Although many organizations have shifted to less stringent conservation measures, the need for mindful N95 use is not over says Julie Cerese, Vizient group senior vice president, performance management and national networks.

As the COVID-19 pandemic began to unfold early last year, clinicians donned and doffed N95 masks as they always had done while caring for an increasing number of COVID patients. When it became clear that personal protective equipment (PPE), such as N95 masks, were in short supply, hospitals began extraordinary conservation and reuse measures. During the peak of the pandemic last year, the nationwide demand for N95 masks was four times the number purchased in 2019.

Today, the picture is much different. New and existing PPE manufacturers in the United States received a huge boost from organizations such as Vizient to support increased domestic production, while individuals wore masks, stayed home and are now being vaccinated.

While the industry is no longer facing an acute N95 shortage, “we’re not out of the woods yet,” says David Gillan, Vizient’s senior vice president of sourcing operations. “The real question is if we get a significant new COVID-19 variant that causes a spike in cases, would there be enough N95 masks? Our data, and the feedback we are getting from members, is that usage demand is being met, but stockpiling demand is not. And stockpile inventory may take some time to satisfy because the daily usage rate is still high.” Health care organizations should continue convservation protocols to optimize their supply of masks and prevent a future shortage.

Stockpiling and preference items drive current constraints

Hospitals are managing the use of N95s more efficiently than in the peak of the pandemic; however, media reports of excess mask inventory sitting in warehouses and continued rationing across health care organizations sends mixed messages.

Most of the excess inventory reported by media is not necessarily an N95 mask, but other types of surgical masks. There are some constraints in N95 masks as health care providers begin to replenish their inventory with preferred types. “Getting a handle on stockpiling is elusive,” he says, adding that hospitals have different stockpile needs, ranging from 90 days to six months of supply on hand. “We’re not in a shortage situation, per se, but the supply of N95 masks will remain constrained until we have a better handle on the stockpile piece.”

An additional challenge for hospitals is obtaining their preferred brand. Members prefer the brands and SKUs that have been through the fit-testing process and approved for use in their hospitals. Changing to a different brand and SKU requires a hospital to go through the entire fit-test process with each employee again, consuming significant time and resources.

Procuring the optimal balance of masks sizes and models for stockpiles is another issue for hospitals currently. Gillan says suppliers are now looking at the allocation of sizes running through their manufacturing to ensure they’re producing the SKUs in highest demand.

Mindful conservation

At the height of the pandemic, many hospitals followed stringent conservation and resterilization measures such as using ultraviolet germicidal irradiation technology and other decontamination methods to extend the life-cycle of the masks they had in stock. One Vizient member hospital in the northeastern United States created an area for COVID-19 patients (red zone) and a clean area (green zone) to conserve N95 masks. Clinicians and staff in the red zone wore N95 masks, while those in the green zone wore surgical masks.

While health care providers no longer face an acute N95 shortage, most understand that even a small change to the supply chain or COVID-19 caseloads could significantly impact their inventory and result in another shortage. That is why N95s remain on protective allocation from the major manufacturers and distributors. “Allocation has a real purpose,” says Gillan, “because when you don’t have a surplus of product, you have to be a good steward of what you do have. Allocation is the process to help ensure equitable distribution. That is very different from having a shortage.”

Although many organizations have shifted to less stringent conservation measures, the need for mindful N95 use is not over says Julie Cerese, Vizient group senior vice president, performance management and national networks. “One of the things we’ve learned from this entire experience is that N95 masks are valuable resources and we should be thoughtful stewards of their use,” she says.

Twenty-two Vizient member academic medical centers have updated their conservation and reuse guidelines as masks have become more available. Their updated plan calls for distributing new N95 mask supply to patient care areas three times a week, although clinicians and staff can replace their masks more frequently at their discretion, such as when they become soiled.

Cerese says she sees hospitals continuing to take a thoughtful and reasonable approach to mask reuse. “When you spend the better part of a year facing a shortage of N95s, you find every way imaginable to conserve what you have” she says. “That mindset doesn’t fade away once you start to have more supply.”

Preparing for the future

As COVID-19 caseloads decline and hospitals continue N95 conservation strategies, now is the time to update your strategic PPE plan to ensure you are ready to meet future challenges. In addition to examining and updating conservation strategies, continue to build your safety stock of critical supplies, including N95s.

Managing the stockpile can pose a number of logistical challenges for hospitals and health systems, including finding adequate storage space, rotating stock and delivering inventory to the right place at the right time. To remove the burden of maintaining massive stockpiles, Vizient offers virtual stockpile services to members, managing the supply to ensure inventory is rotated and replenished regularly.

As N95 supply and demand market dynamics evolve, Vizient continues to work with suppliers to expand access to N95 masks and other critical PPE. Additional information is available via Vizient's COVID-19 guide to face masks and filtering facepiece respirators. Vizient also recommends that all mask conservation strategies align with CDC guidelines. 

Learn more about how Vizient is responding to the pandemic and helping members ensure consistent PPE supply for staff and clinicians.

Published: March 16, 2021