Bayfront Health Seven Rivers

Bayfront Health Seven Rivers 

In normal times, hospital staff donned respirator masks and gowns when they entered a patient’s room who was contagious and tossed the garb into a bin when they left.

But these are not normal times.

As the coronavirus crisis forces hospitals across the country to make tough choices on how to use diminishing resources, many hospital staff reuse disposable personal protective equipment meant to be thrown away after each use.

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Nurses at Bayfront Health Seven Rivers told the Citrus County Chronicle their hospital is now in that group of facilities where health care workers are handed a single gown and mask for their shift and told to make due.

The nurses told the Chronicle they fear getting infected or infecting someone else as they keep the protective equipment on for hours.

“I am absolutely concerned that we’re using the same personal protection equipment for multiple patients and over multiple days,” said Anne Marshall, a Seven Rivers hospital intensive care nurse.

Marshall said she understands the hospital must make its supplies last.

“I don’t know what the solution is … but they should have been more prepared,” she said.

Marshall is at home now recovering from a shoulder injured while lifting a patient. She said the hospital is short staffed and there weren’t enough workers to help her.

She said hospital staff have even taken to putting patient gowns over their own uniforms for a little added protection.

A hospital representative did not dispute that staff were not disposing of masks and gowns and continuing to use them. But regional Bayfront Health spokeswoman Jennifer Siem said the Crystal River hospital was following Centers for Disease and Prevention guidelines.

“At this time, we have sufficient FDA approved supplies on hand to maintain protections for our team caring for current patients and in case our community sees an increase in cases requiring hospitalization, but we need to appropriately conserve supplies given national shortages,” Siem wrote, in part, in an email to the Chronicle when the newspaper asked the hospital about its gown and mask reuse.

“I want to assure you that our hospital is closely following guidelines from the Centers for Disease Control and Prevention (CDC) and the Florida Department of Health," Siem added. "We update our infection control and PPE (personal protective equipment) practices every time new guidance is released.

“We have educated our team members on infection prevention protocols established by the CDC for COVID-19, just as we do for other types of infectious diseases insisting upon the proper use of PPE. We continue to reinforce that education daily."

Before the pandemic, Bayfront Seven Rivers ICU nurses treating patients used new masks and gowns each time they entered a patients’ room, Marshall said.

That’s changed, Marshall said.

Marshall said she treated nine patients over three days using the same protective gear.

She said staff were told to hang their gowns in the room of the last patient they saw at the end of their shift or after removing the gown. She said staff are told to place masks in a baggie with their name written on it in the room of their last patient and reuse them when they come back to work.

Marshall told the Chronicle that under those conditions she’s afraid she’ll bring the virus home.

Over the course of two weeks, six Bayfront Health Seven Rivers emergency nurses told the Chronicle about shortages of gloves and gowns at the hospital and having to reuse the equipment beyond where they felt safe. 

The CDC has guidelines and recommendations for reusing personal protection equipment during times of crisis and shortages brought on from pandemics. Siem said her hospital is following those CDC guidelines.

“Supplies of N95 respirators can become depleted during an influenza pandemic or wide-spread outbreaks of other infectious respiratory illnesses,” according to CDC guidelines posted on its websites.

The Chronicle also contacted Citrus Memorial Hospital for comments about its gown reuse policies. CMH spokeswoman Katie Myers said CMH is not reusing its gowns and masks.

"We are not reusing gowns and masks," Myers told the Chronicle.

But with personal protection equipment in short supply across the country, CMH is asking staff to conserve the equipment, she said.

"This includes collection of certain items (such as goggles and face shields) for sterilization and reuse, cohorting patients with similar respiratory issues where we can and using telehealth technology when possible to conserve PPE," she said.

The CDC website gives recommendations about how best to reuse masks and gowns and extend supplies when supplies are short.

“(The) CDC recommends that a respirator classified as disposable can be reused by the same worker as long as it remains functional and is used in accordance with local infection control procedures,” the CDC states.

“Limited reuse has been recommended and widely used as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics."

The CDC makes the same kinds of recommendations for gowns.

“Consideration can be made to extend the use of isolation gowns (disposable or cloth) such that the same gown is worn by the same health care professional when interacting with more than one patient known to be infected with the same infectious disease …,” the CDC guidelines state.

But the CDC also warns that not all masks are the same and some are strictly intended for only one-time use.

The federal agency also warns that the longer a mask is worn, the greater the possibility of infection.

“The most significant risk is of contact transmission from touching the surface of the contaminated respirator,” according to the CDC. “One study found that nurses averaged 25 touches per shift to their face, eyes or N95 respirator during extended use."

Last week, the 128-bed hospital in Crystal River posted a request on social media, asking for donations of supplies including masks, latex gloves, gowns, face shields and eye protection.

Siem told the Chronicle the hospital was asking for public donations to be better prepared for a potential surge in COVID-19 patients. 

Federal officials continue to say that equipment to protect health workers is making its way through the supply chain. But many hospitals report they are not seeing it. As a result, prices have skyrocketed.

New York state was forced to pay about 15 times the regular price for masks and four times the regular price for gloves, according to ProPublica.

The federal government’s supply has also dangerously diminished as it sends masks, gloves and gowns to the states.

The Department of Health and Human Services told the Associated Press Wednesday that the federal government has distributed 90% of its stockpile of masks, gloves, gowns and face shields. It plans to keep 10% in reserve.

Bayfront Health Seven Rivers is a for-profit Community Health Systems Inc. facility. CHS owns, operates or leases 99 hospitals in 17 states, according to its website. It has 16 hospitals in Florida.

Contact Chronicle reporter Fred Hiers at fred.hiers@chronicleonline.com or 352-397-5914.