A recent survey of registered nurses conducted by the California Nurses Association and the National Nurses Organizing Committee at more than 190 U.S. hospitals reports that many hospitals have inadequate safety gear, infection control training and post-exposure procedures, which will leave them more vulnerable to H1N1 infections should an outbreak occur this fall, according to a report released today.  

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.

Findings of the survey include:

•    Half the hospitals have seen infected patients and 18% have had infected RNs.

•    Nurses at 15 % of hospitals reported that they do not have access or only some have access to the appropriate N95 respirator masks, and at 19% of the hospitals all or some masks were not “fitted,” to ensure their effectiveness against the virus.

•    More than one in five, 22% of the facilities, do not have enough masks.

•    At almost 40% of those which do have sufficient masks, all or some of the masks are expected to be reused. That puts nurses and patients at risk of infection and violates CDC guidelines which say all health care 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% 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 49% of facilities reported 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% of facilities reported 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 reported 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 reported that Tenet has eliminated sick benefits that would ensure nurses could afford to take time away from work if they develop symptoms.

CNA/NNOC also released a list, “The Nurses’ Swine Flu Safety Agenda”  to adequately prepare for a 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

•    Health care 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 health care 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.