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.
“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.
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.