Following a worldwide day of actions of 100,000 registered nurses and health workers demanding substantial improvements in safeguards for the deadly Ebola virus, California officials have announced landmark mandatory Ebola guidelines that should be a model for federal and state action for all US hospitals, National Nurses United said today.
NNU, which has sponsored two months of actions to upgrade Ebola protections, and its California affiliate, California Nurses Association, praised the new standards released today by the California Occupational Safety and Health Administration (Cal-OSHA) under the leadership of Gov. Jerry Brown.
“These rules are a testament to the outspoken efforts of nurses who have repeatedly pressed for the highest level of mandatory safety precautions to protect nurses, patients, and the public. Nurses have raised their voices, and California has now listened, acted, and once again set a benchmark for the nation,” said NNU and CNA Executive Director RoseAnn DeMoro.
The new California standards, an elaboration of existing Cal OSHA regulations on Aerosol Transmissible Disease and other existing regulations, go well beyond the faulty procedures and protective gear employed by hospitals across the US, and the current, unenforceable recommendations of the federal Centers for Disease Control and Prevention.
By contrast, California regulations are mandatory. The guidance under existing standards, which are effective immediately, stipulate the optimal level of personal protective equipment, rigorous training and drills, and break additional ground in identifying modes of possible transmission of the virus and when safety precautions must be engaged for nurses and other front line health workers who encounter patients with the deadly Ebola virus.
“With the hospital industry dismissing the concerns of the nurses, and the federal government failing to order the hospitals to implement the optimal level of Ebola protection, California, under the stewardship of Gov. Brown, has heard the voices of nurses, and established a model that all should follow,” said CNA Co-President Zenei Cortez, RN.
Not only are the new guidelines a substantial step beyond existing federal standards, the California rules are mandatory, with civil penalties for hospitals that fail to comply.
“The nurses are fighting for the public. They went to the governor demanding action. He departed from the paralysis of government and corporate inaction. He listened intently and heard the nurses reports of how deeply unprepared and resistant hospitals were and he moved to protect the public, the nurses, and other health care workers,” DeMoro said, adding, “That’s how government should work, Gov. Brown has delivered an example for the nation.”
In addition to Gov. Brown’s leadership, the nurses also praised the diligent work of Cal OSHA in developing guidance on the standards.
The California regulations embody the precautionary principle NNU has advocated in response to Ebola, that absent scientific consensus that a particular risk is not harmful, especially one that can have catastrophic consequences, the highest level of safeguards must be adopted, and a sharp contrast to the profit principle that has guided the response of most hospitals, DeMoro noted.
Further, the Ebola standards set a new benchmark for strong infection control protections for other epidemics which are expected to accelerate in the coming years.
NNU will press for legislation and regulation in other states, and continue to demand the federal government enact mandatory guidelines all hospitals must follow for Ebola and other epidemics modeled on the California standards.
In California, CNA will closely monitor hospital compliance with the guidelines, and work closely with Cal-OSHA on enforcement.
The California regulations, says NNU, exceed existing federal guidelines, close the biggest loopholes in CDC regulations, and replicate the demands NNU has made across the nation for two months.
Among highlights, under the new standards:
California hospitals are now required to have full-body protective suits, that meet the American Society for Testing and Materials F1670 standard for blood penetration, F1671 standard for viral penetration, that leave no skin exposed or unprotected, and that are available for all hospital staff providing care for a suspected or confirmed Ebola patient, employees cleaning contaminated areas, and staff assisting other employees with the removal of contaminated protective gear.
Hospitals must provide air-purifying respirators (PAPRs) with a full cowl or hood for optimal protection for the head, face and neck of any RN or other staff who provide care for a suspected or confirmed Ebola patient. Like the suits, this requirement extends to cleaning contaminated areas or assisting staff in removal of protective gear. Both these respirators and the suits have been a key NNU demand.
Infection by the Ebola virus can occur not just through direct contact with droplets of bodily fluids, but even through aerosol transmission of fluids from coughing or other aerosol exposure with a symptomatic Ebola patient.
Regular training is required for any staff who are at risk of exposure, including hands on practice in teams with the ability to interact and ask questions. Computer based training does not meet the requirement.
Employees who report hospitals that violate the regulations are protected from retaliation by their employers with whistleblower protection.