Modified Infection Control Standards
Going directly against previous evidence-based infection control measures, hospitals have loosened their safety regulations to ration personal protective equipment (PPE). Six months ago, in most health facilities, reusing an N95 mask or wearing a trash bag would have been grounds for disciplinary action. These days, the same actions are encouraged by hospitals hit by COVID-19.
Because of relaxed infection control standards, healthcare professionals working on the frontlines fear for the safety of themselves, their patients, colleagues, and families. They are afraid that health measures that previously kept them safe from diseases such as influenza and HIV are no longer there to protect them during a time when health measures are needed the most—during the COVID-19 pandemic.
Caught unprepared for rising COVID-19 infections, the US faces a critical shortage of PPE. To address this issue, the Centers for Disease Control and Prevention (CDC) relaxed guidelines for PPE –allowing for the use of such non-medical items like bandannas in place of a surgical mask or N95s. Shortly after the CDC relaxed its guidelines, the National Institute for Occupational Safety and Health (NIOSH) followed suit.
COVID-19 Among Nurses
The National Nurses Union (NNU) is the largest nurse’s union in the US. The NNU fears that substandard infection control measures endanger the safety of nurses and patients, rather than address the actual problem –a shortage of vital PPE. Instead of preventing the spread of infectious disease, as the CDC and NIOSH guidelines are meant to do, the new guidelines may be encouraging its spread to essential frontline healthcare workers.
A University of Washington Center for Health Workforce Studies report projections of approximately 400,000 nurse infected cases of COVID-19 in the US. The estimated deaths measure at 6,809 to19,125. Its projections for healthcare worker infections and deaths, in general, are even tragically higher at 2.5 million infections and 120,00 deaths.
Advocating for Colleagues and Patients
In response to lowered hospital standards and the lack of PPE, nurses have been speaking out regarding the need for PPE’s and adherence to former (higher) infection control measures. Concerned for their safety, the wellbeing of their families, and the health of their patients, nurses are demanding the provision of adequate PPE’s and the re-institution of appropriate evidence-based infection control standards.
In an article from The Guardian, Nurse Mike Gulick and nine of his colleagues were subject to suspension when they refused to enter a COVID-19 room without an N95 mask. N95 masks are standard PPE for airborne diseases, filtering out 95% of particles in the air, but the facility they worked for advised against their use. And although much is yet unknown about COVID-19, it has been confirmed to be a highly transmissible virus, present in fine droplets expelled by infected individuals, and possibly airborne. Hospital administrators, however, deemed the N95 masks unnecessary and failed to provide Nurse Gulick and his colleagues with the PPE.
The nurses began refusing to enter COVID-19 positive patient rooms sometime after one of their fellow nurses at Providence Saint John’s Health Center, located in Santa Monica, California, tested positive for COVID-19. After the diagnosis, one of the doctors on the ward expressed worry about the lack of adequate PPE amongst the nurses. The nurses then decided to take action and manage their own safety.
Although the nurses remain suspended, Saint Jonn’s Health Center has since changed its policy regarding N95 masks. They now provide masks for all nurses assisting with COVID-19 patients.
Protests and PPE
NNU, who is the union representing the suspended nurses, has been vocal about the lack of PPE for nurses. They note how employers appear to be lowering standards and hoarding supplies to conserve PPE. Rationing and hoarding PPE, however, may only be allowing the virus to spread to healthcare workers and does not solve any long term infection control issues.
Saint John’s nurses are now amongst many healthcare professionals who are protesting the lack of PPE in their facilities. On April 21, 2020, nurses gathered outside of the White House to protest for the lack of COVID-19 tests and PPE. Gathered in their scrubs and wearing masks, nurses held up photos of healthcare professionals who had died of COVID-19 infection obtained while working with patients, possibly because of the lack of PPE.
The photos of deceased healthcare workers are a stark reminder of the possible costs of rationing PPE. Questions have popped up regarding whether the shortage of PPE is due to availability or costs. Rather than an actual lack of availability, nurses fear that PPE are instead rationed to eliminate extra costs. The fear is their lives are that hospitals are placing their lives on the line to save dollars.