As hospi­tals nation­wide develop plans to reopen elective surgeries and other proce­dures suspended during the COVID-19 crisis, it is essen­tial to resolve the problem of inade­quate Personal Protec­tive Equip­ment (PPE) first. Since early March, health care workers have been unable to use personal protec­tive equip­ment according to product labeling and longstanding infec­tion preven­tion and control standards.

An overwhelming majority, 89% of WSNA repre­sented nurses in 75% of the largest WSNA repre­sented hospi­tals and facil­i­ties, are deliv­ering care without suffi­cient PPE. This means they are contin­u­ally operating in contin­gency or crisis capacity. Masks are worn for extended periods of times and between patients; masks are reused — removed, stored and redonned over a period of hours and sometimes days; respi­ra­tors are worn until breaking or becoming ineffec­tive, and face shields are re-worn without proper cleaning according to manufacturer’s recom­men­da­tion. Cloth gowns replace dispos­able barrier gowns and are reused multiple times. 

While the FDA has autho­rized emergency permits to disin­fect dispos­able N95 respi­ra­tors, evidence and practices vary on the number of times that a respi­rator may be safely decon­t­a­m­i­nated. In addition, there have been indica­tions that some employers may use Ethylene Oxide for N95 mask decon­t­a­m­i­na­tion, though this is a known carcinogen and as of April 21, 2020 has not been granted FDA emergency autho­riza­tion for use.

Reopening elective surgeries will uninten­tion­ally create internal compe­ti­tion for personal protec­tive equip­ment and further strain our ability to safely care for suspected and confirmed COVID-19 patients. 

Washington state reports shipments of much needed supplies, though nurses in many hospi­tals state that they haven’t seen them on their units and continue to use PPE under contin­gency and crisis guide­lines from the CDC. These guide­lines must not become the new normal.

Nurses and other health care workers have demon­strated commit­ment in caring for patients through the COVID-19 crisis despite the lack of the protec­tive equip­ment needed for their own safety as well as that of their patients and families. They are putting themselves at risk every time they go to work.

While WSNA recog­nizes the need to reopen elective surgeries to provide health care services and to get furloughed health care workers back on the job, it is critical to ensure that nurses and other front line workers have the protec­tive equip­ment so desper­ately needed before diverting PPE to non-essen­tial treat­ments and proce­dures. Equally impor­tant is the need to ensure avail­ability of testing to rapidly identify, isolate and provide contact tracing for those infected with the coron­avirus, including health care workers.

Reopening elective proce­dure areas and surgical centers must happen respon­sibly. We must have adequate protec­tive equip­ment and acces­sible testing for nurses and health care workers on the front lines of the COVID-19 crisis first.

Sally Watkins, execu­tive director of the Washington State Nurses Association:

The bottom line is we as a state cannot reopen elective proce­dures before we have enough personal protec­tive equip­ment for the nurses and other health care workers on the front lines caring for COVID-19 patients and for those working in other areas of hospi­tals where they could be exposed.

The vast majority of hospi­tals and facil­i­ties where our nurses work continue to operate at crisis or contin­gency levels as regards personal protec­tive equip­ment. That means things like masks and gowns are worn for extended periods and between patients. It means masks, N95s and face shields are getting cleaned and reused with methods outside of manufac­turers’ recom­men­da­tions. This cannot become the new normal.

WSNA supports Governor Inslee’s measured, science-based approach of safely returning to public life. In partic­u­larly, we support his call for suffi­cient surge capacity and PPE” prior to restarting elective surgeries.”

Watch WSNA’s video of soiled, broken and stored PPE: