A patient health and safety survey of 23 Arizona hospitals compiled by dozens of registered nurses suggests that a disturbing number of the state's healthcare facilities are not prepared for the coming H1N1/swine flu pandemic, according to results released today by the National Nurses Organizing Committee-Arizona (NNOC-AZ). Arizona is one of 21 states that are reporting widespread influenza activity at this time, with 1,480 lab-confirmed cases, including 297 cases that led to hospitalization, and 22 deaths.

As a result of these finding, NNOC-AZ is calling on all hospitals to adhere to the highest standard of protection for patients and nurses to combat the expected onslaught of new cases this fall and winter. Legislators and elected officials are also being urged to strengthen public protections. The RNs report wide gaps in safety gear, infection control training, and post-exposure procedures.

Among key findings:

- At 20 percent of the hospitals, nurses cite inadequate isolation of swine flu patients, increasing the risk of infection to others.

- Less than half the hospitals (49 percent) have adequate supplies of the proper N95 respirator masks, and in more than six of 10 hospitals (60 percent), nurses are expected to re-use the masks. Both shortcomings expose nurses to infection, contribute to disease spread in the hospitals among other patients, and violate Centers for Disease Control Guidelines.

- There is a widespread problem of RNs being denied paid sick leave in the event of an infection, which would compel them to work while ill.

These numbers are borne out by the controversies that have been reported at hospitals across the country. Examples include:

- At Flagstaff Medical Center, nurses were until very recently denied the appropriate N95 respirator mask while caring for more than eight separate patients in the ICU.

- At Tucson Medical Center, RNs are only able to use three unexcused periods of absence in a three month period - despite recommendations that H1N1-infected caregivers isolate themselves for seven days (If an employee calls out for three consecutive shifts it counts as a single absence).

- RN's in many of the surveyed facilities report that they are not guaranteed sick time in case of swine flu infection. Many nurses are threatened with discipline if they fail to come to work and many need a doctors note stating they were actually sick.

- Tucson Medical Center RNs report that in early swine flu breakout the school districts closed down schools and sent all children to the emergency room at the hospital. There weren't enough caregivers or rooms available.

- Many RNs report that there are not enough masks. The N95 masks are often not available on the units and must be ordered from storage. The shortage causes RNs to reuse rather than run out.

- Preventative measures for suspected cases are too lax. At FMC RNs reports that several days went by before staff was notified of an infected patient.

- Visitors are encouraged but not forced to follow infection control guidelines

The problems uncovered by this data mirrors results found in an August survey of RNs in 190 healthcare facilities in Arizona, California, Florida, Illinois, Maine, Minnesota, Nevada, Pennsylvania, and Texas.

"This report should serve as a wake-up to hospital management, policy makers, and healthcare workers across the state," said Jonna Peterson, a retired Flagstaff RN. "Arizona Hospitals need to be adequately prepared so that they are part of the solution and not part of the problem. Governor Jan Brewer and the Arizona Department of Health Services need to follow through to make sure that the state's hospitals are complying with federal standards set by the CDC in order to keep patients safe and our hospitals accountable to those standards."

The National Nurses Organizing Committee has released "The Nurses' Swine Flu Safety Agenda" as a guide to adequately prepare for this pandemic.

- Minimize infection of hospital patients and workers by strict adherence to the highest standard of infection control procedures, including identification and isolation with appropriate ventilation of infected patients.

- All hospital workers and visitors must be provided with appropriate protection gear at the highest government standards, including N95 respirator masks or better for all who enter the isolation room of a confirmed or suspected H1N1 patient.

- Guarantee all patients and workers full transparency after any exposures to H1N1, in as timely a manner as possible.

- Healthcare workers and facility visitors must receive full information and guidelines on risk exposure and facility infection control recommendations.

- Any RN who is unable to work due to contracting a communicable or infectious disease identified or treated in his or her hospital/clinic shall be guaranteed sick leave, not face disciplinary action, and shall be presumptively eligible for workers' compensation benefits.

- Implement a moratorium on any closures of emergency rooms, layoffs of direct healthcare personnel, and reductions of hospital beds.

- Federal guidelines for protection must be developed that are consistent across agencies.

- Disposable respirator masks must not be re-used. In the event of a demonstrated national mask shortage, facilities should adhere to government recommendations on mask conservation.

Source
California Nurses Association