Pandemic Planning: Best Practices for PPE

ICT spoke with Judson Boothe, marketing director of medical supplies for Kimberly-Clark Health Care, about last year’s H1N1 influenza pandemic and the resulting pressures brought to bear on the healthcare supply chain. Although it’s only summer, it’s not too early to begin planning for the fall and the next outbreak of influenza or other infectious disease that requires significant usage of personal protective equipment (PPE) and the appropriate management of materials to help facilitate infection prevention and control.

Q: How do manufacturers make the decision to provide products to some customers and not to others?

A: As a result of the H1N1 influenza virus alert, we had an unprecedented increase in orders for a number of our healthcare-related products, including our N-95 respirator masks, surgical and procedure facemasks, isolation gowns and nitrile exam gloves. As a result of this increased demand, controls were put in place to insure our normal demand could be met without interruption at historical levels. Prioritization of available supply above current average demand levels was prioritized based upon following customer criteria:

1. Protection of first-line responders: Medical personnel treating the sick, primarily hospitals

2. Protection of pharmaceutical production: Medication production and vaccine research

3. Protection of global commerce/transportation: Global and local transportation, shipping and airline traffic

4. Protection of public transportation employees

5. Protection of major infrastructure/utilities/critical manufacturing customers

6. Protection of the general public

Stockpile building and replenishment orders were delayed until the pandemic alert crisis passed and additional capacity and inventories were available.

Q: How can healthcare professionals be dissuaded or prevented from hoarding key pieces of PPE during a pandemic situation and to be good stewards of supplies during a tough time?

A: In general it all relates to following established protocol. Not every situation requires full isolation protocol, but many tend to over react during a pandemic alert. It’s important to make PPE supplies available to healthcare workers, but there must be forethought to how and when they are used and where they are placed. As an example, we saw some facilities place masks out on the counter in the emergency department lobby where both staff members as well as patients could easily access them. With such easy access, many people often took several masks with them causing a major depletion of the facility’s inventory. Masks are also used throughout an entire healthcare facility. As usage patterns increase in response to a pandemic, some facilities began pulling surgical masks from the operating room (OR) department. We had received calls from OR managers wanting to place orders for surgical masks as they no longer could perform surgeries. This was due directly to surgical masks being taken from other departments during to the H1N1 outbreak. When developing a pandemic plan, it’s key to note that the amount of PPE needed will vary by the staff size, number of patients and the level and severity of exposure within the community. Facilities must take into account that there will be higher numbers of employees and/or volunteers donning PPE as well as higher level of infection control precautions being practiced.

Q: How can healthcare professionals best prepare now for a potential pandemic situation this fall? How can the manufacturer help them calculate and plan for anticipated utilization?

A: The key to any pandemic preparedness plan is to be proactive. Waiting to place orders just before or even during a pandemic is not smart strategy due the immediate run of PPE supplies as we saw during H1N1. The ideal time to plan and place pandemic stockpile orders is during the spring and summer months. To best determine the quantity that your facility will need, the Centers for Disease Control and Prevention (CDC) recommends stockpiling enough supplies for the duration of a pandemic wave, which is estimated to last between six to eight weeks. To assist facilities in determining the amount of supplies needed, Kimberly-Clark developed the PPE Demand Analysis Tool. The tool first begins with outputs from the CDC’s Flusurge.com program, which estimates hospital admissions. The tool then estimates outpatient visits utilizing the same planning assumptions. Combined with the facility’s current average PPE usage, this creates a baseline of information to estimate PPE usage rates per outpatient visit, per admission, per hospital bed and per employee.

Q: How can healthcare professionals best be prepared to meet fit-testing requirements in a chaotic pandemic situation?

A: Again, we go back to planning as the best solution. All employees that are expected to use N-95 respirators in the normal course of their job should be fit-tested at least annually. We also recommend that the facility standardize on a single type of mask to eliminate the possibility of getting the wrong one. Obviously in a pandemic situation, it will be difficult to follow fit-testing protocol for those employees that are not normally subject to annual fit-testing. There is an OSHA qualitative fit-test method for a fit check, which is a way of verifying the mask is making a good seal. We encourage all facilities to consider annual fit-testing, mask standardization, and the fit check as solutions for handling the chaos.