Packing PPE Container – Credit CDC
One of the realities of living in a just-in-time inventory oriented world is that no one keeps large stockpiles of supplies on hand just in case an unusual demand arises. Grocery stores which a couple of decades ago might have been restocked once or twice a week now received tailored deliveries (based on real-time data collected from their Point of Sale system) – several times a day.
Hospitals, too, rely on frequent – sometimes daily – deliveries of consumable goods. Their pharmacy – and their stockroom – are unlikely to carry more than a few days supply of many items.
This parsimony in inventory and procurement extends back through the distributors, to the manufacturers, and even to the suppliers of raw materials to the manufacturers. In order to be competitive, and to maximize profits, everyone runs as `lean’ as they possibly can – relying on finely tuned forecasts of what will be needed, and when.
The problem comes when consumables – such as PPEs (Personal Protective Equipment) – are suddenly needed in much greater quantities – either due to a genuine outbreak, or the fear of an outbreak.
In 2009, we saw shortages of N95 masks during the opening months of the pandemic, and were fortunate that the demand tapered off once we realized the virus wasn’t as virulent as first believed (see Caught With Our Masks Down).
At one time the HHS had estimated the United States could need more than 30 billion masks to deal with a 1918-style pandemic; 27 billion surgical and 5 billion N95s. In 2009 our National Strategic Stockpile contained less than 120 million masks, or less than 1% of what would be needed.
While we aren’t facing an Ebola epidemic in the United States, and we aren’t likely to actually use a lot of PPEs caring for Ebola cases, an Ebola case could literally turn up unannounced at any hospital in the country, so all 5,000 of them need to have the ability to protect their staff should that happen.
A couple of weeks ago, in CDC Stockpiling Ebola-Specific PPE Kits For Rapid Deployment) we looked at one stop gap initiative that could get PPEs to just about any hospital in the country in a matter of a few hours. Still, hospitals are being encouraged to increase their PPE supplies, and the CDC has some advice today.
On October 20, 2014, CDC issued new guidance for Personal Protective Equipment (PPE). HHS has been working closely with PPE manufacturers and distributors in order to maintain visibility on availability of PPE.
Since the issuance of the CDC guidance, there has been a sudden increase in demand for PPE. Across the U.S., availability for these products varies by product type and model, requested quantity, manufacturer, distributor, and geographic region.
- It is important to note that CDC guidance recommends use of either a PAPR or an N95 respirator. Therefore, if a PAPR is not immediately available, a single-use N95 respirator in combination with single-use (disposable) surgical hood extending to the shoulders and a single use (disposable) full face shield can also be worn. Visit the NIOSH Respirator Trusted Source site to identify respirators meeting the requirements specified in the guidance: http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html.
- CDC recommends use of either a fluid-resistant or impermeable coverall or a fluid-resistant or impermeable gown. Therefore, if a coverall is not immediately available, a single-use, fluid-resistant or impermeable gown that extends to at least mid-calf in combination with single-use, fluid-resistant or impermeable boot covers that extend to at least mid-calf can be worn.
HHS is working with distributors and manufacturers to understand various ways customers may be able to find supplies needed for training and use in evaluation and/or treatment of patients with suspected or confirmed cases of Ebola. The following options may assist hospitals in obtaining PPE.
- Work within Healthcare Coalitions, local hospitals, and state and local health departments to create plans for sharing available PPE in the event of a suspected or confirmed case of Ebola. A list of State Public Health Department phone numbers is available./li>
- Work with your distributor, Group Purchasing Organization (GPO), or Healthcare Coalition to discuss substitute brands, timelines, and terms of your contract to determine if viable alternative products are in stock that can substitute for your request.
- Contact manufacturers of product to note your interest in purchasing additional product. Manufacturers may not increase production of items unless they are sure of future orders. Reporting your interest to them may assist in their decision-making. There may still be a 6-10 week timeline before product is delivered due to production and shipment times.
- Consider non-traditional supply partners such as industrial distributors and retailers.
- While manufacturers report that they are increasing production of PPE products and distributors are identifying ways to provide requested quantities and meet delivery timelines, some products may be available but in lower quantities than requested or with a longer delivery time than requested.
- If your facility suspects or identifies a case of Ebola, contact your state health department to facilitate additional assistance.