Should the general public wear facemasks? #

On April 4, 2020, the CDC set forth a recom­men­da­tion in support of wearing cloth face cover­ings in public settings where other social distancing measures are dificult to maintain, (e.g., grocery stores and pharma­cies). A special focus is in areas where there is signi­cant commu­nity-based trasmis­sion. CDC advises the use of simple cloth face cover­ings to slow the spread of the virus and help people who may unknow­ingly have the virus from tranmist­ting it to others. Cloth face cover­ings made from house­hold items at low cost can be used as an additional, volun­tary public health measure. See the CDC refer­ence which describes how to make, correctly wear, and clean homemade cloth face cover­ings. (Reviewed 4/7/2020)

https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​-​n​c​o​v​/​p​r​e​v​e​n​t​-​g​e​t​t​i​n​g​-​s​i​c​k​/​d​i​y​-​c​l​o​t​h​-​f​a​c​e​-​c​o​v​e​rings.html

What is the CDC recommendation for cleaning a facemask? #

The CDC does not provide a recom­men­da­tion to clean or disin­fect facemasks. The CDC provides guide­lines to optimize the use of facemasks which address extended use of facemasks and limited re-use. In settings where facemasks are not avail­able, the CDC suggests that the HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. Homemade masks are not consid­ered PPE, since their capability to protect HCP is unknown. Caution should be exercised when consid­ering this option. Homemade masks should ideally be used in combi­na­tion with a face shield that covers the entire front (that extends to the chin or below) and sides of the face. (Reviewed 4/10/2020)

https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​-​n​c​o​v​/​h​c​p​/​p​p​e​-​s​t​r​a​t​e​g​y​/​f​a​c​e​-​masks.html

What is the time period that the air inside an examination room (occupied by a patient with confirmed or suspected COVID-19) remains potentially infectious? #

The amount of time that the air inside an exami­na­tion room remains poten­tially infec­tious may depend on a number of factors including the size of the room, the number of air exchanges per hour, how long the patient was in the room, if the patient was coughing or sneezing, and if an aerosol-gener­ating proce­dure was performed. Facil­i­ties will need to consider these factors when deciding when a room can be entered by someone who is not wearing PPE.

For patients who are coughing or under­went an aerosol-gener­ating proce­dure, the risk period is likely longer. In these scenarios, it is reason­able to apply a similar time period as that used for pathogens spread by the Airborne route and to restrict HCPs without PPE from entering the room until suffi­cient time has elapsed for enough air exchanges to remove poten­tially infec­tious particles.

The CDC provides general guidance on clear­ance rates under differing venti­la­tion condi­tions. Consult with the Infec­tion Preven­tionist and Facil­i­ties manager in your building for specific guide­lines. (Reviewed 4/2/2020)

https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​-​n​c​o​v​/​i​n​f​e​c​t​i​o​n​-​c​o​n​t​r​o​l​/​i​n​f​e​c​t​i​o​n​-​p​r​e​v​e​n​t​i​o​n​-​c​o​n​t​r​o​l-faq.html

What is the best way to clean my disposable N‑95 mask? #

The CDC and NIOSH do not recom­mend cleaning dispos­able N‑95 respi­ra­tors. These respi­ra­tors are made from a variety of materials and not all respi­ra­tors have the same construc­tion. Self-cleaning a respi­rator may result in degrading the quality of the respi­rator, rendering it less effec­tive or poten­tially ineffec­tive. Taking a used N‑95 respi­rator home to attempt cleaning using microwave or oven heat is not recom­mended. Autoclaving and the use of disin­fec­tant wipes are not recom­mended as they may alter perfor­mance of the filtering facepiece respi­rator (FFR).

Per the CDC guide­lines, FFR (e.g., N‑95) decon­t­a­m­i­na­tion and reuse may be consid­ered in a crisis to support continued avail­ability. Based on limited research, ultra­vi­olet germi­cidal irradi­a­tion, vaporous hydrogen peroxide, and moist heat are poten­tial methods of decontamination.

On March 28, 2020, the FDA issued emergency autho­riza­tion for use of the Battelle decon­t­a­m­i­na­tion system to decon­t­a­m­i­nate compat­ible N‑95 respi­ra­tors. Of note, only respi­rator manufac­turers can reliably provide guidance on how to decon­t­a­m­i­nate specific modes of FFRs. The CDC guide­lines include a table of decon­t­a­m­i­na­tion methods that have been evalu­ated for N‑95 masks. (Reviewed April 2,2020)

Are there FDA-approved methods to clean N‑95 facemasks (filtering facepiece respirators)? #

As of 4/20/2020, there are five decon­t­a­m­i­na­tion systems that have received FDA emergency autho­riza­tion for use on N‑95 facemasks.

Battelle Decon­t­a­m­i­na­tion System – FDA emergency autho­riza­tion March 29, 2020

• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​5​3​0/download
• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​5​3​2/download

Key points:

• Utilizes vapor phase hydrogen peroxide (VPHP)
• Not autho­rized for use with respi­ra­tors containing cellu­lose-based materials
• Masks must be free of any damage, visual soiling or conta­m­i­na­tion (e.g. blood, bodily fluids, makeup)
• Maximum of 20 decon­t­a­m­i­na­tion cycles

STERIS Steril­iza­tion Systems – FDA emergency autho­riza­tion April 9, 2020

• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​8​4​6/download
• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​8​4​4/download

Key points:

• Utilizes vapor­ized hydrogen peroxide (VHP)
• Not autho­rized for use with respi­ra­tors containing cellu­lose-based materials
• Masks must be free of any damage, visual soiling or conta­m­i­na­tion (e.g. blood, bodily fluids, makeup)
• Maximum of 10 decon­t­a­m­i­na­tion cycles

STERRAD Steril­iza­tion System – FDA emergency autho­riza­tion April 11, 2020

• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​8​8​1/download
• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​8​8​3/download

Key points:

• Utilizes vapor­ized hydrogen peroxide (VHP)
• Not autho­rized for use with respi­ra­tors containing cellu­lose-based materials
• Masks must be free of any damage, visual soiling or conta­m­i­na­tion (e.g. blood, bodily fluids, makeup)
• Maximum of 2 decon­t­a­m­i­na­tion cycles

Stryker STERI­ZONE VP4 Steril­izer – FDA emergency autho­riza­tion April 15, 2020

• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​9​7​7/download
• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​6​9​8​0/download

Key points:

• Utilizes vapor­ized hydrogen peroxide followed by the injec­tion of ozone.
• Not autho­rized for use with respi­ra­tors containing cellu­lose based or paper materials, natural rubber, or latex.
• Masks must be free of any damage, visual soiling or conta­m­i­na­tion (e.g. blood, bodily fluids, makeup)
• Maximum of 2 decon­t­a­m­i­na­tion cycles

Sterilu­cent, Inc. Steril­iza­tion System – FDA emergency autho­riza­tion April 20, 2020

• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​7​1​7​0/download
• https://​www​.fda​.gov/​m​e​d​i​a​/​1​3​7​1​6​8/download

Key points:

• Utilizes vapor­ized hydrogen peroxide on flexible cycle
• Not autho­rized for use with respi­ra­tors containing cellu­lose based material
• Masks that are soiled or damage must be discarded
• Maximum of 10 decon­t­a­m­i­na­tion cycles

Do cloth masks offer any protection? Since there are no surgical facemasks available, should I wear a cloth mask? #

During a crisis, in settings where facemasks are not avail­able, the HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. Homemade masks are not consid­ered PPE, since their capability to protect is unknown. Caution should be exercised when consid­ering this option. Homemade masks should ideally be used in combi­na­tion with a face shield that covers the entire front (that extends to the chin or below) and the sides of the face.

https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​-​n​c​o​v​/​h​c​p​/​p​p​e​-​s​t​r​a​t​e​g​y​/​f​a​c​e​-​masks.html

Should I wear a homemade mask over my mask (e.g., surgical facemask or N‑95 respirator) to keep it clean? #

There is no evidence to support using a homemade mask over your surgical facemask or N‑95 respi­rator. According the CDC, cloth masks are not consid­ered PPE. If you are consid­ering covering your mask, the CDC recom­mends using a face shield that covers the entire front and sides of the face to cover your mask.

https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​-​n​c​o​v​/​h​c​p​/​p​p​e​-​s​t​r​a​t​e​g​y​/​f​a​c​e​-​masks.html

When will Washington state get more supplies/​what is the status of getting supplies from the National Stockpile? #

Governor Inslee is working with Vice Presi­dent Pence to increase our allot­ment of personal protec­tive equip­ment from the Strategic National Stock­pile. In addition, our congres­sional delega­tion has asked Congress for more funding specif­i­cally to address the PPE challenges. Washington has received some shipments of PPE, but only enough to cover a fraction of the requests. Governor Inslee is also reaching out directly to PPE manufac­turers to negotiate directly for more product to be sent to our state immediately.

WSNA, with our allies, continues to advocate at the federal level for additional supplies for our state, including working with the Governor’s Office and our congres­sional delega­tion to direct more supplies to our hard-hit state. WSNA, along with our nursing union and firefighter partners, is calling for businesses and individ­uals to turn over unopened boxes of masks and other PPE to health care providers — that site is supplies​save​liveswa​.org.

There is a severe shortage of personal protec­tive equip­ment. Organi­za­tions are using a variety of strate­gies to preserve PPE. What are the CDC recommendations? #

Washington State Nurses Associ­a­tion continues to stead­fastly advocate for personal protec­tive equip­ment at the local, state, and national levels to secure the needed supplies to support all personal safety.

(Reviewed 3/17/2020) The CDC offers a series of options to optimize supplies of personal protec­tive equip­ment where there is a limited supply in an environ­ment of a sudden, unexpected increase in patient volume that challenges or exceeds the present capacity of the facility (surge capacity). Three strata are used to prior­i­tize measures to conserve face mask supplies:

• Conven­tional capacity: measures consist of providing patient care without any change in daily contem­po­rary practices. This set of measures, consisting of engineering, admin­is­tra­tive, and personal protec­tive equip­ment (PPE) controls should already be imple­mented in general infec­tion preven­tion and control plans in health­care settings.
• Contin­gency capacity: measures may change daily standard practices but may not have any signif­i­cant impact on the care deliv­ered to the patient or the safety of health­care personnel (HCP). These practices may be used temporarily during periods of expected facemask shortages.
• Crisis capacity: strate­gies that are not commen­su­rate with U.S. standards of care. These measures, or a combi­na­tion of these measures, may need to be consid­ered during periods of known facemask shortages.

Conven­tional capacity strate­gies use masks in accor­dance with product labeling and local, state, and federal requirements.

Contin­gency capacity strate­gies remove facemasks for visitors in public areas and imple­ment extended use of facemasks.

Crisis capacity strate­gies use facemasks beyond the manufac­­turer-desig­­nated shelf life, imple­ment limited reuse of facemasks and prior­i­tize facemasks for selected activ­i­ties. Guidance is provided in the event that no facemasks are available.

For detailed infor­ma­tion on personal protec­tive equip­ment (reviewed 3/17/2020) please see https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​— n​c​o​v​/​h​c​p​/​p​p​e​— s​t​r​a​t​e​g​y​/​i​n​d​e​x​.html.

Can PAPRs be cleaned without eventu­ally destroying their integrity? #

PAPRs must be worn and cleaned according to manufacturer’s recom­men­da­tions. The respi­rator is no longer effec­tive if the seal around the face becomes loose or is no longer intact.

Can an employer force a nurse to work on a designated ​“COVID-19” floor? Management is denying us masks saying they are not needed when we have to take care of symptomatic patients, what are my rights?

You may have to make a decision about accepting an assign­ment involving abnor­mally dangerous condi­tions that pose an imminent risk to your safety and health and could poten­tially cause serious injury or death. If you have already accepted the assign­ment your profes­sional license may be at risk if you fail to continue that assign­ment, unless you have handed off the assign­ment and been relieved of respon­si­bility for the patient. If you decide to refuse the assign­ment, you should remain at the workplace and offer to perform other work that does not pose an imminent risk to your safety and health (e.g., an assign­ment for which you are provided proper safety equip­ment and training). A decision to refuse an assign­ment could result in disci­pli­nary action taken against you by the employer. Under the collec­tive bargaining agree­ment between the employer and WSNA, there must be ​“just cause” for any disci­pline. WSNA would defend you if you are subjected to unjust disci­pline, but resolu­tion of any such disci­pline would likely be delayed and the outcome may be uncer­tain as a result of the current national and state emergency declarations.

When can I refuse an assignment based on personal health circumstance (pregnant, auto immune disorder, etc.)? #

If you have a health condi­tion that you believe requires some accom­mo­da­tion in the workplace, you should consult with your health care provider and talk to your employer about your need for reason­able accommodation. 

It is imper­a­tive that nurses who are at high risk be accom­mo­dated — especially in the situa­tion we now face of inade­quate supplies of PPE and crisis guide­lines for their use. WSNA is working to address this issue at the state level and individual Local Unit level. We have called on employers to bargain with the union over an MOU that addresses multiple issues related to COVID-19. CHI Franciscan is the first hospital system to agree to and sign a MOU with WSNA and other unions. The MOU includes a section on this issue:

“A nurse or health­care worker who is unable to work due to being part of the CDC’s at-risk group (older than 60 or with an under­lying medical condi­tion) may request an accom­mo­da­tion. If a workplace accom­mo­da­tion cannot be granted, the employee will be granted a leave of absence and have access to accrued time off benefits. If the employee’s paid time off accruals exhaust during the leave, Employer will work on a case by case basis with the employee to ensure appro­priate contin­u­a­tion of medical benefits until the employee is deemed eligible to return to work by the Employer.”

Read the full MOU with CHI Franciscan here: https://​www​.wsna​.org/​u​n​i​o​n​/​s​t​-​c​l​a​r​e​-​h​o​s​p​i​t​a​l​/​u​p​d​a​t​e​/​h​e​a​l​t​h​-​c​a​r​e​-​u​n​i​o​n​s​-​a​n​d​-​c​h​i​-​f​r​a​n​c​i​s​c​a​n​-​r​e​a​c​h​-​a​g​r​e​e​m​e​n​t​-​o​n​-​w​o​r​k​e​r​-​s​a​f​e​t​y​-​a​n​d​-​c​o​mpensation

What will happen now that my hospital is closing units and stopping elective surgeries? #

It is diffi­cult to predict what will happen, though it is antic­i­pated that there will be some reassign­ment of personnel to areas where there is a critical need for staffing and for emergency facil­i­ties like field hospi­tals. As work continues to meet the challenges posed by COVID-19, it is reason­able to be concerned about accepting an assign­ment in an unfamiliar area and with an unfamiliar patient population.

If the situa­tion exceeds your scope, skills or knowl­edge required to care for patients, work collab­o­ra­tively to develop a plan to provide care/​assistance while allevi­ating elements of an unsafe patient assignment.

WSNA and other unions repre­senting health care workers are actively working on agree­ments that address the issue of floating to ensure that nurses are protected and supported if asked to float to another unit or facility. 

We’re also advocating for compen­sa­tion and benefits to address low census, furloughs, paid admin­is­tra­tive leave if you are exposed and more. We have already shared info on state benefits avail­able to you (https://​www​.wsna​.org/​n​e​w​s​/​2​0​2​0​/​s​t​a​t​e​-​r​e​s​o​u​r​c​e​s​-​f​o​r​-​w​o​r​k​e​r​s​-​m​i​s​s​i​n​g​-​w​o​r​k​-​d​u​e​-​t​o-covid-19) and will continue to update you with additional resources and nforma­tion as we move through this crisis.

Can my employer require mandatory overtime? Can employer require me to go to work when I’m not scheduled citing ​“event of an emergency” that is allowed in the CBA or under government declared ​“State of Emergency”? What happens with the new staffing law? Does the employer have to follow it at all, (e.g., breaks, staffing committees, staffing plans)?

Nurses can be required to work overtime during an emergency. On February 29, 2020, Governor Jay Inslee issued a decla­ra­tion of emergency covering all counties in Washington state in response to the coron­avirus COVID-19 outbreak. There­fore, the statu­tory prohi­bi­tion on manda­tory overtime for health care workers is suspended for the duration of the emergency.

Note that the declared emergency suspends the normal require­ment that an employer must make ​“reason­able efforts to obtain staffing” before resorting to manda­tory overtime, so an employer is not required to make reason­able efforts to obtain alter­na­tive staffing before requiring a nurse to work overtime. Similarly, the declared emergency suspends the statu­tory rest between shifts require­ment that a nurse who accepts overtime and works more than twelve consec­u­tive hours must be provided the option to have at least eight consec­u­tive hours of uninter­rupted time off from work following the time worked, since the declared emergency has the effect of suspending the entire manda­tory overtime statute.

ADDITIONAL NOTE: While the manda­tory overtime statute is suspended by the declared state of emergency, any overtime restric­tions and rest between shifts provi­sions contained in your collec­tive bargaining agree­ment may still remain in effect, depending on the specific language of the contract. You should consult with your WSNA nurse repre­sen­ta­tive about the specific situa­tion at your facility.

What will happen now that my hospital is closing units and stopping elective surgeries? Can I get unemployment? #

We expect most nurses to be redeployed; however, if you have been laid off your job, you should gener­ally be eligible for unemploy­ment compen­sa­tion benefits. Unemploy­ment benefits are intended to assist workers who are out of work due to no fault of their own, by partially replacing the income you would earn if you were still working. Unemploy­ment benefits are not based on finan­cial need. The fastest way to apply for unemploy­ment compen­sa­tion benefits is on-line at esd​.wa​.gov/​u​n​employment.

Do not delay applying for unemploy­ment benefits. As of March 18, 2020, Governor Inslee waived the one-week waiting period to allow for faster access to unemploy­ment benefits during the COVID-19 emergency.

The Washington State Employ­ment Security Depart­ment (ESD) is adopting new emergency rules concerning eligi­bility for unemploy­ment compen­sa­tion benefits as a result of the coron­avirus crisis. Eligi­bility decisions are made on a case-by-case basis, so it is diffi­cult to give defin­i­tive answers as to whether nurses will be eligible under any partic­ular scenario.

There are several categories of unemploy­ment compen­sa­tion benefits that may apply to nurses whose work hours are reduced as a result of the coron­avirus crisis. There is a useful list of questions and answers at https://​esd​.wa​.gov/​n​e​w​s​r​o​o​m/covid-19.

Employers that continue operating on a less-than-full-time basis can request ​“Partial” status for their employees, under which eligible workers who were hired for full-time work continue to work a reduced work schedule (at least 16 hours per week) while receiving partial unemploy­ment compen­sa­tion benefits. Workers are not required to engage in an active job search while collecting unemploy­ment benefits under this status.

There is also ​“Furlough” status, a form of tempo­rary lay-off which may consist of a complete stoppage of work or reduced work hours for a period of time.

The only certain way to deter­mine whether you are eligible for unemploy­ment compen­sa­tion benefits is to apply.

If I am sick with a high fever and my employer tells me I have to go into work, what should I do? #

According to CDC guide­lines, a health care provider with even mild symptoms consis­tent with COVID-19 must cease patient care activ­i­ties and leave work. These include fever ≥ 100.0oF and respi­ra­tory symptoms consis­tent with COVID-19 – cough, short­ness of breath, and sore throat. 

A health care provider in any of the risk exposure categories who develops signs or symptoms compat­ible with COVID-19 must contact their estab­lished point of contract (e.g., public health author­i­ties or their facility’s occupa­tional health program) for medical evalu­a­tion prior to returning to work. https://​www​.cdc​.gov/​c​o​r​o​n​a​v​i​r​u​s​/​2​0​1​9​-​n​c​o​v​/​h​c​p​/​g​u​i​d​a​n​c​e​-​r​i​s​k​-​a​s​s​e​s​m​e​n​t-hcp.html

Health care workers with confirmed COVID-19 should not return to work sooner than 7 days after illness onset, or 72 hours after recovery, defined as resolu­tion of measured fever without the use of antipyretic medica­tion and improve­ment in symptoms, whichever is longer. https://​www​.doh​.wa​.gov/​P​o​r​t​a​l​s​/​1​/​D​o​c​u​m​e​n​t​s​/​1​6​0​0​/​c​o​r​o​n​a​v​i​r​u​s​/​H​e​a​l​t​h​C​a​r​e​w​o​r​k​e​r​R​e​t​u​r​n2Work.pdf

WSNA is actively advocating for: 

1. Notifi­ca­tion of nurses that have been exposed to COVID-19 positive patients.
2. Clarification/​consistency regarding quarantine.
3. Access to testing.

If I have a COVID related complaint, how do I go about having my voice heard? #

Commu­ni­ca­tion of concerns requires a multi-pronged approach. 

1. Commu­ni­cate the issue following the estab­lished chain of command at your hospital or health care facility.
2. Complete an incident report at your facility for any event or issue outside the usual opera­tions of the hospital or health care entity.
3. Complete an ADO form and contact your union repre­sen­ta­tive.

Again, please continue to share your questions and concerns. WSNA is committed to providing you with the most accurate, up-to-date infor­ma­tion and advocating at every level to ensure you have what you need to continue your dedicated work to caring for patients through this crisis.