Bay Area Kaiser hospitals not only keep COVID-19 and virus-free patients in the same nursing units, but we have now learned that nurses are also required to move between infected and uninfected patients – and patients are not informed.
“I had two positive patients and two not,” Jill Leon, a nurse at Walnut Creek Kaiser, told me when describing a recent change.
Leon wears protective clothing before entering the rooms of patients with coronavirus and takes them off when leaving. But, she said, she is forced to work a full shift, treating people with and without the disease, while wearing the same N-95 mask. “We get one per shift,” she said.
Nurses I interviewed from hospitals in San Jose, Santa Clara, Antioch, Walnut Creek and San Rafael say that they or their colleagues received a combination of COVID and non-COVID patients in the same shift. In emails, officials at the Santa Rosa and San Leandro facilities reported similar practices.
Julie Glage, a nurse in San Jose, said she raised mixing issues with administrators “and they replied that they were not instructed not to mix patients”.
Perhaps the most disconcerting uninfected patients are not told that they are sharing staff and floors with people, usually in adjoining rooms, who have contracted the coronavirus. Colleen Gibbons, a nurse at the San Rafael hospital, said nurses were warned that informing patients would violate federal medical privacy law.
Not only are designated nurses between COVID and non-COVID rooms, they are also doctors, nurses who fill in meal breaks or provide extra assistance when needed and assistants who often see, clean, bathe, walk and feed patients.
I reported last week that Kaiser was keeping patients with and without the virus in the same nursing units as his hospital in Oakland. I learned of the practice after an immunocompromised elderly relative hospitalized in a mixed unit at the Kaiser facility in Oakland tested positive for coronavirus on the ninth day of her hospitalization, after a negative test on the first, third and sixth days – suggesting 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 consequently contracted the deadly virus. Dr. Michael Vollmer, a regional epidemiologist at Kaiser Northern California, in an interview on Wednesday, said providing such data would discourage patients from seeking the necessary treatment.
But the nurses’ reports indicate that the mix is common in hospitals in the Kaiser Bay Area. And, contrary to what Kaiser suggested last week, we have now learned that nurses must care for infected and uninfected patients at the same time.
In response to questions sent by email last week, Kaiser spokeswoman Kerri Leedy wrote: “At a certain point, a nurse is assigned to patients with COVID-19 or patients who do not have COVID-19, but are not both at the same time”. Asked about it this week, Leedy wrote that the previous answer applied only to the Oakland hospital.
It is unclear how risky mixing practices are.
Dr. George Rutherford, 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, mixing is probably not a major concern, he said. “The problems would come with violations of infection control.”
Jane Thomason, a leading industrial hygienist at the California Nurses Association, said there is a “risk of transmission between patients and between healthcare professionals when you have these types of mixed units.” The magnitude of this risk is difficult to determine because the hospital’s data is poor, she said.
It was probably inevitable that Kaiser would have to resort to these combined measures to deal with the latest increase in patients, which has exhausted many hospitals in the Bay Area and California. What is especially worrying is the lack of transparency.
Patients deserve to know when they are sharing units with infected patients. Kaiser’s answer to the concern for transparency is circular. Asked last week whether Kaiser warns COVID-free patients about infected people nearby, Leedy replied: “This is certainly information that is available to patients and families, if requested, and we have no intention of withholding it” . The problem, of course, is that they would have to know how to ask.
But it is not clear whether they would have an answer if they did. Vollmer, epidemiologist Kaiser Northern California, said patients are not informed because of patient confidentiality.
Monica Rizo, a nurse at the Antioch Medical Center, said that non-COVID patients sometimes ask after seeing special care being taken with infected patients’ rooms. When nurses urged their managers to notify patients, Rizo said: “there was no answer – nothing”.