I have been a practicing RN in Northeast PA for 25 years. I have worked in many healthcare environments: Acute Care, Home Health/Hospice, Outpatient Clinics, Peri-Operative departments, just to name a few.
I also moonlighted as adjunct faculty at my alma mater teaching my most favorite class, “The Fundamentals of Nursing Lab.” I took this class a little over a decade before I taught it, and the fundamental skills taught in that lab remain my favorite part of being a nurse: actually taking care of patients. I love the science behind how each medication affects a patient’s pathophysiology at the cellular level, I love understanding the rationale behind technology like a ventilator’s tidal volume setting for one patient versus another, I love assisting interventionists in procedures that improve patients’ quality of life. But none of it compares to interacting with patients and providing the service of taking care of patients when they’re too sick to do so.
In this lab, I taught the sweetest young men and women things like bedmaking, bedbaths, bandaging. Among our topics, we covered donning (putting on) and doffing (taking off) disposable personal protective equipment (PPE). It is an exact science. The students performed “return demonstrations” that were graded pass/fail. And deviation from the detailed technique meant the nursing students had to make another appointment and come back to try to pass again. It is such serious business because any slight deviation from each careful step can mean contamination for the nurse or the patient. And, under no circumstance, was disposable PPE to be reused. This is what I was taught and what I taught. (Source)
On March 21, 2020, I laughed out loud when Donald Trump suggested, “We have very good liquids for doing this, sanitizing the masks, and that’s something they’re starting to do more and more. They’re sanitizing the masks.” I played the video clip for my husband, and we laughed together. On March 21, 2020, the idea of reusing disposable paper masks and using “liquids” on them between use was a funny joke and evidence that our president, yet again, believed he was an expert in all areas of life, reminiscent of his “raking the forest” comments from November 2018 while discussing California wildfires.
Now our reality in healthcare here in Northeast PA is that there is no supply chain from which we can get N95 masks, and we are using “liquids” to sanitize our reused and contaminated, disposable PPE. The lack of PPE with no hope of replacing our current supplies has created a very unsafe situation for front line healthcare workers. I have not read of any healthcare systems in any geographical area of the U.S. that has access to PPE supplies in such a way that they can dispose of N95 masks after each use. That is until Sunday, April 12th when my local newspaper, The Times-Tribune, hinted at the idea things may be different at a hospital in Northeast PA.
On the front page of that newspaper, a follow-up story ran to debunk a recent Washington Post article where a pregnant nurse described floating between a COVID19 patient unit and immunocompromised cancer patients and neonates while being forced to reuse PPE. The CEO of that hospital made a statement “We adamantly disagree with the newspaper’s representation of our response to COVID19” while simultaneously verifying both complaints: nursing staff is currently being deployed to units where they are needed, and the hospital is following the guidelines set forth by the CDC and the PA Department of Health—guidelines that detail how to “safely” reuse PPE. I’m not exactly sure why this CEO would speak out against the facts being shared by that nurse only to prove her right.
No matter how you look at the issue of reusing disposable PPE, one must acknowledge that experienced, skilled healthcare providers are being asked to “unlearn” what they know. The Best Practices for disposable PPE is single-use and proper immediate disposal. There is no denying this simple fact. Healthcare Facilities are doing what they’re forced to do in light of an absent supply chain as each facility prepares for surges in COVID19 cases.
That these experienced, skilled healthcare providers are our front lines against a virus killing Americans. Why can’t facilities get PPE? Why has our president not used the Defense Production Act to get supplies to our front lines?
By JenRN, Northeast PA
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Centers for Disease Control and Prevention. (March 27, 2020). “Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings”. Retrieved from: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
Pennsylvania Department of Health. (March 11, 2020). “Alert: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings”. Retrieved from: https://www.health.pa.gov/topics/Documents/HAN/2020-PAHAN-486-03-11-ALT%20- %20Infect%20Pr.pdf