This blog is not intended as advice. It is for educational and research purposes only. Read this disclaimer first if you want to read this post.
I am not an expert on infection control, but I do have more expertise on the selection and use of face masks than most doctors. In an earlier life I used to be on-call and run a whole pathology lab by myself at night – including basic microbiology. I am used to handling infected materials. My PhD was on gloves and I am considered an expert on industrial ventilation and have published a bit including a recent book chapter on the topic. One of my MSc degrees was at the London School of Hygiene and Tropical Medicine which is renowned for epidemiology. Their lectures on epidemiology were fabulous.
The suggestions below will probably complement what you already do and I am sure there are more precautions you can take. As I visit people in aged care, I have thought a lot about reducing the risk from me during my visits. No method of control will be 100% effective, but collectively they should reduce risk of infection to a low level.
- If you are infectious the chances are you will not know it. COVID-19 appears to be mutating and become more difficult to detect and more infectious. You need to behave as if you are infected.
- Things like using cashless transactions are good as it avoids the use of money which may be infected.
- To me, the stand-out matters of importance are what you do before a visit. Give yourself a good manicure, including cutting nails short and cleaning under the nails. Normal hand washing will not remove this reservoir of dirt.
- Next remove jewelry from hands including rings and watches and leave them at home or in your pocket. A surgeon does not wear these things in an operating theater and doing likewise is a good precaution.
- Next have a warm, soapy shower. This will remove many of the germs from your skin, especially your face.
- Scrub your fingernails with a nail brush. This will remove some of the dirt loosened by the shower.
- When you dress, wear short sleeved, clean clothes. A short sleeved jacket will keep your body warm. If you feel you need to wear long sleeved clothes, don’t take them to the person you visit. Leave them in the car or reception desk. Don’t wear a tie. This is what responsible doctors do when visiting patients in hospital.
- Try to avoid toilets in public places. The COVID-19 is found in urine and faeces (despite “expert” advice to the contrary). When you use a toilet, an invisible infectious aerosol spreads out for others to inhale and it also coats everything including walls. The control of this aerosol is easy to engineer, but for now, this reasonable and relatively cheap control is being totally ignored by authorities.
- Avoid using air dryers for hands. Even though you think you have done a good job, the dryer will create an infectious cloud of residual germs from your hands. Use paper towels – which will also help remove residual germs.
- Use hand sanitiser at the reception desk and again just before you see your loved one. Use it thoroughly between fingers and wrists and claw your fingernails through sanitiser on your palm. The hand sanitiser will be unlikely to properly clean under your nails (hence the manicure and pre-clean at home), but it will disinfect the surface of your hands. Cleaning your wrists is also important (that’s why wearing a watch is bad news). This is one area of your hands that is badly cleaned. It is also highly likely you will have touched your face, door handles and stair rails at every stage of your journey.
- Limit touching your loved one. No hugs or kisses. Blow a kiss. Try and keep your face 1 m from theirs. If you do sneeze, do it into your elbow.
- Holding a hand is alright, especially if they are dying, even of COVID-19. If they have COVID-19 then making sure you touch nothing before again hand sanitising is important. You may then have to self quarantine for several weeks.
- Wearing any mask or even a handkerchief over your mouth and nose will give some protection to others from you. You will probably get little protection from wearing any face mask, particularly if you have not had it professionally fitted. A Cochrane Review (meta analysis) of using surgical masks found it made little difference to patient infection.
- Keep your voice low. When you raise your voice you produce invisible spittle.
