Both agencies answered in writing their declining to help nurses with the following:
We would like to pose a number of questions regarding the protection of nurses and as a result, patients, against Covid-19. The questions to follow are to help identify areas where new policies, procedures or guidelines may need to be emergently implemented:
Regarding Covid-19 is a Disease Transmitted by Droplet and Airborne Means
Should there be a policy, or guideline that identifies Covid-19 as being transmitted by droplet through an airborne mechanism and that it may be inhaled or contaminate hands, and surfaces? The CDC has categorized Covid-19 as an airborne disease and one that can be transmitted by droplet: The CDC on their Covid-19 page states the following: Transmission is through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html
Regarding Notification of Staff With Potential Exposure
How will nurses be notified of a known potential exposure? This would include notifying such as contract travel nurses, float, per-diem and agency nurses? and,
Should an exposed nurse self-quarantine and if so for how many days?
Regarding the Wearing of Uniforms, Shoes and Attire Worn While in Hospital
To further protect the community and nurses’ families should it not be a matter of policy that nurses change into scrubs, uniforms, and shoes after arrival at work? And should not nurses be required to change out of their attire before leaving the facility? Such practice is common in units such as the Neonatal Intensive Care Unit and perhaps similar policies could be implemented.
Regarding Protecting Nurses From Contracting Covid-19
Should not maximum PPE protection to include N-95 respirator masks, be worn in areas where patients do not have a known test result or history of exposure such as in outpatient areas, emergency rooms, and clinics? And,
Should not maximum PPE protection including N-95 respirator masks be mandatory whenever a nurse is expected to be within six feet of an infected or suspected to be infected person?
Should not all emergency room triage nurses and outpatient nurses be mandated to wear N-95 masks as they are a increased risk of unknown exposure from infected members of the community? And,
Should not there be a specific policy available clarifying when N-95 masks are required and when such as gowns, hair nets, goggles, shoe covers, and double gloves be worn to guide nurses in their practice? And,
Should not there be hospital system wide education, electronically communicated (such as online), of nurses on how and when to don PPE? Many nurses may have remote, outdated education regarding PPE. Many nurses may not have received sufficient education in their practice or basic education regarding PPE. And,
Should there be a policy or procedure, or guideline be implemented as to the appropriate use of Hepa-filters? And,
Should there not be a policy or guideline specifying when N-95 masks can be reused, and how often? And,
Regarding Engineering Controls
Will the hospital system be implementing engineering controls such as though recommended by OSHA and the CDC?
OSHA GUIDANCE ON PREPARING WORKPLACES FOR COVID-19 booklet states for high risk work environments that employers should:
■ Ensure appropriate air-handling systems are installed and maintained in healthcare facilities. See “Guidelines for Environmental Infection Control in Healthcare Facilities” for more recommendations on air handling systems at: www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm.
■ CDC recommends that patients with known or suspected COVID-19 (i.e., person under investigation) should be placed in an airborne infection isolation room (AIIR), if available.
■ Use isolation rooms when available for performing aerosol-generating procedures on patients with known or suspected COVID-19. For postmortem activities, use autopsy suites or other similar isolation facilities when performing aerosol-generating procedures on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death. See the CDC postmortem guidance at:
www.cdc.gov/coronavirus/2019- ncov/hcp/guidance-postmortem-specimens.html. OSHA also provides guidance for postmortem activities on its COVID-19 webpage: www.osha.gov/covid-19.
Regarding Post-Mortem Handling of Patients Suspected to Have Had or Who Were Positive for Covid-19
Should there be a policy or guideline, compliant with OSHA, for the handling of all patients suspected to have had Covid-19 or who had tested positive?
Regarding Cohorting and Nurse Staffing of Covid-19 Patients
Are stable Covid-19 patients to be cohorted? And if these patients are to be cohorted how many patients may be safely assigned to a single nurse? And,
Will Covid-19 patients who are not in the ICU be admitted to all different units or will there be a designated unit or area to cohort?
Regarding When to Test Inpatient and Outpatient Patients for Covid-19
Should there not be a policy or guideline specifying under what conditions an outpatient should be tested for Covid-19? And,
Should there be a screening questionnaire such as there is for exposure to tuberculosis? And,
Should inpatients exposed to another patient or nurse testing positive be immediately tested for the virus? And,
Who should report to the patient’s physician that they have been exposed.
Incentives for Nurses to Remain in the Area and Care For Covid-19 Patients
Though nurses gladly rise to such challenges as Covid-19 the fact is they and their family’s lives are at risk. Should not hospitals respond to the risk nurses are taking with the appreciation of hazardous duty pay? And,
Travel Agencies are offering exceptional pay and bonuses to accept an assignment that includes caring for Covid-19 patients. Should we also not consider hazardous duty pay in the Austin area to encourage nurses to remain in our community serving our hospitals?