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: