Marsha Maurer, DPN, RN (CNO, BIDMC) discussed steps BIDMC is taking to keep staff safe during the pandemic.

Boston Globe – December 3, 2020

Hospitals work to reduce risk of COVID spread among employees

Massachusetts General Hospital has set up a ventilated tent with tables six feet apart for staff to use.Pat Greenhouse/Globe Staff

At Massachusetts General Hospital, the lobbies and atriums are dotted with small tables, about the size of school desks, where employees can eat lunch by themselves. The break rooms at Tufts Medical Center have stickers marking distances of 6 feet, so workers don’t have to guess how far apart they are when they remove their masks to eat a sandwich. And at Beth Israel Deaconess Medical Center, plexiglass has taken over the cafeterias.

This is what health care worker safeguards look like during the second surge of COVID-19. In the spring, hospitals were focused on treating patients with the virus and protecting their workers from infectious ones. Now it’s evident that employees also can spread COVID to each other — especially when they remove their face masks to eat and drink — and hospitals are working to reduce that risk as the pandemic reintensifies.

Massachusetts hit a daily record for new cases on Thursday, and while local hospitals still have enough capacity, more than 1,300 patients with the virus are hospitalized across the state — a figure that has been rising steadily since the end of summer. The nation hit a milestone with more than 100,000 people in hospitals on Wednesday, including more than 19,000 in ICUs, according to the COVID Tracking Project, and experts fear the worst is yet to come.

Hospitals are trying to keep their workers safe with constant reminders against congregating in groups. They’ve removedtruckloads of furniture from cafeterias, break rooms, and conference rooms. They’ve scattered smalldining tables throughout their sprawling campuses. They’ve erected heated tents. They’re also asking staff to stagger their breaks so that small break rooms don’t fill up. And they’re constantly reminding their employees to stay 6 feet away from others — even close friends— when they need to unmask.

These are not just precautions; COVID outbreaks have been traced back to hospital employees who ate together without maintaining at least 6 feet of distance, at Mass. General, Brigham and Women’s, and many other hospitals.

“If you’re having your break, that could be 30 minutes that you’re face to face with someone, talking, laughing, chatting — and exchanging respiratory droplets and other particles,” said Dr. Erica S. Shenoy, associate chief of infection control at Mass. General.

Hospitals are more focused on the risk now as the cold weather sets in, making it more difficult to take breaks outside. Meanwhile, health care workers are weary from fighting the pandemic and from covering their faces all day, every day.

Like so many daily rituals in 2020, the employee lunch break has been reimagined. Mass. General’s new employee dining areas include a tent on the Bulfinch Lawn, which is heated for the winter. “The latest addition we made to it was to pipe in some music,” Shenoy said.

Brigham and Women’s Hospital, where a COVID outbreak in September infected 42 employees and 15 patients, also has a heated outdoor space where employees can get meals from food trucks. Following the outbreak, the Brigham opened three new common areas, including spaces that can be reserved through an app. Hospital officials also converted conference rooms and waiting rooms into break rooms, so staff can have lunch closer to the units where they work, spokesman Mark Murphy said.

Beth Israel Deaconess is among the hospitals that have moved furniture out of cafeterias so that there’s more space between tables. And instead of restricting tables to just one person, they’ve added plexiglass, dividing circular tables into quarters, so that each person unmasks in their own plexiglass partition.

“People can sit down with plexiglass between them and have lunch,” said Marsha Maurer, the hospital’s chief nursing officer and incident commander.

Hospitals are not built for social distancing, and it can be hard to eyeball 6 feet. So in the break rooms at Tufts Medical Center, hospital officials pasted placemats with reminders to “leave enough space!” Tufts added new seating areas inside the hospital, and in an alley outside — though the outdoor space isn’t heated.

“We basically had a team that went around, walked the entire hospital inside and outside,” said Dr. Shira Doron, hospital epidemiologist at Tufts. “Anywhere where there’s a space of 6 feet around it on all sides, we’ve added a table and a chair.”

Despite all the reminders, it can be hard for hospital employees to keep their distance from friends and colleagues they have known for years, said Mary Havlicek Cornacchia, an operating room nurse at Tufts.

“People are definitely trying to be careful, but there’s pandemic fatigue — people are tired — so it can be a challenge,” she said. “If you’re in a rush, you’re not thinking about what you should be doing as much as, ‘I need to grab this bite and get right back to work.’ “

Officials at UMass Memorial Medical Center have begun walking the hospital to monitor whether employees are following masking and social distancing rules.

“The reason why we launched the monitoring program is because we knew there was PPE fatigue out there,” said Dr. Kimi Kobayashi, chief quality officer at the medical center.

They’re passing out stickers and coupons for free coffee to reward employees who follow the rules, but “I feel like I’m the anti-fun police sometimes,” Kobayashi said.

UMass Memorial officials don’t expect their staff will take breaksoutside in the cold anymore, so they’ve turned lobbies and conference rooms into makeshift cafeterias, with tables positioned 6 to 8 feet apart.

Break rooms — there are more than 100 across the medical center’s three campuses — have strict occupancy limits.

In a COVID intensive care unit at UMass Memorial, the staff used to chat while sharing pizza in the break room. Those days are over for now. The room is restricted to three people, said Maureen Horan, a nurse who works nights in the ICU. If Horan wants to eat, and the room is at capacity, she turns around and tries to come back later. She can’t leave her unit to eat because she needs to stay close to her patients, who are among the sickest in the hospital.

“One of the things that keeps us there on the night shift is the camaraderie,” she said. “We all pitch in, we all work together, we all know each other.”

Now, the staff try to keep their distance from each other. “It is what it is,” Horan said. “You have to do it.”