Opinion

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On the frontline? Ditch the stubble and enact the bubble

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It is vital that you reduce your own risk of infection. These are our thoughts and suggestions.
 
Getting ready for work
If your hair is long, tie it back. It’s important to get if off your face.
 
Ladies, style it so you don’t have to flick or adjust during the day. You can also consider a scarf, theatre hat or bandana.
 
Guys, unless you are 100% telehealth, you will need to shave every day and keep the stubble at bay; facial hair impacts on the fit of P2 or N95 masks.
 
Consider this a very early end to a Movember challenge (maybe raise some money with a shave, or – sorry, fellows – just get on with it).
 
In terms of leg hair, there is no need to worry – keep them covered. Scrubs are really good here, otherwise keep your razor sharp and your shaving time short. And no waxing for now.
 
When washing your hands, the first thing to do is remove all rings and watches.
 
Keep your fingernails short, with no polish and no false nails. You will be washing your hands repeatedly, and chipped polish can harbour germs. You can’t take the risk.
 
Toenails can be fire-engine red or the palest pink, or whatever colour makes you feel good, but it will be up to you to maintain them, if you have the time.
 
With clothing, now is the time for GPs to purchase or brush off those scrubs.
 
For practice nurses, reception staff, allied health and caregivers, if you don’t have a work uniform, consider scrubs or dedicate some easy-care clothing just for work.
 
It is important to keep the sleeves short; bare below the elbows, folks.
 
Trousers, on the other hand, must be kept long. This will keep your skin covered and protected. Go with fabric that will withstand lots of hot washes, dries easily, and does not need ironing. 
 
Now is also the time to up our hand-washing game. Think preparation for assisting at surgery.
 
Lanyards, much like neckties, may be a source of infection. Ditch them for now unless you are prepared to clean them thoroughly between each and every patient.
 
On your feet, get a specific pair of closed-in clinic or work shoes. Find some that you can wipe down or easily wash.
 
It’s best to leave your clinic shoes at work and change as you arrive, or in the boot of the car or at the back door.
 
Just be sure to avoid wearing your work shoes in your home.
 
Actually, it’s best for everyone to remove their shoes when they come in from outdoors (outside only for exercise, groceries, medical appointments that could not be done via telehealth) and leave them at the door.
 
Before you leave home
Pack a bag of clean clothes and some shoes to slip on at the end of the day. Washable fabric bags work well in this situation.
 
It’s also important to have something ready into which you can change before you get home and hit the shower. T-shirt, shorts, gym gear, thongs – keep it simple.
 
Consider taking a packed lunch or supporting a local cafe and buying lunch.
 
If you do purchase your lunch, consider whether you need utensils and, if you do, pack a set of your own.
 
You will need to keep your fluids up during these busy days, so make sure you grab your drink bottle. And do you need a coffee cup, or a special tea cup?
 
Either way, make sure it is definitely your cup. Also, use your own distinctive drink bottle rather than the water cooler – this is a high-touch item.
 
Getting to work
Bike or walk if you can – you know you need the exercise and fresh air. (To be fair, we live in Queensland so this is admittedly easier for us to suggest as we head into winter.)
 
Avoid public transport, if possible. But if you do need to take it, be mindful of healthy spacing, avoid unnecessary surfaces, wash your hands and try not to touch your face.
 
Be careful if you are eating on the run. Are your hands clean? Is the food nutritious? Would you approve of your patients eating it?
 
If you are driving, try to keep your car a ‘clean’ space. Wash your hands or use some hand sanitiser before you get in, and regularly wipe surfaces in your car – door handles, steering wheel, gear stick, hand brake, etc.
 
Arriving at work
Put your ‘clean’ gear away, somewhere safe and out of harm’s way.
 
This is ideally in a locker, drawer or cupboard that is not opened during the day. You really want to keep it clean.


Dr Wendy Burton and Dr Kat McLean suggest ‘now is the time for GPs to purchase or brush off those scrubs’.

During the day
We know you know this, but please, do be mindful of the basics, including healthy spacing and surfaces.
 
Imagine a bubble. Stand up, arm above your head and out to the side, then spin around. That’s your bubble. If you’re well, don’t pop the bubble of sick people. If you’re unwell, try to keep your bubble intact.
 
If you are sick, stay home from work and keep your germs to yourself. This is not the year to ‘soldier on’ with a cold or the flu.
 
If you have face-to-face patient contact, keep your mask on. Keep them safe by keeping yourself safe.
 
Wash your hands. Properly. Repeatedly.
 
Always use hand sanitiser or wash before you touch a patient, and after you’ve touched a patient.
Take universal precautions; assume everyone you see is infectious.
 
As always at this time, keep your distance from other people, at least 1.5–2 m. Obviously we breech this when we examine, so keep examinations brief and do the bare essentials.
 
No handshakes, high fives, fist bumps, or any other non-essential contact for now.
 
It is very helpful to clear your desk. Get rid of all the clutter – if it can’t be wiped clean multiple times a day, it must go.
 
Use a transparent box to secure your equipment – such as otoscope (but don’t forget to recharge overnight), stethoscope, blood pressure cuffs, tongue depressors, etc – and only get them out if you really need to examine a patient.
 
And before you use anything, clean your hands, remove the essential piece or pieces of equipment (we are not routinely examining throat or eyes for now), use, clean with an alcohol wipe, wash your hands and place everything back into the box.
 
You can also ask, do you really need to do that examination?
 
It’s a small thing, but don’t take your work pen home. Wipe any pen you do use down with gel regularly, and minimise the number of pens you have on your desk – they will all need to be cleaned.
 
In that same vein, clean your phone/tablet/keyboard regularly (tips here from Apple).  Take your phone out of its protective case to make it easier to clean.
 
Once at work, take the stairs rather than lifts, and don’t touch the handrails. If you do use the lifts, clean your hands once you get to your desk or workplace. Clean your hands before and after going into face-to-face meetings.
 
Have virtual meetings rather than face-to-face, and always follow your workplace protocols for personal protective equipment (PPE).
 
And, difficult though it may be, avoid the tea room/limit contact with your colleagues.
You can all have a big party when this is all over.
 
Are you using your mobile to phone/video call patients? Phones have lots of crevices in which germs can reside, so wipe over frequently with an alcohol solution.
 
You won’t need to clean your phone as often if you put it into a snap lock bag at the beginning of the day, although facial recognition is hit and miss through the bag and it looks to patients like you have Vaseline over the lens.
 
In regards to using your phone to contact patients, you may wish to display your caller ID or consider a separate SIM and/or what your protocol will be if people start to SMS or call you.
 
If your phone is kept in a wallet, separate it out. Try to limit how much you touch your wallet, it will be a contaminated surface. You can keep you driver’s license, credit card in a snap lock bag, and leave the rest at home.
 
At the end of the day
Clean your hands and put some gloves on.
 
Transfer your mobile phone, using a no-touch technique, from its snap lock bag into your clean I’ll-be-taking-this-home bag – mine will be in a drawer I do not touch at all during the day. 
 
Spray down your workspace surfaces and door handles (or allocate this task to another staff member – either way, it has to be done).
 
Remove your gloves and clean your hands.
 
Change out of your clinic clothes before you leave. Take off your work shoes, and spray or wipe them. Try to find a clean space for this process, but understand that once you have changed that space is no longer clean.
 
Place your clothes into what was your clean clothes bag, close it and carry it with you. Leave your shoes at work if you can; if not, consider having a ‘shoe bag’ for transportation. 
 
Now clean your hands again.
 
If you have turned off caller ID on your phone, do you need to turn it back on?
You can then head for home.
 
Arriving home
Take a moment when you first get home, however you have arrived, and consider your priorities.
 
Put your work clothes straight into the wash – as hot a wash as your clothes allow – and include the bag in which you carried your clothing, if possible. Fabric bags work well here.
 
Jump into the shower (if you haven’t already had one at work). Where possible, use a separate bathroom to the rest of your family.
 
It can be helpful to try to sneak into the shower before younger (and older?) family members realise you are home and attempt to run and hug you. If you are spotted, enforce the ‘bubble’ – make this fun, but you know we are serious.
 
If you have children under the age of 10 (depending upon the emotional intelligence of the child) or special needs children who might not understand, consider calling ahead and getting them secured before you come into the house.
 
Once in the shower, take a few minutes to reset – this really is vital. Cry, if it helps, and perhaps even if it doesn’t. It’s okay to not be okay.
 
Try to switch from work to home mode.
 
Don’t feel guilty for getting into your PJs early, or buy (online) some fabulous lounge wear. Either way, proceed deliberately and decisively back into your home space.
 
We feel we should say this
Has it crossed your mind that you should be keeping a healthy space at home? Do you have vulnerable people in your household? Are you working in a frontline position, with direct patient contact? Are vulnerable members of your family well secured at home and do you now pose the biggest risk to them?
 
If the answer is yes, you might ask some more questions:

• Can you maintain a healthy space?
• Can you spend no more than 15 minutes face-to-face, or two hours in the same room each day?
• Can you forego hugs, cuddles, kisses and intimacy?

If you are thinking you should make these changes, then we are sorry to say, but you should.
 
Will all of this work?
If you pay strict attention to it, the evidence is yes, it will.
 
Dr Atul Gawande, writing in The New Yorker, reviewed the current evidence and came to the following conclusion on 21 March:
 
The factors that appear to be important in protecting healthcare workers from the disease have been [ensuring] meticulous hand hygiene and cleaning; restricting clinics and hospitals to necessary patient visits; shifting as much care as possible to virtual channels (such as phone and video); and applying standard droplet precautions (surgical mask, gloves, and gown) with respiratory patients.
 
And don’t forget the essentials
Exercise is key.
 
A morning walk? Run? Bike ride? Get some fresh air, blue sky and green grass if possible. Do you have treadmill or gym equipment at home? It’s time to dust it off, or maybe buy some online.
 
Exercise apps can be great. If you like gym classes you can check out Les Mills or whatever you find works.
 
Virtual dance classes are also very rewarding. Seriously, singing and dancing are good for the soul. Make time for some every day.
 
Once home, don’t catch up on the news straight away, you need to unwind. Instead, catch up on what everyone else did – if your brain has not already turned to mush (or perhaps, particularly if your brain has turned to mush) this may be the antidote.
 
You can also engage in some yoga, meditation mindfulness, etc. Prioritising is important here – you won’t find the time to do this, you will have to make the time. Schedule it in. Now.
 
If you are living with a vulnerable person, you have to consider whether you have made a choice to forego physical contact for now, despite close attention to all of the above. Do you have a safe hug alternative?
 
Be sure to eat nourishing food; fruit and vegetables need to be a priority.
 
And be mindful of how much alcohol you have when you are at home – we all know it’s not the answer.
 
If you have been working long shifts and have no time to prepare meals, can you task your family/friends/neighbours with helping you to stay on top of the situation?
 
You will also need to debrief, where possible. Buddy up with friends/family/colleagues/appropriate people via the phone or social media and, where and as appropriate for your audience, share your feelings (confidentiality still applies and you need to leave work at work).
 
Groups such as Adopt a Healthcare Worker Queensland are emerging around the country. It should be possible to buddy up with someone somewhere. Mindspot has put together a terrific list of tips, which you can incorporate into your life.
 
Hobbies can be a great way to decompress and distract. Make time to do something you love; something ordinary or something extraordinary; create something beautiful; have some fun; switch off; connect.
 
Just be you, if only for a moment or two.
 
Sleeping is a big one. Exhaustion has work for many, but the brain has a way of keeping it from really sleeping.
 
Make sure you leave work at work and sleep well.
 
Tomorrow is another day, and this too shall pass.
 
Disclaimer: These are just our thoughts/suggestion. There are no papers to quote, no studies we have reviewed, just our lived experience and common humanity.

A version of this column first appeared on GPs can. It is republished with permission.

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coronavirus COVID-19 doctors

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