Are We Covered? PPE in Texas
Thursday, April 23, 2020
Posted by: Shanna Howard
By Serena Bumpus, DNP, RN, NEA-BC
The COVID-19 pandemic has highlighted multiple gaps in our healthcare infrastructure, including our national supply chain systems. Personal protective equipment, formerly abundant and at our disposal, is now a rare commodity in places where we need it most to care for highly infectious patients. The demand for a necessary amount of PPE requires a large increase in manufacturing, which is a process that will take time to produce. The question is, do we have time to wait?
When the first cases of COVID-19 were discovered in the United States, the Centers for Disease Control and Prevention expressed concern about our rapidly depleted stock of PPE and established conservation guidelines for health care organizations to follow. While these measures have impacted the way nurses practice and how hospitals operate, they prevent us from experiencing a higher supply usage and potential depletion of supplies leaving us in the position where all we have left is a cloth mask or bandanna and a garbage bag to protect ourselves.
The CDC’s guidelines have caused great concern and confusion amongst the nursing profession leading nurses to question if their personal safety matters. The greatest concerns focus around the use of a N95 vs. surgical mask during patient care and the request to reuse PPE (such as masks) throughout the shift rather than single patient use. These concerns, among others, leave nurses to question the system, their leaders, and themselves.
We know that COVID-19 is transmitted via large droplets except during aerosolized procedures. Because of this, droplet precautions and the use of a Level 3 Surgical Mask are appropriate when caring for patients under investigation (PUI) or those with a confirmed diagnosis of COVID-19. An N95 mask is recommended if the patient is receiving nebulizer treatments, using BiPap, or during intubation.
Nurses are being asked to reuse their masks causing increased risk for cross contamination during the donning and doffing process thus increasing the risk to their own personal safety. Many healthcare organizations require their staff to place their masks in a brown paper bag at the end of their shift and keep it in a centrally located area so it can be used again after five days. However, some organizations are now turning to the evidence and putting processes in place to decontaminate masks, thus decreasing the safety concerns and increasing the supply of PPE.
The process of decontaminating disposable PPE is rapidly growing as an option for the preservation of PPE. When considering decontamination and reuse of disposable PPE, there are several options for healthcare facilities to choose from. Vaporized hydrogen peroxide, ultraviolet germicidal irradiation, and short-term heat exposure are a few options organizations across Texas are considering. There are minimum requirements organizations must meet in order to meet the efficacy of the various techniques.
- CDC guidelines for decontamination of disposable PPE
- Ultraviolet germicidal irradiation
- Vaporized hydrogen peroxide
- Ozone Therapy
Over the last month, Texas Nurses Association has engaged frontline nurses and nurse leaders in advocacy efforts to ensure our healthcare workers have the appropriate amount of PPE in their facilities. Over 600 nurses responded to our Nurse Action request for state legislators to assist with obtaining PPE for Texas healthcare organizations. Our legislators heard us loud and clear. TNA continues to receive phone calls from state legislators and their staffing asking about what we need and what they can do to help. This action alone, has resulted in the purchase of more than $83 million in essential supplies and the production and delivery of one million masks per week to the State of Texas. The rapid acceleration of PPE manufacturing will keep us a few steps ahead in the COVID-19 fight.
While we sit and wait for a potential influx of patients into our facilities, it is important for nurses to evaluate their current work environment. There is no better time than now for nurses to come up with creative and innovative solutions to decrease the use of PPE and improve the efficiencies in their workflows. In the year of the nurse, this is a time for nurses to lead, a time to engage, a time to take ownership of our practice, and a time to be proud! Texas nurses are 400,000 strong and our collective voices are very powerful when aligned.