Critical Care with Covid-19: PPE, No Need to Pee
The PPE (Personal Protective Equipment) is starting to make everyone a bit miserable. For those with the best skin, you wind up with a sore nose and marked cheeks. Some of us now have wounds on the bridges of our noses or over our ears from the masks. When I first heard about the number of nurses to patients I was worried about pressure sores. I did not realise they would be on the staff.
Hydration is also a problem. It’s hot in the PPE. You’re sweating more than normal and drinking less. You can’t have a drink with you. It takes at least 5 mins to put your PPE on or take it off properly. There isn’t enough time in a day to take it off, have a drink and put it back on every time you need to. On the bright side, at least you also no longer need to pee. I’m a bit worried about people fainting. Blood pressures will be lower because we’re less hydrated and the masks make some people feel light headed or a bit dozy. This is likely because the CO2 you breathe out can’t escape as it normally would, so you’re breathing a portion of it back in.
Our hands are also taking some serious punishment. Encased in gloves at all times, they get sweaty and very soft and then we’re being extra careful with handwashing when our gloves are off which strips the moisture right out of your skin. It also takes a minimum of three handwashes every time you take your stuff off, because you clean them at various stages of the doffing (taking off). The other difficulty is knowing who in the world you’re talking to! We’ve started labelling ourselves with markers. Name, job and ITU or Non-ITU makes life a lot easier.
At least half of my colleagues are currently self-isolating, or have already been ill and returned to work. I have too. A few cases could be put down to incorrect usage of PPE or not being stringent enough with the precautions but I seriously question this being the problem for so high a proportion of staff. As a cohort we are good with our hand hygiene, have high awareness of infection control measures and have been preparing for this for weeks now. What the trust provides for us fully complies with what Public Health England recommend, and they can only provide us with what is being supplied. It makes me wonder: were we already being exposed before we officially declared an outbreak in the UK? I’m starting to suspect that it was circulating in the general population long before we were aware of it. We won’t know until antibody testing becomes available I guess.
Far worse than the PPE is the fear in the unit. There is always a certain amount of apprehension around ITU and breathing tubes which makes sense. You’re seriously unwell, it’s scary. But now the conscious patients on the unit are utterly terrified. I’ve never seen such fear. They sit in their bed where they can see maybe two or three other people with breathing tubes and wait to see if they’ll need one too. I’ve been begged not to let them die, not to forget about them once they’re asleep. It’s heartbreaking. It wears you down, because when you tell them they’ll be ok, you’re never sure. The odds are not good if you need intubating. And they are all alone. Visiting is not allowed, with the exception of people who are dying.
A second temporary mortuary is being constructed this week. The lady who begged me not to forget her sadly passed away a few days later. I won’t forget. Some people stay with you.