COVID-19 Lesson: How IPs Can Ensure We Never Run Out of PPE Again

The supply (or lack thereof) and utilization of personal protective equipment (PPE) has been one of the most frustrating aspects of dealing with COVID-19 for infection preventionists (IPs). Enacting emergency re-use and extended-use policies and protocols is not only a novel situation but something that goes against our natural tendencies. One of the first ways we can work toward more sustainable efforts is to first focus on daily PPE counts. This is something most likely to do with larger, international and national supply chains from manufacturers and distributers, but overall, this is a good measure to establish as a standard IPC practice. 

The COVID-19 pandemic shed light on the dependency we in healthcare and in the United States have on international suppliers and manufacturers of critical items, like PPE.  

As Maryn McKenna noted in February, “According to data compiled by the US Department of Health and Human Services, 95% of the surgical masks used in the US and 70% of the respirators-thicker, tight-fitting masks that offer better protection against viruses-are made overseas. That leaves the mask supply vulnerable to labor disruption if a pandemic sickens manufacturing workers, as well as to flat-out diversion if a government decides to keep its own stock at home.” 

As the COVID-19 pandemic fluctuates and might be more severe in some countries, supply chains will likely be impacted. Shortages extend beyond masks and gowns, but also into tubing, Foley catheter kits, disinfecting wipes, hand hygiene, disposable laryngoscope blades, and much more. COVID-19 ultimately represents the bigger issue of hospital preparedness and how we integrate critical aspects, like supply chain and surveillance.

Keeping a continued eye on critical supplies is one piece to addressing a vulnerable supply chain. Moreover, are IPs evaluating days on hand or also considering surges? In many cases, the relationship between IP and the supply chain department is passive and fluctuates with emergencies or new products. What if, though, we worked to have a more proactive relationship that involved weekly meetings regarding the level of supplies, like PPE? Right now, many of us are getting daily reports on the number of supplies we have and how many days of utilization that translates to.

Working with the supply chain department to set up more continuous, proactive check-ins that are measured by days of supplies on hand and how that would fluctuate with varying surges can be immensely helpful. 

In addition, IPs can possibly utilize more sustainable PPE. Full-face respirators have become more common with the COVID-19 pandemic. These offer an alternative to N95 respirators and, in some cases, combine eye protection. A benefit to these devices is that they are re-usable and able to be cleaned and disinfected between use. Like powered air purifying respirators (PAPRs), they offer a long-term alternative for extended use that is often more comfortable for staff. More importantly, they allow staff to re-use them with disinfection protocols that change the traditional disposable notion of PPE. While IPs have traditionally thought of PAPRs for only emergency preparedness situations, perhaps full-face respirators offer a middle ground that can change pandemic preparedness in healthcare. 

Face shields are another piece to this puzzle. More research is being done about the feasibility of utilizing face shields in several environments-for all triage staff as protection measures, but also as a potential alternative for community mask use. While these offer protection for eyes, respiratory protection will still be required for those in isolation requiring a mask (e.g. surgical or N95). The use of face shields in the community as an alternative to face masks is an increasing topic of conversation and while changes cannot be made to current PPE protocols at the moment, it will be interesting to see where this research leads.