Occupational Therapist Provides Inspiration and Expert Care

Lea Tsao, MS, CSRS

The Rehabilitation Department at Mount Sinai West would like to highlight Lea Tsao, MS, CSRS, an occupational therapist who works on our inpatient unit and on the acute medical floors.

When Lea started working with us, she was immediately dedicated to patients, willing to learn, and eager to help. She has a track record for going above and beyond for her patients, giving them not only excellent care but in difficult moments giving heartfelt words of encouragement that could inspire anyone else in the room listening.

Lea has been involved in several challenging cases, but we’d especially like to acknowledge her role in helping a patient who had a complex clinical presentation and a limited support system. Over several months, Lea remained an advocate for his functional progress and for the goal of getting him home.  She advocated for interdisciplinary communication, family involvement, and comprehensive care. Her consistency allowed for the continuity of care we strive for as health care providers to best meet the individual needs of our patients.

Without a doubt, this patient also benefitted from the care of numerous physical therapists, including Caitlin Counihan, Victor Rhee, and Erika Chason. Many of them worked to bring the patient’s mobility closer and closer toward functional independence.

We are very lucky to have a team of dedicated therapists and good human beings.

 

Ditch the Itch: Avoiding Skin Reactions to Halloween Costumes and Make Up

Halloween treats, costumes, and decorations are exciting for parents and children alike, but these holiday staples may be associated with unpleasant allergic reactions, such as contact dermatitis or urticaria (hives). As Halloween approaches and you are choosing your child’s costume, here are some helpful tips from Melissa Levoska, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai on how to protect your child’s skin.

Know the signs of a reaction

Your child may be experiencing an adverse skin reaction if redness, itching, dryness or blistering of the skin develops. If you notice these signs, immediately wash off any make-up/body paint and remove their costume and accessories. For some children, the rash may improve with removal of the offending agent, but others may require treatment topical corticosteroids or oral antihistamines. Contact your doctor if your child isn’t improving.

Do a spot check before applying face paint and makeup

Face paint and make-ups may contain preservatives such as methylchloroisothiazolinone/methylisothiazolinone, dyes, or fragrances that can be irritating to the skin. Be sure to test the face paint or makeup on a small area of your child’s skin, such as a spot on the arm, three to five days prior to full application on Halloween, to make sure your child does not develop a reaction.

Avoid false eyelashes and nails

Fake eyelashes are held in place with glues and acrylic nails, and contain potential contact allergens such as cyanoacrylates, latex, and formaldehyde. Furthermore, these products may damage your child’s nails and eyelashes over time.

Beware of hidden nickel  

Costume jewelry and accessories, such as belts, can also cause skin reactions as they commonly contain metals such as nickel, which is one of the most common causes of allergic contact dermatitis.

Opt for a natural, breathable fabric

When choosing a costume for your child, 100 percent cotton fabric is recommended. Other materials, such as wool and polyester, may be irritating to the skin. Irritation is especially likely if your child has a history of sensitive skin or eczema. Looser fitting, breathable fabrics also decreases the incidence of skin issues on the big day.

Most importantly, have fun and Happy Halloween! 

Melissa Levoska, MD, is an Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai and a board-certified dermatologist. Her patients are her top priority, and she strives to provide compassionate and patient-centered care.

Recognizing Our Colleagues: Rio Rivera at Mount Sinai Queens

“Rio Rivera, a phlebotomist at Mount Sinai Queens, is exceptional! She is excellent at prioritizing ‘stat’ labs to ensure that they arrive to the lab in a timely manner, improving patient outcomes. She is hard-working, kind to all patients and staff, professional, and efficient. I appreciate that she takes her time with hard sticks, accepts challenges, and really does her best to locate the best vein and minimize the number of times a patient is stuck with a needle—decreasing their pain and risk of infection. And very importantly, she is usually very successful at getting the specimen we need! She is a team player. We are so lucky to have her!”

Hoda Farghaly, BSN, RN, 3 East, Mount Sinai Queens

COVID-19: How Do I Know If My Workplace Is Safe?

COVID-19 has fundamentally changed the workplace. To reduce the spread of the virus, some organizations have allowed more people to work remotely and instituted daily health checks and staggered start and break times for those working in-office.

Even with social distancing signage and the presence of hand sanitization stations, those unable to work from home may still be concerned about office safety. In this Q & A, Dana S. Mazo, MD, MSc, an Assistant Professor of Medicine (Infectious Disease) at the Icahn School of Medicine at Mount Sinai and physician lead for Infection Prevention at Mount Sinai Queens, offers practical advice on how to protect yourself in the office.

How do I know that my office is safe?

The U.S. Occupational Safety and Health Administration (OSHA) has put out a set of guidelines for larger offices during the COVID-19 pandemic. You can check with the facilities department or your manager to see if the building is following these recommendations.

The rules start with conducting a thorough risk assessment to identify potential workplace hazards that could increase risks for COVID-19 transmission. Building owners and facilities managers should modify or adjust seats, furniture, and workstations so employees sit at least six feet apart. OSHA also recommends improving ventilation in the building by increasing total airflow as well as the percentage of outdoor air in the offices. And, housekeeping should clean and disinfect all surfaces that are frequently touched by many people on at least a daily basis.

How should I clean my office?

Start by cleaning the major high-touch surfaces—such as your desktop, keyboard, mouse, and the arms of your chair—with a sanitizing wipe. Hard surfaces, such as desks and chairs, are more likely to hang onto germs than porous materials, such as paper. If you’re not sure whether to clean, remember an extra swipe can’t hurt.

It is important to clean surfaces after someone else has touched them, since it is possible to transmit the virus by touching a contaminated surface with your hand and then touching your face, especially mouth, nose or eyes. If someone else used your work space within the past three days, make sure to clean before you start work.

Having a personal air purifier might be helpful in your immediate area. But what would be more useful would be if the entire building follows OSHA recommendations on air flow during this time.

Do I need to wear a face covering throughout the entire day?

If you have a closed office all to yourself, you don’t need to wear a face covering until someone wants to come into your space. If you share the office with someone, you’ll want to wear your face covering all day. This recommendation is especially important if desks are closer than six feet apart, but when people are sharing office space for an extended amount of time, six feet is not a hard boundary.

Open office plans are a different story as you may sit close to several people. Plus, there are those who walk by on their way to a meeting, the lunchroom, or the bathroom. The safest advice is to wear a face covering, even if co-workers are more than six feet apart. Throughout the Mount Sinai Health System, employees are required to wear face coverings at all times, unless in a closed office by themselves. But, even if it is safe to take your face covering off because there are no co-workers close by, keep it handy. If someone stops to chat, try to keep a distance of six feet and put your face covering on. You may be thinking that if your colleague seems fine, and it’s just the two of you, you don’t need to cover your face. But remember, your office mate could be infectious but not have any symptoms.  Also, sharing the air with that person means you are at risk for everyone that person has had contact with—on their way to work, in the supermarket, or at home.

How should I navigate elevators and communal office spaces?

Always wear a face covering in hallways, bathrooms, meeting spaces, kitchens, and any other communal spaces. You never know when someone is going to come around the corner.

When riding the elevator, keep your face covering on. Most buildings limit the number of people on each elevator car, often at 50 percent capacity. This means even before you get to the elevator, you must be careful as lobbies may be full of people waiting for their turn to ride up. If there are so many people that you cannot socially distance, you may want to wait outside the lobby for a few minutes until the area clears. Remember, outdoors is always safer than indoors because of the air circulation and often greater space for social distancing.

Inside the elevator, try to keep an arm’s length away from anyone else and limit conversation as talking forces respiratory droplets into the air. And, if you must push a button for your floor, don’t forget to wash your hands after.

How do I safely eat lunch at the office?

Lunchtime is often the time of greatest risk for transmission, because you have to take off your mask. Also, people let their guard down. You may not have seen your colleagues in months and want to catch up. But you still need to be on guard. It is important to keep at least six feet away from people during lunch when your face covering is off so that you can eat and drink.

Additionally, remember to wash your hands after using highly touched items like the office refrigerator, sink, microwave, or water cooler.

What about the bathroom?

The one place you cannot avoid during a day in the office—other than your desk—is the bathroom. Make sure to keep on your face covering and create as much social distancing as possible. Try not to stand next to someone; if there are multiple sinks or urinals, leave an empty spot between you and anyone else. There are a lot of commonly touched items in bathrooms, so the key here is hand washing. Wash your hands when entering and leaving the bathroom. And, before you flush, close the toilet lid—if possible.

When in doubt, maintain social distance, wear a face covering and wash your hands.

Now that we’re back in the office, are in-person meetings safe?

The best way to meet during a pandemic is virtually. But if the whole point of coming into the office was to be able to interact in person, then you’re going to need to be creative. Face coverings are a given, but you also need to think about ways to maintain social distance. One option, if possible, is to meet outdoors. If that isn’t an option, think about using a large auditorium, even for a group of a dozen people, as it’s easier to keep six feet apart if you have a few people in a large space.

Wherever you go, you should take the basic COVID-19 precautions: face coverings, hand sanitizer, and disinfecting wipes. Some people also wear gloves, but most experts recommend against it. Because gloves can lead to complacency and you could easily end up touching your face or not washing your hands sufficiently. If you do wear gloves, remain vigilant.

Treating Patients As Family by Dr. Jeremy Boal

Part of what makes MSBI so unique is that our employees, regardless of discipline or role, create genuine connections with patients and take care of them even beyond their basic medical needs. We recently discharged a very special person who touched the hearts and souls of so many of our colleagues. I am inspired by the way so many of you cared for this patient as if he is family. 

This patient’s story is complicated. He is developmentally delayed and needs full-time care. Both he and his father, who was also his sole caretaker, contracted COVID-19 early on in the pandemic’s arrival in our region. His father did not recover, which left his son orphaned and anxious about being taken from the only home he has ever known.

Early on, Rachael Holbreich, MD, the psychiatry intern serving on 9 Silver, helped staff connect with him.

“Because he mainly expresses himself with non-verbal cues, it became apparent that the staff needed to adapt to better understand and communicate with him. I tried to set an example that he was a kind and loving person who does express his needs. This demonstrated that we can work with him and help him transition during this difficult time,” said Dr. Holbreich.

The staff quickly learned to understand our very special patient and took every step to help him heal, adopt him as their family, and find a new, stable home environment that met his needs.

When I say every step, I mean it:

  • Our social workers and physicians accompanied him to many group home interviews and oversaw his care until we could get him a new guardian. Our staff helped fit him for hearing aids, framed photos of his family in his room, and danced and made music with him.
  • Our psychiatry and music therapy teams regularly came to check in with him.
  • Denise Green, PCA on 9 Silver, would let him help with the linen to keep him busy. He loves the singer Selena, and she would play Selena videos for him on available workstations.
  • Fanny Castillo on our environmental services team would take him on walks through the unit. “He didn’t always understand what we were saying, but we always had a good time,” said Fanny.
  • Vivian Frimpomaa on our food services team also took incredible care of him. He preferred to eat his meal in the hallway, and she would help set up his table and put the condiments he liked directly on his food. She paid special attention to the menu items he liked.
  • It is impossible to name everyone who cared for him during his time with us, but it was a labor of love and based on teamwork across many different disciplines.

One of my favorite stories is that Alicia Tennenbaum, LCSW, our Senior Director of Social Work, advocated and got an expedited hearing to appoint him a guardian. She coordinated with the guardian to go to the patient’s home to gather some belongings like his stuffed animals to bring him comfort. His father had put a mechanism on the door to keep him from wandering out, and the guardian got locked inside the house. He had to climb the out the window and down the fire escape to get out. It was worth it. Having a few items from his home comforted our very special patient during this transitional time.

This new guardian cares deeply about him, and we recently discharged him to a group home in Queens. Paul Guzman, 9 Silver PCA, took the day off for his discharge so he could accompany him to his new home to ensure that he felt comfortable with the transition. Mr. Guzman has since traveled two hours each way to visit him multiple times and plans to continue twice a week. They have a special connection.

“When he got a certain look, I knew I needed to sit right next to him and just be there. Sometimes he needs to sit quietly near someone he trusts,” said Mr. Guzman. He is regularly in touch with the caretakers at the group home where he now lives.

“It was unexpected love. I will always be there for him,” he said.

Some of the other staff members have also checked in with him via FaceTime.

“I checked in with his new community, and he is doing very well. I’m thankful; he now has a community. We have improved his life in so many ways,” Ms. Tennenbaum said.

This is because of your extraordinary teamwork and compassion.

I am in awe of the compassionate, connected care you provide to our patients each and every day.

Keeping You and Our Community Safe by Dr. Jeremy Boal

After the nearly overwhelming pandemic came to our region in the first half of this year, I am thankful that we are in a better place now and can continue serving all the needs of our community members.

We have taken so many steps to ensure that our patients and colleagues are safe. I’m so thankful for everyone who is taking part in this.

The most observable change is that all of our entrances now require us, our patients, and our visitors to be temperature-checked and screened for other COVID-19 symptoms before or upon entering our facilities. Those who screen positive for symptoms then return home with education on how to contact Employee Health for further directions. I can’t stress how important this is. We have to guarantee everyone who steps foot inside our facilities to take care of patients is 100% healthy.

Implementing this new process is a complex endeavor that requires ongoing teamwork among our clinical, security, support, transformation and other teams. Thanks to many people across numerous departments for taking on screening shifts and welcoming our patients and employees to a safe environment. With your feedback, we will continue to fine tune and improve the process.

We are also taking many precautions prior to a patient’s ambulatory appointment to ensure safety for patients and staff. We test all pre-surgical patients for COVID-19 before their procedure and pre-screen ambulatory patients on the phone before they arrive. These are just a few examples of the many proactive actions we are taking.

Our Union Square concierge team has been particularly accommodating by pressing the elevator buttons for our patients. We greatly appreciate this. At Chelsea, the security team has been explaining the screening process to patients with kindness and empathy. In addition, you may have seen the social distancing signage all over our many locations to remind everyone to maintain maximal distancing.

There are many more actions we are taking to ensure safety in our facility. You can read about them on the Mount Sinai Safety Hub, which is updated regularly. You will also find material to help you communicate with patients and colleagues about these topics. I hope you will visit.

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