by Tanvi Desai
MD, MBA, Physician Advisor, Accreditation

Never has personal protective equipment (PPE) been as coveted as it has been during the COVID-19 pandemic.  Prior to the pandemic, if a clinician accidentally grabbed a duckbill surgical mask instead of an anti-fog surgical mask or grabbed the wrong-sized gloves, he or she simply discarded these items and reached for the correct mask and gloves.  Today, many caregivers are lucky if they even have options to choose from in their protective gear. 

In response to shortages, organizations are shifting their strategies surrounding PPE supply capacity.  A conventional capacity strategy is a set of measures consisting of engineering, administrative, and PPE controls that are implemented for general infection prevention and daily usage control plans.  These measures allow for patient care without any change in daily practices for the donning and doffing of PPE.  The pandemic has pushed organizations to shift from their conventional capacity strategies to contingency and even crisis capacity strategies. 

Contingency capacity strategies are measures that may change daily standard practices but should not have any significant impact on the care delivered to the patient or the safety of the health care personnel. These practices may be used temporarily during periods of expected PPE shortages.  An example would be extending the use of N95 respirators.  Instead of disposing of the N95 respirator after use with each patient, now a single N95 respirator would be worn up to 8-12 hours by a clinician to take care of multiple patients with the same diagnosis such as COVID-19. 

Crisis capacity strategies encompass measures outside of general standards. These measures need to be considered during periods of known PPE shortages.  An example would be to implement limited re-use of the N95 respirators. This would allow for the same N95 respirator to be used, removed and used again by the same clinician for a limited number of uses as per the manufacturer’s guidance or up to five uses if no guidance is available.  While this is not ideal, this drastic step is necessary to conserve the N95 respirators.  Similar concepts would apply to other PPE supplies such as surgical masks, isolation gowns, etc., and any PPE that is grossly contaminated should be discarded. 

Both the contingency and crisis capacity strategies are being employed throughout the U.S. during the pandemic, and organizations will likely have to continue to rely on them while PPE supply remains at suboptimal levels.  So, what can organizations do during a shortage to mitigate risk for caregivers?

Three actions to take to protect health care personnel when PPE supply is tight

  1. Use a calculator tool to determine the average consumption rate, or burn rate, for each type of PPE. The Centers for Disease Control and Prevention (CDC) offers a tool and Vizient also has a calculator available for its members. Users of the CDC’s calculator will enter the number of full boxes of each type of PPE in stock (gowns, gloves, surgical masks, respirators and face shields, etc.) and the total number of patients at the facility. The calculator will then estimate how long the remaining supply of PPE will last based on the average consumption rate, providing useful information on when to acquire additional PPE if available or when to take measures needed to extend the life of current supplies.
  1. Extend the use of PPE, decontaminate and re-use.  Many organizations are forced to extend the use of PPE such as surgical masks and isolation gowns by using them on multiple patients with COVID-19 before discarding the PPE as well as decontaminate and re-use filtering facepiece respirators, such as N95 respirators.  Both tactics have proved helpful, and there’s evidence to support the measure. Limited research shows that ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat have the most promise as methods to decontaminate N95 respirators.  .  Organizations will need to keep track of the number of cycles of decontamination as they vary depending on the method of decontamination used as well as ensure that the integrity of the respirator has not been compromised.  In addition, the CDC has provided guidance when using expired PPE beyond the manufacturer-designated shelf life which will also help preserve PPE supply during the COVID-19 pandemic. 
  1. Stay aware of ongoing and potential supply disruption and stay in contact with agencies and suppliers who can help.  Tracking PPE inventory as well as communicating with local, state and federal public health partners can help in optimizing the procurement and maintenance of the PPE supply.  Examples include the Strategic National Stockpile and state stockpiles, which help to supplement an organization’s PPE supplies.  Remain in contact with manufacturers and supply chain coordinators to stay updated on shortages and plan accordingly.  Recently, some overseas manufacturers in Asia have experienced flooding, which has impacted their ability to produce PPE supplies.  Looking for alternatives is essential.

There was a time when clinicians working in the emergency department, ICU, and OR never gave a thought to the availability of personal protective equipment.  It was always there when they needed it.  COVID-19 changed all of that, making hospitals scramble to find, re-use, and save whatever PPE they could.  It has forced the world never to take PPE for granted again.  The health and safety of our patients and our health care personnel depend upon it.

About the author.  In her role as Accreditation Advisor, Dr. Tanvi Desai is responsible for delivering Accreditation and Regulatory Services to Vizient members encompassing hospital, ambulatory and critical access organizations. She provides content expertise on CMS conditions of participation and The Joint Commission (TJC) accreditation standards interpretation. Additionally, Dr. Desai conducts compliance assessments, on-site or virtual coaching during TJC surveys, and delivers educational presentations on accreditation and CMS compliance topics. Prior to joining Vizient, Dr. Desai was a TJC surveyor of the Comprehensive Accreditation Manual for Hospitals conducting triennial surveys, extension surveys and team leader for Medicare Deficiency surveys.   Dr. Desai is certified by the American Board of Pediatrics and is licensed to practice medicine in North Carolina.