Edmonton nurses refuse to perform COVID-19 swabs without N95 masks

Some 30 nurses in Edmonton have refused to swab patients for the coronavirus because Alberta Health Services (AHS) won’t provide N95 masks, their union says.

The United Nurses of Alberta (UNA) Local 196, says the community nurses “have exercised their right to refuse work” at three assessment clinics in the city.

“Based on their assessment of what they need to be properly protected, and the information that they have available to them, which is what everybody has available to them, they believe they need N95 to properly protect themselves,” union vice-president Sandi Johnson told CBC on Friday.

“They believe that when they request one, they should be provided one from the employer without question.”

The union and AHS disagree on whether N95 masks are required to protect nurses swabbing patients. (Tyson Koschik/CBC)

Unlike surgical masks worn by Alberta nurses who conduct swabs, the N95 respirator fits more tightly and protects against aerosol transmission.

On its website, the union says all frontline workers in contact with patients suspected or confirmed of having COVID-19 should have access to the N95 mask because “the science remains uncertain on how the virus is transmitted.”

“My biggest concern is that one of these nurses, at least one of these nurses, is going to contract disease as a result of doing the work of the employer,” Johnson said.

The COVID-19 test in Alberta is performed with a nasopharyngeal swab, which looks like a Q-Tip. 

The swab is inserted into the nostril to collect cell samples by rubbing the back of the nose and throat. During the test, people are likely to cough or sneeze, the union said.

We are confident that the guidelines and equipment we have in place will protect our workers from exposure to COVID– Kerry Williamson AHS

The UNA and AHS disagree when it comes to recommendations on minimum requirements.

“According to the Public Health Agency of Canada (PHAC) guideline, a Nasopharyngeal Swab process does not require the use of an N95 respirator,” said Kerry Williamson, AHS spokesperson, in an email.

“We are confident that the guidelines and equipment we have in place will protect our workers from exposure to COVID.”

Williamson said COVID-19 is not an airborne illness, but rather “an illness known to be transmitted by droplet” through contact with nasal and oral secretions from a case.

“The personal protective equipment guidelines in place in Alberta are the known best practice to protect against illnesses transmitted by droplet,” Williams wrote.

However, the union notes that, according to the U.S. Centers for Disease Control (CDC), the research on transmission isn’t conclusive. 

The swab used to test patients. (Nova Scotia Health Authority)

“Because of the conflicting opinions on PPE (personal protective equipment) from leading public health institutions and uncertainty around transmission, we must practice the precautionary principle and recommend the higher standard,” the union states on its website.

Its position is in line with the Canadian Federation of Nurses Unions (CFNU), the CDC and Prevention and the European Centre for Disease Control in Prevention, the union added.

On Friday afternoon, Williamson said AHS had completed an investigation to assess the safety for the Edmonton nurses refusing to swab.

“In all of these cases, the investigation was completed and determined that the work was safe and that the procedure mask provided was appropriate for the Nasopharyngeal Swab process,” Williamson said.

He said AHS met with unions on Friday to discuss the protection requirements and they are “working toward common ground.”

‘Adequate supply’

The union said it tried unsuccessfully to find out how many N95 masks the province has. When CBC inquired, AHS did not provide a number.

“AHS has an adequate supply of N95 respirators,” said Williamson. “To ensure we continue to have an adequate supply, we must ensure that equipment is being used appropriately.”

On Friday, Prime Minister Justin Trudeau unveiled a plan to ramp up production of medical supplies and protective gear for health workers.

Public Services and Procurement Minister Anita Anand said the government has so far secured 11.3 million N95 masks. She said it is beyond what provinces, territories and other health organizations have asked for.

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