Nurses, staff at Spokane Providence hospitals worry about mask conservation policies

click to enlarge Nurses, staff at Spokane Providence hospitals worry about mask conservation policies
Providence Sacred Heart

Nurses and staff at Providence Sacred Heart and Holy Family hospitals say they're worried about their own safety and that of their patients as the hospital system restricts use of personal protective equipment that's in short supply globally.

With a tense work environment, none of the nurses from Providence Sacred Heart and Providence Holy Family hospitals who spoke with the Inlander were willing to share their names on the record, for fear of losing their jobs.

But what they all said is that under current conservation efforts, Providence has essentially put its N95 high-filtration masks under "lock and key," only to be used during the highest-risk respiratory treatments. Significantly more effective than surgical masks, the N95 masks have been shown to effectively filter the novel coronavirus COVID-19.

For normal surgical masks, staff are being asked to use the same mask all day if possible.

When patients with respiratory symptoms come into Providence's hospitals, they're being given masks as available while they're told to sit in a common area. The masks they've received to prevent potential spread of their infection have included donated industrial N95 masks that were handed out at Holy Family this week for a short time, even as nurses were told they couldn't use them.

"The facility is not letting us use them because we have not been trained or fit-tested for them," one nurse said of the donated N95 masks that weren't manufactured explicitly for medical purposes. "It's disconcerting that people are trying to get us supplies and we're not able to use them."

Providence spokeswoman Jennifer Semenza confirms that the system is conserving masks and personal protective equipment (PPE) due to a global backlog of orders, but also notes that providers are getting protective equipment within the standards set by the Food and Drug Administration and the Centers for Disease Control and Prevention.

"Not knowing what it is going to look like is almost worse than being in the middle of it."

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Nurses also report that while symptomatic patients wait to be seen, there is no physical separation between them and others waiting in the ER other than social distance, as one seating area has been designated for respiratory symptoms.

From there, if a patient is seen for severe respiratory symptoms and needs to be intubated or have a nebulizer treatment, nurses are allowed to get an N95 mask from a supervisor, but then they're asked to wear that mask up to a handful of times with that same patient, the nurses say. Normal protocol would call for throwing away the mask after each visit to the room.

Re-using both surgical and N95 masks and not having enough access to the higher filtration N95 masks more frequently has many nurses worried they could contract COVID-19 while seeing patients who arrive to be tested for the virus. What's more, there's a fear that if masks are already in short supply, the region may not be able to handle an onslaught if hundreds of patients with severe respiratory issues need help at the same time.

One nurse at Sacred Heart likened the fear over the current protective equipment policies to a scene from Lord of the Rings, where Gandalf says, "It's the deep breath before the plunge," and Pippin responds, "I don't want to be in a battle. But waiting on the edge of one I can't escape is even worse."

"Not knowing what it is going to look like is almost worse than being in the middle of it, I imagine," the nurse says. "It’s the worst kind of anxiety because it never leaves you. We’re all trying to be really diligent about self-care and about calming. A lot of us, we pray or we meditate, we try to work out."

If treating a patient suspected of having COVID-19, nurses are asked to wear gowns, gloves, eye protection, and face shields or surgical masks, unless they're doing a "high-risk" procedure like intubating a patient or using a nebulizer, when droplets are most likely to become airborne, one nurse explains. If doing that higher risk procedure, an N95 mask would be worn.

"Some materials and equipment such as masks, gowns and gloves are in short supply," Semenza, the Providence spokeswoman, tells the Inlander by email. "This is a worldwide issue, not just a local one. We are part of a health care system that is helping us find PPE resources for our health care teams and we're identifying resources for additional PPE."

Washington agencies are coordinating efforts to collect more personal protective equipment via purchases through manufacturers, donations, and requests to the Strategic National Stockpile. As of a Thursday afternoon press call, the state this week obtained and started distributing 500 ventilators, 1,200 gowns, 500,000 N95 masks, and 130,000 surgical masks.

Other items on the way included an order for 2.4 million N95 masks and 13,000 thermometers, and it was anticipated that there'd be another order Thursday for 2.2 million N95 masks, 300 ventilators, and 2,500 disposable stethoscopes, said Linda Kent, public affairs director for the Department of Enterprise Services, on the call.

"The state is seeking all available quantities right now to address what we know is going to be an ongoing need," Kent said on the call. "We’re hopeful many measures the state’s taking to slow the spread of the virus, and some PPE conservation measures taken by health care providers, will help."

Spokane County now has a collaborative drive-thru test site set up at the Spokane County Interstate Fairgrounds where people with symptoms can be tested. The hope is for the site to help minimize the use of protective equipment at local hospitals and reduce the risk of patients going there and spreading the virus to others.

But if someone appears at an ER for testing, the ER may not, by law, send them away to get that testing done elsewhere, Semenza says.

"We have an obligation to treat them in that location," she writes.

People who have a fever and a dry cough and/or difficulty breathing may now self-refer to the fairgrounds test site to get evaluated and see if they should be swabbed, without needing a doctor's referral.

While Providence hospitals await shipments from manufacturers and potentially the Strategic National Stockpile, some surgical masks are being collected and sent to Medline Industries for reprocessing and reuse, Semenza writes.

"They can reprocess about half of what is collected," Semenza writes. "After proper decontamination protocols are followed, the products are as safe and functional as brand new ones."

Meanwhile, nurses say they're not allowed to bring in their own masks if they have them, whether that's an N95 mask or a homemade surgical mask.

In response to an outpouring of community support, including crafters who've taken it upon themselves to start sewing face masks, Spokane's Emergency Coordination Center is opening up a donation site.

But the message to the public right now is that health care systems are not asking you to sew face masks, according to a news release from the center.

"While homemade masks will provide some level of protection from respiratory droplets, the primary transmission means for COVID-19 infection, they will not provide the same degree afforded by N95 masks/respirators," says Dr. Bob Lutz, Spokane County Health Officer with Spokane Regional Health District. "

The centralized donation site at the Spokane County Fair and Expo Center, 404 N. Havana St., will be open daily starting March 26, from 9 am to 3 pm, to accept donations of personal protective equipment.

The site will accept new, unopened personal protective equipment including masks, gloves, eye protection, gowns, hand sanitizer, paper towels, toilet paper, and household disinfectants.

"We will also accept homemade masks at our collection site," the news release states. "Once we assess the quantity of masks received and community need, we will communicate future need for additional masks. While all efforts are greatly appreciated, masks that comply with CDC guidelines are of greatest impact."

Providence confirmed its hospitals are not able to accept homemade masks at this time.

"Providence is so thankful for the outpouring of community support," says Beth Hegde, director of communications for Providence Healthcare, in the news release. "At this time, we are not able to take homemade masks or other protective equipment, but we are consistently assessing needs and will update as needed."

MultiCare has designated volunteers working on making masks to supplement their supply.

"In an effort to conserve our current protective personal equipment (PPE) we are creating our own masks to supplement our purchased masks," says George Hampton, Regional Marketing Director for MultiCare Health System, in the release. "We have designated volunteers willing to give their time and talent to make masks from materials we will provide for them. We have enough volunteers at this time to assemble the needed masks.”

Spokane Fire Chief Brian Schaeffer reiterated that there is currently not a request out to the community for more masks, and that all donations of protective equipment should be processed through the centralized donation site to ensure proper decontamination and dissemination.

Staff writer Josh Kelety contributed to this report.

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About The Author

Samantha Wohlfeil

Samantha Wohlfeil covers the environment, rural communities and cultural issues for the Inlander. Since joining the paper in 2017, she's reported how the weeks after getting out of prison can be deadly, how some terminally ill Eastern Washington patients have struggled to access lethal medication, and other sensitive...