A simple surgical mask or an N95 mask…does it matter what nurses use in the battle against COVID-19?
For the nurses at Ross Memorial Hospital (RMH) in Lindsay, the answer is yes — and some are refusing to work with infected patients without the superior shielding qualities of the N95.
“I feel unsupported and scared,” says a nurse who didn’t want to be identified for fear of job reprisal. She has been working on the newly established COVID-19 floor at RMH.
The nurse tells the Advocate that RMH nurses are being told to wear surgical masks with face shields, not N95 ventilator masks.
“Paramedics picking up a suspected COVID-19 patient get issued N95s, the health workers at the screening centre wear N95s. But us — the nurses on the COVID-19 floor of the hospital — we have been told that we will be fined if we wear them,” says the nurse.
Despite threats by management at RMH, according to the nurse, most nurses are refusing the order to stick with the surgical masks.
“As far as I have seen, everyone refuses to see a patient who has been swabbed (tested for COVID-19) without one,” she says.
So what’s the difference?
A surgical mask is a disposable, loose-fitting mask designed to be a barrier between the nose and mouth of the wearer and environmental contaminants.
The N95 filters any particles in the air and seals off the nose and mouth from the outside environment. It protects against airborne germs and is recommended by the public health agency of Canada for any kind of close contact with COVID-19 patients, including procedures such as intubation.
On March 12, near the start of the COVID-19 crisis in Ontario, Public Health Ontario suddenly revised their recommended “use of personal protective equipment for care of individuals with suspected or confirmed COVID-19.”
In a news release the day before, four unions representing health care workers, including the Ontario Nurses Association (ONA), warned the province was “watering down guidelines regarding the level of personal protective equipment for front-line health-care workers.”
The unions represent 250,000 health-care workers in the province.
The new provincial regulations hinge on some assumptions of COVID-19 — a disease that has only been studied anywhere in the world for three months. The key assumptions underlying this change are that, “COVID-19 cases and clusters demonstrate that droplet/contact transmission is the route of transmission” and “there is no evidence that COVID-19 is transmitted through the airborne route.”
So at the moment, nurses are denied N95 ventilators because “droplet prevention” is being exercised. These new regulations state that “airborne precautions” – such as wearing an N95 mask — is only needed when performing procedures like intubation (installing a breathing tube).
Veronica Nelson, interim president and CEO of RMH, notes that the chief medical officer of health, and Public Health Ontario have issued a directive with regard to personal protective equipment – and RMH is simply following it.
“All Ontario hospitals and healthcare workers are required to follow this directive, which outlines when surgical masks versus N95 masks are to be used,” says Nelson.
“This means that staff and physicians providing care to patients with suspected or confirmed COVID-19 must follow droplet/contact precautions, including surgical mask, gown, gloves and eye protection with proper hand hygiene,” Nelson says.
This contrasts with staff members who are performing aerosol-generating medical procedures (AGMP) for patients with suspected or confirmed COVID-19. In this case they must follow airborne, droplet and contact precautions, including N95 respirators, gown, gloves, eye protection and proper hand hygiene.
“Staff who do not follow the directive will receive additional education, and may be subject to discipline,” Nelson confirms.
However the New England Journal of Medicine reported on March 17 that the COVID-19 virus can live for hours in the air.
Given that it is such a new disease with so many unknowns, many believe front line nurses should be using the same recommended safety procedures as under SARS. (In fact, at least within the scientific community, the disease has already been renamed from COVID-19 to SARS-COV-2).
Just yesterday (March 23) RMH announced they would take donations of personal protective equipment from the public, saying in a Facebook post “If you have unused gowns, surgical masks or N95 respirator masks and would like to donate them, please contact Christine at or 705-324-6111 ext. 4628 to arrange.”
The nurse who spoke to the Advocate says we should be erring “on the side of caution” and let all nurses use the N95 masks. Her understanding is that there is currently a four-week supply of N95 masks, depending on what happens.
“I am using them for as long as I have access to them,” she says.
–with files from Roderick Benns