Implementing Physical Distancing in the Hospital: A Key Strategy to Prevent Nosocomial Transmission of COVID-19

Hospitalists serve as frontline healthcare professionals caring for the increasing number of COVID-19 patients in the United States. The safety of hospitalists and other frontline healthcare workers is paramount to preventing high nosocomial transmission as has been reported in several other countries. Much effort to date has rightly focused on ensuring healthcare workers have appropriate personal protective equipment (PPE) given the known increased risk of nosocomial infection to healthcare workers. However, another important strategy to prevent nosocomial transmission is to implement “social distancing,” or avoiding close contact with others. While this approach has received considerable press with regards to implementation in communities, social, or physical, distancing in the hospital is also a critical way to prevent nosocomial transmission and ensure the health and welfare of our workforce to meet the challenge. The Centers for Disease Control and Prevention (CDC) defines close contact as less than 6 feet away for over 10 minutes.¹ Given the myriad clinical interactions that occur within teams in the hospital, such distancing can prove challenging.

At the University of Chicago Medicine in Illinois, our hospitalist group was an early adopter of implementing several strategies to facilitate physical distancing in the context of clinical care to minimize community transmission of COVID-19 among healthcare professionals. We describe how to implement physical distancing effectively in specific hospital settings, including some challenges and strategies to surmount them.

Educational conferences and administrative meetings need to be transitioned to virtual meetings. While it may be easy to broadcast a conference in lieu of meeting in a conference room, it is critical that hospital clinicians do not “huddle close together” in front of a computer, which would defeat the purpose of physical distancing. While “flipping the classroom” in preclinical and higher education is common, this method can be effective to deliver standard education followed by a virtual question and answer session or chat room.²

Educational discussions can also occur asynchronously through learning management systems, such as Canvas, or even closed social media channels, such as Slack, that enable discussions. These tools require training to work, so it is important to invest in education on the chosen platform to ensure that it functions smoothly. It is equally important that administrators become familiar with these tools while working remotely and can facilitate administrative meetings without difficulty. We created a one-page tip sheet to help ease the transition for department administrators. The tip sheet highlighted how to start a virtual meeting and meeting etiquette (eg, mute upon entry into the meeting, mute when not talking, announce yourself when talking) as well as ensuring that dial-ins could easily access the meeting by including one-touch options, when available, on calendar invites in addition to the weblink. A daily email update can be an important adjunct to administrative meetings to ensure critical updates are reaching all clinicians in a group and also preserves meeting time for clarifying questions.