We are now months into the COVID-19 pandemic, and our healthcare professionals and staff have been rightfully lauded for their extraordinary caregiving under the severe stress of the unprecedented circumstances in which they are working. Many individuals and organizations have joined in supporting the front lines through meals and thanks, which are very much appreciated.
But there is, unfortunately, another pressing unmet need for our healthcare heroes -- the need for optimal personal protective equipment (PPE) while rendering care in the era of COVID-19.
While some health facilities have managed to provide PPE that is consistent with long-standing evidence-based best practices that help reduce exposure to known respiratory pathogens, there is tremendous variation among hospitals and health systems locally, regionally, and nationally in whether optimal PPE is being made available to their frontline staff.
Even one of the esteemed guiding agencies, the CDC, has now amended their conventional evidence-based best practice recommendations to bend their standards and include two additional but suboptimal levels of protection -- contingency and crisis -- with the associated recommendations in those categories no longer based solely on the science of evidence-based best practice, but based on supply.
Health systems can now justify the provision of suboptimal PPE by citing the fact that their practices are based on CDC recommendations, without specifying what the level of recommendation is that they are using -- conventional (evidence-based and optimal) or the suboptimal supply-related categories of contingency and crisis.
The law and regulatory agencies set minimum standards; ethics guide decision making focused on the best interests of the people that are affected by those decisions.
Shouldn't all healthcare facilities be exceeding the minimum standards to protect workers to the best of their capabilities? And if these are simply supply-driven decisions, why are some caregivers not being allowed to wear equipment such as N95 masks that they bring to their workplace themselves?
A national accrediting agency for hospitals and health systems has weighed in on this:
"The Joint Commission supports allowing staff to bring their own face masks or respirators to wear at work when their health organizations cannot routinely provide access to protective equipment that is commensurate with the risk to which they are exposed."
There are examples across the country of physicians, nurses, and others who have questioned the suboptimal PPE and have been fired or resigned after speaking out on behalf of themselves or others; this creates an ongoing moral hazard in addition to the physical ones for many who remain. Employer retaliation is never an acceptable remedy.
The U.S. has long prided itself on being a world leader in healthcare, and the science and technology that drives it. It is really difficult to understand how one of the wealthiest nations in the world finds itself unable to provide personal protective equipment for dedicated health professionals in the midst of a novel disease outbreak that has spread fast enough and far enough to be a pandemic.
As stated in a recent CDC study of healthcare personnel infected with COVID-19, "It is critical to make every effort to ensure the health and safety of this essential national workforce of approximately 18 million Health Care Personnel, both at work and in the community."
Carol Kerrigan Moore, MS, is a recently retired family nurse practitioner who began practice in 1982.