Concern about PPE shortage remains as MN moves to allow elective procedures

Yellow and purple PPE on a bed.
PPE including gloves, a face shield, eye shield, disposable gown and single-use mask sit on a bed. As the state prepares to reopen hospitals for elective procedures, some nurses at United Hospital in St. Paul are speaking out about a shortage of personal protective equipment.
Evan Frost | MPR News file

Updated: 5:09 p.m. May 8 | Posted: 6:22 p.m. May 5

As the state prepares to reopen hospitals for elective procedures, some nurses at United Hospital in St. Paul are speaking out about a shortage of personal protective equipment, or PPE, such as N95 respirators, even as the hospital operates at a reduced capacity.

Zetella Caauwe, a registered nurse in the hospital’s emergency room, said she’s concerned about the current protocol for reusing N95 masks.

“By the end of my 12-hour shift, I no longer have a good seal on the mask, and you can just feel the air coming in,” she said. “I say that if you're wearing an N95 and you cry, you know that the seal isn't good if the tears go inside your N95, rather than going along the sides.”

Last week, Allina Health, which owns United Hospital, issued a policy that directs staff to wear their masks for a full shift and then seal them in bags for five days before wearing them again. The Centers for Disease Control and Prevention says the procedure is adequate to kill the coronavirus. Staff are then told to reuse the masks in this fashion five times before disposing of them.

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“It's really a good practice from a conservation perspective, and just as safe as taking a new mask,” United Hospital President Sara Criger told MPR News last week. “We think that's important right now to ensure that we have what we need when and if the surge hits us, that we're not putting people at risk either now or in the future.”

Allina Health said on Friday that the policy is in line with PPE guidelines from the CDC, the state Health Department and its infection prevention experts.

“These practices are aligned with other local and national hospitals. Our policies prioritize the safety of our staff and patients, while enabling us to allocate the appropriate supplies for daily patient care and for a spike in COVID-19 cases,” a spokesperson said in an email to MPR News.

United is not the only hospital having to go against past practices to preserve PPE for a potential surge in COVID-19 cases. Health care providers across the country and states have been trying to source N95 respirators amid unprecedented global demand.

In Minnesota, a working group has been assigned to track down and purchase PPE. Their progress is tracked on the state’s coronavirus dashboard. As of Tuesday, it showed a current inventory of 344,000 respirators, with 147,000 already distributed and 1.6 million more ordered.

A spokesperson said the state distributes its PPE stock when a healthcare entity expects to run out within four to seven days.

“I just don’t understand why there are that many N95s [in storage] and we are obviously using N95s until they don’t work at all,” Caauwe said.

Nurses allege retaliation for wearing hospital scrubs

United Hospital nurses are also frustrated by Allina Health’s policy on using hospital scrubs.

Typically, nurses would wear their own scrubs and launder them at home. But with the coronavirus’ high transmission rate, nurses are afraid they’ll bring the virus home on their clothes. So some have been wearing scrubs reserved for surgeries and other settings that the hospital stocks and has professionally cleaned.

Caauwe said she and her colleagues have been subject to disciplinary meetings with their supervisor, department director and human resources for wearing the scrubs against hospital policy. She said she is likely to be suspended or fired the next time she is disciplined, based on the hospital’s progressive discipline policy.

In its statement on Friday, Allina Health said it has not disciplined any employee for raising safety concerns.

“We need and appreciate feedback from our employees during this very complex time. Our preference is always that education and coaching efforts will be successful,” the statement reads.

The hospital does provide protective gowns that staff can wear over their personal scrubs, but Caauwe said they leave your legs and back exposed.

Criger told MPR News that nurses are also given pillowcases to safely take their scrubs home, and that there aren’t enough hospital scrubs to go around. Caauwe disputes both points.

“I am not entirely sure how many scrubs they have, but I do know that we're not doing elective surgeries, so there are hospital-issued scrubs that are actually not being used,” she said. “They're just sitting there.”

Caauwe said it costs the hospital 50 cents per item to have the scrubs professionally laundered. Without elective surgeries to bring in revenue, many hospitals have been implementing cost-saving measures, including furloughs.

But Criger said the hospital’s policies are made with staff safety in mind.

“That is our highest priority through this,” she said. “We need to be able to provide care and we need to ensure that our team members are safe and protected for themselves, for their family members, and to ensure that we're not not a source of spread.”

Caauwe said she understands the hospital is facing unusual and difficult circumstances. She just wants to see more collaboration.

“We'd like to sit down and discuss the scrubs policy, the COVID-19 surge plan, the N95 masks so that so that we can all be on the same page and understand where each other is coming from,” she said. “We have not experienced our surge yet. This is the time for us to get together and really prepare.”

MPR News reporter Kirsti Marohn contributed to this story.