As coronavirus continues to spread across the U.S., experts say the outbreak is revealing the healthcare industry inability to control infections at its own facilities or protect employees.
Twelve people have died from the virus as of Thursday, according to the Centers for Disease Control and Prevention, with nine linked to an outbreak within a single nursing home in suburban Seattle. On Wednesday, California reported its first COVID-19 death involving a patient who was being treated at a hospital near Sacramento, according to reports.
Infections spreading within facilities like the Washington nursing home indicates that staff may not be prepared to execute proper infection control and safety, according to critics.
According to National Nurses United on Thursday, 44% of surveyed nurses said their employer provided them with information to identify potential coronavirus cases. Only 19% of the 6,500 nurses across 48 states surveyed knew if their employer had policies to address if workers were potentially exposed to the virus.
"All nurses must be protected on every shift throughout our hospital and in every hospital through our country," said Cathy Kennedy, a registered nurse at Kaiser Permanente's Roseville Medical Center in California and executive council vice president for NNU. "When nurses are not protected the community is not protected."
Sixty-three percent of survey respondents reported having access to N95 respirator masks on their units, which are recommended by the CDC for protection against infection. Thirty percent reported their employer had sufficient supplies of personal protective equipment in stock in the event they got a sudden surge of COVID-19 patients.
But the results also pointed to more systemic issues regarding infection control.
Only 29% of nurses surveyed reported their employer had a plan in place to isolate patients suspected of having coronavirus, while 58% reported their employer had instituted travel history screening for all patients with symptoms to assess their level of risk of virus exposure.
In the U.S., nearly 1.7 million patients acquire an infection in a healthcare setting, resulting in more than 98,000 deaths annually, according to the CDC. While evidence shows healthcare providers have improved in reducing infections, a 2018 report conducted by the Leapfrog Group found the percentage of hospitals achieving zero infections has declined since 2015.
Many hospitals are preparing for a major coronavirus outbreak by ensuring they have an adequate number of air isolation rooms for patients.
But a brief snapshot of isolation protocol violations of 10 hospitals conducted between June 2018 and January 2020 by patient safety technology firm Avasure found providers committed nearly 50 violations in that period, with 82% committed by staff.
Among the violations identified included clinicians going into isolation room without donning personal protective equipment, personnel not washing their hands after leaving a room, and nurses not being updated on isolation precautions.
"I think there's a burden for staff," said Lisbeth Votruba, vice president of innovation and clinical quality at AvaSure, which has more than 850 hospital clients. "Gown and gloves are sweaty and hot, and you think you're just going to in [the room] and not touch anything and before you know it you've touched a patient."
Several Avasure clients used the company's video monitoring equipment during the 2014-2016 Ebola outbreak to check on patients remotely and reducing the number of times clinicians must put on and take off personal protective equipment to enter a room. Votruba said the same technology can be repurposed to monitor COVID-19 patients to increase the safety of clinicians.
The CMS on Wednesday directed state survey agencies to limit the focus of their inspections of nursing homes and hospitals to infection control and abuse allegations, citing concerns over a major coronavirus outbreak within healthcare facilities.
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, acknowledged complying with infection control practices has proven challenging for many hospitals, which has led to lapses at every facility.
COVID-19 and influenza share many symptoms, and the nature of coronavirus is still relatively unknown. That may affect hospitals' ability to develop better safety protocols.
Adalja said better protocols will lessen the need for hospitals to implement potentially harmful strategies like quarantining healthcare workers who may get exposed to the virus.
"That's going to be increasingly untenable if we're doing that because you're going to have major parts of hospitals staff that are quarantined and unable to work," Adalja said.