Health care employers neglect workplace protections amid pandemic, instead blame nurses for infections

Submitted by ADonahue on
Nurse holds sign "PPE Now"

Since the beginning of the Covid-19 pandemic, nurses and health care workers have called for employers and governments to follow the precautionary principle—that we shouldn’t wait for proof of harm before implementing measures to protect health. With a novel virus like the one that causes Covid-19, we needed to start with the highest level of protections, taking layers off as we learned because adding protections after the fact is not possible.

Now, nearly a year into the pandemic, a growing body of scientific research affirms the need for comprehensive infection control plans and optimal PPE to prevent transmission of Covid-19 within health care facilities. And yet, hospitals and other health care employers continue to neglect basic infection control measures. As of XX, at least XX health care workers and at least XX nurses have died from Covid-19.

Infection Control Measures to Prevent Transmission of Covid-19 in Health Care Facilities and Supporting Scientific ResearchNNU’s Most Recent Covid-19 Survey of Nurses Shows Continued Failure of Employers to Prevent Occupational Covid-19 Exposuresi

Dedicated Units (no mixed units, no mixed assignments) 

Chen et al., Anesthesia & Analgesia, July 2020.
Glasbey et al., J Clinical Oncology, Oct 2020.
Liu et al., Frontiers in Public Health, Oct 2020.

Hospitals and other health care facilities mix Covid-19, suspected Covid-19, and non-Covid-19 patients.

  • Only 60 percent of RNs who work in hospitals report that their facility has a dedicated Covid unit or area.  
  • Nearly 10 percent of RNs in hospitals report that their facilities shut down their Covid unit or area.

Screening All Patients for Covid-19 (symptom screening, testing, and recent exposure history)

Burns et al., J Hospital Infection, Nov 8, 2020.
Khonyongwa et al., J Hosp Inf, Oct 13.
Piapan et al., J Hosp Inf, Aug 13.
Touati et al., J Hosp Inf, July 15.

Hospitals and other health care facilities do not effectively screen patients for Covid-19. Given that approximately 50% of transmission is from asymptomatic or presymptomatic infections, all patients, regardless of symptoms, should be considered potentially infected with Covid-19.

  • Just 16.5 percent of RNs in hospitals report they have universal PPE in the emergency department.  
  • Only one in five nurses report that all patients are screened for respiratory symptoms before admission to a health care facility; 43.6% of RNs who work in hospitals report that all patients are screened for Covid-19.

Optimal Personal Protective Equipment (PPE)

Bhaskar & Arun, JAMA, Aug 17, 2020.
Chin et al., Anesthesia & Analgesia, July 2020.
Feldman et al., JAMA, April 2020.
Hou et al., Precision Clinical Medicine, July 20, 2020,.
Jung, Jiwon et al., Journal of Infection, June 24, 2020.
Marago, Italo and Isa Minen, Lancet, July 27, 2020.
Nguyen et al., The Lancet Public Health, July 31.
Oksanen et al., medRxiv, Aug 18, 2020.
Park et al., J Hosp Infection, Oct 16.
Tong et al., Immun Inflamm Dis, Aug 20, 2020.
Wang, H et al., J Hospital Infection, April 15, 2020.
Wang, Wei et al., medRxiv, April 28, 2020.
Wang, Xinghuan et al., J Hospital Infection, March 3, 2020.
Xue, Ming et al., Hospital Practice, July 26, 2020.
Zhan et al., AJIC, Aug 10, 2020.
Zhu & Zong, QJM An International Journal of Medicine, Aug 18, 2020.

Employers are not providing nurses and health care workers with the necessary PPE to do their jobs safely.  

  • More than 80 percent of nurses report they reusing at least one type of single-use PPE.  
  • About 20 percent of nurses in hospitals report that their employer has recently limited the use of N95 respirator masks.

Testing for Nurses and Health Care Workers (after exposure and weekly for surveillance)

Chin et al., Clin Infect Dis, Oct 26.

Nurses are not getting tested and are not being informed in a timely manner when they are exposed to Covid-19 at work.  

  • Only one-third of RNs overall and fewer than half (42 percent) of RNs in hospitals report that they have ever been tested for Covid-19.  
  • Over 70 percent of nurses say their employers do not inform them of exposures in a timely manner.

Staffing

Maltezou et al., Journal of Hospital Infection, Oct 2020.
Kim et al., NEJM Catalyst, June 2020.

Short staffing was an issue for many nurses before the pandemic; now, employers are using the pandemic as an excuse to cut corners and short staffing is at crisis levels.

  • Nearly half of hospital nurses report that staffing has gotten slightly or much worse recently.   
  • In addition, 20 percent of nurses report being reassigned to units where new skills or competencies are required, without adequate training.

 

Minnesota Star Tribune acrticle

 

Northeast Ohio healthcare workers getting COVID from community spread, Cleveland Clinic doctor says

 

Thousands of health care workers sickened by coronavirus, worsening crisis in L.A. County hospitals

 

Nurses hold signs "Protect Nurses"

Employers are blaming nurses and health care workers when they claim staff infections happen only in break rooms and community settings.

The fact of the matter is that nurses and health care workers do not have the protections they need to care for Covid-19 patients safely.  

Employers may say they have data that indicates that staff infections happen in break rooms and community settings, but little of that data has been shared publicly and there is a common flaw in the data that has been shared.

 

Employers use the CDC’s definition of exposure, but this definition denies science:

A HCP should be excluded from work for 14 days if they have had prolonged close contact (15 min within 6 feet) with a person with confirmed COVID-19 IF

  • The HCP was not wearing a respirator or facemask;
  • The HCP was not wearing eye protection if the person with COVID-19 was not wearing a face covering; or
  • The HCP was not wearing all recommended PPE (gown, gloves, eye protection, respirator) while performing an aerosol-generating procedure.

But we know that:

  • A definition of exposure should not be contingent on an arbitrary 15-minute timeframe. There are multiple reports of infections that occurred with exposures less than 15 minutes.ii
  • A definition of exposure should not be contingent on an arbitrary 6-foot distance. Covid-19 is transmitted via infectious aerosols emitted when people who are infected breathe, speak, cough, sneeze, sing, or have aerosol-generating procedures performed. These aerosols range from very small to large and can travel long distances (up to about 25 feet) and stay suspended in the air.iii
  • A facemask does NOT provide adequate protection from Covid-19. Infectious aerosols can travel around and through a facemask. A respirator at least as protective as an N95, in addition to other PPE, is necessary to protect nurses and health care workers from Covid-19.

 

Nurses hold signs "Protect Nurses"

The bottom line is — employers have a legal and moral obligation to provide a safe and healthful workplace to employees.

For Covid-19 that means:

  • Comprehensive infection control plans (as listed above) and optimal PPE, including a powered air-purifying respirator, coveralls that are impervious to virus and head and shoe coverings, and medical-grade gloves. Under no circumstances should a health care worker be expected to care for a suspected or confirmed Covid-19 patient without a respirator at least as protective as an N95.
  • Safe spaces for meal and rest breaks- which may require employers to create additional spaces for breaks during the Covid-19 pandemic.