HCA Healthcare stands up universal masking

No battle plan survives first contact with the enemy.

In an email to all 280,000 HCA Healthcare colleagues last week, chief executive officer Sam Hazen recalled this military adage as he urged us to be just as flexible as we are resilient in responding to the unique challenges of COVID-19.

Around the world, healthcare systems are being called upon to adapt and work together in a coordinated race to save lives.

As a learning healthcare system, HCA Healthcare continually captures and processes information to improve care. But this crisis has made rapid cycle improvement a near daily occurrence. We are in a unique position to see, in real time, COVID-19 data across our organization and identify trends that can be used to inform clinical practices, supply chain and resource needs.

We’ve stood up many processes to get ready for significant COVID-19 surges, with a focus on protecting our patients and teams. These actions include:

• Adding approximately 1,400 screeners in our facilities to manage the new screening and visitor control processes.
• Working with the major commercial lab companies to increase capacity in our own facilities for testing.
• Increasing telemedicine capabilities at over 5,000 sites, to allow physicians to connect with their patients in a safer care environment.
• Standing up a universal masking policy for all staff and providers in patient care areas.

This week’s announcement that all staff and providers in all patient care areas will now wear masks, expanding their use beyond suspected or positive COVID cases, reflects the evolving nature of this crisis.

We took the step because of the powerful evidence that while social distancing is a key strategy for interrupting the spread of coronavirus, it is difficult to maintain in the busy patient care environment.  Moreover, our latest analysis of our ability to meet the demand for additional use of masks gave us confidence that our colleagues in supply chain could address our needs.

But we cannot overplay our hand. Even though HCA Healthcare currently has adequate supplies of personal protective equipment (PPE), we must continue to take steps to conserve PPE, including reuse and reprocessing of PPE where appropriate, because we do not know precisely what lies ahead of us.

COVID-19 is spread by droplets. At this time, the evidence analyzed by infectious disease experts is that the virus doesn’t appear to float in the air like pollen. It attaches itself to fluid like mucous. So preventing the spread of COVID-19 means stopping the spread of droplets – by washing hands, cleaning surfaces, and using masks against droplets.

To be clear, we are now deploying three types of masks, depending on the clinical role, the type of care the patient is receiving, and the level of suspicion for infection with COVID.

• Level I “procedure” masks for all staff not needing higher levels of protection. These masks can also be used for caring for suspected or confirmed COVID patients when paired with a full faceshield.
• Level 3 masks for additional protection from fluids and droplets, and for use by staff caring directly for suspected COVID or COVID positive patients, except when performing aerosolized procedures.
• N-95 respirators for staff caring for suspected COVID or COVID positive patients, and are the only mask that should be used during  aerosolizing procedures, such as intubation, nebulization, bronchoscopy, or suctioning.

As this crisis evolves, HCA Healthcare will continue to evolve to meet the challenges, with the resilience and flexibility they demand of us.

Jane Englebright, Ph.D., RN, CENP, FAAN

Senior Vice President and Chief Nurse Executive

Jane Englebright

Chief Nursing Officer