About Betsy Todd, MPH, RN

Former clinical editor, American Journal of Nursing (AJN), and nurse epidemiologist

As Conflicting Recommendations Sow Public Confusion, Nurses Still Lack Adequate PPE and Equipment

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. April 3.

One problem central to the experience of nurses during this pandemic is the disastrous lack of essential supplies and equipment. How different would your work days be right now if you had plenty of PPE and ventilators? In the parts of the country with the most COVID-19 cases, this problem is far from being resolved. In many other cities and states, unbelievably (after three months), you are likely to be faced with it soon.

Where is our PPE?

For weeks, nurses and physicians in states that were initially hardest hit by the pandemic (New York, California, Washington) have reported severe shortages of personal protective equipment. (See, for example, this ICU nurse’s anonymously published note to AJN.) Respiratory protection has been in particularly short supply. In many hospitals, staff are reusing one droplet mask or N95 respirator for an entire shift or longer. These dire circumstances were predictable. A  2015 article from researchers at the National Institutes of Health predicted that in a pandemic in which only 20 to 30 percent of the population is infected, up to 7.3 billion N95 respirators would be needed. COVID-19 is likely to infect a considerably higher percentage of the population. Where are our masks? […]

2021-01-21T11:08:39-05:00April 3rd, 2020|infectious diseases, Nursing, Public health|3 Comments
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COVID-19: What a New Study Says and Doesn’t Say About the Possibility of Airborne Transmission

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published: March 20. 

As we have become a little more comfortable with the concept of social distancing as a way to mitigate the spread of this new coronavirus, a new worry seemed to dominate conversations this week: the idea that the virus can linger in the air. The takeaway for many people, at least in the conversations I’ve been having, is that you can become infected by simply walking down the street. There is no evidence that this is true (unless, of course, someone sneezes in your face!).

Results of recent experiment deepen our understanding.

A March 17 research letter published in the New England Journal of Medicine reported on experiments in which SARS-CoV-2, the virus that causes COVID-19, was artificially aerosolized. (For comparisons, SARS-CoV-1, which causes SARS, was also aerosolized.) A nebulizer was used to aerosolize the virus, and the aerosol was fed into a rotating drum. The drum apparatus helps to keep the suspended aerosols from settling out of the air, so that their dynamics can be more closely studied.

Under these controlled conditions, the researchers were able to demonstrate that artificially aerosolized virus remained viable and infectious for three hours, and that therefore it’s “plausible” that, if something causes the virus to aerosolize outside of the lab, this could be another mode of […]

2020-03-20T14:14:49-04:00March 20th, 2020|infection control, infectious diseases, Nursing, Public health|4 Comments
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Making Sense of Interim CDC Guidance on N95 vs. Surgical Masks for COVID-19

Surprising new CDC guidance.

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published: March 13, 2020. New posts will appear on this blog about aspects of the pandemic as the situation and our knowledge about the virus continue to evolve.

For nurses, the biggest news this week wasn’t the declaration of the COVID-19 epidemic as an official pandemic. It was the CDC’s release on March 10 of new interim infection prevention and control recommendations for COVID-19.

Many of us were taken aback to read the new document, which recommends the use of regular surgical face masks instead of N95s and the routine placement of patients suspected or confirmed of having COVID-19 infection in private rooms with the door closed instead of housing them in a negative pressure isolation room (which are always in short supply).

Unfortunately, without first acknowledging the concerns such a change from longstanding infection control practice might occasion among nurses and others, the CDC presented it as necessary due to an N95 shortage, stating, “When the supply chain is restored, facilities . . . should return to use of respirators for patients with known or suspected COVID-19.”

While it’s clear the CDC could have crafted this message more carefully, are caregivers being thrown […]

2020-03-16T10:25:22-04:00March 13th, 2020|infection control, Public health|2 Comments
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Is Your Facility’s Computer System a Patient Safety Risk?

Discussed in this post: “How Often Do EHRs Result in Patient Harm?” (AJN, News, March).

When we first had computers in the hospital—that is, while we still charted on paper but had quick online access to lab, radiology, and pathology results and could easily look up a patient’s prior admission history—it was wonderful. No more little lab slips floating all over the nurses’ station. No more unit-to-unit searches trying to figure out who last had custody of the patient’s X-ray films. (How could objects so large be so easily lost?)

A rocky transition to EHRs.

electronic health recordsThe transition to almost fully digital charting, on the other hand, has been pretty much a nightmare from the beginning. Nursing was rarely included in initial needs assessments. Many rollouts were chaotic, without additional staffing for the inevitable glitches that are bound to occur. Training of frontline clinical staff has been routinely minimal; we seem to be expected to pick up the many fine points of new software by some kind of digital osmosis.

That elusive clinician friendly EHR.

It’s very clear at this point that electronic health records (EHRs) were designed primarily for data collection and billing purposes. I have yet to see a system that could in any way be […]

2020-03-12T08:02:22-04:00March 12th, 2020|digital health, Nursing, Technology|2 Comments
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If I Want to Wear a Face Mask to Prevent COVID-19, Why Shouldn’t I?

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published. March 6; updated March 12.

Times are uncertain. We don’t know how the spread of the new coronavirus will play out, or what parts of the country will be affected next. Many people continue to insist that wearing a mask in public places is “added insurance” against infection. But the reasons for NOT wearing a face mask far outweigh the purported benefit of keeping your nose and mouth covered when you’re out and about.

First, some background.

Health care workers use two main kinds of mouth and nose protection: either a regular surgical face mask, or an N95 respirator.

The purpose of a surgical mask is to prevent the wearer’s respiratory secretions from contaminating other people or surfaces. This is an example of “source control” in preventing infections. It is the reason the surgical team wears masks during operations and other invasive procedures.

N95 respirators look very much like face masks. They are designed to protect the wearer from inhaling hazardous particles (infectious agents, dust, etc.). Health care workers wear these when caring for people with COVID-19 or other serious respiratory infections.

But at least a face mask provides a physical barrier. Why shouldn’t I […]

2020-03-11T12:10:37-04:00March 6th, 2020|infection control, Nursing, Public health|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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