Nurse frustrated with mask directives

Hospital dismisses complaints as union-bellyaching

MARK BRODEUR loves his work as an intensive care and emergency room nurse at Berkshire Medical Center in Pittsfield, but he is frustrated by directives coming from administrators on how staff should use personal protective equipment, or PPE, in the midst of the pandemic.

The guidelines attempt to strike a balance between conserving PPE, given the worldwide shortage of the equipment, and protecting workers. But, in his view, the guidelines don’t do enough to protect workers from getting infected. So Brodeur has decided to ignore his employer’s guidelines and wear the equipment he believes will keep him safe.

Specifically, he wears an N95 mask, so named because it filters out 95 percent of airborne particles. “I feel safe wearing it, and I feel like my patients are safer, my family is safer, and everyone else I come in contact with is safer,” he said.

Current policies at Berkshire Medical Center direct medical staff to wear N95 masks only when they perform an aerosolizing procedure such as intubating a patient who needs to be put on a ventilator. At other times, a surgical mask is worn, which filters somewhere between 60 to 80 percent of airborne particles. “Surgical masks prevent you from giving the virus to someone else when you cough or sneeze, they don’t keep you from getting infected,” Brodeur said.

Brodeur believes that all hospital staff members who have direct contact with patients should wear N95 masks. Because people can transmit the virus before or without ever showing symptoms, he said, it’s important to treat every patient as if they’re infected. “That’s how we can ensure the virus spreads as slowly as possible,” he said.

The supply chain for N95 masks and other PPE was disrupted this winter when the pandemic erupted in China, which manufactures most of the equipment. In response, the US Centers for Disease Control and Prevention revised its protocols to include strategies for optimizing the use of facemasks and other equipment in case of extended shortages. While use of an N95 mask with a plastic face shield is regarded as preferred use for medical staff working with infectious patients, a surgical mask with face shield or goggles is considered an acceptable alternative.

Brodeur said the CDC’s new position is a mistake. ”They should not relax safety standards because there is a shortage of equipment,” he said. “What should have happened is that our state and local health care leaders should have gone to legislators and asked them to put pressure on the federal government to tell our manufacturers, ‘You need to make these masks.’”

Brodeur is a member of the Massachusetts Nurses Association, the state’s largest nursing union, which has been advocating with little success over the past month for a more consistent and rigorous use of PPE in hospitals around the Commonwealth.

Michael Leary, a spokesman for Berkshire Medical Center, dismissed Brodeur’s safety concerns as so much union belly-aching. “Nearly every other day,” he said in a statement, “the MNA leadership issues a statement that attempts to turn the nationwide challenge of personal protective equipment supply into a labor dispute between the MNA and Berkshire Health Systems management. It is not the time for such distractions. As we have repeatedly assured our community and hospital staff, we are meeting or exceeding the COVID-19 safety standards for PPE that have been established by the leading national and regional healthcare organizations, including the Centers for Disease Control and Prevention and the Massachusetts Department of Public Health. Unlike those organizations, the MNA is a labor organization and not a clinical one.”

Leary notes his hospital has exceeded standards with superb infection control, strategic supplies management, continuous staff education, and mandatory use of masks by all staff. As a result, BMC has far lower rates of staff infected with COVID-19 compared to its counterparts nationally.

Brodeur said his hospital has responded well to the pandemic in certain ways. BMC moved quickly to isolate COVID-19 patients and install negative pressure rooms to contain infection.  But in regards to PPE, he said the leadership’s response was slow off the blocks.

Staff at Berkshire Medical Center started seeing patients testing positive for the virus in early March. But Brodeur said it wasn’t until March 27 that the hospital administration sent out a memo directing all direct care staff to wear surgical masks and goggles. Prior to that, he said, staff were ordered not to wear masks unless they were working with patients who had tested positive. As a result, many staff were needlessly exposed.

According to MNA spokesman Joe Markman, over 100 BMC nurses were furloughed for a two-week quarantine after being exposed to patients positive for COVID-19.  About three quarters of the exposures (86) occurred on floors where patients were not initially diagnosed with COVID-19, and where nurses were directed not to wear masks or other face-coverings.

Brodeur said the system used for identifying which staff were exposed was flawed in that only staff who made notes in the charts of infected patients were quarantined. Those who assisted another nurse in close-contact procedures, such as a bed turn, were not identified as being exposed.

Until the supply chain is more stable, Brodeur said N95 masks can be conserved by limiting the number of people who give direct care to patients and by reorganizing staff roles. Standard procedures require medical staff to remove gowns and masks as they leave an infected patient’s room. However, a few staff could be assigned to get medications or supplies and deliver them to patient rooms, limiting the number of times direct care staff shed and replace PPE.

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Brodeur said he and many of his coworkers are using their N95 repeatedly. He has been wearing the one he currently uses for the past few weeks, protecting it from splashes by putting a surgical mask on top of it.

“Our hallway looks like some sort of weird elementary school art project, with all these masks in paper bags hung up on the wall with everyone’s name on them,” Brodeur said.