- The Pennsylvania Department of Health this week issued an order requiring hospitals to update protocols ensuring staff safety throughout the COVID-19 pandemic. New policies include universal mask wearing for everyone entering a facility and comprehensive contact tracing among workers.
- Hospital staff who have been in contact with confirmed or probable COVID-19 cases must be notified within 24 hours and provided instruction for quarantine and work exclusion. The order also requires testing for both symptomatic and asymptomatic staff after exposure upon that employee's request.
- The policies cover all hospital staff, including those in therapeutic, social, housekeeping or dietary services, as well as maintenance. Pennsylvania hospitals have until Monday to adhere to the new rules.
Healthcare workers across the country have faced an intense physical and psychological toll in caring for COVID-19 patients. Many have dealt with inadequate personal protective equipment.
To date, more than 72,000 healthcare workers nationwide have tested positive for the virus and more than 380 have died, according to the Centers for Disease Control and Prevention, which warns those estimates are certainly an undercount.
In New York, nurses sued hospitals and the state health department alleging unsafe working conditions amid the pandemic. One lawsuit was tossed out by a judge arguing the dispute should be resolved in arbitration.
More than 5,000 healthcare workers in Pennsylvania have tested positive for COVID-19, according to a statement the Pennsylvania Association of Staff Nurses and Allied Professionals sent to Healthcare Dive.
"Since March, [the union] has been fighting to hold hospitals accountable for their lack of PPE and policies that have left dedicated frontline healthcare employees and their patients vulnerable to COVID-19," the group said.
At the union's urging, Pennsylvania Gov. Tom Wolf's "administration is, through this new order, forcing hospitals to be accountable to their employees and ensure that they, and therefore their patients, are safe," the 8,500-member group said.
The new mandates in Pennsylvania focus on effective contact tracing that is labor intensive, Gerald Maloney, chief medical officer for Geisinger Health, which operates 10 hospitals in the state, told Healthcare Dive.
"It's possible in the past three days I was around 96 people, and now somebody has to call all of them," Maloney said.
But the unique setup of hospitals, carefully accounting for the whereabouts of patients, visitors and staff, make tracking COVID-19 exposure somewhat more do-able than in other settings. Some facilities are also brimming with untapped labor after implementing furloughs or other workforce reduction measures to offset ongoing volume declines.
Geisinger has more than 30,000 employees, some of whom have now been tapped to help with contact tracing efforts following the cancellation of elective surgeries and temporary closure of some facilities.
The health system does in-house COVID-19 testing, Maloney said, rendering faster results than public health laboratories and helping staff determine who needs to self-quarantine or who may have been exposed.
Other new state guidelines further outline what constitutes adequate PPE for healthcare workers. Those assigned to provide direct patient care in COVID-19 units must be provided particulate-filtering respirators approved by the National Institute for Occupational Safety and Health.
If unavailable, respirators approved by the Food and Drug Administration, including through an Emergency Use Authorization, are permitted. If a mask becomes soiled, damaged or otherwise ineffective, it must be replaced as soon as practical.
After the onset of the COVID-19 pandemic, the CDC changed its guidance on N95 respirators and surgical mask usage for healthcare workers, allowing them to bring homemade coverings, extend their use and employ new decontamination procedures.
Some advocacy groups, such as National Nurses United, say the new PPE guidance puts nurses at risk.
During a House Committee and Oversight Reform hearing Wednesday, NNU Executive Director Bonnie Castillo said that after the decontamination process, masks are often returned deformed or with loosened straps. There is also limited scientific evidence proving the process is safe or effective, she said.
"We know that reuse will result in more infections, and more nurses and frontline workers falling ill and out of the workforce," Castillo said.
The union and other advocacy groups are still calling for the Trump administration to fully invoke the Defense Production Act in order to supply frontline workers with enough effective PPE.
Correction: A previous version of this article misstated the number of hospitals Geisinger has in Pennsylvania. The system has 10 hospitals in the state.