MINNEAPOLIS — The nationwide shortage of personal protective equipment (PPE) has already prompted Minnesota hospitals to begin rationing it, according to internal hospital records obtained by KARE 11 along with interviews with over a dozen of Minnesota’s frontline health care workers.
Records show Twin Cities area hospitals have adopted practices that would have been considered improper just a month ago. That has frontline workers battling coronavirus worried they’re being put at higher risk of being infected.
“I think that is probably what makes most bedside caregivers the most nervous right now is: Am I going in protected well enough that I can show up to work tomorrow and do this again?” said Twin Cities nurse Kelley Anaas.
If too many doctors and nurses get sick, Anaas and other health care workers said staff shortages could cripple the health care system. And they worry about infecting their own families.
“We’re scared,” Anaas said. “When health care workers are becoming patients themselves, that’s a problem.”
As the public sees shocking images of New York’s health care workers protecting themselves against infection by donning plastic trash bags, both Minnesota’s health care workers and hospitals say they have enough PPE – for now.
What they don’t know is how long supplies will last. They fear that at the rate PPE is typically used, they will soon run out.
As manufacturers race to ramp up production and hospitals wait for new supplies, health care systems across the state are trying to stretch out their existing stock as long as possible, according to doctors and nurses who spoke to KARE 11 and records we obtained.
One example is the dramatic change in how specialized N95 respirator masks are being used. Those masks help protect medical workers from airborne viruses like COVID-19.
For years, nurses say they were taught to use a mask to treat one seriously infected person, then dispose of it in order to prevent the spread of infection.
That has changed.
“We’re being told to use the masks multiple times over,” said Anaas, who works in the ICU at Abbott Northwestern, the largest not-for-profit hospital in the metro area.
Nurses now use the same mask to treat multiple patients. And instead of throwing the mask away when they have a break in their shift, she says nurses sometimes keep them in paper bags to be used when they come to work again.
At Allina Health Care, which runs Abbott Northwestern, a copy of their PPE guidance obtained by KARE 11 shows that last week staff were told to limit the N95 mask to aerosol procedures such as intubation, and it should be continued to be worn until it’s soiled or taken off.
“This is a very challenging situation. Our PPE supply and use are carefully tracked at Allina Health,” the health care provider said in a statement. “We reassess our PPE supply daily to adapt to changes in community disease activity and PPE supply while striving to maximize staff safety. Our goal is to ensure our staff always have the correct PPE required when caring for patients who may, or are proven to have COVID-19.”
Too much risk?
Some health care workers believe the hospitals’ conservation efforts have gone too far.
Nurses who work at the metro-area M Health Fairview Hospitals, for example, voted no confidence on Thursday against hospital management, saying they were “flagrantly violating” their safety in response to coronavirus.
Modestus Okorie, who works at Bethesda Hospital in St. Paul, said face shields that used to be worn once before being thrown away are now being shared among the staff. Gowns he fears could be contaminated are instead re-used over and over.
“The way we’re being asked to use equipment poses a risk of transmission in the community and to our families,” he said.
M Health Fairview responded in a statement following the vote, saying that their focus was on delivering the best care for their patients while protecting their staff’s health and safety.
“We share their frustration with the national shortage of PPE. We continue to work with state and federal officials to obtain necessary supplies, purchasing whatever is available, and with the support of the community for donated supplies,” Fairview said.
At a HealthPartners clinic in Plymouth, KARE 11 obtained a video taken on March 26 during a drive-up test for coronavirus, showing the staffer didn’t change his gloves in between tests. Instead, he used hand sanitizer to clean gloves.
“Were you told not to change your gloves and just use the sanitizer?” the patient asks.
The worker replies: “No, it’s one or the other.”
The FDA has said that using alcohol-based sanitizers “may degrade” hospital gloves.
HealthPartners said in a statement that using hand sanitizer on the medical gloves violated protocols.
“Our protocol states that clinicians should remove gloves after administering a COVID-19 test, perform hand hygiene, and put new gloves on before administering the next COVID-19 test. We have educated – and will continue to educate – our colleagues about properly administering these tests, and we’ll monitor testing to ensure they’re performed as they should be.”
As of Friday, five health care workers were infected with coronavirus by other health workers, according to the Minnesota Department of Health.
But it’s unclear how often health care workers are being tested. Okorie, the nurse at Fairview, said nurses who believe they have been exposed to the virus have to wait several days before being tested, and go to work until then.
‘They will get sick’
For most routine care with confirmed or suspected COVID-19 patients, several hospitals have told frontline workers to wear and re-use surgical masks and face shields, according to records and interviews.
But experts say those masks and shields do too little to stop airborne droplets that could carry the virus. Dr. Lisa Brosseau, a retired professor and national expert on respiratory protection and infectious diseases, calls the hospital recommendations, “egregious.”
“Health care workers will get infected at a fairly high rate. They will get sick. They may die. And they will not be there when we have a surge,” Brosseau said. “And we will get stuck, because we were not there to help them.”
For the last two weeks Minnesota hospitals have been asking the federal government for more equipment, while even soliciting the public for donations. Until then, the hospitals say they are following CDC and Minnesota Department of Health Guidelines.
When it was clear there would be a shortage of N95 masks, the CDC changed its guidance on March 10 to say that surgical masks were an “acceptable alternative when the supply chain of respirators cannot meet the demand.”
Dr. Amy Cho, a Twin Cities emergency room physician, said she was disturbed by the change, fearing it was a compromised decision not based on science.
“That could spread infection,” she said.
Deaths in Italy
What worries Cho most about coronavirus is how it can be easily spread, including by people who are asymptomatic.
Cho looks at studies like one done in China, the COVID-19 virus was found on some of the most commonly used surfaces at a hospital, like doorknobs, computer keyboards and even hand sanitizer bottles.
She watches videos of South Korean hospital workers, who donned hazmat-like equipment when treating any suspected COVID patient in an emergency room. And she says her heart breaks when she reads stories out of Italy, where the virus infected more than 4,000 hospitals workers, killing more than 50 doctors, many of whom were treating sick patients when protective equipment was lacking.
Cho wants to prevent Minnesota from going down the same path.
“Health care workers want to protect patients, and we don’t want to contribute to the spread of the epidemic,” she said. “That's why it is so critical to have appropriate PPE."
Minnesota nurses on the front lines hope additional protective equipment arrives soon.
“We love our jobs, we’re good at our jobs, we’ve been well-trained to do our jobs. And we’re ready to do them,” nurse Kelley Anaas told KARE 11. “But we need to be kept safe so that we can do them.”
KARE 11’s coverage of the coronavirus is rooted in Facts, not Fear. Visit kare11.com/coronavirus for comprehensive coverage, find out what you need to know about the Midwest specifically, learn more about the symptoms, and keep tabs on the cases around the world here. Have a question? Text it to us at 763-797-7215. And get the latest coronavirus updates sent right to your inbox every morning. Subscribe to the KARE 11 Sunrise newsletter here. Help local families in need: www.kare11.com/give11.
The state of Minnesota has set up a hotline for general questions about coronavirus at 651-201-3920 or 1-800-657-3903, available 7 a.m. to 7 p.m.
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