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Maryland hospital system tells providers to save protective gear for coronavirus, avoid using it for MRSA patients

The University of Maryland Medical System has sent a memo telling medical providers to preserve their protective equipment for COVID-19 cases and not to use it in treating some patients with potentially dangerous infections such as MRSA.

The 13-hospital system isn’t alone in taking this or other such steps to ration protective gear, much of it directed or recommended by federal health authorities. But the memo nonetheless offers a look at how the shortage of personal protective equipment, known as PPE, is lacking in the Maryland hospitals, affecting policy and unsettling workers.

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“The change is a direct result of the COVID-19 pandemic,” reads the memo dated Friday and provided to The Baltimore Sun by an alarmed medical provider.

The memo explicitly says not to use “contact protections (gloves and gowns) with MRSA colonization and/or clinical infection for ALL patients." The hospital system implemented similar limits with VRE earlier. MRSA and VRE are often hard-to-treat bacterial infections spread by personal contact.

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But Dr. Gregory Schrank, infectious disease specialist at the University of Maryland Medical Center, said Tuesday the memo applies only to routine care when there is a low risk to health care workers from the infections.

Hospitals in Maryland and around the country have been struggling to maintain adequate supplies of gloves, gowns, masks and other equipment needed to shield workers from becoming infected themselves with the coronavirus as they treat a surge of patients.

More than 14,000 people have tested positive for COVID-19, the illness caused by the virus, and about 600 have died in Maryland as of April 21.

There have been more than 3,000 related hospitalizations in the state. To care for them, workers have been instructed on how to clean and reuse masks, for example, and have been taking donations of everything from homemade masks to 3D-printed face shields.

At the University of Maryland system hospitals, staff members have been keeping close count of equipment so it can be moved where it is most needed, system officials said.

Schrank, also an incident commander for the hospital’s COVID-19 response, said the MRSA decision was made after the U.S. Centers for Disease Control and Prevention released strategies for optimizing supplies. It’s one of several policy changes to preserve protective gear, such as using plastic face shields — which can be more easily cleaned — over masks.

“Everyone is putting policies in place to help preserve PPE,” he said. “This is one component, and everything is within CDC guidance.”

MRSA is Methicillin-resistant Staphylococcus aureus, a bacteria that can infect different parts of the body and can be harder to treat than other staph infections because it is resistant to common antibiotics. VRE is Vancomycin-resistant Enterococcus, a bacteria that is resistant to a specific antibiotic and can infect a woman’s genital tract and the bloodstream.

Both infections can be passed from person to person. And both can become deadly.

Because of this, Schrank said, workers should “absolutely” wear gloves if there are fluids or wounds involved that make transmission more likely. Otherwise studies show that other measures such as hand washing are sufficient, he said.

Protection of workers and patients is the top priority, he said, adding the system has been “ahead of the curve” on policies to stem COVID-19 infections. Workers wear protections whenever they are near patients with confirmed cases or suspected cases, he said, but in other situations the system thoroughly assesses risks and makes policy changes.

The availability of personal protective equipment (PPE) for health workers has become a major issue as coronavirus cases surge in Maryland.

Jania Matthews, a university system spokeswoman, said the hospital system continues to acquire more protective gear and take donations from companies such as Under Armour.

The sports apparel company said it would make more than 500,000 masks, assemble and distribute 1,000 face shields and make thousands of hospital gowns for the university system hospitals and others in Baltimore.

The scramble for supplies has become a national issue, with governors complaining of having to bid against one another in the absence of a federal plan.

Bob Atlas, CEO of the Maryland Hospital Association, said the hospitals are getting protective equipment with help from the state and downplayed any threats to staff.

He said hospitals are equipped to isolate and treat patients with a variety of infectious diseases without harming the patients or other patients, visitors and staff.

“There are different processes and precautions in place for various care settings,” Atlas said. “For example, team members testing and treating COVID-19 patients will have full personal protective equipment and may get their temperature taken before and after shifts to ensure the care providers are safe. Those working with immunocompromised patients will wear a mask and gloves to ensure the patients are protected from the care providers.”

Atlas did acknowledge “challenges” in obtaining protective equipment.

“Maryland hospitals are seeing the same equipment challenges that hospitals across the country are facing,” he said. “They are making considerable efforts to get as much personal protective equipment as possible — working with their own supply chain providers and the state to quickly bring in additional material.”

Governors in various states have complained that the federal government hasn’t taken steps to ensure states get the gear they need.

Charles Gischlar, a spokesman for the state health department, confirmed the state has gotten federal deliveries.

“The Maryland Department of Health receives ongoing shipments of PPE from the Strategic National Stockpile, as well as through private industry donations,” he said in an emailed statement. “Although PPE shortages remain a challenge, MDH continues to search for ways to conserve PPE and maintain reliable supply sources.”

Separately Wednesday, Maryland Attorney General Brian Frosh joined with attorneys general from 18 other states to urge PPE maker 3M to do more to combat price gouging by its distributors, including by ceasing to do business with those who violate 3M’s price gouging policies.

Hogan has said that the supplies on hand at hospitals are insufficient. He said adequate protective equipment constitutes a pillar of his strategy for eventually reopening the state by lifting restrictions on businesses, schools and individuals.

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The other pillars are widespread testing for COVID-19, tracing contacts to identify those who may be infected and expanding hospital capacity.

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He took a step Monday to boost testing with the $9 million purchase of 500,000 coronavirus tests from South Korea with the aid of his Korean-born wife, Yumi Hogan, though the step drew the ire of President Donald Trump.

Hogan has not yet outlined a plan to increase protective gear. In a statement Monday about the tests, Hogan said he would introduce a “Roadmap to Recovery” later in the week touching on all the necessary steps.

“This recovery plan has four building blocks, including a robust contact tracing operation, increasing our supply of PPE, and increasing hospital surge capacity,” he said. “Our team is making significant progress on each of these criteria.”

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