Jane Englebright, senior vice president and chief nurse executive for HCA Healthcare, discusses efforts to protect our colleagues during COVID-19.
How is our supply of N95s?
The question of the availability of N95 respirators and other critical personal protective equipment (PPE) is not only on the mind of every caregiver at HCA Healthcare, it is also being asked around the globe.
Our answer: HCA Healthcare currently has adequate supplies, and we are doing everything in our power to ensure we continue to have enough to protect our colleagues as they provide care to patients. As our CEO Sam Hazen recently committed to colleagues, “Our top priority is protecting you.”
We are not alone. The World Health Organization reports: “The current global stockpile of PPE is insufficient, particularly for medical masks and respirators … surging global demand − driven not only by the number of COVID-19 cases but also by misinformation, panic buying, and stockpiling − will result in further shortages of PPE globally. The capacity to expand PPE production is limited, and the current demand for respirators and masks cannot be met, especially if widespread inappropriate use of PPE continues.”
This is a challenge for hospitals across the country. It requires a thoughtful, pragmatic approach that considers the safety of our colleagues and the wellbeing of our patients, not just today but as this pandemic continues. Even though HCA Healthcare currently has adequate supplies and more on the way, we must take prudent steps to conserve PPE. Our infectious disease experts and nursing leadership have carefully reviewed clinical evidence and FDA best practices for PPE conservation and reuse, and we are taking the following steps consistent with CDC guidelines:
- Allowing the use of both N95 masks and standard facemasks. The evidence suggests that COVID-19 is spread by droplets, for which a standard face mask offers adequate protection. For aerosolizing procedures, the use of an N95 mask is recommended, when available. However even in this setting, evidence shows that a regular face mask, coupled with a face shield, offers protection from transmission to the healthcare worker.
- Limiting inappropriate use of PPE. There are areas in hospitals where PPE is not required. Use of PPE by colleagues who are not at risk for exposure limits availability for colleagues who care for infected patients.
- Using supplies beyond the manufacturer’s recommended shelf life. As stated by the CDC: “Many models found in U.S. stockpiles and stockpiles of healthcare facilities have been found to continue to perform in accordance with NIOSH performance standards.”
- Reuse of PPE. There are specific protocols that we are adopting, outlined by the CDC, to guide healthcare workers toward appropriately maintaining their PPE for reuse. HCA Healthcare has implemented a process for reuse of PPE based on this guidance.
- Reprocessing of PPE. HCA Healthcare is collecting goggles, face shields and N-95 respirators for reprocessing. Goggles and shields are being reprocessed in our Sterile Processing Departments, using national guidelines. The Food and Drug Administration (FDA) is looking at standards for re-processing of masks and a decision is expected soon.
We recognize these are extraordinary measures, but they are necessary because the COVID-19 pandemic is creating extraordinary challenges. We want you to know as we address them, that we are following these three principles:
- Ensure that strategies for protecting our workforce are optimized, and designed for the long term. Over-utilizing PPE today puts caregivers at risk in the near future.
- Ensure that our patients get the care they need, when and where they need it. We do this by protecting our caregivers.
- Make decisions based on the known evidence and guidance from national authorities such as the CDC.
Responding in times of crisis is what we do as an organization and what you do as a healthcare professional. Your commitment to our patients is inspiring. We care like family, and we will do everything in our power to keep all of us safe.
-Jane Englebright, Ph.D., RN, CENP, FAAN
Senior Vice President and Chief Nurse Executive
Nashville-based HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising 184 hospitals and approximately 2,000 sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 21 states and the United Kingdom. With its founding in 1968, HCA Healthcare created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. HCA Healthcare is a learning health system that uses its more than 35 million annual patient encounters to advance science, improve patient care and save lives.