I am the director of critical care for a hospital. Five days ago I tested positive for COVID-19. I can’t know for certain where exactly I contracted the virus. But when my hospital admitted its first COVID-positive patient, I stayed until 3 a.m. to set up the isolation ward and care for the patient until she was intubated and transferred to the ICU. I entered the isolation room wearing new, clean personal protective equipment—mask, gown, face shield, and gloves—and discarded the entire set when I left.
Eight days later, that disposal seems like a luxury. Faced with impending supply shortages, hospitals are rolling out new, dangerous protocols asking clinicians to care for COVID-positive patients with reused protective gear.
Although hospital executives point to CDC guidelines outlining best practices for reusing personal protective equipment, they are, in effect, asking clinicians on the front lines to risk their own personal health.
On the surface, hospital leaders appear justified in their efforts to extend their existing mask and gown supplies as far as possible. But why are we asking our clinicians to accept any level of exposure to the virus when there are still masks and gowns on hospital shelves?
When we ask nurses and doctors to reuse protective gear, hospital leaders are accepting a higher number of infected health care workers in exchange for a longer usage runway. We need to remind ourselves of the ethical line we cannot cross: we cannot exchange our clinicians’ health for more supplies on the shelves. We must look at our doctors and nurses squarely in the face at the beginning of each shift and assure them they have the best protections we have available.
To be sure, these are terribly difficult decisions to make. It will be a dark day when we run out of the protective equipment we need. That day is not far away, and our instincts are to push it away even further. Those instincts, however, may not serve us well.
This is a time for hospital leadership to set aside those fears and act from a place of courage. We can only ask nurses and doctors to risk their health when we can confidently say we have exhausted every other option. Medical leaders need to provide creative, viable solutions that individual hospitals, units, and nursing cohorts can implement as appropriate.
Over this past weekend, I have been working in isolation from home, remotely leading efforts to adopt clinical practices across my hospital. As a leadership team, we have recommitted to keeping clinicians safe above all. We’re doubling down on efforts to reduce our use of protective equipment by implementing a cluster care model; rather than having a supply director allocate gowns to each nurse at the start of each shift, we now ask clinicians to estimate how many gowns and masks they’ll need to care for their patients.
A nurse with an acute patient might need fifteen gowns, but another nurse might decide three gowns are sufficient. We’re trusting our doctors and nurses to make strategic decisions about how they provide bedside care. Sharing the responsibility to minimize our use of precious resources means that people at every level of the hospital are involved in making decisions that affect their own health and safety.
Even though my hospital’s incident command team is working around the clock to procure more supplies, the shortage is real. The entire hospital staff is watching our supplies dwindle and we will probably run out of gowns in a few days. But when that happens, we will know that we worked together to use every single one of them in the most strategic way possible. We will have kept every last clinician as safe as possible for as long as possible.
We will implement the next safest option when there are no more gowns in our storage rooms, but not a moment sooner.
Thank you to Jerilyn Sambrooke for her help in writing this article.
April Chaffin is a critical care nurse.
Image credit: Shutterstock.com
