Florida’s largest private hospital system will restrict N95 respirator masks for use only when healthcare workers are performing medical procedures that could cause the novel coronavirus to become airborne, such as intubating patients for a ventilator or performing a bronchoscopy, according to copies of new guidelines obtained by the labor union representing nearly 10,000 workers of the for-profit hospital corporation.

Doctors, nurses and other healthcare workers at HCA Florida hospitals will use surgical masks and face shields during all other interactions with patients who have tested positive for — or are suspected of having — COVID-19, the guidelines say.

HCA Florida is part of the nation’s largest hospital chain, HCA Healthcare, and its South Florida network includes Aventura Medical Center, Kendall Regional Medical Center and Mercy Hospital in Miami.

Click to resize

Stacy Acquista, a vice president for HCA East Florida, said the more restrictive policy applies only to the 14 hospitals in South Florida that are considered at risk of a surge of patients and are facing supply shortages.

Acquista declined to provide a written copy of the company’s updated guidelines for N95 and said it was restricted for “internal communication.”

She said the hospital company is following CDC guidance for preserving protective equipment such as N95 masks because, “We do not know what our future needs will be.”

Part of the concern is whether the coronavirus can become airborne and spread through speaking, coughing and breathing. The U.S. Centers for Disease Control and Prevention says the virus spreads mainly through droplets produced when an infected person coughs or sneezes. Droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

However, there is no conclusive research ruling out the potential for the coronavirus to spread through the air, including by breathing.

Heightened concern among workers

Dale Ewart, Florida regional director for Local 1199 SEIU, said the policy was announced this week and followed an earlier directive requiring HCA Florida healthcare workers to use a single N95 mask for an entire shift — a change that has caused heightened concern among the hospital systems nurses and others.

HCA Florida healthcare workers also are prohibited from bringing their own protective equipment from home, he said.

“What the company did this week was take a step backwards,” Ewart said. “Caregivers are supposed to be providing care for patients who are known to have COVID-19 without what we believe is adequate protection — a face mask, but not an N95 respirator. This is a serious concern.”

On Thursday, the hospital workers’ labor union sent a “cease and desist” letter to HCA Florida demanding that the company’s hospitals provide N95 masks to all employees who interact with patients who have tested positive for the coronavirus and those suspected of having the infection.

Reusing gear is encouraged

Acquista said HCA has encouraged healthcare workers to reuse and conserve protective gear, but not to exceed CDC guidelines for infection prevention. She added that HCA has instructed workers to use a surgical mask along with a face shield and hospital scrubs when interacting with patients who are positive for COVID-19 or suspected of having the disease.

“The evidence suggests that COVID-19 is spread by droplets, for which a standard face mask offers adequate protection,” she said. “N-95 fit tested masks with full face shield should be utilized by staff performing aerosol-generating procedures, such as intubation, nebulization, bronchoscopy or suctioning.”





Healthcare workers such as nurses, doctors and technicians are at heightened risk of contracting COVID-19, the disease caused by the coronavirus, but there is limited information about the numbers of workers who have contracted the disease at hospitals and other healthcare settings.

According to a recent report from the CDC, more than 9,000 healthcare workers in the United States have contracted COVID-19. Most of those workers were not hospitalized, the CDC report said, but there were severe outcomes, including 27 deaths.

The CDC recommends that healthcare workers use N95 or higher-level respirator masks and infection isolation rooms when performing procedures that can cause the coronavirus to become airborne. For care that does not include such procedures, the agency has recommended use of respirators “where available.”

The federal agency’s guidelines for downgrading to surgical masks from N95 masks is a strategy only during “crisis capacity” shortages of protective equipment.

Ewart said HCA Florida has not reported a critical shortage of protective equipment. He shared a corporate memo signed by Charles Gressle, division president for HCA East Florida, which includes Palm Beach, Broward and Miami-Dade county hospitals.

The April 9 memo states that “HCA Healthcare has adequate supplies of PPE” and that “we currently have 38 days’ worth of universal masking, 29 days of N95 masks and ten days’ worth of isolation gowns in inventory.”

A national shortage of N95 masks

Prior to the coronavirus pandemic, N95 masks were disposed of after each patient interaction. But the pandemic has led to a national shortage of protective equipment for healthcare workers, especially N95 masks, and most hospitals have since instructed healthcare workers to use a single N95 mask for an entire shift.

Joaquin Garcia, an X-ray technician at Kendall Regional and a member of the labor union, said he was told to use the same N95 mask for a week “until it breaks.” As a technician, Garcia said it’s not possible to keep 6 feet away from patients.

“We are right on top of them because we have to put the X-ray plate behind them,” he said. “So we get like within inches.”

Garcia, 67, said that whenever he interacts with COVID-19 patients, he dons an N95 mask, a face shield, goggles, gloves and a protective gown. He said starting on Thursday, a day after the new N95 policy was announced, Kendall Regional also instructed healthcare workers to reuse protective gowns.

A Kendall Regional nurse who works on the hospital’s floor for COVID-19 patients said she does not feel safe without an N95. The nurse, who spoke on condition of anonymity, said healthcare workers at the hospital are committed to caring for patients but want to feel protected.

“We’re very worried about our safety but when we have a patient in front of us, it’s like caring for ourselves,” she said. ”We’re there to save lives. We’re not there to allow people to die for no reason.”