Dealing with PPE Shortages: Safety Paramount for Healthcare Professionals

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By Debra Wood, RN, contributor and Carol Johnson, AMN Healthcare

Personal protective equipment (PPE), which is critically important to avoid the transmission of the novel coronavirus causing COVID-19, remains in short supply, creating concern for nurses, physicians and other healthcare workers across the nation.

“The shortages are not only affecting the United States but countries around the world,” explained Paulette Anest, MSN, RN, and Vice President of Clinical Operations at AMN Healthcare.

“Clinicians are being asked to follow the conservation and crisis CDC guidelines to reuse and sanitize their masks in the absence of a normal supply of personal protective equipment. Meanwhile, health care facilities are in a very difficult situation as they must conserve PPE, while taking steps to mitigate the lack of recommended protection,” she explained.

Anest, a tenured and respected clinician and industry leader, along with AMN’s Chief Clinical and Experience Officer, Dr. Cole Edmonson, DNP, FAAN, recently shared observations about the pandemic’s impact as it relates to PPE.

“There isn’t a nurse, doctor, therapist, technician, paramedic, or leader today who doesn’t want to help in any way they can,” Edmonson said. “The strain on the PPE supply is multifactorial, but one thing is clear, it has created moral distress on healthcare providers.”

Edmonson, who also leads clinician and customer experience at AMN Healthcare, has seen situations of heightened concern before, having been at the forefront of patient care during the 2014 Ebola outbreak as it came to the United States.

Both AMN healthcare leaders stay abreast of prevailing guidance that practicing without appropriate PPE is unsafe.

Protection benefits the provider, the patient and fellow healthcare workers so they don’t get novel coronavirus, thereby reducing the ability to help patients and possibly increasing contact-spread risk to others.

AMN Healthcare has a dedicated team of more than 60 tenured licensed healthcare Clinical Managers and Directors on call 24/7 during normal periods of care, with increased support for clinicians on assignment during the current pandemic.

“They’re skilled, caring professionals, who, along with their normal duties, are also staffing a Clinical Crisis Hot Line and Clinical Care Call program to provide additional crisis counseling support for healthcare professionals with potential and confirmed exposures,” Anest said.

There will be days when clinicians express concerns, acknowledged Anest and Edmonson.

“We want our team members and customers to know that AMN’s Clinical Managers proactively address those concerns,” Anest added.

Not surprisingly, one of the most prevalent concerns is around PPE. Anest explained that AMN Healthcare has a limited supply of PPE, which is secured for fit-testing during the healthcare professional’s onboard process. In this time of critical need, AMN Clinical Managers may provide N95 masks to healthcare professionals as needed beyond the masks provided for fit testing.

What’s more, AMN provides ongoing education to healthcare professionals and AMN team members on CDC guidelines and recommended guidelines from other accreditation organizations, such as The Joint Commission.

On March 31, The Joint Commission leadership announced support for healthcare staff to bring their own masks to work if healthcare organization could not supply adequate protection for their level of risk of infections.

As the COVID-19 crisis continues to spread state-to-state, more and more healthcare professionals are exposed, with increasing risk of becoming infected and potentially infecting others with the disease.

As a result, increasing numbers of healthcare professionals are quarantined, which negatively impacts an already constrained healthcare environment and creates additional stress on the healthcare professional, his/her family and community.

“Impacting critically-needed healthcare professionals in the workforce worsens an already extremely difficult situation,” Edmonson added.

Professional organizations advocating for clinicians

The American Medical Association, the American Nurses Association, the American Hospital Association and many other organizations have been advocating for additional PPE.

“Physicians don’t have enough masks; they are wearing a single mask all day, cleaning them at home, and sewing their own protective gear,” said Patrice A. Harris, MD, MA, president of the American Medical Association, in a release. She also has cautioned that if physicians and nurses catch the coronavirus, it will leave the health system without clinicians on the front line.

“We have been working closely with our client partners and clinical leaders with facilities across the country to understand the supply shortage,” Anest said. “Everyone wants to protect his or her self and to protect their patients, families and other caregivers.”

Optimizing supply: Ideas run the gamut, from conservation to DIY

Changing recommendations. Recognizing the shortage of PPE, the Centers for Disease Control and Prevention has issued strategies for optimizing the supply of N95 respirators and face masks. In some instances, the agency agreed to use face masks instead of N95s, which offer a higher level of protection.

The Occupational Safety and Health Administration has suspended its annual fitting of the N95 testing requirement. This will preserve supply of N95 respirator masks.

Encouraging donations, and cancellations of elective procedures. The federal government has asked construction companies to donate N95 masks and called for elective procedures to be cancelled to conserve supplies. Apple, Facebook and Salesforce also have donated masks.

Some dental offices and non-essential medical offices are also donating their excess supplies of masks and other PPE to hospitals and hospice facilities.

Reusing some supplies.The Food and Drug Administration has recommended clinicians wear the same gloves with patients who have the same diagnosis.

Nebraska Medicine in Omaha is using ultraviolet light to decontaminate masks, so they can be reused. Other healthcare facilities are encouraging the reuse of masks.

The American College of Emergency Physicians reports some physicians are spraying masks with bleach at the end of the day, allowing them to dry, and then reusing the masks.

Finding creative solutions. A neurosurgeon at the Billings Clinic in Montana is using 3D printers to develop reusable masks.

Nurses at one hospital are using long intravenous tubing and placing pumps in the hall, so they do not have to go into the room to check the pumps.

Some strategies, however, may be better than others.

Healthcare Safety: Best Practices in Time of Pandemic

Considering best practices to slow the spread of the virus and promote safe staffing, AMN Healthcare supports PPE preservation and acquisition strategies that include:

  • Cross-institutional partnerships to cohort patients and supplies within a geographic territory
  • Isolating COVID-19 patients in one area within a hospital
  • Applying for supplies from the national stockpile
  • Partnerships with suppliers in and outside of healthcare to produce PPE
  • Setting up triage tents outside the hospital to screen patients and limit exposure to the broader healthcare team
  • Limiting visitors to the hospital and using video technology to support communication
  • Implementing social distancing and promoting stay home-stay safe orders
  • Screening healthcare professionals and rescreening as needed
  • Sending sick healthcare professionals home and expediting testing for those on quarantine
  • Promoting follow up with local health care provider through telehealth services

“We continuously evaluate policies and processes in light of the situation at hand, which includes fit testing requirements, distribution of N95 masks for fit testing, and considering how we can support healthcare professionals who are providing desperately needed medical care in facilities across the United States,” Anest said, noting that the company will have three-way conversations that include facilities, clinicians and AMN’s clinical support team.

AMN is working to keep healthcare professionals on assignment, while recruiting even more talented candidates to support staff during the current crisis.

“At AMN, living our mission is evidenced in our daily work and our hourly conversations with healthcare professionals by actively listening, providing emotional support, employee assistance programs (EAP) and working to find a solution to keep them safe—both physically and psychologically,” Edmonson added.

AMN Healthcare set up a COVID-19 hotline for its on assignment clinicians: 800-887-1456.

New APIC Survey Highlights Shortages

The Association for Professionals in Infection Control and Epidemiology (APIC) conducted an online national survey of its U.S.-based infection preventionist members March 23-25, 2020. The APIC members were asked to categorize their supply of personal protective equipment (PPE) and other items, such as hand sanitizer and cleaning products on a 5-point scale (plenty to none). Of the 1,140 respondents, 20% (233) reported that their facilities have no respirators, close to 28% (317) say they are almost out of respirators.

In addition, nearly half of the respondents stated that they do not have enough face shields, with about 36% reporting that they are almost out and just over 12% stating they are completely out., while hand sanitizers were in short supply at 1 in 4 of the facilities surveyed.

About one-third of survey respondents stated that they have accessed supplemental PPE through state or local sources with 25% receiving private donations of supplies. Another 17% said they created their own solution, such as sewing masks. Only 12% of respondents reported receiving supplies from the Strategic National Stockpile.

In a statement following the survey release, APIC president Connie Steed, MSN, RN, CIC, FAPIC, stated that “Immediate action is needed to protect healthcare workers and save lives – every minute matters.” Steed and APIC called on the federal government to activate the Defense Production Act and other means at its disposal to get supplies needed to treat COVID-19 patients and protect healthcare workers.

Stepping up production of PPE

Honeywell and 3M, existing manufacturers of N95 masks, have stepped up production of personal protection equipment in recent weeks and the clothing manufacturer Hanes Brands has said it would start making N95 masks, as well.

According to recent news reports, Ford Motor Company is collaborating with 3M in making air-purifying respirators, face shields and 3-D printing N95 respirator masks. Ford is using F-150 parts to design the respirators and reportedly has multiple teams working on products.

Also, GM, Ventec Life Systems and an organization, StopTheSpread.org have coordinated a private sector response to the need at hospitals by supplying FDA-cleared ventilators expected to ship as soon as April.

Meanwhile, governors have complained about the bidding war to obtain those critical supplies for their states. New York Gov. Andrew Cuomo urged the federal government to purchase the supplies for states, as states bid against each other, pushing up the costs of masks and other equipment. Masks that cost 85 cents each before the pandemic are now on the market for $7 each, he said.

AMN Healthcare monitors and educates both clinicians and clients as information becomes available.

“We’re an organization that advocates on every level for the safety of all healthcare professionals and communities across the United States,” Edmonson said. “We will continue to work tirelessly on behalf of every person working the frontline, and partner strategically with our colleagues leading in healthcare facilities to employ leading practices and increase safety and quality because that is the right thing to do.”

FOR MORE INFORMATION:

Resources for Personal Protective Equipment Guidance

Joint Commission

  • Joint Commission Statement on Use of Face Masks Brought from Home: The Joint Commission leadership announced support for healthcare staff to bring their own masks to work if health care organization could not supply adequate protection for their level of risk of infections.
  • Doffing Personal Protective Equipment (PPE): Joint Commission Demonstrates Ways to Safely Remove a Gown in Order to Prevent Infection.
  • Shortages of Personal Protective Equipment in the COVID-19 Pandemic: Mark Pelletier, MS, RN, chief nursing officer and chief operating officer provides insight on measures to conserve supplies of PPE and what’s ahead.

Centers for Disease Control and Prevention

Journal of the American Medical Association (JAMA)

American Nurses Association (ANA)

American Association of Respiratory Care (AARC)

  • AARC Provides a Joint Statement Regarding Placement of Multiple Patients on One Ventilator: Read the statement issues by SCCM, AARC, ASA, APSF, AACN, and CHEST.

Food and Drug Administration (FDA)

  • The FDA’s Letter to Healthcare Providers on Surgical Mask and Gown Conservation Strategies: The FDA provides conservation strategies for healthcare organizations and personnel to assist operating procedures during COVID-19 outbreak. The information is intended to augment information developed by healthcare organizations, CDC or HICPAC.
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