ShareThisIn the race to check the H1N1 pandemic, some California nurses are at odds with their hospitals. They complain that rules on the use of one simple, yet important weapon -- respirators -- may not protect them from on-the-job exposure to the virus.
But hospitals counter that their respirator practices are safe.
The novel H1N1 virus, also known as swine flu, has spread around the globe since it emerged this winter from a Mexican village. A new surge in infections is expected this fall, raising concern among health care workers about workplace safety.
The federal Centers for Disease Control and Prevention reports that half the health care workers infected with the new H1N1 virus were exposed at work.
Nurses say their concern is not limited to their own ranks.
"This is about patient and healthcare worker protection, and it has nothing to do with contracts and money," said Karen Brown, an adult intensive care unit nurse at the University of California, Davis Medical Center.
The California Division of Occupational Safety and Health, requires staff to don respirators when caring for suspected and confirmed H1N1 patients. Cal-OSHA,
Nurses say respirators should be used just once. But hospital administrators say that because of a shortage, masks should be reused -- and that such a step is safe for workers and patients.
Along with UC Davis, other California hospitals also instruct employees to reuse respirators. In an e-mail, Mercy hospitals officials said they're "encouraging nurses to use one per shift" because of the national shortage.
Respirators should not be confused with surgical masks, though they look similar. Respirators reduce exposure to airborne contaminants while surgical masks do not. Surgical masks are merely physical barriers for large particles and body fluids. Respirators must be individually fitted and should tightly seal to a user's face. The most widely used respirator in hospitals is the N95 model, which is disposable and costs about $1.
Federal workplace safety rules today allow for reuse of respirators when there is a shortage, and as long as " ... the device has not been obviously soiled or damaged and it retains its ability to function properly."
Cal-OSHA's stance on respirator reuse is not entirely settled.
"Under normal circumstances, according to federal OSHA, you would throw the respirator away after using it," said Deborah Gold, a safety engineer for the state agency. "But under conditions of a shortage, can you safely put a respirator on the same worker? We're investigating this right now."
For now, suppliers are rationing respirators. Respirator manufacturer 3M -- UC Davis Medical Center's N95 source -- has capped the orders a hospital can place, hospital officials said.
3M spokeswoman Donna Fleming Runyon said a surge in demand for respirators has made it impossible to immediately fill all orders.
Asking nurses to re-don disposable respirators increases the chance of transmitting infection, according to the California Nurses Association. Taking off a respirator affects the mask's seal, and storing a respirator is worrisome, said Bonnie Castillo, the CNA's director of government relations.
At UC Davis Medical Center, nurses are told to store masks in plastic bags.
Written hospital instructions say: "It is safe to re-use N95 masks -- following the steps listed below -- for up to 12 hours, unless the masks becomes wet, torn or otherwise damaged."
Marsha Koopman, a manager of infection prevention at UC Davis, said the instructions are based on science.
Nurses disagree.
"To put a mask in a plastic bag and then having to put it back on basically means that you have to give yourself whatever is stuck to that mask," said Janet Braillard, an ICU nurse at Sutter Solano Medical Center in Vallejo, Calif.
Hospitals say they are looking at the big picture.
"The expert agencies have said that if there isn't a sufficient supply of masks available they can be reused," said Sutter Solano spokesman Sy Neilson. "We have been and continue to be in full compliance with Cal-OSHA guidelines."
Nurses do say hospital preparedness has improved this summer.
Brown, the UC Davis ICU nurse, recalled that in June, when one of the first H1N1 patients was rolled into UC Davis' intensive care unit, nurses had only one box of respirators, size small. Brown said her unit now has respirators in all sizes.
Nurses say they believe their push has helped improve hospital safety. In July, a nurse at Mercy San Juan Medical Center in Carmichael died from H1N1, prompting the CNA to launch a survey of safety protocols at 100 California facilities -- and a public campaign calling on hospitals to improve practices.
Braillard, the ICU nurse at Sutter Solano, said she and several other nurses filed a Cal-OSHA complaint in July over respirator protocol. Now, she said, nurses have unlimited access to respirators in all sizes.
Contact Anna Tong at atong(at)sacbee.com
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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