More than four months into the COVID-19 crisis, hospitals are continuing to struggle to find enough personal protective equipment (PPE) for front-line healthcare workers.
Particularly in the wake of new spikes in cases reported in states across the country, the ongoing shortage of PPE has pushed facilities to rely on the once unheard-of practice of reusing equipment—officially known as reprocessing—in order to shore up supplies.
“Do we have enough PPE for a nurse to go in and treat a patient and throw it away every time? Absolutely not,” said Charley Larsen, a registered nurse and senior director at Banner Health, a hospital system with a large footprint in new COVID-19 hot spot Arizona. Infection totals have hit record levels over the past few weeks in several Sunbelt states including Arizona as well as Florida, Texas, North Carolina and South Carolina. “We do have it by new standards with infection control and reprocessing N-95 masks and make it usable again.”
Banner is among hospitals around the country that began using reprocessing after the Food and Drug Administration began approving sterilization practices to allow hospitals to reuse and conserve PPE supplies this spring. A recent survey from the union National Nurses United found that 85% of respondents reported reusing a mask for a COVID-19 patient.
Normally, the acute health care community uses about 25 million N-95 masks a year. But so far this year the healthcare community has used more than 300 million, said Chaun Powell, group vice president of strategic supplier engagement for Premier, a healthcare improvement company that has more than 4,000 member hospitals. A Premier survey of 100 health systems back in June found that 53% had N-95 masks on back order. Isolation gowns and shoe covers were the second most product on back order with 49%.
“We saw that same surge in demand across the entire globe, which put tremendous pressure on the supply chain,” Powell told Fierce Healthcare.
It doesn't appear the supply chain is going to catch up anytime soon.
Rush to reprocess
While hospitals have acknowledged the practice isn't ideal, it's the best and most acceptable option in the midst of a crisis that has put the supply chain for PPE under unprecedented strain.
A separate survey from Premier found that ultraviolet radiation was the most common tactic used by hospitals for reprocessing with 40%. “Part of the challenge with reprocessing is there is a cost associated with reprocessing that exceeds the cost of a new mask,” Powell said.
Another problem is that sometimes a mask couldn’t be reprocessed, such as if it gets contaminated with makeup or lotions that don’t rub off.
A number of groups representing front-line healthcare workers are concerned about the safety risks it poses.
Mary Lynn Briggs, a registered nurse at Mercy Hospital and Mercy Southwest Hospital in Bakersfield, California, said nobody in her facility likes using the reprocessed masks.
A major problem is that they do not know the process used by the facility for killing all of the bacteria. Another issue is that the hospital has turned to industrial-grade N-95 masks instead of medical grade.
“They do not seem to be as effective or as [long-lasting] as the medical-grade ones are,” said Briggs, Mercy's chief nurse representative for the California Nurses Association.
The hospital system has been overwhelmed with COVID-19 cases, mirroring a major outbreak across the entire state.
Briggs isn’t the only nurse with safety concerns about reprocessing.
National Nurses United said that many of the decontamination methods used by systems haven’t been tested against COVID-19.
“Decontamination processes may damage the respirator’s ability to filter out the virus, its structural integrity, and/or its face seal,” the union said in a statement to Fierce Healthcare.
Gearing up for another surge
Things may not get better for hospital systems as the fight against COVID-19 continues.
Hospitals are continuing to stock up to prepare for a potential second surge in the fall, and cases are continuing to rise in major hot spots as hospital capacity fills up.
Another growing concern is not just a shortage of gowns and N-95 masks, but gloves. This has prompted the federal government earlier this week to procure 4.6 billion surgical gloves to shore up the Strategic National Stockpile.
Even though the domestic manufacturing of PPE has increased, demand is still expected to skyrocket.
“The ultimate thing we can share is that there has got to be a more robust focus on conservation and include reprocessing in conservation,” Powell said. “Clearly the manufacturers in the space are not able to meet current demand so we have to take it on ourselves to conserve wherever possible.”