COVID-19: No PPE!!

[BsnBull]

Hello all !! I'm at a loss of words for what I witnessed at a well-known hospital's Covid unit!! I saw nurse's walk into Covid positive rooms with only scrubs and surgical or mask only! No shield no gowns, no goggles!! Then I saw many go into the ventilated patients rooms and then step back to the nurses station talking to friends and charting!! Many not even washing their hands just sanitizing!! Has anyone else seen this practice lately???

[Kitiger, RN]

No, and I hope I don't!

[NRSKarenRN, BSN, RN]

Please report your concern to facilities Infection Control  Dept. to confirm facility policy adherence and/or to Compliance hotline.

Sanitizing hands with alcohol based product acceptable.

Infection Control in Healthcare | COVID-19 Treatment Guidelines
 

Quote

 

For health care workers who are performing aerosol-generating procedures on patients with COVID-19, the COVID-19 Treatment Guidelines Panel (the Panel) recommends using an N95 respirator (or equivalent or higher-level respirator) rather than surgical masks, in addition to other personal protective equipment (PPE) (I.e., gloves, gown, and eye protection such as a face shield or safety goggles) (AIII).

Aerosol-generating procedures include endotracheal intubation and extubation, sputum induction, bronchoscopy, mini-bronchoalveolar lavage, open suctioning of airways, manual ventilation, unintentional or intentional ventilator disconnections, noninvasive positive pressure ventilation (NIPPV) (e.g., bilevel positive airway pressure [BiPAP], continuous positive airway pressure [CPAP]), cardiopulmonary resuscitation, and, potentially, nebulizer administration and high-flow oxygen delivery. Caution regarding aerosol generation is appropriate in situations such as tracheostomy and proning, where ventilator disconnections are likely to occur.

For health care workers who are providing usual care for non-ventilated patients with COVID-19, the Panel recommends using an N95 respirator (or equivalent or higher-level respirator) or a surgical mask, in addition to other PPE (I.e., gloves, gown, and eye protection such as a face shield or safety goggles) (AII).

For health care workers who are performing non-aerosol-generating procedures on patients with COVID-19 who are on closed-circuit mechanical ventilation, the Panel recommends using an N95 respirator (or equivalent or higher-level respirator), in addition to other PPE (I.e., gloves, gown, and eye protection such as a face shield or safety goggles) because ventilator circuits may become disrupted unexpectedly.

 

[Corey Narry, MSN, RN, NP]

1 hour ago, BsnBull said:

Hello all !! I'm at a loss of words for what I witnessed at a well-known hospital's Covid unit!! I saw nurse's walk into Covid positive rooms with only scrubs and surgical or mask only! No shield no gowns, no goggles!! Then I saw many go into the ventilated patients rooms and then step back to the nurses station talking to friends and charting!! Many not even washing their hands just sanitizing!! Has anyone else seen this practice lately???

If you are referring to using a wall dispenser to sanitize the hands with an alcohol-based gel after exiting a room, that qualifies as washing hands.  Unless the hands are visibly soiled, it's an accepted alternative for handwashing with soap and water except for patients with C diff infection.  If what you're seeing in the workplace violates COVID-19 infection control precautions, then you should report it to your local health department.  In our county, there is an online reporting system for such issues and the link is posted conspicuously in the hallways. 

[MunoRN, RN]

There have been a number of states' departments of health and departments of labor that have taken the position that only surgical / procedure masks are necessary when caring for Covid positive patients. 

At the federal level, OSHA would appear to disagree with that and require NIOSH approved respirators with the exception of when a facility meets CDC criteria for limiting respirator use to "Aerosol Generating Procedures", which is itself an embarrassingly stupid premise, but OSHA hasn't appeared interested in enforcing it's requirements over conflicting state requirements.  

As for 'sanitizing' with alcohol vs handwashing, there's no reason to believe there is a benefit to handwashing vs alcohol based hand hygiene when it comes to Covid.  

[TheMoonisMyLantern, ADN, LPN, RN]

My hands were completely raw this past week from handwashing on the covid unit. Skin was cracking, contact dermatitis appearing, the research I did actually suggested for healthcare workers working with covid to use hand sanitizer with moisturizers to maintain skin integrity during the dry months. I've always been a big fan of soap and water so I'm still doing a lot of handwashing but I'm also using more hand sanitizer which is helping my poor hands. ?

[BsnBull]

Thanks all for your input!! All of you have helped me with wrapping my mind around all of this. So I did get that using the wall station hand sanitizer is sufficient enough. I guess I was more concerned about the airborne room doors being cracked open, and no gowns being used while they were in the rooms performing care. It's like the precaution protocol's have become too relaxed by some staff! And I looked at the staff as possible super spreaders by leaving the rooms with the same scrubs on and sitting at the nurses station, going into the breakrooms, etc. 

 

 

 

 

[NRSKarenRN, BSN, RN]

So what have you decided to do about your concerns?

[carti, BSN, RN]

I just wear an n95 respirator if I'm going inside their rooms to fix a beeping IV alarm or something minor like that. I don't see the point in wasting supplies if imma be in the room for <2 minutes & not touching the patient. I don't think anyone actually does handwashing at my hospital tbh unless we did something dirty like change soiled bedsheets. It's also very common to take off our masks in the nursing station if were drinking water or having a tiny snack. I guess we can break "some " rules as night shifters LOL

[JBMmom, MSN, NP]

Our patients are not in airborn precautions. We only have one critical care bed that has negative pressure and maybe half a dozen med-surg negative pressure rooms. Airborn precautions don't seem to be necessary, and on our med-surg unit for the beds that are more than 15 feet from the door they do leave the doors open. (our ICU rooms are too small so the doors remain shut) 

As far as not wearing a gown, I can't imagine that is acceptable practice in any hospitals at this time. I know sometimes people think they're just going in for a second and won't touch anything, but I figure you never know when I'm going to have to do something I didn't expect and I'd rather be prepared. Not worth saving the paper gown. 

[CCU BSN RN]

If I actually followed our hospital's 'donning and doffing' guidelines every time I entered a COVID room: 

1. We would be out of gowns and gloves

2. My patients would be dead, because their levophed would be paused for the 4-6 minutes it would take me to reach the 'upstream occlusion' alarm. And that's 4-6 minutes if I'm right there and catch it right away. Usually I'm in another of my 4 ICU patient's rooms, and don't notice until their SBP is 50. 

 

So yeah. I sanitize my hands. I wear a mask and eyewear at all times while inside of the walls of the hospital. But the rest of the PPE guidelines at my hospital would mean hundreds of deaths, and I'm not willing to do something I feel would be akin to murder just because a hospital administrator teamed up with a hospital lawyer to determine how to avoid legal responsibility. 

Finally, to clarify, if there are adequate time and resources, and if I'm going in to a room to touch a patient or provide any direct care...of course I'm following our policy to a T. But if each of us wasted 120 gowns a shift for trips into a room that are so short we sometimes hold our breath if we don't have an N-95 nearby...nobody would be happier or safer.