By Kristine B. LeFebvre, MSN, RN, NPD-BC, AOCN®, and Pamela K. Ginex, EdD, MPH, RN, OCN®
Although many oncology nurses are well versed in donning and doffing (removal) of personal protective equipment (PPE) for administering hazardous drugs, but not infection control. Additionally, nursing colleagues in other specialties may not wear PPE as part of their daily practice. As the COVID-19 novel coronavirus pandemic changes that, oncology nurses should understand PPE use for infection control to promote safety for nurses and patients.
Similar Process But Different Equipment
Hazardous drug PPE equipment is somewhat different than used in infection control. Oncology nurses who handle hazardous drugs use two pairs of chemo-tested gloves, eye protection, a chemo-tested gown, and face or respiratory protection as needed. Infection control includes masks, eye protection, gowns, and single gloves. However, N95 respirators (masks) are recommended for use with patients with suspected or confirmed COVID-19 infection. Infection control procedures for donning and doffing recommend having an observer present to ensure proper procedures, especially for doffing to prevent transmission. The Centers for Disease Control and Prevention (CDC) provides printable posters that describe the process of PPE donning and doffing for infection control.
CDC also has interim infection prevention and control recommendations on its website and indicates that if respirators are not available, a face mask is an acceptable alternative, but facilities should consider elastometric half-mask, full-facepiece air-purifying respirators, and powered air-purifying respirators for respiratory protection.
Healthcare providers should continue to wear eye protection, gowns, and gloves when caring for an individual with known or suspected COVID-19, and those patients should be placed in a single room with the door closed or in negative-pressure rooms. Individuals with symptoms such as fever, cough or shortness of breath, and known or suspected infection with COVID-19 should be instructed to wear a face mask.
With supply shortages, healthcare settings are struggling to protect their workers from exposure. Institutions should meet daily or more frequently to discuss the ever-changing environment, what supplies are available, and how they can best be used. If not enough gowns are available, consider reserving them for aerosol-producing procedures such as suctioning patients on ventilators.
Processes and Procedures
Engineering controls should be used, such as physically isolating people with symptoms or those with suspected or known COVID19 infection, using isolation or negative-pressure rooms, clustering necessary procedures to limit time with infected patients, and screening and limiting visitors. Administrative controls, such as improved policies, procedures, and workflow practices, will protect healthcare workers and patients.
Flexibility and Creativity
COVID-19 infections, community spread, and supplies may vary widely by region, so be prepared for the situation to worsen and to respond to changes as they occur. Follow institutional, local, state, and federal guidance when it is available. The ONS COVID-19 website and COVID-19 Community provide the latest updates and reliable information on the pandemic’s effect on oncology nurses and patients with cancer.