Nurses being told to reuse masks at Manitoba hospitals, says union

The province's guidelines on the use of personal protective equipment are putting front-line health workers in danger, the Manitoba Nurses Union says.

Union president Darlene Jackson says nurses in hospitals are being forced to sign out personal protective equipment, including masks and gowns, and are told to wear one mask for an entire shift, placing it in a plastic or brown bag when on a break or lunch to be reused after the break.

"Reusing PPE is nothing but a form of rationing. I don't believe it's safe. Nurses don't believe it's safe. And this situation is just declining as the days go by," said Jackson.

"Shared Health and this government continue to insist that we have adequate PPE, that this is not a concern, but nurses aren't feeling that at all."

It sends a message, Jackson says, that nurses are "dispensable," and that "if they become exposed, if they become ill, they can always be replaced."

Last week, CBC reported that several unions in Manitoba were also concerned about a "one mask per shift" policy for home-care workers.

A new framework for personal protective equipment the province introduced last month established a colour-coded zone system, with masks, gowns and associated gear appropriate to each zone.

Shared Health's guideline for health-care workers treating patients in many areas, including acute and emergency care, is to extend the use of their masks over multiple patients, for a maximum period of an entire shift, even when treating COVID-positive patients ⁠— as long as they do not remove the mask. 

They are told to change it if it becomes wet, soiled or damaged. 

In a prepared statement, a Shared Health spokesperson said the PPE guidance was a "necessary part of pandemic planning as Manitoba witnessed the supply challenges of other jurisdictions."

"In certain settings and situations, masks are to be used for an extended period," wrote spokesperson Paul Turenne.

"This approach is similar to that in place in a number of jurisdictions … to protect staff and patients while ensuring appropriate supplies of PPE are available for the duration of the COVID-19 response."

He said under the colour-coded system, reuse of a mask after it has been removed is only permitted when treating "green zone" patients (those that do no meet the current COVID-19 testing criteria). 

He said that nurses were told to sign out PPE after Shared Health "saw significant amounts of PPE go missing or unaccounted for."

WHO recommends extended use in 'crisis'

The World Health Organization has recommended extending the use of masks in a "crisis" situation when there is a "serious shortage" of supply.

However, the WHO says these are temporary measures that "should be avoided as much as possible," according to its April 6 report on the rational use of PPE. 

It warned that extended use may:

• Increase risk of contamination of the mask with COVID-19 virus and other pathogens.
• Increase the chance of the health-care worker touching the mask, or inadvertent touching under the mask.
• Lead to clogging of the mask's filter, increasing breathing resistance and the risk of breathing unfiltered air from the sides of the medical mask.

Jackson acknowledges that reusing a mask for an entire shift is better than not having a mask at all, but says if things are that desperate, the government needs to be more open about its stocks of personal protective equipment.

She also wonders why the government would reopen surgeries and other personal services that would use PPE that is needed in the hospitals. 

"We've been asking this government for weeks for transparency on PPE," she said.

"If we're rationing PPE in acute care settings and long-term care settings for front-line workers, what's happening with an elective surgery?"

Nurses can decide how often they need to change a mask, she says.

"Nurses should be allowed to use their own professional assessment skills and clinical judgment to decide when they need a mask, when they don't need a mask, and what kind of type of a mask they need."