State’s largest hospital and clinic unions call for highest possible level of personal protec­tion for caregivers during COVID-19 outbreak

The CDC has announced new interim recom­men­da­tions on the use of personal protec­tive equip­ment (PPE) for situa­tions where adequate supplies are unavail­able. The CDC recom­men­da­tions state that face masks are an accept­able alter­na­tive when the supply chain of respi­ra­tors cannot meet the demand. We maintain our position that N‑95 respi­ra­tors are the gold standard and are neces­sary protec­tion for our nurses and health­care workers caring for suspected and confirmed COVID-19 patients, and the CDC agrees that when the supply chain is restored, providers should return to the use of N95s. The CDC states that This interim guidance has been updated based on currently avail­able infor­ma­tion about COVID-19 and the current situa­tion in the United States, which includes reports of cases of commu­nity trans­mis­sion, infec­tions identi­fied in health­care personnel (HCP), and short­ages of facemasks, N95 filtering facepiece respi­ra­tors (FFRs) (commonly known as N95 respi­ra­tors), and gowns.”

The supply shortage must continue to be addressed in the most aggres­sive way possible. We continue to call on the CDC to proac­tively and effec­tively target the supply of respi­ra­tors and use other controls to reduce the risk of infec­tion in health care workers, knowing that our profes­sionals are at the highest risk of infec­tion. The federal govern­ment should do all in its power to increase the supply of N‑95 respi­ra­tors and other PPE, which includes releasing the national stock­pile and targeting supplies to areas where the outbreak has already occurred; incen­tivizing U.S.-based compa­nies to produce more N‑95s; and promoting the use of powered air purifying respi­ra­tors (PAPRs) in health care settings.

We addition­ally call on hospi­tals, clinics and other health care facil­i­ties to provide personal protec­tive equip­ment in an equitable manner. All health care workers — providers, nurses, technical staff and service workers including environ­mental services janito­rial staff — who have the poten­tial for direct or indirect exposure to COVID-19 must be afforded the same standard of PPE. Further­more, many health care workers speak English as a second language. Instruc­tion in the use of PPE and in safe work practices in environ­ments where COVID-19 may be present must be provided in multiple languages and in clear, uncom­pli­cated phrasing in order to increase access to essen­tial infor­ma­tion.

As nurses and health care workers, we care deeply for our patients and take pride in the roles we play on the front lines of patient care, partic­u­larly during a commu­nity health crisis like the one presented by COVID-19. We are committed to the health of our patients and our commu­ni­ties. We will continue to work closely with health care employers and with federal and local public health agencies to ensure all caregivers have access to the highest level of PPE avail­able so we can continue to provide the high-quality health care our commu­ni­ties require.

Highlights of CDC interim guidance issued March 10, 2020 based on key concerns we’ve heard from members:

Personal Protec­tive Equip­ment (PPE)

  • Facemasks are an accept­able alter­na­tive when the supply chain of respi­ra­tors cannot meet the demand. During this time, avail­able respi­ra­tors should be prior­i­tized for proce­dures that are likely to generate respi­ra­tory aerosols, which would pose the highest exposure risk to health care providers. 
    • Facemasks protect the wearer from splashes and sprays.
    • Respi­ra­tors, which filter inspired air, offer respi­ra­tory protection.
  • When the supply chain is restored, facil­i­ties with a respi­ra­tory protec­tion program should return to use of respi­ra­tors for patients with known or suspected COVID-19.
  • Facemasks are cleared by the U.S. Food and Drug Admin­is­tra­tion (FDA) for use as medical devices. Facemasks should be used once and then thrown away in the trash.

Adhere to Standard and Trans­mis­sion-Based Precau­tions

  • Health care providers who enter the room of a patient with known or suspected COVID-19 should adhere to Standard Precau­tions and use a respi­rator or facemask, gown, gloves, and eye protec­tion. When avail­able, respi­ra­tors (instead of facemasks) are preferred.

Train Health Care Providers on PPE

  • Provide health care providers with job-specific or task-specific educa­tion and training on preventing trans­mis­sion of infec­tious agents, including refresher training.
  • Ensure that health care providers are educated, trained, and have practiced the appro­priate use of PPE prior to caring for a patient, including atten­tion to correct use of PPE and preven­tion of conta­m­i­na­tion of clothing, skin, and environ­ment during the process of removing such equipment.

Patient Place­ment in Facil­i­ties

  • If admitted, place a patient with known or suspected COVID-19 in a single-person room with the door closed. The patient should have a dedicated bathroom.
  • Airborne Infec­tion Isola­tion Rooms (AIIRs) (See defin­i­tion of AIIR in appendix) should be reserved for patients who will be under­going aerosol-gener­ating procedures.
  • To the extent possible, patients with known or suspected COVID-19 should be housed in the same room for the duration of their stay in the facility (e.g., minimize room transfers)
  • Patients should wear a facemask to contain secre­tions during trans­port. If patients cannot tolerate a facemask or one is not avail­able, they should use tissues to cover their mouth and nose.
  • Consider alter­na­tive mecha­nisms for HCP and patient inter­ac­tions including telephones, video monitoring, and video-call appli­ca­tions on cell phones or tablets.
  • Whenever possible, perform procedures/​tests in the patient’s room.

Imple­ment Environ­mental Controls (cleaning equip­ment, etc.)

  • Dedicated medical equip­ment should be used when caring for patients with known or suspected COVID-19.
  • All non-dedicated, non-dispos­able medical equip­ment used for patient care should be cleaned and disin­fected according to manufacturer’s instruc­tions and facility policies.

Managing Visitors in Facilities

For COVID-19 Patients:

  • Limit visitors to patients with known or suspected COVID-19. Encourage use of alter­na­tive mecha­nisms for patient and visitor inter­ac­tions such as video-call appli­ca­tions on cell phones or tablets.
  • Visitors should not be present during AGPs or other specimen collec­tion procedures.
  • Visitors should be instructed to only visit the patient room. They should not go to other locations in the facility.

Additional consid­er­a­tions during periods of commu­nity trans­mis­sion (the Seattle area is in a period of commu­nity transmission): 

  • All visitors should be actively assessed for fever and respi­ra­tory symptoms upon entry to the facility. If fever or respi­ra­tory symptoms are present, visitor should not be allowed entry into the facility.
  • Limit points of entry to the facility.

Link to Interim Infec­tion Preven­tion and Control Recom­men­da­tions issued March 10, 2020 for Patients with Suspected or Confirmed Coron­avirus Disease 2019 (COVID-19) in Health­care Settings.