my family, but that's not something I'm willing to do either. I do wash my hands on returning to the house and wash my hands a ton during my shift. I do shower pretty quickly after returning home, but that's more of a habit than anything else.
posted by AlexiaSky at 2:15 AM on March 23 [1 favorite]

posted by RolandOfEld at 5:42 PM on March 24

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