JOINT STATEMENT FROM WASHINGTON STATE NURSES ASSOCIATION, SEIU HEALTHCARE 1199NW AND UFCW21 ON PERSONAL PROTECTIONS FOR HEALTHCARE WORKERS

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.