Concord school nurse questions PPE quality as COVID cases rise

  • Erin Stewart, a school nurse at Rundlett Middle School, doesn’t flinch as she gets her COVID vaccine administerd by Master Sgt. John McDowell of the Air National Guard Wednesday, December 30, 2020 at the Steeplegate Mall. GEOFF FORESTER

Monitor staff
Published: 1/18/2022 5:31:44 PM

Each morning to begin her work day Erin Stewart, a school nurse at Rundlett Middle School, puts on an Envo N95 respirator over her mouth and nose, goggles over her eyes and gloves to cover her hands. She also has gowns and face shields on hand in case of splash risk.

She knows it’s an important safety measure as recent Concord School District results have shown between 41% and 49% of students who are tested are COVID-19 positive. Since the start of the year, 237 cases have been detected at Rundlett, including six probable clusters and two probable outbreaks. Stewart estimates about half of the symptomatic students who enter her office on a daily basis end up testing positive for COVID-19 and she works closely with them, taking temperatures, checking their throats and providing care. Before November, she was also administering COVID-19 rapid tests, though testing now takes place only at Broken Ground School.

This month, Stewart is raising concern about federal COVID guidelines that recommend fit-tested N95 respirators – medical-quality face coverings that provide a tight seal over the nose and mouth – for school nurses working with suspected COVID patients. It’s a safety measure most school nurses haven’t had to think about before the COVID era, but it’s one that Stewart hopes will make herself and other New Hampshire nurses safer.

“I’ve been a nurse for 22 years and I’ve never worn a fit-tested N95, because back before COVID, it was only for active TB, and stuff that I wasn’t working with,” Stewart said. “Most school nurses have no idea that their districts are violating all the guidelines by not giving them fit-tested N95s. I only know because I fell into this rabbit hole of research.”

The New Hampshire Department of Health and Human Services updated its guidance last week to clarify that it is following CDC guidelines on school nurse safety protocols. The CDC recommends that healthcare personnel (which includes school nurses) working with COVID-positive or suspected-positive patients should wear a N95 or equivalent or higher-level respirator approved by the National Institute for Occupational Safety and Health, gown, gloves and eye protection. When N95s are used, CDC guidance says they should be fit-tested to make sure they maintain a proper seal.

Less regulated KN95 masks, which had been authorized for emergency use during a PPE shortage, are no longer approved by the FDA for healthcare employees working with COVID patients.

Since the start of the school year, Stewart has been buying her own face masks – first KN95s (before she learned the FDA had revoked their approval) and then the National Institute for Occupational Safety and Health-approved N95 Envo respirator. Stewart petitioned the state Department of Labor for guidance on workplace safety for school nurses in a Nov. 8 email, one month before a state inspection. In the email, Stewart wrote that the Concord School District provided nurses with KN95 masks, which weren’t marked with a number certifying their efficacy. When Stewart asked for N95s, she said the district provided her office with a box of 20 N95 masks but they were too big to create a seal around her face. (The District has also provided nurses with gloves, gowns and face shields.)

Superintendent Kathleen Murphy said the district had been providing nurses with KN95 masks, due to a lack of available N95 masks from the district’s supplier, Cintas.

“The issue around N95 masks has come up and we were not able to get any of those, the distributors indicated those were designated for first responders and hospital personnel,” Murphy said Wednesday. “We’re in the process now, we’re reaching out to our distributor to see if we can get them.”

A report released Friday from the Department of Labor’s safety unit also shows that the Concord School District received counsel from infectious disease specialist Dr. James Noble and several DHHS liaisons that more common white and blue surgical masks are “appropriate/adequate respiratory protection” for school nurses who are conducting COVID-19 tests, a stance that was confirmed by the Department of Health and Human Services to be recommended state guidance, but is now out of date.

For Stewart, the situation feels like an unfair – and unsafe – double-standard, an example of health care workers in a public school setting having access to fewer resources than those in the private sector.

“At doctors’ offices, all staff who comes into contact with PUIs – people under investigation for COVID systems – have to have a fit-tested N95,” Stewart said. “The OSHA guidelines makes that really clear. If I were at a private school I’d have to have to fit-tested N95s under OSHA.”

A Department of Labor inspection of Broken Ground School Dec. 15 found nurses working without fit-tested N95 respirators, but the Department of Labor report found no need for additional safeguards, saying there is no evidence that nurses are adversely impacted. “Although there was evidence of a steady increase of infection among the student population, this did not correlate to the nurses,” the report stated.

Stewart remains concerned that if Concord’s nurses do contract COVID-19 due to inadequate masks, it could leave the district short-staffed.

“When we all get COVID in the next few weeks and they don’t have any nurses, I’m not quite sure what they’re going to do,” Stewart said.

The Department of Labor report recommended the Concord School District follow the DHHS’s newest guidelines, which is to follow CDC recommendations for fit-tested N95 respirators when dealing with positive or suspected positive patients.

On Friday, Stewart received an email from the district saying fit-testing for masks was scheduled for the third week of January.

Stewart will continue to advocate for school nurse safety, and hopes DHHS guidance will offer clarity to all school districts on what safety measures they are mandated to provide for their employees.

“This is a gap in how school nurses are seen and what they’re given,” Stewart said. “I think what will come of it is that it will make every school nurse in New Hampshire safer.”


Eileen O

Eileen O'Grady is a Report for America corps member covering education for the Concord Monitor since spring 2020. O’Grady is the former managing editor of Scope magazine at Northeastern University in Boston, where she reported on social justice issues, community activism, local politics and the COVID-19 pandemic. She is a native Vermonter and worked as a reporter covering local politics for the Shelburne News and the Citizen. Her work has also appeared in The Boston Globe, U.S. News & World Report, The Bay State Banner, and VTDigger. She has a master’s degree in journalism from Northeastern University and a bachelor’s degree in politics and French from Mount Holyoke College, where she served as news editor for the Mount Holyoke News from 2017-2018.



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