SAN DIEGO — Hospital nurses working with COVID-19 patients are scared and upset over a new policy that OKs the use of less-protective surgical masks.
The policy change comes from the CDC and the World Health Organization. The more-protective N95 respirator masks are in short supply.
It directs nurses to use surgical masks for routine treatment of COVID-19 patients instead of N95 respirators. Reaction came fast on social media and in news interviews.
“We are on the front lines and as a person, as a human being, I'm concerned for my colleagues and the people I spend my time and my days with. I want everybody to be safe,” said Christine Bower-Baca, a neurologist with University of Colorado Hospital.
Medical protective gear is in short supply all across the country. The CEO of a hospital group in Georgia said he's never seen a run like this before.
“What normally takes us six months, we've gone through in just one week,” said CEO Scott Steiner of Phoebe Putney Health Hospitals.
Here in San Diego, nurses with UC San Diego Health are taking to social media by storm.
Nurse Tiffany Zalinski with Jacobs Medical Center in La Jolla posted on Facebook, “I know that we nurses are scared. I know that it is unethical to put us directly in harm's way.”
The nurse’s union National Nurses United agrees.
“Nurses are being asked to actually reuse masks, including surgical masks, which provide no protection,” said Bonnie Castillo, NNU executive director.
N95 respirators will still be used for more complicated procedures, like intubation and also inside the ICU.
UC San Diego Health emailed the following statement to News 8:
UC San Diego Health physicians, nurses and staff provide care to a wide variety of patients requiring contact, droplet and airborne precautions. We regularly train and expect all staff members to wear personal protective equipment (PPE) appropriate for the test or procedure they are performing, in accordance with evidence-based guidance from multiple health agencies, including the World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH). Training and education on the use of PPE for each type of precaution begins in medical and nursing school, and continues throughout a career. This fundamental skill is reviewed annually with all UC San Diego Health team members who interact with patients.
As new information becomes available specific to patients with COVID-19, system-wide emails and other communications platforms are used to keep all UC San Diego Health employees informed. Nursing supervisors and other managers review this information with their teams, and communications are archived and available on our intranet for future reference and guidance.
Recent protocol changes
As COVID-19 continues to evolve and spread in our community, we are following the WHO and CDC’s latest evidence-based changes to how we care for possible COVID-19 patients. Most recently, with the aforementioned guidance, UC San Diego Health and all other UC Health centers moved from airborne protections to droplet/contact protections when caring for suspected and diagnosed COVID-19 patients. This means that for routine care of patients with COVID-19, staff wear gowns, gloves, eye protection and surgical face masks, but no longer need to use N95 respirators. Staff will continue to use N95 respirators during more complicated procedures, such as intubation, bronchoscopy and nebulizer treatments.
Staff should never reuse any PPE that has been used for COVID-19 patients, except goggles and a type of respirator called a PAPR, as these can be cleaned using Oxivir 1 disinfectant. Reuse of other PPE used for COVID-19 patients, even in an attempt to reduce usage, is not acceptable. This continues to be UC San Diego Health policy.
We are aware that messages shared by the California Nurses Association regarding Cal-OSHA standards may differ. However, the CDC and WHO guidelines followed by UC San Diego Health and UC Health represent the latest, state-of-the-art, evidence-based analyses by national and international authorities on the most appropriate standards of care.
N95 respirator availability
The availability of N95 respirators is constrained globally. UC San Diego Health’s supply chain managers are monitoring the daily use of supplies and took early action to secure a supply of N95 respirators. UC San Diego Health, and all responsible health care systems, are following strategies provided by the CDC for optimizing stocks of N95 respirators. These include regular reminders to staff to conserve N95 respirators through best practices, such as using them only when they are required; distributing respirators daily to teams caring for patients under airborne precautions; and implementing practices that allow for extended use or limited reuse of N95 respirators for non-COVID-19 cases.
Additionally, we have secured a supply of N95 respirators from a manufacturer different from our routine supplier. We began fit-testing physicians and nurses for this new mask several weeks ago. With these two sources of N95 respirators, we have an adequate supply to keep our team members safe and productive. We continue to be in close contact with vendors, CDC, CDPH and San Diego County as we monitor ongoing respirator availability and other necessary items.
Communicating with staff
We have been communicating with our staff multiple times each day since activation of our Hospital Command Center (HCC) on February 5, 2020, to manage our response to COVID-19. Our HCC, in coordination with executive leadership, nursing leadership, infectious disease specialists and other subject matter experts, are providing up-to-the-minute information about patient care, supply chain management, PPE use and other developments via frequent system-wide emails, regularly updated intranet content and video training, plus regular in-person communication and training with managers and supervisors.