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COVID-19 for CNAs and HHAs

1 Contact Hour
This peer reviewed course is applicable for the following professions:
Certified Nursing Assistant (CNA), Home Health Aid (HHA), Medical Assistant (MA), Medication Nursing Assistant
This course will be updated or discontinued on or before Sunday, September 1, 2024

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


Outcomes

≥92% of participants will understand how to care for patients with Covid-19.

Objectives

After completing this course, participants will be able to 

  1. Identify signs and symptoms of COVID-19.
  2. Discuss transmission.
  3. Discuss recommendations for prevention.
  4. Discuss airborne precautions.
  5. Identify long-term complications.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Introduction

Since its first reported case in Wuhan, Hubei Province, China, the Coronavirus infection 2019 (COVID-19) has greatly changed global healthcare. There were about six million deaths reported by March 2022. Like all viruses, COVID-19 changes its’ genetic structure over time. This change causes similar infections, but symptoms and the severity of symptoms vary. These changed viruses are called variants.

Signs and Symptoms

Symptoms of COVID-19 include:

  • Fatigue
  • Weakness
  • Muscle pain
  • Loss of taste
  • Cough
  • Sore throat
  • Fever

There may also be shortness of breath, lack of appetite, diarrhea, vomiting, and headache. Older people with multiple diseases are more likely to have severe respiratory problems and a higher death rate. In young people, the symptoms are less severe.

Transmission

The virus is commonly transmitted when an infected person puts out droplets when they cough, sneeze or talk. Exposure to an infected person within 6 feet for at least 15 minutes can cause transmission of COVID-19. More brief exposure and people with fewer symptoms are less likely to cause transmission. The virus lives on surfaces an infected person touches for a short time. The infection can also be transmitted by touching an inanimate (not alive) surface that an infected person touched. The problem is touching an infected surface and then touching your face or eating can transmit the virus.

Recommendations on Prevention

Respiratory Hygiene/Cough Etiquette

Respiratory hygiene/cough etiquette is a way to reduce the transmission of respiratory infections. Signs educating patients and families about respiratory hygiene/cough etiquette protocol should be posted at every entry door. The instructions are that persons with cough, congestion, rhinorrhea (runny nose), or increased respiratory secretions should:

  • Cover the mouth and nose when coughing or sneezing.
  • Dispose of used tissues promptly.
  • Use a surgical mask if coughing and if tolerated.
  • Wash hands after contact with respiratory secretions.
  • Separate at least three feet from persons with respiratory infections in common areas when possible.

Handwashing

Handwashing with soap and water is a way to keep hand hygiene in non-healthcare settings, and the CDC and other experts recommend its use in these situations. Handwashing is one of the most effective methods for preventing patient-to-patient, patient-to-staff, and staff-to-patient transmission of infection. A high level of hand hygiene can stop outbreaks in healthcare facilities and reduce the transmission of infection. There are many reasons why healthcare professionals are non-compliant with hand hygiene protocols, such as lack of time, inconvenience, high workload, and poor staffing.

Hands should be washed, or alcohol-based rubs should be used:

  1. before and after patient contact
  2. between patient contacts
  3. after gloves are removed
  4. after contact with blood, body fluids, secretions, mucous membranes, excretions, and contaminated equipment
  5. after contact with inanimate objects and medical equipment near a patient
  6. after using the bathroom
  7. before eating
  8. In certain situations, e.g., between tasks on the same patient to prevent cross-contamination. Cross-contamination may happen if you clean a bowel movement, then start washing the patient’s face without changing gloves

In addition to traditional handwashing with soap and water, the CDC recommends using alcohol-based hand cleansers by healthcare workers who perform patient care because they address some of the barriers that healthcare professionals face when taking care of patients and frequently washing their hands.

Alcohol-based hand rubs work well, in most cases, as well as soap and water. They reduce the number of microorganisms on the skin, are fast, and cause less skin irritation than soap and water. When using an alcohol-based hand rub, apply the product to the palm of one hand and rub your hands together for approximately 20 seconds, covering all surfaces of the hands and fingers until the hands are dry. Alcohol-based hand rubs take less time than traditional hand washing. In addition, hand rub dispensers can be mounted almost anywhere, instead of going to a sink.

Soap and water should be used when hands are visibly dirty. For all other situations, an alcohol-based hand rub can be used. The use of hand hygiene does not eliminate the need for gloves. Gloves can significantly reduce hand contamination, prevent cross-contamination, and protect patients and healthcare workers from infection. However, incorrect use of gloves can greatly increase hand contamination. Gloves must be removed after patient contact and a new pair put on for each new patient contact, and they should be replaced if they are torn, damaged, or grossly soiled. Healthcare workers should not wear artificial nails and keep natural nails less than one-quarter of an inch long if they care for patients at high risk of getting infections.

Face Masks

Since COVID-19 is usually transmitted by contact with droplets from an infected person, the correct and consistent use of face masks is recommended to prevent transmission. The use of masks is advised when in transit or poor ventilated areas. Health workers can use N95 if available.

Limiting Contacts and Physical Distancing

Closed physical contact in crowded spaces increases transmission. Since the virus can be transmitted by respiratory droplets floating in the air, having a physical distancing policy is recommended in communities with high infection rates. The current guideline recommends maintaining a physical distance of at least 6 feet from suspected active infection cases and asymptomatic individuals. Setting a physical barrier and having sign reminders might help reduce the rate of new infections.

Airborne Precautions

Airborne Precautions are implemented in the hospital for COVID-19, transmitted by airborne droplets. When droplets dry up, tiny parts float in the air and can travel around in the wind. If COVID-19 is suspected, airborne precautions should be taken. Possibly infected patients should be separated from others and asked to wear a surgical mask.

Respirators are required to be worn by healthcare workers if Airborne Precautions are in place. These respirators will block at least 95% of infectious parts 3 microns or larger. The N95 is a single-user, disposable item that must be fit-tested to be effective. Fit testing should be done when first using an N95. A user should do a seal check each time the N95 is used. The N95 respirator is disposable. It cannot be cleaned or disinfected. An N95 mask can be used more than once. There are guidelines for the reuse of N95 masks. Follow your facility’s policies.

Airborne Precautions also require using an airborne infection isolation room (AIIR) with special airflow and ventilation systems. AIIR is a specially ventilated room with at least 12 air changes per hour; negative air pressure that is lower than the hallway, so the air does not flow out into the hall; and outside exhaust or HEPA-filtered in the room to recycle the air. The door to the room must be kept closed, and the negative air pressure should be monitored. Gowns and gloves are required. When the patient in airborne precautions has to be moved or transported, the patient should wear a surgical mask from when they leave the isolation room until they return.

Contact Tracing and Quarantining

Contact tracing of confirmed infections includes obtaining detailed information about possible transmission, identifying and talking with people exposed to the infection, and collecting healthcare information. People exposed to the active case should be educated on the risk of exposure, symptoms of the infection, and why they should have testing. Quarantining is isolating all exposed people and starting a close check for symptoms. Other preventions strategies recommended by the CDCD include:

  1. Avoid unnecessary indoor and outdoor gatherings
  2. Protect people and special populations at risk of severe illness or death
  3. Protect essential workers
  4. Avoid traveling to high-risk locations
  5. Increase room ventilation
  6. Increase personal hygiene, space cleaning, and disinfection
  7. Vaccination

Vaccines

Vaccination is considered the most effective long-term strategy for preventing and controlling COVID-19. As of June 30, 2022, the CDC guideline on vaccines and vaccination strategies only recognizes three COVID-19 vaccines approved by the FDA. This approval is under the Emergency Use Authorization (EUA) and the Biologics License Application (BLA) schedules. These vaccines include;

  • Pfizer-BioNTech COVID-19 Vaccine/COMIRNATY
  • Moderna COVID-19 Vaccine/SPIKEVAX
  • Janssen (Johnson & Johnson) COVID-19 Vaccine

Long-Term Complications

Long-term complications of COVID-19 can make the patient disabled in many ways. Studies on COVID-19 show dysfunctional/delayed bladder emptying as a common long-term neurologic complication. Other problems include drooping of the upper eyelids, mild residual peripheral neuropathy (numbness, tingling), and facial weakness (Valderas et al., 2022). A post-viral cough lasting for about eight weeks has been reported as a common pulmonary complication of COVID-19.

Chest tightness, difficulty breathing, and chronic runny noses have also been reported in children (Borch et al., 2022). Nausea, abdominal pain, and vomiting are the most reported gastrointestinal complications. Multisystem inflammatory syndrome in children (MIS-C) has also been reported in many. Researchers have reported a high incidence of major depressive disorder as a common psychiatric complication in adolescents. Other findings have also reported anxiety, avoidance, arousal, and consistent flashbacks in many patients. In patients with an onset of COVID-19 complications, clinical support is recommended.

In patients with pre-existing medical conditions, including diabetes, chronic kidney diseases, and cardiovascular diseases, the risk of developing a systemic illness or long-term complications of COVID-19 is higher. In this population, the most reported complications of COVID-19 include multiple organ failure, acute respiratory failure, and sudden clinical deterioration. In the long term, there is an increased risk of myocardial infarction, deep venous thrombosis, arterial thrombosis, and ischemic strokes (Katsoularis et al., 2022). Cardiogenic shock, malignant arrhythmias, and cardiomyopathies have also been reported. Acute renal failure is another long-term complication of COVID-19 linked with a high risk of mortality (Sabaghian et al., 2022).

Case Study

Jane is being admitted to the hospital with a diagnosis of COVID-19. The CNA Sue is moving the patient from the emergency department to an AIIR hospital room on airborne precautions. Jane is in an isolation room in the ER. Sue checks with the RN to see if the patient has been educated to wear a surgical mask while being transported. The RN had not educated the patient. Sue reminds the RN of the transport policy. The RN then educates the patients, applies a surgical mask, and Sue proceeds with the transport.

The outcome is the correct masking policy was followed for the admission of a patient to an AIIR room for airborne precautions. If Sue had not brought the mask policy to the attention of the RN, the patient might have been transported without a mask. This failure to follow policy could expose hospital staff to COVID-19.

Conclusion

Symptoms of COVID-19 are fatigue, weakness, muscle pain, loss of taste, cough, sore throat, and fever. There may also be shortness of breath, lack of appetite, diarrhea, vomiting, and headache. Older people with multiple diseases are more likely to have severe respiratory problems and a higher death rate. In young people, the symptoms are less severe. The virus is commonly transmitted when an infected person puts out droplets when they cough, sneeze, or talk. Respiratory Hygiene/Cough Etiquette is a way to reduce the transmission of respiratory infections at the first point of entry into a healthcare setting. Handwashing with soap and water is a sensible strategy for hand hygiene in non-healthcare settings, and the CDC and other experts recommend its use in these situations. Since COVID-19 is usually transmitted with physical exposure to droplets from an infected person, the correct and consistent use of face masks is recommended to prevent transmission. Close physical contact in crowded spaces increases the transmission rate. Contact tracing of confirmed infections includes obtaining detailed information about possible transmission methods, identifying, and communicating with people exposed to the infection, and collecting healthcare information. Vaccination is considered the most effective long-term strategy for preventing and controlling COVID-19. In patients with pre-existing medical conditions, including diabetes, chronic kidney diseases, and cardiovascular diseases, the risk of developing a systemic illness or long-term complications of COVID-19 is higher.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

References

  • Borch L, Holm M, Knudsen M, Ellermann-Eriksen S, Hagstrom S. Long COVID symptoms and duration in SARS-CoV-2 positive children - a nationwide cohort study. Eur J Pediatr. 2022 Apr;181(4):1597-1607. Visit Source.
  • Katsoularis I, Fonseca-Rodríguez O, Farrington P, Jerndal H, Lundevaller EH, Sund M, Lindmark K, Fors Connolly AM. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. BMJ. 2022 Apr 6;377: e069590. Visit Source.
  • Sabaghian T, Kharazmi AB, Ansari A, Omidi F, Kazemi SN, Hajikhani B, Vaziri-Harami R, Tajbakhsh A, Omidi S, Haddadi S, Shahidi Bonjar AH, Nasiri MJ, Mirsaeidi M. COVID-19, and Acute Kidney Injury: A Systematic Review. Front Med (Lausanne). 2022 Apr 4; 9:705908. Visit Source.
  • Valderas C, Méndez G, Echeverría A, Suarez N, Julio K, Sandoval F. COVID-19 and neurologic manifestations: a synthesis from the child neurologist's corner. World J Pediatr. 2022 Jun;18(6):373-382. Visit Source.