Analysis

COVID-19: the steps to take when your shift ends to stay safe at home

Online sources list a number of rigorous steps to take after each shift – but what do the experts say?

 iStock
First and foremost, wash hands thoroughly at the end of every shift and when you arrive home
Picture: iStock

Many nurses will have spotted the lists circulating on social media, advising healthcare professionals on complicated routines to initiate when they arrive home after work to help halt the spread of COVID-19.

These posts suggest that multi-stepped approaches such as leaving your shoes outside and dashing straight to the shower will help nurses protect their families by eliminating the risk of bringing COVID-19 into their homes.

Among the steps generally advocated are showering and changing out of your uniform at work at the end of every shift.

View our COVID-19 resource centre

Who writes these online lists?

The lists suggest that, when they arrive home, healthcare professionals should not touch or hug any family members but put their coat and bag in a plastic box near or outside the door, leaving shoes outside, and wiping all these items down with a soapy cloth.

Phones should have been kept in a disposable sealed bag at work, they say, and should be sanitised. Then the nurse or doctor should shower again and put their uniform and the used towel straight in the washing machine. At this point, and not before, they are safe to greet their family, the lists suggest.

But, as it is not clear where most of these guides originate from, there is uncertainty about what measures nurses really should take after a long and tiring shift.

Washing hands is the most important step

Nursing Standard has reviewed government guidance and spoken to infection control nursing experts, who suggest that while some of the suggested steps are backed up by evidence, most are unnecessary.

The single most important step nurses can take to reduce the risk of spreading the coronavirus is to wash their hands thoroughly at the end of their shift.

‘The critical thing that staff must do as they leave the clinical area is to thoroughly wash their hands and forearms with soap and water and dry them’

Jennie Wilson, professor of healthcare epidemiology, University of West London and vice president of the Infection Prevention Society

Jennie Wilson is professor of healthcare epidemiology at the University of West London and vice president of the Infection Prevention Society
Jennie Wilson: Hands are the main route
by which the virus will be transmitted

‘There are a lot of complex strategies floating about but most of them are not necessary,’ says Jennie Wilson, professor of healthcare epidemiology at the University of West London and vice president of the Infection Prevention Society.

‘The critical thing that staff must do as they leave the clinical area is to thoroughly wash their hands and forearms with soap and water and dry them. They may have picked up virus on their hands from contaminated surfaces, but these are easily removed by washing or using alcohol hand gel.

‘It’s important hands are cleaned so that the staff member does not transfer virus from their hands to their own mucous membranes or those of their family when they get home – this is the main route by which the virus will be transmitted.’

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Not all staff have access to at-work
laundry services Picture: iStock

What about removing uniforms and showering at work?

Changing out of your uniform at work, as is generally recommended in these lists, is advisable, but nurses do not need to shower at work, infection control experts say.

Nurses should change into their own clothes at work if possible, according to Public Health England advice on infection prevention control during COVID-19.

But the document does say this is more to do with public perception than the actual risk of spreading the virus. This does not apply to community staff who wear their uniform while travelling between patients.

Healthcare laundry services should be used to launder staff uniforms, Public Health England says. Where there is no laundry facility available, which is often the case, uniforms should be transported home in a disposable plastic bag.

They should be washed separately from normal household linen, in a washing machine not more than half full, at the highest temperature permitted by the fabric.

Uniforms should then be tumble dried or ironed. 

‘At this time particularly, especially with nurses working long hours, it’s important that we can touch, hug and show affection to our children and loved ones’

Deirdre Harris, independent infection control consultant nurse

Professor Wilson stresses that the risk of contamination from uniforms is low anyway.

‘Nurses should have been protecting it from contamination during the day with plastic aprons, or gowns if they are caring for COVID-19 patients.

‘Even with protection with a plastic apron, it is unlikely that much virus will contaminate clothing, it will only get there if it is in contact with contaminated surfaces or respiratory secretions get onto it. One study from China found no contamination on gowns, although did find it on surfaces.’

The steps you should take after a shift

 iStock
Use antibacterial wipes or soap and
water to clean your phone Picture: iStock

When your shift finishes

  • Wash hands and forearms with soap and water and dry them
  • If possible, remove uniform and change into your own clothes
  • Give uniform to work laundry (if available)
  • If not, put uniform in a plastic bag

When you arrive home

  • Wash your hands again
  • Put your washing in the machine and wash by itself in the highest temperature that the fabric can tolerate. Then iron or tumble dry
  • Throw away the plastic bag that you carried your uniform in
  • Wipe down your phone

And the things you do not need to do

  • Avoid family members
  • Shower
  • Immediately wash the towels you used after showering
  • Separate out or disinfect the objects you took to work with you

 

Wiping down phones and general good practice

Deirdre Harris, an independent infection control consultant nurse based in London, says uniform guidance should be adhered to.

Deirdre Harris is an independent infection control consultant nurse based in London
Deirdre Harris: A quick wipe of your
phone doesn't take much effort

‘Nurses shouldn’t be wearing their uniforms home, but that has always been the advice,’ she says. ‘It is good practice, and people need to be more rigorous than normal about it.

‘But the absolutely fundamental thing is to wash your hands thoroughly when leaving work, and after your journey, especially if you use public transport.’

She recommends wiping down phones with an antibacterial wipe or a little soap and water.

‘They are an area of concern for me, ordinarily, as well as now,’ Ms Harris says. ‘A quick wipe over doesn't take much effort and will make all the difference.’

 iStock
There’s no need to avoid family
members at home Picture: iStock

Contact with family doesn’t need to be avoided

But staff do not need to shower when they get in and do not need to avoid family members, she says.

‘I have some colleagues who shower after work, but if nurses have been following good hand hygiene, have been wearing appropriate personal protective equipment and, as the virus doesn’t persist on hair, there is no need to shower before hugging family members.’

Contact with family members in your own household is more important than ever in this challenging period, she says. 

‘At this time particularly, especially with nurses working long hours, it's important we can touch, hug and show affection to our children and loved ones.’

Community nurse? Here's what steps you should be taking

For community nurses, infection control can be particularly tricky. Going in and out of patient’s houses and into their own cars can add extra concerns around maintaining high standards of cleanliness.

While most nurses are advised to change out of their uniforms when travelling, the official COVID-19 guidance from the government recognises that community nurses need to travel about in their uniform.

Jennie Wilson, professor of healthcare epidemiology at the University of West London and vice president of the Infection Prevention Society, advises community staff to:

  • If possible, check before the visit if the patient has symptoms of COVID-19 and rearrange the visit for a few days later if it does not compromise patient care
  • Always have a set of personal protective equipment (PPE) ready for each visit in case the patient or someone else in the household has developed symptoms of COVID-19
  • Always carry hand sanitiser 
  • Avoid taking your personal belongings or unnecessary equipment into patients’ homes 
  • Put on PPE as soon as you enter the house. Don't forget to change gloves immediately before doing an aseptic procedure or contact with a susceptible site
  • Remove and discard protective clothing on leaving the home – it can be placed in the patient's household waste 
  • Decontaminate hands after removing gloves and after all the protective clothing has been discarded
  • Wipe clean any equipment with a disinfectant wipe (for example phone or tablet)
  • Remove your uniform when you get home and place directly in the washing machine – then wash your hands.

Professor Wilson adds that provided you are scrupulous in decontaminating hands after each visit and protecting your uniform with a plastic apron, then you will not transfer any significant contamination to your car or home


Erin Dean is a health journalist


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