COVID-19 Protocols, Discrepancy in Maui Hospital Cluster Count Explained

By Wendy Osher

Maui Now reached out to Maui Health, seeking answers to some questions raised in recent weeks regarding COVID-19 response efforts at the Maui Memorial Medical Center and policies and procedures relating to recent cases.  The following was compiled after a series of email communications with the Maui Health team which was exchanged over the course of several days.

Discrepancy in Cluster Count Explained:

The state Department of Health says that as of April 30, there are 60 COVID-19 positive cases, including 38 staff and 22 patients under investigation as potentially associated with the cluster.

That differs from the Maui Health count, which as of May 5, 2020, was 46–including 39 staff and 7 patients.  Maui Health says that of that number, 24 staff/providers have recovered.

State Health officials say their investigation is ongoing to determine whether COVID-19 infection occurred as a result of the outbreak or whether they may have had the infection related to another exposure. Several hundred healthcare personnel and patients were tested in the course of this investigation. The DOH says they are awaiting a more accurate estimate of total tested from MMMC infection control.

The DOH explains that the investigation is ongoing and “that may account for discrepancies between MMMC numbers and DOH numbers.”

Maternity Ward Protocols, Mother in C-Section Delivery Later Tests Positive for COVID-19

Maui Now learned that a mother who underwent a caesarean section delivery at the Maui Memorial Medical Center last month later tested positive for COVID-19.

“The mother did have a C-section at the hospital and did not come into contact nor suspected contact with any COVID-19 positive patient, employee or provider. She developed symptoms while at home and went to a community provider to be tested and was positive for COVID-19,” according to Maui Health.

The source of infection at this time is unknown however, Maui Health noted that the hospital “has never had an OB patient, provider or employee test positive for COVID-19.” Employees in that department were tested in April, with all results returned as negative.

“The baby was not tested as DOH concluded there was no indication to test the baby,” according to Maui Health.

“OB does have a workflow for COVID+/Persons Under Investigation and is working on getting another area ready to provide fetal monitoring in this area,” a spokesperson said.

According to Maui Health, the Maui Memorial Medical Center averages about 30 to 35 delivers per week.

Once babies are born, they are kept in the room with their mother and procedures are done bedside.  “For babies born via C-section, only the baby is allowed in the nursery. No one, other than staff, are allowed in the nursery,” according to Maui Health.

Procedures in Confirming COVID-19 Recovery and Roommate Policy:

Last week, the Honolulu Star-Advertiser reported that an elderly patient appeared to have beaten the virus only to test positive again during a follow-up test the next day.  This case raised questions over testing procedures and rooming arrangements for infected individuals.

In response to our questions about policies and procedures in this respect, Maui Health explained that in order for a patient to be cleared as a negative COVID-19 test patient, they must have two confirmed, back-to-back, COVID-19 negative results. “This is a part of the routine care in order to clear their positive COVID-19 status,” a spokesperson said.

“Patients who are positive are tested every 7-10 days until they present as COVID-19 negative.  Once the first negative test is confirmed, they will be tested again within 48-72 hours to confirm the negative test.  (The) patient must have two negative tests to be cleared,” according to Maui Health.

“A positive test after a negative test does not mean the patient contracted COVID-19 again,” said a Maui Health spokesperson, “it means the first test was a false negative, which is why patients MUST be tested again and have two back to back negative results.”

Maui Health acknowledges that the patient did share a room with another COVID-19 positive patient “of similar indication, such as ambulating and asymptomatic.”  According to Maui Health, the roommates were situated six feet apart, “however once this patient received a negative test result, she was moved to a private room.”

According to Maui Health, “COVID patients having a roommate is made only with the recommendation of our Infection Control physician, under circumstances in which we are at bed capacity. Selection of roommates is made carefully based on multiple factors of both patients such as current isolation status, date of test, compatibility with a roommate, date of last test, current symptoms, etc.”

Policy on Floating Nurses and PPEs:

As for policies and procedures relating to treatment of COVID-19 patients, we asked Maui Health about the use of floating nurses if the they are required to change Personal Protective Equipment or PPEs when switching between departments.

Maui Health responded saying, “We are following the Department of Health requirements for floating staff who care for our COVID patients on the warm units.”

A spokesperson further explained that a warm unit is a cohort of patients with COVID-19 suspected or positive status. “Not all patients are positive and most are awaiting results. There are barriers at entrances and staff for those units follow strict protocol for PPE including but not limited to N95 masks, hospital scrubs, eye protection and gloves. Staff are trained to put on and take off PPE in the closed off area before they enter or exit the unit to protect themselves, patients and other staff,” according to Maui Health.

We are told that nursing staff, including sitters, “do not float between warm and non-warm units during a shift.”

“We have also restricted floating into or out of specific units per the Department of Health recommendations,” according to Maui Health.

Negative Pressure Rooms:

Maui Now posed a question to officials with the State Department of Health inquiring if the COVID-19 cases at Maui Memorial Medical Center were being placed in negative pressure rooms or regular rooms.

Hospital staff informed us that there were a limited amount of such rooms available and the location was dispersed throughout the facility.

State health officials responded during a press conference on April 25, saying, “All COVID-19 positive cases which are hospitalized would be in isolation in a negative pressure room and with lots of other safeguards in place to assure that there wasn’t disease transmitted in the hospital. Those assurances are made and we do inspect the facilities to be sure that they’re in place–and Maui has those in place now.”

When we followed up with Maui Health this week, we were told that this is not the case.  All COVID-19 patients are not placed in negative pressure rooms; but instead, the hospital has set up specific areas for housing patients with suspected or confirmed COVID-19 infection.

“CDC guidelines suggest that droplet precautions are appropriate for patients with suspected or confirmed COVID-19 unless they are undergoing procedures known to produce aerosolization of the virus,” according to Maui Health.

On Monday, Maui Health re-opened the Maui East unit as a medical surgical unit and noted that it is no longer serving as a COVID-19 unit, according to a hospital spokesperson.