Not only do Bay Area Kaiser Hospitals keep COVID-19 and virus-free patients in the same nursing units, but we now hear that nurses also need to transport between the infected and uninfected – and the patients are not told.
“I had two patients who were positive and two who were not,” Jill Leon, a Walnut Creek Kaiser nurse, told me when she described a recent move.
Leon puts on protective clothing before entering the rooms of coronavirus patients and pulls it off as he leaves. But according to her, she has to work a whole shift and treat people with and without the disease while wearing the same N-95 mask. “We get one per shift,” she said.
Nurses I interviewed at hospitals in San Jose, Santa Clara, Antioch, Walnut Creek, and San Rafael say they or their colleagues received a mixture of COVID and non-COVID patients on the same shift. In emails, staff members from Santa Rosa and San Leandro facilities reported similar practices.
Julie Glage, a nurse in San Jose, said she addressed the mixing problems with administrators “and they replied that they had no direction not to mix the patients.”
Perhaps the most disturbing, uninfected patients are not told that they share staff and floors with people, often in adjoining rooms that have contracted coronavirus. Colleen Gibbons, a nurse at San Rafael Hospital, said nurses had been warned that informing patients would violate federal medical privacy law.
It is not only nurses who go between the COVID and non-COVID rooms, it is also the doctors, nurses who break during meals or provide extra help if necessary, and assistants who regularly turn, clean, bathe, walk and feed .
I reported last week that Kaiser keeps patients with and without the virus in the same nursing units as his Oakland hospital. I learned of the practice after an elderly, immunocompromised family member admitted to a mixed unit of Kaiser’s Oakland facility in the hospital tested positive for coronavirus on the ninth day of her stay, after she was on the first, third and sixth day tested negative – indicating that she was probably infected while she was there.
Kaiser refuses to say how often they mix patients in the same nursing units or how many patients have contracted the deadly virus as a result. Dr. Michael Vollmer, the Kaiser Northern California regional epidemiologist, said in an interview Wednesday that providing that data would discourage patients from seeking the necessary treatment.
But according to nurses’ reports, the mix is common in Kaiser’s Bay Area hospitals. And contrary to what Kaiser suggested last week, we are now learning that nurses need to care for infected and uninfected patients at the same time.
In response to questions from e-mail last week, Kerri Leedy, Kaiser’s spokeswoman, wrote: ‘At any given time, a nurse is assigned to patients with COVID-19, or to patients who do not have COVID-19, but not both at the same time. ‘ Leedy questioned about this this week, writing that the earlier response only applied to Oakland Hospital.
It is unclear how risky the mixing practices are.
Dr George Rutherford, a professor of epidemiology at UCSF, said his hospital aims to keep coronavirus patients and their nurses separate from uninfected patients. But with proper infection control, the mixing practice is probably not too worrying, he said. “The problems can be caused by violating infection control.”
Jane Thomason, the lead industrial hygienist at the California Nurses Association, said there is a “risk of transmission between patients and between healthcare providers if you have such mixed units.” The extent of the risk is difficult to determine because the hospital data is poor, she said.
It was probably inevitable that Kaiser would have to use such mixing measures to deal with the latest surge of patients, which many Bay Area and California hospitals have used. What is particularly worrying is the lack of transparency.
Patients deserve to know when they share units with infected patients. Kaiser’s response to the transparency issue is circular. Asked whether Kaiser warns COVID-free patients against nearby infected people last week, Leedy said: ‘This is definitely information that patients and families have available upon request, and we do not intend to withhold it. ‘ The catch, of course, is that they will need to know how to ask.
However, it is not clear that they would respond. Vollmer, the Kaiser epidemiologist in Northern California, said patients do not tell it because of the patient’s confidentiality.
Monica Rizo, a nurse at the Antioch Medical Center, said patients who are not COVID sometimes ask about the special precautions taken with the rooms of the infected patients. When nurses asked their managers to notify the patients, Rizo said, “There was no answer – nothing.”