This illustration, created at the CDC, reveals ultrastructural morphology exhibited by coronaviruses, when viewed electron microscopically
HealthSeptember 04, 2020

Infection control considerations for nursing faculty during COVID-19 pandemic

By: Catherina Chang-Martinez, PhD, MSN, RN, ARNP
The Covid-19 pandemic caused by the coronavirus sars-CoV-2 has presented nursing faculty and students in the U.S. and worldwide with unprecedented challenges. Suddenly, nursing faculty and students were faced with transitioning from traditional face-to-face programs to virtual classrooms and online platforms. Nursing faculty were then faced with the need to host student conference meetings, lectures, examinations, and evaluations via online platforms with limited preparation time.

At a time when thousands of individuals in the U.S. and worldwide continue to test positive for the disease, the use of physical distancing, face masks and handwashing procedures continue to be advocated in the fight against the coronavirus. It is unclear for how long this new “norm” will remain in effect; especially when the percentage of laboratory tests positive for sars-CoV-2 continue to be on the rise, and the prospects of a successful vaccine remains unknown.

With the prolonged duration of this pandemic, it is uncertain “when”, “if” and “how” nursing faculty and students will resume traditional face-to-face education, whether for lecture time, clinical skill practice or healthcare rotation. Higher education institutions and healthcare organizations are transitioning to the new “normal” with social distancing requirements. It will be important for nursing educators to become familiarized with these new guidelines and measures.

Nurse educators will need to assess the amount of risk presented in the classroom, clinical or healthcare environment. Nursing faculty must keep in mind that the more an individual interacts with others, and the longer that interaction, the higher the risk of Covid-19 spread. The Centers for Disease Control have established guidelines to determine the risk of Covid-19 spread increases in Institutions of Higher Education non-residential and residential (i.e. on-campus housing) settings.

  • Lowest risk – Faculty and students engage in virtual-only learning options, activities, and events.
  • More risk – Small in-person classes, activities, and events. Individuals remain spaced at least six feet apart and do not share objects (e.g. hybrid virtual and in-person class structures or staggered/rotated scheduling to accommodate smaller class sizes).
  • Highest risk – Full-sized in-person classes, activities, and events. Students are not spaced apart, share classroom materials, or supplies and mix between classes and activities.

Infection control measures in the face-to-face classroom

Nursing faculty must keep in mind that Covid-19 is mostly spread by the release of respiratory droplets when people talk, cough or sneeze. The virus may spread from a contaminated surface to the individual’s hands; then to the nose or mouth, causing the infection. Personal prevention practices (including hand hygiene, staying home when sick) and environmental prevention practices (cleaning and disinfection) will be important for nursing faculty and students to follow in order to help lower the risk of Covid-19 exposure and spread in the classroom and simulation or practice lab.

These infection control practices must include:

Personal prevention practices:

  • Hand hygiene, washing hands with soap and water for at least 20 seconds each time.
  • Using a 60% ethyl alcohol hand sanitizer if soap and water are not available.
  • Practice Social Distancing. Minimize interactions that may place you at risk of exposure, outside of the classroom.
  • Keep track of your activities and contacts. Contact tracing may be needed should you become Covid positive.
  • Avoid sharing personal supplies, such as pens, pencils, erasers, markers, notepads in the classroom.
  • Self-screen for signs related to Covid (fever or flu-like symptoms) and, notify supervisor and self-quarantine if symptoms present.
  • Wear face masks in public settings when around people outside of their household, especially when other social distancing measures may be difficult to maintain.
  • Face mask coverings may include the cloth face masks or disposable masks, which may be used for non-healthcare settings, and must be washed or replaced daily respectively. Medical or surgical mask and N-95 respirator mask should be reserved for those working in the healthcare environment.
  • Maintain yourself well-informed on local Covid-19 infection trends.
  • Stay informed, educate, and prevent.

To reduce the spread of Covid-19, the Centers for Disease Control recommend that people wear masks. A mask may not protect the wearer, but it may keep the wearer from spreading the virus to others.

Masks should not be worn by: children younger than 2 years old, anyone who has trouble breathing, or anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

Environmental prevention practices must include the following:

  • Keeping six feet distancing rule via the use of masking tape or markings to delineate the distancing between students and with faculty teaching the course.
  • Cleaning and disinfection of equipment whether by faculty and students before dismissal from the classroom, simulation lab or practice lab.
  • Maintaining healthy environments through cleaning and disinfection of frequently touched surfaces. These may extend to desk areas, computer keyboards, podiums, door handles, bathrooms, sinks, elevator buttons.
  • Using signage to communicate measures to prevent the transmission of Covid-19 such as physical distancing, handwashing, and cough etiquette.

It will be important for nursing faculty, educators and students to review institutional policies on social distancing in the classroom and clinical lab or simulation settings. Guidelines or policies should include social distancing procedures, face mask requirements, disinfection, temperature protocols, as well as departure and arrival protocols after a lunch or restroom break.

Infection control measures in the blended face-to-face and online classroom

It has been well discussed that the online learning model remains the safest approach to reduce physical exposure and possible Covid-19 transmission. While there are limitations associated with online learning, especially with lack of hands-on clinical practice, it presents opportunities for implementation of infection control practices, in the case of blended learning. In settings where students have the opportunity to learn via traditional face-to-face mode, and other students benefit from online learning, faculty will be faced with the need to maintain infection control guidelines in the classroom setting and role model these practices for students who may be joining via an online platform. The infection control measures in the face-to-face classroom described above will need to be followed.

Infection control measures in the healthcare setting

Nursing faculty and students participating in clinical rotations in the healthcare setting will need to review the following:

  1. Check the healthcare organization’s policies and guidelines on student rotations. Some organizations may opt for a reduced number of students, students rotating in non-Covid nursing units, or providing care to Covid-19 positive patients in Covid designated units.
  2. Follow healthcare facility guidelines and higher institution guidelines on infection control, use of personal protective equipment and prevention of transmission of Covid-19.

    Some healthcare organizations may opt for providing faculty and students with personal protective equipment. Higher education institutions may also opt to provide both faculty and students with additional personal protective equipment for their assigned rotation.
  3. Wear a facemask at all times while in the healthcare facility, including breakrooms or other spaces where there might be healthcare personnel or visitors. The Centers for Disease Control recommend cloth face coverings not to be worn instead of a respirator or facemask if more than source control is needed. Respirators with an exhalation valve should not be used as they allow unfiltered exhaled breath to escape.

    Wear an N95 or equivalent or higher-level respirator, instead of a facemask in aerosol generating procedures (i.e., open suctioning of airways, sputum induction, cardio-pulmonary resuscitation, endotracheal intubation and extubation, non-invasive ventilation, bronchoscopy, manual ventilation) and surgical procedures that might pose a higher risk for transmission if the patient has Covid-19.

    Nursing faculty and students should consider wearing the same respirator or facemask throughout their entire work shift, instead of intermittently switching back to their cloth face covering. This will help to reduce the number of times the individual may touch their face and self-contaminate in the process.

    Nursing faculty and students should remove their respirator or facemask, perform hand hygiene, and put on their cloth face covering when leaving the facility at the end of their shift.
  4. Wear gloves when there is a possibility of contact with the patient’s blood, stool, or body fluids. Dispose of used gloves into a lined trash can and wash hands right away.
  5. Wear eye protection in addition to their facemask to ensure protection of eyes, nose, and mouth from exposure to respiratory secretions during patient care interactions.

As faculty, it will be critical to self-adhere and have students adhere to these guidelines and measures in the prevention of transmission of the coronavirus. A team-based approach, taking into consideration mitigation of risk, in settings where physical distancing may be limited, will be vital to the success of these measures.

Nursing faculty and students will need to work together and practice these infection control guidelines. Only then, we will be successful in containing the pandemic. To get the students’ buy-in, it will be important to engage them in the conversation on infection control measures. It will be important to determine their perception of these measures.

What are best safe infection control practices in the classroom for faculty and students who engage in the traditional face-to-face option, blended mode, and clinical mode?

Can we deliver optimal content wearing a mask? What are your thoughts?

References

American Association of Colleges of Nursing. (2020). Considerations for Covid‐19 preparedness and response in U.S. Schools of Nursing. Retrieved from https://www.aacnnursing.org/News-Information/News/View/ArticleId/24590/AACN-Considerations-COVID19

Centers for Disease Control and Prevention. (2020). Use of Masks to Help Slow the Spread of Covid-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

Centers for Disease Control (2020). Community, Work & School. Considerations for Institutions of Higher Education. Updated May 30, 2020. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/colleges-universities/index.html

Centers for Disease Control (2020). Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (Covid-19) Pandemic. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J (2012) Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS ONE 7(4); Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338532/#!po=72.2222external iconexternal iconexternal icon).

Gardner, L. (2020, March). Covid‐19 has forced higher ed to pivot to online learning. Here are 7 takeaways so far. The Chronicle of Higher Education. https://www.chronicle.com/article/Covid‐19‐Has‐Forced‐Higher‐Ed/248297

Catherina Chang-Martinez, PhD, MSN, RN, ARNP
Writer, Wolters Kluwer Health