Modesto nurses reusing masks as more COVID-19 patients are admitted to local hospitals
You won’t see nurses at Modesto hospitals covering their faces with bandannas to keep from catching the coronavirus.
But a limited supply of N95 respirator masks and gowns persists and it’s increasing the risk that nurses and doctors will become infected with the virulent illness.
While the pandemic has quieted down in a few areas of California, a growing surge of people sickened by COVID-19 has pushed intensive care units to the limit at hospitals in Stanislaus County.
The county’s five hospitals are treating 166 patients confirmed with COVID-19, with 45 in intensive care and almost 50 suspected of coronavirus infection. The 166 hospitalizations is more than hospitals in larger Bay Area counties. San Francisco has fewer than 100 COVID patients in hospital beds, according to posted data.
“How can we say we are prepared for a surge when we are reusing masks,” said a nurse at Doctors Medical Center who cares for COVID-19 patients who are seriously ill.
The nurse said she’s required to put her N95 mask in a bag when her shift ends. She said she’s expected to use the same mask the rest of the week. The shortage heightens the risk that nurses will catch the contagious illness and spread it to loved ones at home, the nurse said.
With a shortage of gowns, rain ponchos are worn by nurses on some floors.
A physician at Kaiser Modesto Medical Center said staff are expected to create their own stash of N95 masks. “The N95 masks are still tightly controlled and reused over and over,” the physician said.
The doctor pointed out that surgical and isolation masks are more readily available. “I use one per shift. We do not have enough gowns at all locations,” the physician said.
Hospital executives make no claim that suppliers across the country have caught up with demand for masks, gowns and other PPE for health care workers.
The hospitals said they are following the newer contingency guidelines of the Centers for Disease Control and state Division of Occupational Safety and Health that were adopted to optimize available supplies during the pandemic.
DMC chief nurse says hospital following guidelines
Cheryl Harless, chief nursing officer at Doctors, said last week the hospital has an adequate number of N95 masks and is following the federal and state contingency guidelines.
In response to questions from The Modesto Bee, Harless went on to say Doctors is exploring options for decontaminating masks for reuse.
“There are nationwide challenges with the supply chain for N95 masks,” Harless said. “The demand is exceeding the capacity of suppliers. As part of a large health care organization, we have access to a variety of suppliers and are wielding our large purchasing power to obtain the supplies we need.”
In recognizing the “tremendous” challenges of PPE shortages during the pandemic, the CDC has permitted contingency measures, such as decontamination to kill germs on masks through ultraviolet irradiation, hydrogen peroxide vapors and moist heat. It has also advised hospitals on stretching the limited supply of protective equipment and allowed the purchase of PPE from a foreign countries under FDA rules.
The American Nurses Association surveyed 14,000 nurses in the United States, asking if they’re working with an ample supply of PPE. According to the results released in June, 79 percent said they’re required or encouraged to reuse protective equipment like N95 masks that are intended for single use.
Typically, a nurse changes a mask upon leaving a room occupied by a patient with contagious disease.
Almost 60 percent said reusing masks made them feel unsafe. Nurses were also uncomfortable with the new practice of decontaminating masks. The survey included nurses working for hospitals and long-term care facilities in large cities, suburban and rural areas.
The N95 masks were found to provide the best protection for health workers in an analysis published last month in The Lancet that reviewed studies on surgical masks and other face coverings.
A nurse who worked at Kaiser Permanente’s Fresno Medical Center died in May after she and other nurses were infected in a March coronavirus outbreak at the hospital. The California Nurses Association has attributed the death to a lack of protective equipment.
Where are the masks purchased by state?
California Gov. Gavin Newsom in April arranged the purchase of 150 million N95 masks and millions of other masks from BYD, a China-based electric car manufacturer.
Brian Ferguson, spokesman for the Governor’s Office of Emergency Services, said the state has distributed 75 million N95 masks to counties across the state, with almost 400,000 of the N95 masks going to Stanislaus County.
The state also has sent out 197 million surgical masks across California for use by workers in health clinics, nursing homes, schools, public agencies, agriculture, construction, business offices and hotels. The face masks were from different sources including the BYD purchase, Ferguson said.
With so many masks distributed across the state, it raises questions why the most protective masks are being used “over and over” at Modesto hospitals, which are getting more and more COVID patients.
Harless said last week that Doctors just received some masks from the state purchase. She did not reveal how many. “We are in the process of evaluating and fit-testing those masks,” she said.
Spokespeople for county public health couldn’t say how the masks delivered by the state were distributed.
Nurses anticipate getting sick
Nurses and doctors assigned to hospital floors with COVID patients risk carrying the virus home and infecting their children or spouses. Some live in detached quarters, use separate entrances to their homes or change their clothes in the garage. Those working closely with COVID patients should have access to proper protection, the nurse at Doctors said.
“We feel we are going to get too many patients,” said the nurse, who spoke on condition of anonymity out of fear of disciplinary action. “There has been a resignation among nurses that we are probably going to be exposed and, if we get sick, it’s just a matter of how sick we will get.”
The nurse hoped county residents will wear masks, practice social distancing and wash their hands often to reduce the spread of coronavirus and relieve pressure on hospitals.
Public health efforts to slow the spread of coronavirus have failed since the county began reopening the local economy in the second half of May. Thousands of county residents have tested positive since then and Stanislaus was one of 19 counties ordered by the state July 1 to close indoor restaurant dining, bars and arcades.
According to the state data, 2,150 county residents have tested positive in the last two weeks, lifting the total caseload to 4,101, more than San Francisco, which has 340,000 more residents. Statewide, more than 290,000 have tested positive with more than 6,700 deaths.
Stanislaus County reported five additional deaths Wednesday, raising the death toll to 50. The 135,000 deaths from COVID-19 nationwide is almost four times the seasonal flu deaths in the United States.
A percentage of people infected get sick enough to need hospital care. In a typically slow month, local hospitals are filling with a combination of COVID-19 patients and people who delayed treatment for medical issues in the early months of the pandemic; the hospitals also have resumed elective surgeries.
Memorial Medical Center, affiliated with Sacramento-based Sutter Health, sought donations of masks, gowns and other items when the coronavirus surfaced in the Modesto area in March. Sutter acknowledged the current national supply shortages in releasing a statement Tuesday.
“We operate in 22 counties and because our hospitals, surgery centers and ambulatory clinics are interconnected, we can move people and resources— whether that’s personal protective equipment, ventilators or beds — to where they are needed most,” a Sutter spokesperson said.
“While we are encouraged by our progress in securing PPE — and our supply is currently adequate at Memorial Medical Center and across our network — our job is far from over.”
Kaiser Permanente, which alerted staff last week its Modesto and Manteca hospitals had reached capacity, said it’s providing staff with personal protective equipment aligned with the latest science and guidance from public health authorities. “As infectious disease and public health experts have learned more about the disease, they have evolved their guidance, we have done the same,” Kaiser said.
The organization said its health care teams are asked, in certain cases, to reuse their respirators. Kaiser has also implemented tested and approved processes for decontaminating N95 respirator masks.
“Reprocessing helps to ensure that Kaiser Permanente can continue to protect frontline staff in the face of a limited worldwide supply or new N95 respirators,” Kaiser’s statement said.
This story was originally published July 9, 2020 at 2:05 PM.
