6 PPE Considerations for Seasonal & Pandemic Flu & Other Pandemics
One of the biggest challenges related to the three different types of infection outbreaks—seasonal flu, pandemic flu and pandemics caused by special pathogens such as Ebola or cholera—is estimating what types of personal protective equipment (PPE) are needed, as well as the proper amount.
“Some hospitals don’t have enough and others are overstocked and preparing for worst-case scenarios,” says Peggy Luebbert, MS, CLS, CIC, CHSP, CSPDT, an infection preventionist and safety specialist who works with healthcare facilities and Halyard Health to assess infection control and safety.
Supply chain leaders also need to evaluate if new and improved PPE products are worth the upgrade.
“The variety of PPE that HealthTrust offers has expanded in the last few years, especially after the Ebola crisis of 2014,” says Angie Mitchell, RN, former assistant vice president of physician services at HealthTrust. “The HealthTrust Sourcing team in partnership with the Infection Prevention Specialty Committee is always working to keep current with the latest technologies.”
Luebbert and Mitchell offer the following tips to help hospitals evaluate their risk for outbreaks and plan their PPE purchases accordingly.
1. Prepare a risk assessment.
Form a multidisciplinary team and utilize a tiered approach to assess your hospital’s role in the community in responding to any outbreak, Luebbert advises. “Will you be a frontline hospital during an Ebola-type event, or are you going to be an assessment or treatment hospital? If you have a pact among regional hospitals, the larger hospitals may take the pandemic and influenza patients, while your hospital takes the overflow.”
A hospital will also need to determine which of its employees would potentially be exposed in a pandemic. Will there be a core team to care for patients, or do you expect all employees to be able to wear PPE and be put at risk?
2. Ensure that the proper equipment is on hand.
The amount of PPE needed for each day of patient care during an outbreak will depend on multiple factors such as expected number of patients, acuity of patients, projected number of staff expected and the number of employees.
For a seasonal event, surgical masks should be worn when entering a flu patient’s room, and gloves, gowns and eye protection are necessary for tasks that might involve fluids. To calculate amounts, start by basing it on the past four or five years of patient load, Luebbert suggests. Ask questions such as: What PPE products will most likely have increased demand during an intense flu season? Who will wear the PPE when encountering flu patients?
Though the types of PPE needed for the seasonal and pandemic flu are similar, in a pandemic, the quantity of PPE required is larger and the duration may be longer, typically occurring in at least two waves of 12 weeks each. With high-risk, aerosol-generating procedures, have enough N95 respirators and facial protection on hand to manage the event.
In relation to special pathogens, some lessons learned during the Ebola crisis can be applied to other outbreaks, Luebbert says. “Though large hospitals will bear the majority of such outbreaks, small and rural facilities should have enough PPE available for their emergency department staff to manage the initial intake of patients until they can transfer them to an assessment or treatment hospital.”
3. Manage the stockpile efficiently.
Whether it’s the infection prevention, emergency management or supply chain department, make sure the task of stockpile management is included in the list of formal responsibilities and that other departments know who’s in charge.
Good stockpile management requires an awareness of each product’s shelf life. Most equipment necessary for outbreaks expires somewhere between two to five years. “It’s a good idea for annual infection control and prevention reports to show a clear inventory of what PPE is on hand and what’s expiring in the next year,” Luebbert suggests.
It’s also important for the stockpile manager to institute protocols to prevent damage, contamination, spoilage and even supplies disappearing. Most facilities don’t have a lot of space to spare, so it can be a challenge to find the proper PPE storage area that avoids dampness or improper temperatures—but not doing so can be costly.
“When we pulled gloves out of one stockpile, they shredded in our hands because they were so old and the temperature extremes were so bad,” Luebbert recalls. “In another, the respirators in the stockpile were an older design and different than the recommended N95 respirators the hospital was now using.”
Mitchell also advises that the management of PPE encompasses more than flu season and pandemic readiness; “it includes the right protective products for cleaning patient rooms, disinfecting contaminated instruments and protecting against airborne particles,” she says. “There’s a lot to consider when you think about all of the products used in the daily operations of the hospital.”
4. Try creative solutions for storage.
“Some facilities are exploring the idea of a community or regional stockpile that facilities can pull from when they need them,” Luebbert says. Other hospitals may be able to work with some suppliers to store critical items in their warehouses that can be shipped or delivered immediately in case of emergency. Collaborate with your supplier, distributor or facility warehouse to understand what the response time would be in the case of increased demand, keeping in mind that your facility or healthcare system may not be the only one experiencing an urgent need. For those items ordered directly from the supplier, the distance from the facility to the manufacturing plant may extend the delivery time for a large emergency order.
5. Prioritize training.
It’s helpful for facilities to include emergency planning in new employee orientation as well as in annual competencies for clinicians. “Training needs to be scheduled on a quarterly or biannual basis to keep up the level of competency and help healthcare providers practice for the unexpected,” Luebbert says. “Some hospitals do quarterly tabletop trainings or full-scale disaster drills to prepare for unique pathogens like Ebola.”
Training should include practice drills with actual PPE. “You can go through all the PowerPoint educational presentations you want, but until you actually don and doff the gowns, gloves and N95 respirators, you won’t be comfortable doing it when an actual pandemic occurs,” Luebbert continues.
6. Consider costs.
The risk assessment process should include input from the facility’s financial administrators and suppliers. “You have to weigh the risk of cost versus the risk of an outbreak actually occurring,” Luebbert says. “You want to balance good financial stewardship with preparedness.”
“Some HealthTrust members help control their costs in this area by developing a formulary that identifies products in certain categories that they’re going to stick to,” Mitchell says. “This keeps them from having six different types of gloves or gowns that offer the same level of protection.”
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