By John Palmer
It’s not an understatement to say that most people who work in healthcare organizations long for the days when just getting their workers to wear the proper personal protective equipment (PPE) was the biggest issue.
Times have changed, of course, in the new normal brought on by COVID-19. Where hospitals were once coached by safety professionals to ensure they had enough PPE stockpiled, they are now begging the U.S. government to share PPE from the stockpile. Once upon a time, workers were told to use their surgical masks only once. Today, those masks get put into a bag at the end of a shift and used the next day—and maybe the day after that.
Some communities have brought in huge PPE cleaning machines that can disinfect thousands of masks in one sitting, while other healthcare workers have turned to procuring their own masks, gloves, and respirators from painting suppliers and home improvement stores. It’s become a free-for-all in some places.
“Because of the scarcity, PPE has become a protected resource inside hospitals,” says Benjamin Kanter, MD, FCCP, chief medical information officer (CMIO) for Vocera Communications, a California-based company that develops platforms to improve clinical communication and workflow.
“Hospitals are taking special precautions and establishing new protocols for accessing and preserving PPE,” he says.
Kanter spoke to PSQH about the state of PPE supplies, procedures, and protocols in the United States, and how it might change the way hospitals prepare and respond to future pandemics.
PSQH: What are some alternate PPE procedures and protocols being developed by hospitals to help preserve PPE supplies and extend the life of the PPE that healthcare workers have access to?
Kanter: The situation is complex, in part because COVID-19 recommendations have been in flux as we learn more about the disease.
Hospitals are establishing protocols to avoid confusion and minimize stress about the type of PPE required in different situations, such as in a standard droplet precaution room, where a surgical mask can be worn, versus a negative air room that requires wearing an N95 mask. Hospitals are now also adopting systems that decontaminate N95 masks, which originally were designed for single use but are sometimes worn throughout a worker’s full shift because of mask shortages. The decontamination systems make it possible for N95 masks to be used on multiple occasions over a longer period of time.
PSQH: What are some safety measures that organizations can take now to help keep patients and staff safer, and will these continue to be in place even after the COVID pandemic?
Kanter: One of the most important ways that hospitals can keep staff and patients safe is to minimize the number of times that a doctor or nurse has to take on and off protective gear.
There is a widely held misconception, even among healthcare workers, that if I put on PPE, I am safe. Unfortunately, that isn’t the case for a number of reasons. If you are going to don and doff PPE, it must be done vigilantly and in a very specific way to avoid gaps in coverage. A large study published last year by a major U.S. medical center found that roughly 40% of their trained physicians and nurses removed their PPE incorrectly, putting themselves at risk of self-contamination. If you are self-contaminated and don’t know it, you could touch a surface and unwittingly put everyone else at risk. Even in the best-case scenario where everyone is vigilant and following CDC guidelines, you are at risk of infection every time you go into a patient’s room.
PSQH: What about communications? Working in PPE can sometimes be very difficult, especially if you need to communicate with a team.
Kanter: Hospitals are working hard to find solutions that keep staff protected, preserve PPE, and minimize the number of times staff members need to go in and out of a room. One way to do this is to allow two-way communication between care team members or a patient in the room and staff outside the room. Having the ability to communicate remotely, instead of going into a patient’s room, saves time and PPE. More importantly, staff members don’t have to risk contamination to communicate.
In addition, hospitals are giving staff hands-free communication devices that can be worn under PPE. If you are wearing full PPE and in a patient’s room, you need an easy way to communicate with care team members outside of the room without having to remove PPE and step outside the room. I think we’ll see modern PPE include a hands-free communication component like what first responders have as part of their uniform. We would never send a firefighter into a burning building without protective gear or require them to remove their gear in order to communicate with team members. The same holds true now for hospital staff: We need to help clinicians perform their jobs while protected with PPE. Doctors and nurses never work alone, and even if they are isolated in a patient’s room, they need to stay connected with care team members without having to risk contamination by taking off PPE.
An additional way that hospitals can keep patients and staff safe is to add two-way communication technology for temporary pop-up hospital beds. To manage patient loads during surges, many hospitals have set up pop-up beds, though they are rarely equipped with nurse call systems. To ensure patients in these pop-up locations can communicate directly with their care teams, hospitals are attaching wireless two-way communication devices to these beds, which keep staff and patients connected.
PSQH: How does the PPE response compare to previous pandemics, such as the H1N1 pandemic? Why did we seem to have enough PPE then but not now?
Kanter: During H1N1, I was working in a San Diego hospital, and we did run short of N95 masks and we did have to borrow ventilators from facilities outside of the county in order to care for all of the influenza cases at that time. Surgeries were cancelled and influenza patients on ventilators were scattered throughout the hospital.
COVID-19 is quite different from H1N1, and there are still many unknowns. With influenza, we have medications that minimize the symptoms. We also have vaccinations that decrease the risk of contamination. Today, we have a situation where we still don’t understand who is resistant to the virus, and there is no vaccine or simple way to administer treatment. A further complication is that COVID-19 symptoms for some people can be so minor you may not even know you are infected but could still be a vector transmitting the disease to other people. Because signs and symptoms of COVID-19 are so variable, the risk of contamination is higher and requires a different protocol for PPE. Patients with COVID-19 (for now) continue to require contact precautions (gloves and gowns) in addition to airborne isolation, whereas that isn’t true for influenza; COVID-19 places a bigger burden on healthcare supplies than influenza.
John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at firstname.lastname@example.org.