Nurses will not tend to coronavirus patients unless given adequate protective clothing – MUMN

The Malta union of Midwives and Nurses (MUMN) has instructed its members not to tend to COVID-19 patients outside of select areas unless they are provided with full-coverage protective clothing.

The few areas where nurses can treat patients with the gear provided is in the negative pressure rooms – areas where air is filtered and sucked out, the union explained. There are a total of ten beds in such areas in the ITU and the Infectious Disease Unit (IDU). A further seven beds have been placed between the ITU and IDU which will be covered by some form of negative pressure apparatus, the union said.

“The CDC recommends that patients with the coronavirus should only be nursed in a negative pressure environment which no wards have at Mater Dei Hospital (excluding some rooms in the IDU and ITU), primary health care centres, Mount Carmel Hospital, St Vincent de Paule Residence, Gozo General Hospital, Karen Grech Rehabilitation Hospital,” the union said.

A girl and her parents were diagnosed as the first three coronavirus cases in Malta last Saturday.

The union said that Malta’s health sector is able to handle a small number of patients in the aforementioned beds, but if there is an outbreak, there will be issues since the staff are only being given basic protective gear suggested by the WHO, while the union insists that the health authorities should be abiding by the Center for Disease Control and Prevention (CDC) suggestions to wear coveralls which cover the entire body. The union stressed that while most other countries are using such gear, this was not the case in Lombardy in Italy, where the government has been heavily criticised and 10% of the nurses have been infected.

The union’s president, Paul Pace, said that the gear nurses are being provided with is a simple gown as per the WHO’s minimum recommendations, which the union says is not adequate. “Nurses are human beings too, with children, elderly parents. They should be given adequate protection to ensure they do not catch the virus and pass it on to their families.”

The union said that the health authorities treated the virus like the seasonal flu up until late January, despite the MUMN warning to take it more seriously.

The union also said that it was approached by frustrated nurses who “feel betrayed by the way the health authorities are treating nurses and other health professionals with regard to the coronavirus Personal Protective Equipment (PPE), and the lack of information and consultation with the nurses.”

Pace also highlighted that nurses are not being given adequate training to deal with the coronavirus. The union said that nurses are only being shown how to wear the gowns they have and how to remove them, with training taking 15 minutes. Nurses, he said, need to be trained in how to work while using the protective gear. Nurses in Malta today have never worked during an outbreak, Pace said, so if one occurs and training in how to operate is inadequate, then there will be confusion. He also said that the health authorities have not informed the nurses of their plans, and that nurses are receiving conflicting information.

The union explained that some beds were placed in a holding area between the ITU and theatre areas. The union said that theatre nurses were told by Mater Dei Hospital management that they would not be involved with any patients in the ITU, while ITU nurses were told that theatre nurses would be taking care of patients in the ITU. “This is an example of the confusion,” Pace said.

Nurses have not been informed which wards will handle coronavirus patients should there be an outbreak, and do not know who will be working at Sir Paul Boffa Hospital. Plans are also underway to use Boffa Hospital’s 60 beds should the need arise in the future.

The union also said that only a few nurses have had their N95 masks fit tested, adding that such testing is important for all nurses who could come into contact with coronavirus patients, as not all faces are the same size or shape.

The union said that someone needs to take responsibility for the lack of preparedness, and also said that ordering the more effective protective gear now is difficult since so many countries are doing so.

The union has, as such, issued a number of directives

“All nurses and MUMN members who do not feel sufficiently protected in the basic gown provided and who have not been fit tested for the N95 mask are not to attend lectures on donning and doffing procedures of a simple gown, and are not to tend to patients with coronavirus in any hospitals in Malta and Gozo.”

“No nurses and MUMN members are to tend to any patients infected with the coronavirus. Once a ward in any hospital is cleared of patients, nurses on that ward are to report to the Senior Nurse Managers Office to be transferred to another ward.”

The union said that nurses in the relieve pool at Mater Dei Hospital and other nurses from the hospital’s wards are not to tend to coronavirus patients in the IDU. Such nurses would be deployed without the necessary coveralls, as a result of which they would be serving as “sacrificial lambs.”

The union added that “infection control nurses are not to provide any lectures to their respective staff unless the Personal Protective Equipment we are requesting is provided.”

“There is no plan in terms of which nurses will on the frontline on any ward designated for coronavirus patients at Mater Dei Hospital or Mount Carmel Hospital. No nurse rotation is being proposed and no additive staff to the designated wards have been agreed to or planned for. Nurses are being instructed to abandon their wards for their own health and safety if no proper Personal Protective Equipment is given. No staff rotation (relieving staff members after two weeks) and no danger money is being provided.”

The union said, however, that insurance cover has been agreed to.

The union added that nurses at health centres are not to perform any nebulizer treatment without a face mask. “This directive is being issued since all face masks are being locked and are not available to the staff.”

The union said that it expects the health division to provide the 360-degree coveralls with head protection as all affected countries have provided to their respective nurses.

The MUMN expects Superintendent of Public Health Charmaine Gauci “to recognise the fact that Malta is not prepared to treat a coronavirus outbreak due to the MUMN industrial directives being issued to the 4,000 members belonging to the to the biggest trade union in the health sector.”