State health and safety inspectors have penalized two Twin Cities hospitals for serious problems related to insufficient COVID-19 protections for front-line caregivers.

North Memorial Health Hospital in Robbinsdale and United Hospital in St. Paul were each hit with $2,100 citations after workers complained to the state about an array of allegedly unsafe practices related to breathing devices and other personal protective equipment (PPE).

All told, inspectors from Minnesota's Occupational Safety and Health Administration (MNOSHA) have conducted unannounced site visits at seven Twin Cities hospitals for COVID-related complaints from workers since May 5.

Two inspections led to fines, while three cases were closed with no penalties. Two more investigations, at M Health Fairview's Southdale and East Bank hospitals, are pending. OSHA has also opened an investigation into the COVID-19 death of a North Memorial worker on June 1.

United Hospital, which is part of Allina Health, is appealing its Aug. 11 citation, which says employees restapled broken elastic straps of their tight-fitting N95 respirators early in the pandemic, when hospital beds were filling up quickly and protective masks were in short supply. Many nurses there have since switched to more durable respirators with replaceable filters.

Restapling broken elastic straps on a disposable N95 mask is a safety risk because it can change how it fits the face, and because staples can put holes in the material designed to filter out virus-carrying particles, said United Hospital Emergency Department nurse Brittany Livaccari, co-chair of the Minnesota Nurses Association unit there.

In a statement to the Star Tribune, Allina denied telling workers to restaple broken straps on N95 masks, saying employees are told not to use broken or altered respirators.

Livaccari disputed that, saying workers were verbally instructed during daily "safety huddles" to restaple their masks if the straps broke during a work shift. She said she heard the instruction, and heard multiple employees tell OSHA inspectors they heard managers saying it.

Livaccari said it didn't make sense to think workers would restaple N95 respirators to make them last longer when they know they're designed to be disposable. "We know that this is a one-time-use mask, and they are trying to get us to wear it for five days," she said, referring to practices in place in April and May. "There's no way employees would have, on their own, just stapled a mask together. We wanted to keep ourselves safe."

In a follow-up comment, an Allina spokeswoman said Friday that the health system stands behind its statement.

"We have and continue to adhere to the latest guidance" from the Centers for Disease Control and Prevention and Minnesota Department of Health, the statement said.

Health care workers in Minnesota have been contracting COVID-19 at work or through community spread at a rate of more than 44 per day. That includes all health care workers, not just hospital staff.

The latest data show 2,379 health care workers were exposed to the virus likely while working, and another 5,100 got it from sources not classified in public records.

Statewide, the Health Department has reported 69,584 lab-confirmed cases of COVID-19, including 728 cases added to the tally on Sunday. The state has seen 1,767 deaths, including six newly reported fatalities.

On Sunday, there were 301 people in the hospital for COVID-19, including 137 in intensive care. The number of people hospitalized for the virus peaked just above 600 in late May but has not been above 400 since mid-June.

Sunday also brought the news that seven more Minnesotans who attended this month's Sturgis Motorcycle Rally have tested positive, bringing the total number of Minnesota cases linked to that event to 22.

"Unfortunately, I think this is just the beginning of the cases we will see from Sturgis," Kris Ehresmann, the state Health Department's director of infectious diseases, said via e-mail. Other states also have reported cases linked to the South Dakota event.

Hospitals' policies around the use of personal protective equipment to treat COVID-19 patients have evolved over time, and some of the early emphasis on the use of air-filtering N95 masks has shifted to other forms of protection. At United Hospital, many nurses have switched to using "elastomeric" respirators, which have replaceable filters.

Both United and North Memorial were cited by MNOSHA for failing to train workers on how to use another form of breathing protection, called a powered air-purifying respirator, or PAPR, which uses battery power to force air through a filter.

United's two workplace deficiencies — restapling of N95s and training lapses for PAPRs — resulted in the $2,100 penalty Allina is negotiating with the state. MNOSHA investigated but did not recommend penalties for other allegations, including not providing the right protective gowns to workers and not permitting telework when feasible.

At North Memorial, MNOSHA cited two deficiencies — failing to adequately train imaging department staff on how to use PAPRs and not providing them with the right medical evaluation to use PAPRs.

The initial penalty of $2,100 was reduced to $1,470 through an Aug. 3 settlement that gave the hospital 30 days to prove it had corrected the problems, records show. A single PAPR device costs between $900 and $1,800, according to a 2015 publication from the Institute of Medicine.

"Throughout the COVID-19 pandemic, we have implemented many operational changes, trained personnel to use additional and different PPE and supported our teams," North Memorial Health Hospital President Jeff Wicklander said in an e-mail. "The OSHA investigation ... found one area where we could have done more to prepare our teams."

MNOSHA investigators, who could not do a walk-through inspection of the hospital because of COVID-related concerns in mid-May, didn't cite North Memorial for other complaints lodged in April and May.

North Memorial intensive-care nurse Mary Turner, who is president of the Minnesota Nurses Association labor union, said members at her hospital were particularly upset when management mandated reuse of protective equipment called "isolation gowns." Normally, such gowns are put in the laundry or disposed of after each visit to an isolated patient.

MNOSHA investigators found the nurses' claims to be true. But they ultimately decided it was not a workplace safety infraction because the CDC has published guidelines on how to reuse cloth isolation gowns during a crisis, which the hospital followed.

Staff writers Chris Snowbeck and Kim Hyatt contributed to this report. Joe Carlson • 612-673-4779