COVID-19 outbreak among staff, patients at Puyallup hospital. Union files complaint
MultiCare Good Samaritan Hospital in Puyallup is the latest hospital to face a series of COVID-19 cases among staff that started with a patient testing positive.
MultiCare says it cannot link the staff cases together because of the rate of spread in the community at large.
A union representing workers at the hospital is pushing back against that assessment and what it says was delayed notification to workers.
The current third surge in coronavirus cases across the state and nation has invaded different hospitals in the area in recent months in both the CHI Franciscan and MultiCare systems, including St. Joseph Medical Center in Tacoma, St. Anthony in Gig Harbor and Auburn Medical Center in Auburn.
On Dec. 9, Tacoma-Pierce County Health Department reported on its website that, initially, 10 cases tied to an outbreak (nine staff and the one patient) at Good Samaritan.
The department, in response to questions from The News Tribune, said the number was at 15 as of Wednesday — nine staff, six patients — and that it first learned of the Good Samaritan cases on Nov. 25.
MultiCare on Thursday released its own timeline and details of the reported cases after multiple requests this week from The News Tribune.
MultiCare described the initial patient case and infections among staff as follows:
“On November 19, a patient in an in-patient cardiac care unit at Good Samaritan Hospital returned a positive COVID-19 test prior to a scheduled procedure. We immediately moved forward with our COVID-19 protocol and isolated the patient, who had been masked while in the hospital.”
“Despite the low risk and lack of additional patient cases in this unit, we have also acted on Public Health’s suggestion to notify and test patients who were potentially exposed by any COVID-19 positive employees during that time.”
MultiCare said it was working with Infection Prevention and staff at Good Samaritan to finalize a list of potentially exposed patients in the unit and ”preparing to begin notifications. Doctors will order COVID-19 testing for all of the potentially impacted patients in this unit of the hospital as an extra precaution.”
The health system said it tested 129 staff “who had come into contact with this patient within the last 14 days, of which nine employees returned a positive COVID-19 test result.”
“With COVID-19 rates as high as they are in our communities right now, we cannot definitively link all of these cases,” MultiCare said in its announcement Thursday.
Late Thursday, Anna Agnew, media representative for MultiCare, told The News Tribune via email, “We have new employee numbers ... and have 14 total (employee) cases.”
When asked about the different tally from the health department, Agnew wrote that there were five patients who had tested positive, the original case plus four others, but the health system could not determine those were related given the prevalence in the community.
“So far in our investigation, we have not identified a patient who received a hospital acquired transmission or who has developed symptoms of COVID-19 from the initial positive patient,” she wrote via email.
COMMUNITY VS. WORKPLACE SPREAD
The challenges of determining whether a COVID-19 case spawned from the workplace setting or via community spread has been an ongoing between unions representing health care workers and the health systems that employ them, most recently with CHI Franciscan’s St. Joseph Medical Center.
Washington State Nurses Association disputes the latest community spread stance coming from MultiCare.
Christine Watts, senior labor consultant with the Washington State Nurses Association, said MultiCare’s not linking the cases to each other or to the workplace is becoming common among health systems with infected workers.
“We see a trend that facilities are oftentimes doing the contact tracing, and if the nurse is exposed to a patient ... many of them are referring to CDC requirements, that is 15 minutes or more of exposure to a COVID-positive patient without proper PPE,” Watts said.
In those cases, she said, it could then be tied to the workplace.
But, “if a nurse is wearing the proper PPE, which the hospital in many cases determines that the nurse is wearing the proper PPE, then they are calling it community acquired because essentially, they should have been protected if they were using the proper PPE,” Watts said.
The problem, she noted, is that nurses are coming into contact with COVID at the hospital in a variety of ways, with multiple avenues of exposure, “and not at all times wearing the highest level of PPE.”
She offered one example: “If a patient is a suspected COVID patient under testing, the nurse may not have the highest level of PPE required, compared to a COVID positive patient. And then they test COVID positive.”
With more cases deemed “community acquired,” the workers also face dipping into their own vacation and sick time to cover time loss for illness and quarantine.
“I think that administrators need to step up and pay administrative leave for any nurse that’s awaiting their test results and/or in quarantine,” Watts said.
MultiCare in its statement Thursday said: “While the staff who tested positive had been around patients, it’s important to know that the risk of staff-to-patient transmission is very low because the staff were wearing appropriate PPE.”
The health system noted that its first round of testing was completed, which yielded the nine positive cases out of 129 employee test results.
It added that there are 54 follow-up tests pending results, “and we will continue to collaborate with Public Health to support any follow-up testing as we continue our investigations. Employees who tested positive are taking time to recover at home.”
COMPLAINT FILED WITH STATE
Notification to workers about outbreaks has long been on the radar of health care workers’ unions in the pandemic. In August, UFCW 21 brought their concerns to a news conference about slow or no notification received by nursing staff and others amid an outbreak at CHI Franciscan’s St. Michael Medical Center in Kitsap County.
Ruth Schubert, communications director for WSNA, alerted The News Tribune about the current situation this week with Good Samaritan and what the union’s workers had experienced.
She wrote via email: “Nurses are concerned that they are not being informed in a timely manner. ... We are concerned about whether all nurses in the unit, which is spread over three different floors, are getting the needed COVID tests.”
Schubert shared a copy of the complaint WSNA has filed with the state Department of Labor & Industries’ Division of Occupational Safety and Health.
The complaint says the union believes at least two patients exposed workers after they tested positive at the hospital and argued for more broad contact tracing.
“Given that break rooms, huddle rooms, medication rooms and nursing stations do not allow for guaranteed social distancing and allow for staff members to take their masks off for eating and drinking, contact tracing should have been performed following every positive test,” according to the complaint.
“As the proclamation released by Governor Inslee Nov. 25 clearly notes, in order to offer non-urgent services, procedures and surgeries, hospitals must notify health care employees within 24 hours of a known exposure to COVID and testing must be timely, with results within 24 hours.”
Watts told The News Tribune that in the union’s investigation, “It was taking upwards of days. I think at one point that it was at least a week, or five days to a week, before (workers) were notified.”
Dale Phelps, communications lead for the health department’s COVID-19 response, told The News Tribune via email that the health department’s guidance for Good Samaritan “has been consistent with guidance provided for other hospital outbreak situations.”
That guidance is to “identify and quarantine close contacts of positive cases. Test all staff and currently admitted patients that have been on the unit since first date of possible exposure every 5-7 days until no new positive cases for 14 days. Notify patients that are now discharged that were on the unit since the first date of potential exposure.”
Phelps added that the hospital is “taking steps to prevent future exposures, including changes to PPE protocol.”
The health system, in its Thursday statement, said: “MultiCare is following all public health recommendations and has the PPE we need for our employees to continue to safely care for all of our patients at Good Samaritan Hospital and throughout our health system.
Watts offered this advice for MultiCare and other health systems facing what she said was a “crisis” in staffing levels.
“I think the employers really need to take care of their own nurses. Incentivize them to pick up extra shifts, provide them with safe working environments, provide them with assurances that if they do contract COVID, the reality is they most likely, it should be assumed that they have caught it or contracted COVID on the job. They are with these patients 24 hours a day, seeing multiple interactions with COVID positive (patients); it should be assumed that the COVID positive nurses and staff have contracted it at work.”
