Hospital interpreters are some of the most careful people I know when it comes to infection prevention. In the first hospital where I worked, my colleagues regularly wiped down their desks with disinfecting wipes at the end of the day. They had rank-ordered the bathrooms in areas they frequented by cleanliness, and would walk up to different floors to visit their personal favorite. And all of us wash our hands innumerable times per day.
This concern about limiting the spread of microbes isn’t particular to staff interpreters: other healthcare workers, and the system as a whole, share this concern. When my current hospital inaugurated a new kind of portable computer/phone for staff, they also began an initiative to encourage cleaning the phones with disinfectant wipes, and even bought and placed a special type of wipe in strategic places. I had never even considered how dirty my own personal phone might be until the hospital began this initiative, but as one colleague said to me, “Most people know to clean their toilet regularly, but never think to clean their phone!”
As the number of coronavirus cases in the United States increases, many interpreters, like other healthcare workers, seek to stay informed and prepared. The news has been flooded with stories and articles, and the big concern for many people, including healthcare workers and healthcare systems, is how do we limit the spread of disease and keep ourselves healthy while we support those who are sick? In this article my goal is not to repeat information about high-quality hand-washing and not touching your face (though you should do both of those things). Instead, I want to share some information on what preparations you might expect to see within a hospital that are in place to minimize infection risk.
Not everyone who comes through the hospital has something contagious – think injuries from car crashes or broken bones – but healthcare systems recognize that many patients do. Plus, even though we may be treating someone for a broken bone, that doesn’t mean they (or their visitors) don’t have a cold or something else that isn’t the reason they’re receiving treatment, but could be contagious. So we assume that everyone who comes through the door is contagious (just to be on the safe side) and take are steps as part of our normal day-to-day that are intended to minimize infection risk across the board. Precautions hospitals regularly take are called standard precautions and include things like:
• Hand sanitizing when entering and leaving a patient’s room, and after touching a patient
• Respiratory Hygiene: letting patients and visitors know to cover their mouth and nose when coughing or sneezing and wash their hands after touching a tissue
• Keeping the door to the patient’s room closed (especially important for droplet!)
• Having dedicated equipment for a room (maybe leaving a stethoscope in a patient’s room, instead of clinicians using their personal stethoscope)
• Cleaning all equipment between patients, and disinfecting rooms in a way that is appropriate to the level of how soiled it got
What happens if we can tell by someone’s symptoms that they have something contagious? By this point most of us have heard about people wearing masks to protect from the coronavirus, but what infection prevention measures do hospitals use? Although there are Standard Precautions – routine steps healthcare systems have in place to minimize infection risk in general – Isolation Precautions are specific steps hospital staff take to make sure that diseases that are clearly present don’t spread.
Some diseases are spread by contact, meaning you have to touch something a sick person has touched to get it. Others are spread by droplets – breathing in the small droplets from another person’s cough or sneeze (if you’ve ever sneezed and then smelled it, you were inhaling your own droplets – gross, I know, but it’s an easy way to explain droplets). Here are some examples of additional measures you might expect on top of standard precautions:
• Cleaning “high-touch” items daily: things like faucets, door handles, bedrails… anything that gets touched a lot.
• Minimize how many people go in the room – if they aren’t essential, they don’t go in.
• Putting the patient in a negative pressure (or AIIR) room. This is a room where every time the door opens air gets sucked into the room instead of flowing out. This is useful if the disease a patient has is transmitted through the air.
• Putting on appropriate PPE before going in the room, and taking it out when leaving the room. Check out the FDA’s website to learn more about personal protective equipment and specific information about each item of PPE: masks, gowns, and gloves.
Depending on how a disease spreads, the steps that are taken are different, which leads us to having different types of isolation precautions. In general, they fall into 5 categories. We won’t get into all of them, but if you’re interested, you can read more.
• Airborne precautions
• Contact precautions (sometimes with handwashing required)
• Droplet precautions
• Neutropenic precautions (Protective environment)
• Radiation precautions
Personal Protective Equipment (PPE)
PPE is an important component, and one that many people have been worrying about (apparently there is a shortage of facemasks now). Personal Protective Equipment, or PPE, are the items healthcare workers wear to protect themselves from getting or transmitting any illness the patient has, and there are strict rules about how to put on and take off these items in order for them to be effective protection for us. See this handy PDF from the CDC to learn more about those rules.
The type of isolation precaution a patient is on dictates what items we need to use – for example, if a person has clostridium difficile, which produces terrible diarrhea, we don’t need a mask. In this case just a gown and gloves are needed, because diarrhea is not spread through droplets in the air. But c.diff. is not killed by alcohol foam we usually use for cleaning our hands, so we have to wash our hands with soap and water after leaving that patient’s room. Those are the steps I, as an interpreter, have to take to maintain “contact precautions – handwashing required.” The rest is all done by the rest of the staff.
The news has informed us that COVID-19, like other coronaviruses, is a virus that affects the respiratory tract and produces symptoms that usually require droplet precautions. But because it is a new virus, and hospitals are making extra effort to prevent it from spreading, they may take additional measures. These could include placing the patient in a negative pressure room (to avoid droplets getting out) and requiring staff (including interpreters!) who are going to interact with the patient wear slightly more rigorous PPE. Currently the CDC is currently recommending: N95 respirators and (if available) face shields, as well as the usual gown and gloves that go with droplet precautions.
As a medical interpreter, you’re protected by both Standard Precautions and Isolation Precautions. If you go to interpret for a patient with COVID-19, and really when Isolation Precautions of any kind are in place, you should participate in maintaining them by putting on the appropriate PPE before you enter a room and taking it off before exiting. If you are unsure what PPE is appropriate, you can ask the staff, but in my experience if you are not wearing something you should be, staff will tell you that you need it. If you are someone who gets nervous about the risk you are taking when you go to interpret at a hospital or health clinic, hopefully knowing that these standards and protections are in place helps you feel a little bit safer.
Kate Dzubinski is a Certified Medical Interpreter whose background draws from the southern US, Austria, and northeastern Spain. She grew up speaking four languages, and currently works as a hospital interpreter, continuing education developer and lead facilitator in the Interpreter Training department at ALTA Language Services.