Infectious Disease

The Nurses Union has expressed concern about hospital conditions and aerosol transmission of COVID-19

March 11, 2021

4 min read

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Adalja does not report any relevant financial information. Healio Primary Care was unable to confirm the relevant financial information from Marr or Muhindura at the time of publication.

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According to a recent survey, many nurses in the United States remain at significant risk due to the COVID-19 pandemic due to unsupported employers.

The survey was conducted by National Nurses United, the world’s largest union for registered nurses.

Reference: National Nurses United. The RN national survey shows the hospital continued to fail to prioritize the safety of nurses and patients during a pandemic. https://www.nationalnursesunited.org/press/fifth-survey-of-national-nurses-highlights-continued-hospital-failures. Accessed March 10, 2021.

“We have been in this deadly pandemic for a year and hospitals are still failing to provide the vital resources necessary to keep nurses, patients and medical staff safe.” Bonnie Castillo, RN, Executive Director of NNU said in a press release. “This survey highlights how hospital administrators, during COVID-19, nurses, continue to compromise one of society’s most valuable workers by prioritizing profits over basic safety and infection control measures. Testing healthcare workers and patients for COVID-19, providing optimal personal protective equipment, and ensuring safe staffing are a breeze to tackle this pandemic. “

The survey results follow a recent petition by the NNU and 44 other unions and organizations asking the CDC to update its guidelines on aerosol transmission of COVID-19. The petition states that the CDC does not fully recognize aerosol transmission, so both workers and the general public are not protected from exposure to COVID-19.

In an update to its COVID-19 guidelines in October 2020, the CDC said SARS-CoV-2 could “sometimes be spread by airborne transmission”.

Results of the NNU survey

In a nationwide survey by the NNU, more than 9,200 RN reported their experiences from February 2nd to 28th.

Among respondents, 53% said that hospital staff shortages were their main safety concern, and 47% of hospital nurses said staff has deteriorated slightly or much recently.

In addition, 81% of nurses said they are forced to reuse PPE for single use.

Of the nurses who work in hospitals, 52% said that all patients will be screened for COVID-19.

The survey also found that 54% of all RNs and 61% of hospital RNs have ever been tested for COVID-19. Only 32% said their employers informed them about COVID-19 exposures in a timely manner.

Compared to how they felt before the pandemic, 43% of RNs in the hospital said they had more trouble sleeping, 61% were more stressed, 57% felt more anxious, and 51% were more sad or depressed.

Many nurses – around 22% – said they face increasing levels of violence in the workplace, which they attribute to changes in patient populations, reduced staffing levels, and visitor restrictions.

Testimony of experience, aerosol transfer

Pascaline They change, RN, A critical care nurse at Research Medical Center in Kansas City, Missouri, and a member of the NNU, spoke to the United States House Education and Labor Committee’s Labor Protection Subcommittee about her experience during the pandemic and the need to change guidelines for aerosol transmission from COVID-19.

Muhindura said her facility “still forces us to unsafely reuse the same N95 for an entire shift and recommends that we use surgical masks on COVID-19 patients.”

“To date, the CDC does not recognize aerosol transmission of COVID-19,” she said, adding that current guidelines allow employers to distribute surgical masks to nurses and force them to reuse N95.

“Management withholds PPE and they have used CDC guidelines as a justification for putting our lives at risk,” she said.

As a result, she said the CDC needs to update its guidelines to reflect the latest scientific evidence on aerosol transmission and that a federal occupational safety and health agency standard needs to be put in place to ensure employers protect the health and safety of workers.

“We need immediate action so that nurses and our patients have the protection we need,” she said.

In another testimony, Linsey Marr, PhD, The professor of civil and environmental engineering at Virginia Tech University said there is “overwhelming evidence that inhalation of tiny, virus-laden aerosols is the main route of transmission for COVID-19”.

In her written testimony, Marr stated that this is shown in superspreader events – which she believes are best explained by inhalation of aerosols from shared air – asymptomatic and pre-symptomatic transmission – as people don’t cough and therefore the virus gets through Speaking and speaking spread breathing that produces fewer large droplets and more aerosols – indoor transmission – as aerosols dilute quickly outdoors – and scientific studies that have identified viable SARS-CoV-2 in aerosols in hospitals.

According to Marr, when people breathe, laugh, speak, sing, breathe, cough or sneeze, they release more aerosols than respiratory droplets. These aerosols will remain airborne over time in a room that is not properly ventilated and that can move with airflow for distances greater than 6 feet.

She said ventilation is key to preventing aerosol transmission, that respirators and masks are considered the “last line of defense” against infection, and that workers at increased risk of infection should wear high-performance masks or respirators.

Marr also said that at this time “most CDC guidelines have not yet been updated or strengthened to address and limit inhalation exposure to aerosols”.

Notes on aerosol transfer

Amesh A. Adalja, MD, The senior scientist at the Johns Hopkins Center for Health Security and board member of Infectious Disease News told Healio Primary Care that he did not think an update of the CDC guidelines was warranted.

“To the best of my knowledge, aerosol delivery of SARS-CoV-2 in healthcare occurs only during certain aerosol-generating procedures such as bronchodilator treatment via nebulizers, bronchoscopy, BiPAP / CPAP, and possibly endotracheal intubation,” he said.

In other areas of health care, Adalja said regular surgical masks and eye protection are enough to prevent the spread of COVID-19.

In the community, he noted that aerosol transmission can occur in “environments where, for example, people are singing or breathing vigorously, such as during an exercise class, but the primary mode of infection is still breath droplets that are transmitted directly from person to person. ”

References:

Education and Labor Committee. Clearing the Air: Science-Based Strategies to Protect Workers from COVID-19 Infections. https://edlabor.house.gov/hearings/clearing-the-air-science-based-strategies-to-protect-workers-from-covid-19-infections. Accessed March 11, 2021.

Education and Labor Committee. Testimonial from Linsey C. Marr, PhD. https://edlabor.house.gov/imo/media/doc/MarrLinseyTestimony03112021.pdf. Accessed March 11, 2021.

. National Nurses United. The RN national survey shows the hospital continued to fail to prioritize the safety of nurses and patients during a pandemic. https://www.nationalnursesunited.org/press/fifth-survey-of-national-nurses-highlights-continued-hospital-failures. Accessed March 10, 2021.

National Nurses United. Nurses, unions and allies urge the CDC to recognize the transmission of Covid-19 aerosols in order to bring the virus under control. https://www.nationalnursesunited.org/press/nurses-unions-allies-urge-cdc-to-acknowledge-covid-19-aerosol-transmission. Accessed March 10, 2021.

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