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Time to build up for future pandemic
Short supplies, high costs plagued hospitals
As the H1N1 virus receded even as a seasonal influenza threat, there was a collective sigh of relief in the health care community. It wasn't as bad as was feared.
But as a "drill" for a worse pandemic, H1N1 leaves behind a key question: Are hospitals prepared to protect their employees from a widespread, emergent virus that is a respiratory hazard?
As H1N1 struck, hospitals struggled with shortages of respirators, goggles, safety needles, children's masks, and even swabs. When respirators ran out, hospitals scrambled and were forced to pay more for brands and models their employees had never used, which then meant time-consuming and expensive fit-testing. Can we do better than that?
"[The H1N1 pandemic] was a good test of the supply chain. It showed where we had some holes in it," says Al Cook, CMRP, FAHRMM, chief resource director at Regional Medical Center in Orangeburg, SC, and chair of the Health Sector Coordinating Council of the Health and Public Health Critical Infrastructure Protection Advisory Committee, which advises federal agencies on preparedness. "Thank goodness the effects weren't as severe as everyone anticipated."
Hospitals need to analyze how they fared during the pandemic and take steps to address the supply issues, Cook told HEH. But they'll need some support from the federal government and cooperation from manufacturers, he says.
"The manufacturing and warehouse folks have no business incentive to carry surplus inventory and they don't know how much inventory to carry," explains Cook. "We still are studying the overall impact. How many masks per patient day will we actually consume [in a severe pandemic]? This was not a severe pandemic."
Wanted: Respirators, masks, needles
A pandemic presents a sort of "perfect storm" for hospitals. For typical emergency preparedness, The Joint Commission requires hospitals to be self-sustaining for four days. In that timeframe, supplies and personnel could be brought in from unaffected areas of the country.
But a pandemic spreads rapidly from coast to coast. A survey of materials managers and infection preventionists at hospitals around the country found that 58% experienced shortages of respirators. Even surgical mask supplies were tight as demand suddenly surged; 38% said they had a shortage or back orders of masks. Safety needles were needed for millions of vaccinations and 46% of respondents said they were unable to vaccinate frontline workers from September to November 2009.
(The survey was conducted in February and March 2010 and had 1,109 responses. It was sponsored by Materials Management in Health Care, the Association for Healthcare Resource and Materials Management (AHRMM) and the Association for Professionals in Infection Control & Epidemiology (APIC) and was originally published in Materials Management in Health Care in June 2010.)
For example, at Regional Medical Center in Orangeburg, a facility of 286 beds, the normal use of four to five boxes a week of N95 respirators spiked to a demand for four to five boxes per day. Cook centralized the distribution, so that nurses would receive a supply of respirators upon request. This was designed to cut back on hoarding or taking respirators for family members.
He also had previously obtained reusable respirators elastomerics and powered-air purifying respirators (PAPRs) that could become a primary resource if the disposables ran out.
Meanwhile, Cook fielded calls from materials managers at other hospitals that had run out of masks. He tried to connect them with resources.
"To me it's a scary thing," he says. In a pandemic with a disease that had higher morbidity and mortality, a hospital treating patients without appropriate protective gear "could be the epicenter for the spread," he says.
Circulate the inventory
What can hospitals do to prepare? Ideally, hospitals should develop a circulating inventory of N95 respirators, says Cook. They can't be stored indefinitely because the respirators can break down due to temperature or humidity, he says.
Some health care organizations and at least two states Virginia and Michigan have developed agreements with distributors to pay the carrying costs of an N95 inventory, he says. In a pandemic, the distributor would ship the respirators within 24 hours, and the customers would then pay for the product. The distributor would manage the inventory, so it would remain fresh.
Hospitals also should work with their group purchasing organizations to obtain better pricing for an alternative brand and model of respirator so they'll still have price protection if their preferred model is not available, he says.
The federal government can encourage the development of inventories through financial incentives, such as tax incentives, he suggests.
Hospitals that were forced to pay steep prices for respirators and other supplies may be taking a new look at their pandemic preparedness. Cook notes that supplies usually stabilize about 45 to 60 days after an emergency, but it took five to six months for the N95 respirator market to stabilize.
"I really hope they're managing that inventory and not sequestering it," he says, noting that without a plan to circulate the inventory into regular use, "eventually it will become unusable."