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Washington State University

Safety Guidelines for reopening of Clinical Performance and Simulation labs

Objective: This page establishes feasibility guidelines for limited skills and simulation learning events to resume at WSU College of Nursing campuses. These guidelines apply to all lab staff, faculty, learners and standardized patients and abide by WSU policy, CDC, OSHA, state and federal guidance to effectively reduce exposures to Covid-19 virus. It will outline Personal Protective Equipment (PPE) requirements, physical distancing and cleaning/disinfecting of all learner lab and simulation lab areas, surfaces and equipment.

Definitions:

  • PPE: All individuals entering the lab area are required to wear cloth masks at all times. Higher levels of PPE are determined on the activity being attended. If face shields are required (e.g. for Physical Assessment (PA) groups), students will be issued one face shield per semester and will be required to clean it after attending each PA group.
  • Students will be given instructions via Blackboard on proper cleaning of the face shields.
  • PPE Disposal: PPE disposal will be in accordance with OSHA, EPA and CDC laboratory guidelines and containers are provided by the lab.
  • All skills lab and simulation rooms are equipped with hand hygiene and PPE capabilities.

Physical equipment and surfaces: Examples of frequently touched surfaces in the physical spaces that require cleaning and decontamination include low- and high-fidelity manikins, task trainers, computers, keyboards, touch screens, beds, tables, door handles, countertops, light switches, desks, sinks and carts. Cleaning and decontamination of frequently touched hard surfaces will be done by lab and simulation staff with the Environmental Protection Agency’s (EPA) list N of approved disinfectants and solutions products to be used against COVID-19.

Practice Lab

The lab will have a designated pre-entry, entry, and exit area that will have signage and tape on the floor to ensure 6 feet distancing.

Pre-entry/Entry:

  • Each campus will develop their own screening procedure based on Washington State health department guidelines for the geographic location.
  • Students are to arrive by assigned skills groups (8 per group) according to instructions posted by their clinical instructor on Blackboard.
  • Only students who are scheduled for a skills group will be allowed in the lab.
  • There will be no independent practice allowed for Fall semester 2020.
  • Students will be expected to arrive in clean street clothes for skills groups; if students are coming directly from a clinical site in scrubs they will be expected to apply appropriate PPE to mitigate any COVID-19 spread (e.g. gowns).
  • Students will follow marked spaces outside the main lab door and enter the lab at 6-foot intervals. All students will arrive wearing reusable, washable, cloth masks and are required to wear them for the duration of their time on campus. Expectation is that the mask will be laundered daily.
  • Upon lab entry students will individually enter a handwash and PPE station, located in a separate lab space area.
  • Handwashing will be accomplished according to CDC/DOH guidelines and appropriate PPE will be donned depending on level required for the skills group they are attending.
  • All Physical Assessment (PA) skills groups will be required to wear a mask, face shield, gloves and gowns.
  • All other skills groups will be required to wear cloth masks and gloves as appropriate for that skill.
  • Hand sanitizer will be available throughout the skills lab and simulation areas.
  • Students will be discouraged from bringing in any backpacks or other items from home except for writing utensils as required. Writing utensils will not be provided in skills groups or simulation rooms.

Main Lab

  • Only one clinical group (8 students, 6 feet spacing) will be allowed in the main lab area or any of the designated rooms at any time for a designated skills competency group practice/demonstration.
  • All skills labs will be reorganized to provide:
    • Individual student designated areas will be outlined with floor tape that provides a minimum of 6 feet between students at all times.
    • Hospital bed, headwall with oxygen/air/suction, bedside table (if applicable for skill) will be used with 6 feet distancing.
    • Only 2 students per bed will be allowed, one at the head and one at the foot at all times.
    • Equipment/supplies required for lab groups will be exercises placed at individual station areas prior to the scheduled skills group.
    • Students will not be allowed to move freely throughout the lab. They must report to their designated area and stay in that area unless a comfort break is needed or until released to exit.
  • Skills groups sessions will be scheduled a minimum of 15-30 minutes apart to allow for cleaning before new learners arrive. Learners arriving more than 10 minutes prior to scheduled start time will not be permitted into the lab.

Exit

  • Once students have completed their assigned skills group, they are to proceed to the hand hygiene area in 6-foot increments (tape on the floor) and doff and dispose of any PPE (except for cloth masks); they must perform hand hygiene according to CDC/DOH guidelines and then exit the lab. Writing utensils will not be provided.

Simulation Lab

  • No more than three students in a simulation or debriefing room at one time, two students will provide patient care, one student will observe/record, all other students will be observing via Zoom. Debriefings with each clinical group will take place via Zoom.
  • Control rooms will have only one facilitator and one sim tech at any given time; instructors will observe the simulation via Zoom.
  • All students coming in for simulation lab will follow the procedures outlined above for entry (e.g. handwash, don PPE as appropriate) and exit. In simulation room they will wear the aforementioned PPE, in addition to an isolation gown, donned and doffed upon entry and exit of the simulation room.
  • Students in the simulation room are not anticipated to be closer than 6 feet, at most, to each other during the clinical simulation. Tape markings will ensure 6 feet distancing in each simulation and debriefing room.

Miscellaneous

Student Belongings

  • Students are discouraged from bringing any items that cannot be kept on their person (e.g. to include book bags and backpacks).
  • If absolutely needed storage cubbies are available, however items must be immediately removed when exiting lab. Any items left after each activity will be immediately disposed. Available cubbies will adhere to the 6 feet guidelines. Cubbies will be disinfected immediately after each group.
  • Any needed equipment in the lab, such as stethoscopes, will be provided and disinfected or placed in quarantine for 7-10 days after each use.

Appropriate Attire

  • Students are required to have hair pulled back before entering the building.
  • Students are required to wear clean street clothes in the practice lab and scrubs in the simulation lab.
  • If a student is coming directly from a clinical site, they will be required to wear PPE over their scrub attire.
  • Students are required to wear closed toe shoes.
  • Jewelry below the elbow is strongly discouraged.

Restroom

Upon returning to lab from a restroom break, students will enter through the designated area, wash hands and put on required PPE while keeping a mask on at all times.

Break/Lunch

Breaks only as needed; No communal area will be provided for lunch; skills groups and simulations are approximately 2 hrs in length.

Missed Skills Groups:

If a student has an excused absence from a required skills group, make-up sessions will be arranged on a case-by-case basis and may be accomplished via Zoom sessions. If a simulation if missed it is unlikely it can be made up due to the current social distancing restrictions.

Cleaning and Disinfecting

Skills Lab

  • All commonly touched surfaces, manikins, task trainers, and equipment will be cleaned and disinfected daily.
  • At the conclusion of each scheduled skills practice group, lab personnel will clean and disinfect frequently touched hard surfaces, equipment, and manikins with the Environmental Protection Agency’s list of approved disinfectants and solutions to be used against COVID-19, referred to as “List N”.
  • At the end of each day, all lab personnel will disinfect all general areas in use for the day. Lab personnel will wear gloves and masks when cleaning and disinfecting and will wear additional PPE as indicated by each unique situation.
  • Beds, Stretchers, Exam Tables, Chairs: Mattresses, handrails, headboards, exam tables and chairs will be cleaned and disinfected after each skills practice group by lab personnel with the Environmental Protection Agency’s list of approved disinfectants and solutions to be used against COVID-19, referred to as “List N”.
  • Disposable paper drapes will be used in place of linens and gowns, and they will be disposed of after each group by lab personnel. Lab personnel will wear gloves and masks when cleaning and disinfecting and will wear additional PPE as indicated by each unique situation.

Simulation Lab

  • All manikins, simulation equipment and rooms to include IV pumps, monitors, counter tops, med vials, and stethoscopes, will be cleaned and disinfected after each simulation event.
  • An additional 15-30 min between simulation events will be allotted to ensure cleaning can be accomplished.
  • All manikins will be disinfected using 70% isopropyl alcohol as per manufacturer guidelines after each use.

Guidelines for Cleaning Manikins

  • Clean all manikins with soap and water prior to disinfecting.
  • Laerdal (SimMan Essential, SimMan 3G, SimJunior, and Nursing Baby) will be disinfected using 70% isopropyl alcohol as per manufacturer guidelines.
  • Do not scrub the manikin skin

Electronics

  • Use manufacturer guidelines for cleaning. If none, use an alcohol-based cleaner of at least 70% isopropyl alcohol and allow to dry.
  • Avoid bleach/alcohol/abrasives on touch screens.
  • Simulation Asus tablets will be wiped down after every simulation using 70% isopropyl alcohol.
  • All laptops, computers, and AV touch panels will be wiped down after each simulation encounter.

Beds, Stretchers, Exam Tables, Chairs

Mattresses, handrails, headboards, exam tables and chairs will be cleaned and disinfected after each simulation by simulation lab personnel with the Environmental Protection Agency’s list of approved disinfectants and solutions to be used against COVID-19, referred to as “List N”.

Disposable paper drapes may be used in place of bedsheets and will be disposed of after each simulation.

References/Additional Information

Face Cloth Coverings
The DOH recommends cloth face coverings when in public settings where maintaining 6 feet of distance from others is not possible. Guidance on Cloth Face Coverings from the Washington State Department of Health (PDF). 

Hand Washing
Fight Germs. Wash Your Hands Demonstration
Covid-19 Handwashing PSA (CDC) 

2020 Guidance on Preparing Workplaces for COVID-19 (PDF)

Cleaning
Cleaning and Disinfecting Your Facility
Cleaning and Disinfecting for Healthcare Simulation


Developed: 18 May 2020 by Kevin Stevens RN, MSN, MS, RD, CHSE

Based on guidelines developed by Prof. Nikki Bly, Highline College shared through CNEWS and Columbia University School of Nursing shared through SSiH listserve.

Approved: 20 May 2020 by WSU CON program and campus directors, ADAA, Assistant Dean for Community Engagement, Associate Dean for Academic Affairs.