Nurses and other health providers continue to raise many questions and concerns regarding PPE. On behalf of RNAO, I have raised concerns regarding shortages, gave advise to government, provided guidance on the use of N95 masks (and here is more) and wrote an update on plans for their re-processing. I will continue to provide updates. For now, here are important tips.  

Practical tips for safe use of masks

Thanks to Dr. Jeff Powis, Medical Director, Infection Prevention and Control, Michael Garron Hospital, for sharing practical tips for the safe use of masks: 

• Put your mask on when you arrive and don't take it off. Don't keep fiddling with your mask as every time you touch it you could contaminate yourself.
• Staff that wear a hijab or headscarf should use a headband with buttons on it to put their ear-loop mask on or use a surgical mask with ties. Otherwise they may be more likely to self-contaminate as it is hard to put your ear-loop on with the hijab over your ears.
• Do a Point-of-Care Risk Assessment to determine the need for N95 mask. These are only needed for Aerosol Generating Medical Procedures (AGMP) – see here.
• Self-contamination is the biggest risk when using a mask. Focus on PERFECTION with respect to technique of doffing, vigilant hand hygiene and purposeful timed cleaning of your workspace. I would recommend doing this at the start and end of each shift.
• Donning and doffing N95 respirator: I recommend using a Tupperware/plastic container, as I demonstrate in the video here. That way you can doff and re-use without touching it with your hands.
• Use a face shield as this will make it less likely for you to touch your face. Face shields are superior to goggles, especially in units with COVID.
• Be aware of fatigue and mindfulness. I've noticed this myself. When I get tired I get sloppy and have almost made a mistake when doffing. Take a moment to think about your technique before you do it. We take for granted the complexity of donning and doffing but now it is critical!!!

Your messages: Voices and responses

Every day we welcome new readers to this daily report: thank you deeply for the work you do during this public health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share these updates with other health professionals and other organizations both at home and abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues.

Thank you for your messages! Here are two must share with you:

A wonderful message: “Dear Registered Nurses' Association of Ontario, my name is Monica Andrews, I’m a grade 7 student in Ottawa. I’m writing this letter to thank the RNAO and all the nurses who have been working in hospitals and taking care of people affected by COVID19. I’m deeply thankful for each and every nurse who has risked their health to care for sick patients. The work nurses do in general is incredible and during this pandemic it’s fascinating how many nurses have continued working. The work nurses are doing is keeping my grandparents safe, my neighbors safe and my community safe. Thank you. Once we get through this pandemic, the only people we will have to thank are the doctors and nurses. You are our heroes!” RNAO’s response: Dear Monica, Thank you so very much for your beautiful message which I will share in my report tomorrow morning with 250,000 nurses, doctors and others in Ontario, Canada and abroad. I hope one day you will too become a nurse – its the BEST profession ever!!!!! Warm regards, Doris

Fears are normal and talking about them must be welcomed: A nurse writes: “I heard from a colleague of mine that she, along with other hospital staff, were told by her nursing supervisor "you knew when you signed up that this could happen." This was stated while addressing their fears over caring for COVID-19 patients without the necessary PPE. First, I doubt anyone would have dreamed that something on this scale would ever happen during their career. Second, even if that statement were true, management would have been prepared to provide us with appropriate PPE. These so called “leaders” who never leave their offices to provide direct COVID patient care yet have the audacity to belittle our fears with ludicrous remarks will be held accountable when the dust settles. Thank you. Please print this.” RNAO’S response: Dear RN colleague, please don't call that manager a "leader," because he or she is not. Leaders know how to listen, and feel and act with knowledge, compassion and courage. Leaders walk with others in times of pain and distress. I am very sorry that your colleagues needed to experience such unprofessional and callous behaviour! Please ask them to write to me – they deserve better! Please keep safe and well, Doris.

You can read earlier responses here. 

MOH EOC Situational Report #78 here for Sunday, April 12

 Situation:

• 401 new cases were reported today in Ontario, bringing the cumulative total to 7,049 (this includes 3,121 resolved cases and 274 deaths).
• In Ontario, a total of 103,165 people have been tested, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 1,619 tests under investigation.
• 738 patients are currently hospitalized with COVID-19; 261 are in ICU; and 196 are in ICU on a ventilator.

EOC report #77 for April 11 informs of the following actions taken: 

• The Ontario government has extended all emergency orders that have been put in place to-date under s.7.0.2 (4) of the Emergency Management and Civil Protection Act until April 23.
• The Ontario government is temporarily preventing child care centres from collecting payments from parents, while also ensuring that their child care spaces are protected. Child care centres, with the exception of those accommodating health care and other frontline workers, were ordered closed to help prevent the spread of the virus and keep the children and child care staff safe.

EOC report #78 for April 12 informs of the following actions taken:

• The Ministry has updated the guidance document for Consumption and Treatment Services sites.
• Thousands of businesses and private citizens have stepped up and offered to help the Ontario government defeat COVID-19.  More than 7,500 emergency supply submissions have generated nearly $90 million in purchases of critical equipment and supplies.

RNAO’s ViaNurse Program

RNAO launched its COVID-19 ViaNurse program on March 13 and it has already registered 272 nurse practitioners (NPs), 999 critical care RNs (who have experience and continued competency in the provision of critical care) as well as 7,117 RNs for virtual/clinical care.

RNAO is actively staffing nursing homes and retirement homes requiring NPs, RN and PSWs; so far, 390 organizations have registered. We have also staffed many hospitals and indigenous communities. We urge CNEs, CNOs, and managers – in all sectors and regions of Ontario - to access this talent now to build HR surge capacity. For details and forms, please go here.

Staying in touch          

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and in other regions – especially New York and the rest of the United States, Italy, Spain, France, Iran and Germany – now hit the hardest. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we are and will continue to tackle COVID-19 with the best tools at hand: accurate information, calmness, determination and swift actions. 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO  

RECENT RNAO POLICY CORNER ITEMS:

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

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