Thinking back to February 2020, along with the rest of the world, we did not wear masks in public, we shook hands upon meeting for the first time and gathered as we shared spaces for work and leisure without caution. Now masks, face-shields and various personal protective equipment (PPE) have become vital parts of the frontline uniform. Hand shaking has been replaced by waving hand as the new way to greet someone and maintaining a social distance of at least two meters is what everyone adheres to when in public spaces. Indeed, the COVID-19 pandemic has created new challenges in the way we live and work especially in the health care setting. As a phlebotomist (MLA/T) at The Hospital for Sick Children, we also face unique challenges daily and the hospital has implemented changes since the novel coronavirus was officially declared a pandemic by the World Health Organization (WHO).
The biggest change I have encountered involves the use of PPE and specifically the change to our mask policy. Wearing the proper mask is essential to protect us from contracting the virus. Masks protect us by limiting the amount of droplets we inhale from others as well as protects everyone else by limiting the spread of our droplets when we cough, sneeze and speak. Initially masks were required when interacting with patients with droplet or airborne precautions. As the pandemic progressed, our hospital established an extensive Universal Masking policy for all staff, patients, visitors and vendors when entering the hospital. Surgical masks and eye protection or face shields are now required for all patient facing staff. In addition, gowns and gloves are required when working with patients with droplet or contact precautions. Fitted N95 masks are required when caring for patients with airborne precautions and are now required for patients undergoing Aerosol Generating Medical procedures (AGMP) such as High Flow Oxygen therapy (HFOT), patient on ventilation and those with a tracheostomy tube for open suctioning.
Phlebotomists are also required to conduct a Point of Care Risk Assessment (PCRA) prior to each patient interaction to determine the most appropriate PPE for the encounter and to ask for assistance if the patient may be combative and could possibly remove PPE during the procedure. Hospital provided masks are now required for everyone age 6 and older and for younger patients if the child is COVID-19 positive or has high risk factors for COVID-19 infection. If a patient is not able to wear a mask safely due to risk of introducing germs to the face, increased difficulty breathing, possible choking or strangulation, in these situations, staff may work with the child and the family to find safe alternatives. The COVID-19 virus can be spread by asymptomatic individuals or those who do not know they have the virus. These policies are essential in preventing the spread of the virus amongst staff and patients when physical distancing is not possible.
The hospital also developed a systemic approach for communication to staff who have interacted with patients that are at a high risk for COVID-19 infection. Phone calls and/or emails are sent to staff that had direct contact with a COVID-19 positive patient. Staffs are also required to contact the Occupational Health department when they are symptomatic, if they have been exposed to COVID-19 positive person or if they have had a break in the use of PPE. Staffs are able to get the most up to date practices via urgent practice alerts and the supervisor reviews the new practices with individuals should any concerns or questions arise.
The pandemic has also changed the way we interact with our colleagues at work. Reductions to the number of staff in the break room as well as limitations for the number of people allowed in the elevator at once ensures the health and safety of all staff. However, we must not overlook the mental distress caused by the effects of social distancing and self isolation as well as burnout due to an increased workload. The most important thing that has not changed is the endless support from my colleagues and supervisor of the phlebotomy team. Whether it’s a wellness check-in from one of my coworkers or an in-depth discussion with my supervisor, I know I can speak to them in a safe environment without fear of judgment. I can share my concerns about a certain task as well as discuss my personal well-being in a supportive atmosphere. This is essential for creating a positive work environment, reducing anxiety and encouraging resilience during this unprecedented time. Although the COVID-19 pandemic created new challenges in the workplace it also presented an opportunity for us to come together in an extraordinary way. As a proud member of the phlebotomy team, I believe the key to successfully overcome the pandemic is to be vigilant about enforcing infection control practices while creating support systems to help staff cope with the emotional challenges.
Jenny Chan, MLA/T