Nurses on the front lines of the battle against the coronavirus pandemic at some Long Island hospitals said they are being told to reuse critical protective equipment, a change to long-standing protocol.
“We’re being told there aren’t enough supplies, that this is what we have to do,” said Tracy Kosciuk, 52, a registered nurse at St. Charles Hospital in Port Jefferson and chapter president for New York State Nurses Association, a union representing 42,000 nurses across the state, including 4,000 at 10 hospitals on Long Island. “There are seasoned nurses who are absolutely terrified.”
She and Robin Strecker, 52, a nursing assistant at Long Island Community Hospital in East Patchogue, described reusing N95 respirator masks for days. They said they were instructed to scrub and reuse face shields and protective gowns, then hang the gowns in hospital hallways outside patients' rooms. The gowns were not used for multiple patients' rooms.
Some of these are typically single-use items, discarded before leaving a patient’s room to limit the risk of cross-contamination. In normal times, violating that protocol could be a fireable offense, said Michael Chacon, Long Island representative for the state nurses association and a registered nurse for 25 years.
The hospitals said they are following Centers for Disease Control and Prevention guidelines that allow for extended use or reuse of some gear under what the agency calls "crisis capacity strategies."
Long Island Community Hospital has an estimated five- to seven-day supply of personal protective equipment and is following CDC guidelines that include “maximizing the use of gowns through a number of strategies, including extended wear,” spokeswoman Katherine Heaviside said. LICH “is exploring every public and private source for PPE and other vital equipment during this period of unprecedented demand, coupled with uncertainty of supply.”
About 100 patients at the hospital have been diagnosed with COVID-19 or are suspected carriers, with many using ventilators, Heaviside said.
CDC spokeswoman Arleen Porcell said the pandemic "has directly impacted supply chains for tools needed by health care systems" and led them to issue strategies to hospitals on how to conserve personal protection equipment.
"While these strategies do not adhere to the typical standards of care in the U.S., they reflect the hard realities on the ground," Porcell said.
Agency guidelines allow for "limited re-use" of N95 masks, though there is "no way of determining the maximum possible number of safe reuses." The most significant risk is "contact transmission from touching the surface of the contaminated respirator," according to the agency's website.
In some cases, protective gowns can be worn for an extended period of time or reused. But if health care providers treating COVID-19 patients share gowns or a provider uses the same gown to treat multiple patients, the risk to providers is "unclear," according to the agency's website.
Strecker said she was instructed to wear the same gown for an entire 12-hour shift, or until it ripped. She said she was told to use an ammonium-chloride based disinfectant, Virex Plus, to wash down her gown.
“I am now taking this gown and spraying it with chemicals while I still have it on my body to try to get every inch of it,” Strecker said. “Then I take it off, I hang it, I let it dry. And, I have to put these PPE back on my body to go into a room and see another patient to do care on that patient."
Some LI Community Hospital health care workers are wearing garbage bags over their gowns, Heaviside said. The hospital "has not instructed" them to do so, but "if they choose to do so, LI Community Hospital will not stop them," she said. She also hailed health care workers for "brave and inspiring work on the front lines."
Strecker said she got a new N95 mask Monday. She planned to use it for three 12-hour shifts before asking for a new one.
As added protection, she said she bought surgical masks on her own and is placing one of those on top of her N95 before visiting patients in an attempt to keep it useful longer.
“At the end of my shift, I completely cleaned my N95 with alcohol, I put it in a brown paper bag and it is now in my locker,” she said. “It will be there when I go to work.”
Major hospital systems on the Island also said they're following CDC guidelines.
Christine Hendriks, vice president for public relations and communications for Catholic Health Services, which runs a network of six hospitals on Long Island, including St. Charles and St. Catherine of Siena Medical Center in Smithtown, said in an email that the hospitals have "adequate supplies."
"CHS policy follows CDC recommendations on use and re-use of masks and gowns when caring for patients with, or suspected to have COVID-19," she said in the email.
Hendriks added that CHS hospitals "have recently installed UV-light N95 mask sterilizers that can sterilize three masks in 60 seconds. Additionally, large quantities of masks, face shields and gowns are being distributed to all CHS facilities."
Mount Sinai South Nassau hospital in Oceanside also was reusing protective gear, even shipping masks to a sterilization facility in Oregon, said Paula Zweig-Cohen, a registered nurse who is director of infection control for the hospital. She said it was unclear how long supplies would last, but the hospital now has "everything we need" and was getting new supplies.
At Northwell Health, chief medical officer Dr. David Battinelli said health care providers have not had to reuse gowns, but, like Strecker, were trying to conserve N95 masks by wearing surgical masks over them.
When health care workers are wearing appropriate personal protection equipment, "The risk of transmission to health care workers is very, very low, probably approaching or even lower than the risk of community spread," Battinelli said.
Northwell is adequately supplied for at least several weeks, he said.
Dr. Susan Donelan, medical director of Healthcare Epidemiology at Stony Brook Medicine, said health care providers there were not reusing gowns or gloves, but the hospital is about to implement a plan for preserving N95 masks after some procedures when they typically would be discarded.
Chacon said nurses at St. Catherine of Siena also had been told to reuse equipment. Of the roughly 500 nurses the union represents at that hospital, at least six nurses have been diagnosed with COVID-19, and 24 were considered PUI, or persons under investigation for contact with the virus, he said earlier this week. "They're saying they have adequate supplies — they obviously don't," he said.
Three St. Charles nurses were persons under investigation Wednesday, he added in an email. Hendriks did not respond to an email request to confirm those numbers. An employee of St. Catherine's hospital died of COVID-19 complications, administrators said Tuesday, without offering additional information.
Chacon said reuse was a significant departure from normal protocols.
Nurses interviewed for this story — some of whom worked during the H1N1 flu pandemic and the Ebola outbreak — said the job, always stressful, has turned gut-wrenching.
“A lot of nurses are not sleeping. Everyone is complaining of anxiety,” said Michelle Farid, 28, an ER nurse at LICH. “People are stressed out. People are crying.”
Working under rules that sometimes feel as if they change by the day, with equipment that too often feels makeshift, “We don’t feel like we’re protected," Farid said. "We can’t take care of other people if we can’t take care of ourselves first ... Who is going to help us? We feel helpless. It’s crazy.”
With David Olson