A patient health and safety survey of 190 American hospitals from coast to coast compiled by registered nurses in nine different states finds that a disturbing number of our nation's healthcare facilities are not prepared for the coming H1N1/swine flu pandemic, according to results released today by the California Nurses Association/National Nurses Organizing Committee.
The data reflects a survey conducted over the past four weeks by RNs in hospitals in Arizona, California, Florida, Illinois, Maine, Minnesota, Nevada, Pennsylvania, and Texas. And it comes just a day after release of a report from the President's Council of Advisors on Science and Technology predicting nearly 2 million Americans could be hospitalized due to swine flu infections this winter, and as many as 90,000 could die, nearly triple the deaths that occur in a normal flu season.
What the RNs reported are wide gaps in safety gear, infection control training, and post-exposure procedures. Among key findings:
- At more than one-fourth of the hospitals, nurses cite inadequate isolation of swine flu patients, increasing the risk of infection to others.
- Nurses at 15 percent of hospitals do not have access to the proper respirator masks, exposing nurses and patients to infection; at up to 40 percent of the hospitals, nurses are expected to re-use masks, in violation of Centers for Disease Control Guidelines.
- At 18 percent of the hospitals, RNs report that nurses have become infected; one Sacramento, Calif. RN has already died.
CNA/NNOC is calling on all hospitals to adhere to the highest standard of protection for patients and nurses to combat the expected onslaught of new cases this fall and winter, and urging legislators to strengthen public protections.
"These continuing problems increase the risk that many hospitals will become vectors for infection, with inadequate patient protections leading to a spread of the pandemic among other patients, their friends, family, and caregivers, and the surrounding community," warned Deborah Burger, RN, CNA/NNOC co-president. "What we're hearing from around the country is dangerous to patient health and safety, but with smart and clinically appropriate leadership we can fix policies in time for the upcoming pandemic."
On Wednesday, nurses at more than 50 of these hospitals, mostly large hospital systems, will hold actions to demand hospital administrators immediately implement safety improvements for nurses and patients. Contact CNA/NNOC to find out about what nurses are doing in your area.
CNA/NNOC leaders will also be testifying in a joint California Senate hearing in Sacramento Thursday on preparedness for swine flu in the state's health and education systems. The hearing is at 9 a.m. in Room 112 at the State Capitol.
"This report should serve as a wake-up to hospital management, policy makers, and healthcare workers across the country. We need to urgently increase our readiness," Burger said. "We do not yet have a complete picture of the morbidity of the H1N1 pandemic. But that is no justification for hospitals making inadequate preparations and endangering the health and safety of patients and their community. When September comes, we expect that infection rates of H1N1 will spike due to the beginning of the school year, prompting overcrowded emergency rooms, which will put our public health readiness to the test."
"The swine flu is not the type of flu we are used to. This pandemic will stress every aspect of our healthcare system. Hospitals must be proactive in protecting the public," said Houston RN Terry Hardin. "The state of Maine has identified over 300 cases of H1N1 infection, resulting in at least 19 hospitalizations and one death," said Cokie Giles, EMMC, president of Maine State Nurses Association/NNOC. "A recent survey of our membership indicates that there may be some areas of serious concern regarding preparedness policies. We are calling on MSNA/NNOC represented facilities to ensure that patients and nurses are protected to the fullest extent from exposure to H1N1."
"It is important for hospitals to meet full safety standards for swine flu so that our patients and our nurses are protected," said Temple University Hospital RN Patricia Eakin, president of the Pennsylvania Association of Staff Nurses and Allied Professionals/NNOC.
"I don't know how the local hospitals will staff up for the pandemic. Nurses at my institution don't accrue sick time, we use our accrued vacation time to call out sick. We also work short [staffed] instead of having a replacement when someone does call out. In these economic times, you tell me who will be staffing the hospitals?" said Tampa Bay area RN Peggy Bowen.
Illinois hospitals, says Chicago RN Brenda Langford, "are not prepared to deal with this pandemic. We have provided our copies of our surveys to management and they have not moved to change our practice to be in compliance with the recommendation set for by the CDC. If the Cook County Health and Hospital System won't make these needed changes and the Cook County Department of Public Health won't support our efforts to protect the nurses and the public, it is left up to the NNOC to make sure these needed protections are implemented."
Findings of the survey include:
- Half the hospitals have seen infected patients. At 18 percent, RNs have been infected, nurses say.
- Nurses at 15 percent of hospitals report that they do not have access or only some have access to the appropriate N95 respirator masks, and at 19 percent of the hospitals all or some masks were not "fitted," to ensure their effectiveness against the virus
- More than one in five, 22 percent of the facilities, do not have enough masks, say nurses. - At almost 40 percent of those which do have sufficient masks, all or some of the masks are expected to be reused, say nurses. That puts nurses and patients at risk of infection and violates CDC guidelines which say all healthcare personnel who enter rooms of patients in isolation for H1N1 should wear a fit-tested disposable N95 mask, and that the masks should not be reused.
- Nurses at 26 percent of hospitals report that infected patients are not being properly isolated, in appropriately ventilated rooms, raising the possibility of the infection spreading to others in the facility. At nearly a third of the facilities, proper infection controls are not being followed.
- Nurses at fewer than half of facilities (49 percent) report that they have been adequately trained on H1N1 issues, including identification of infected patients, and procedures for caring for these patients.
- Nurses at only 35 percent of facilities report that they are guaranteed adequate sick leave if they become ill while caring for a patient, penalizing them for appropriately staying home while infectious.
These numbers are borne out by the controversies that have been reported at hospitals across the country. Examples include:
- At the University of California Davis Medical Center (near Sacramento), a patient who subsequently died from H1N1 was transferred to an intensive care unit as the patient's condition deteriorated. But rather than be kept in strict isolation with proper ventilation, the door to the patient's room was kept open the entire time, placing other high-risk patients, visitors, and caregivers at risk.
- Nurses at Temple University Hospital, a major acute-care hospital in Philadelphia, are concerned that the level of preparedness is not sufficient. The hospital has yet to make clear to nurses its plans and procedures for dealing with H1N1 which is expected to worsen with the start of the school year. The nurses are already seeing an influx of more patients due to the closure of one of Temple's nearby facilities, Northeastern Hospital, and are concerned that without better preparation and sufficient staff, the anticipated influx of patients due to the pandemic would be especially dangerous.
- At Sutter Solano Medical Center in Vallejo, Calif., there were not enough masks to deal with three infected patients in the ICU. Within short order, approximately 10 nurses were affected. The state office of occupational health and safety is investigating.
- Nurses report that a Kaiser Hospital South Sacramento has informed patients and visitors that N95 respirator masks are not necessary and that simple "surgical" masks will suffice, which directly contravenes standards issued by every government agency.
- Nurses at Los Alamitos Medical Center near Los Angeles report that Tenet has eliminated sick benefits that would ensure nurses could afford to take time away from work if they develop symptoms.
In conjunction with the report, CNA/NNOC is releasing a list of demands - "The Nurses' Swine Flu Safety Agenda" - to adequately prepare for this pandemic.
- Minimize infection of hospital patients and workers by strict adherence to the highest standard of infection control procedures, including identification and isolation with appropriate ventilation of infected patients
- All hospital workers and visitors must be provided with appropriate protection gear at the highest government standards, including N95 respirator masks or better for all who enter the isolation room of a confirmed or suspected H1N1 patient.
- Guarantee all patients and workers full transparency after any exposures to H1N1, in as timely a manner as possible
- Healthcare workers and facility visitors must receive full information and guidelines on risk exposure and facility infection control recommendations
- Any RN who is unable to work due to contracting a communicable or infectious disease identified or treated in his or her hospital/clinic shall be guaranteed sick leave, not face disciplinary action, and shall be presumptively eligible for workers' compensation benefits
- Implement a moratorium on any closures of emergency rooms, layoffs of direct healthcare personnel, and reductions of hospital beds.
- Federal guidelines for protection must be developed that are consistent across agencies
- Disposable respirator masks must not be re-used. In the event of a demonstrated national mask shortage, facilities should adhere to government recommendations on mask conservation.
California Nurses Association