Nurses' union expresses concern over hospital conditions, aerosol transmission of COVID-19

Many nurses in the United States continue to face significant risks amid the COVID-19 pandemic because they lack support from their employers, according to a recent survey.

The survey was conducted by National Nurses United, the world’s largest union for registered nurses.

“We are a year into this deadly pandemic and hospitals are still failing to provide the vital resources needed to ensure safety for nurses, patients and health care staff,” Bonnie Castillo, RN, executive director of NNU, said in a press release. “This survey shines a light on how hospital administrators are continuing to jeopardize one of society’s most valuable workforces during COVID-19, registered nurses, by prioritizing profits over basic safety and infection control measures. Testing health care workers and patients for COVID-19, providing optimal personal protective equipment and ensuring safe staffing is a no-brainer to help combat this pandemic.”

The survey results follow a recent petition from NNU and 44 other unions and organizations urging the CDC to update its guidance on aerosol transmission of COVID-19. The petition states that the CDC does not fully acknowledge aerosol transmission, leaving both workers and the general public unprotected from COVID-19 exposure.

In an update to its COVID-19 guidance in October 2020, the CDC said SARS-CoV-2 “can sometimes be spread by airborne transmission.”

NNU survey results

In a nationwide survey conducted by the NNU, more than 9,200 RNs reported their experiences from February 2 to February 28.

Among respondents, 53% reported that short staffing in hospitals is their primary safety concern, and 47% of hospital nurses said staffing has recently become slightly or much worse.

Additionally, 81% of nurses reported that they are forced to reuse PPE meant for single use.

Of nurses who work in hospitals, 52% said that all patients receive screening for COVID-19.

The survey also revealed that 54% of all RNs and 61% of hospital RNs had ever undergone testing for COVID-19. Just 32% indicated that their employers told them about COVID-19 exposures in a timely manner.

Compared with how they felt before the pandemic, 43% of hospital RNs said they have more difficulty sleeping, 61% are more stressed, 57% feel more anxious and 51% are more sad or depressed.

Many nurses — about 22% — said that they are facing increased workplace violence, which they attributed to changes in patient population, decreased staffing and visitor restrictions.

Testimony on experiences, aerosol transmission

Pascaline Muhindura, RN, a critical care nurse at Research Medical Center in Kansas City, Missouri, and member of the NNU, testified before the U.S. House Education and Labor Committee's Workforce Protections Subcommittee on her experience during the pandemic and the need for a change in guidance on aerosol transmission of COVID-19.

Muhindura said her institution is “still forcing us to unsafely reuse the same N95 for an entire shift and is recommending that we use surgical masks with COVID-19 patients.”

“To this day, the CDC does not recognize aerosol transmission of COVID-19,” she said, adding that current guidelines allow employers to distribute surgical masks to nurses and force them to reuse N95s.

“Management withhold PPE, and they used CDC guidelines as their justification for putting our lives at risk,” she said.

Therefore, she said the CDC needs to update its guidance to reflect recent scientific evidence on aerosol transmission, and that an Occupational Safety and Health Administration standard needs to be implemented at the federal level to ensure that employers protect employees’ health and safety.

“We need an immediate action so that nurses and our patients get the protections we need,” she said.

In another testimony, Linsey Marr, PhD, professor of civil and environmental engineering at Virginia Tech University, said that there is “overwhelming evidence that inhalation of tiny, virus-containing aerosols is the main route of transmission for COVID-19.”

In her written testimony, Marr explained that this is shown in superspreader events — which she said are best explained by inhalation of aerosols from shared air — asymptomatic and pre-symptomatic transmission— as people are not coughing and are therefore spreading the virus by talking and breathing, which produces fewer large droplets and more aerosols — indoor transmission — as aerosols are quickly diluted outside — and scientific studies, which have identified viable SARS-CoV-2 in aerosols in hospitals.

According to Marr, people release more aerosols than respiratory droplets when they breathe, laugh, talk, sing, breathe, cough or sneeze, and these aerosols remain in the air over time in a room that is not properly ventilated and can travel with air current to distances greater than 6 feet.

She said that ventilation is key in preventing aerosol transmission, that respirators and masks are considered “a final line of defense” against infection, and workers with an increased risk for infection should be wearing high-performance masks or respirators.

Marr also said that, currently, “most CDC guidance has not yet been updated or strengthened to address and limit inhalation exposure to aerosols.”

Evidence on aerosol transmission

Amesh A. Adalja, MD, senior scholar at Johns Hopkins Center for Health Security and an Infectious Disease News board member, told Healio Primary Care that he does not believe an update to the CDC guidance is warranted.

“To the best of my knowledge, aerosol transmission of SARS-CoV-2 occurs in health care settings only during the presence of certain aerosol-generating procedures such as bronchodilator treatment via nebulizer, bronchoscopy, BiPAP/CPAP and possibly endotracheal intubation,” he said.

In other health care settings, Adalja said regular surgical masks and eye protection are sufficient to prevent the spread of COVID-19.

In the community, he noted that aerosol transmission may occur in “settings where, for example, people may be singing or breathing vigorously such as during an exercise class, but the primary mode of infection is still respiratory droplets that pass directly from person to person.”

References:

Education & Labor Committee. Clearing the Air: Science-Based Strategies to Protect Workers from COVID-19 Infections. https://edlabor.house.gov/hearings/clearing-the-air-science-based-strategies-to-protect-workers-from-covid-19-infections. Accessed March 11, 2021.

Education & Labor Committee. Testimony of Linsey C. Marr, PhD. https://edlabor.house.gov/imo/media/doc/MarrLinseyTestimony03112021.pdf. Accessed March 11, 2021.

. National Nurses United. National RN survey highlights continued hospital failures to prioritize nurse and patient safety during pandemic. https://www.nationalnursesunited.org/press/fifth-survey-of-national-nurses-highlights-continued-hospital-failures. Accessed March 10, 2021.

National Nurses United. Nurses, Unions, Allies Urge CDC to Acknowledge Covid-19 Aerosol Transmission to Help Bring Virus Under Control. https://www.nationalnursesunited.org/press/nurses-unions-allies-urge-cdc-to-acknowledge-covid-19-aerosol-transmission. Accessed March 10, 2021.