According to CDC data, the 2017-2018 influenza season was considered a high-severity season, with many outpatient facilities and ERs being caught off-guard by elevated levels of patients presenting with flu-like illness. There were also high influenza-related hospitalization rates. To make matters worse, last year’s flu season was geographically widespread and one of the longest in recent years.
Though healthcare organizations cannot simply look at activity from the prior year to predict upcoming needs, last year’s flu season was an important reminder that preparation is essential to having the critical supplies needed to protect healthcare workers and prevent further spread of the disease during periodic surges of patients that can occur with a high-severity and prolonged flu season.
Seasonal Vs. Pandemic Flu
In our homes we often develop plans for multiple emergency scenarios. Many families understand and plan differently for a short power outage (flashlights, blankets, and board games) versus the more long-term implications of natural disasters (water, dry food, generators, even evacuation). For hospitals and health networks, outbreak readiness requires similar multi-scenario planning.
Not all flu outbreaks are the same. When determining which and how much personal protective equipment (PPE) to stock, such as surgical masks, gloves, and gowns, it is first important to understand some differences between seasonal and pandemic flu.
According to the CDC, for seasonal flu virus impacting patients every winter, some combination of known or anticipated influenza B and influenza A virus strains are typically the culprit in these annual human transmissions.
Flu viruses are constantly changing, though. Often these are minor changes — or antigenic drifts — in which the new virus remains closely related to its source and a person’s immune system can still recognize it and respond.
However, at other times, influenza A viruses in particular can go through an antigenic shift, which creates a new and different virus. In these scenarios, the human population has little-to-no immunity, creating potential risk of a flu pandemic.
Pandemics can also be caused by unique pathogens such as the Ebola virus (EVD), cholera, and plague.
Different Flu Demands Different PPE
According to OSHA recommendations, when entering the room of a patient diagnosed with seasonal flu or influenza-like illness (ILI), a surgical mask should be worn for protection from contact with the large droplets generated when a patient coughs, sneezes, talks, or breathes. This evolves if there are any tasks involved in the interaction that might create splashes or otherwise put healthcare workers at risk of contamination. In these cases, gloves, gowns, and eye protection should be worn.
Lastly, for aerosol-generating procedures, at minimum, a fit-tested N95 disposable respirator should be used. For maximum protection, healthcare workers should use a full face shield in front of a respirator to reduce potential for exposure.
In the case of pandemic flu, the types of PPE required are similar to seasonal flu. However, the need to utilize maximum PPE protection happens more frequently. For example, more employees and tasks may be considered high risk, so increased respiratory protection such as N95 respirators may be required for more clinicians than in a seasonal flu situation. Additionally, more isolation gowns are typically indicated to protect from blood and bodily fluids (droplet precautions) in the case of pandemic flu.
This variance means that hospitals need to have a supply strategy in place to ensure both proper preparation for seasonal flu and the flexibility to meet increasing demands in the case of pandemic flu.
Determining Your Strategic Supply
The amount of PPE required to protect healthcare workers from exposure during seasonal flu is unique to each organization. Therefore, preparing starts with a thorough assessment that identifies the different roles within the organization and the exposure risks for each job — categorized as high, medium or low — and corresponding tasks.
Once the assessment is completed, determine what mix of PPE is required for each category and task. For example, do staff nurses in medical patient care areas require simply a mask with gloves, or a combination of gown, mask or respirator with gloves?
Lastly, estimate the number of employees who fall into each category and the frequency of their corresponding tasks to determine the number of items needed on-hand. In other words, it can be helpful to use the following formula:
Exposure Risk X PPE Mix X Frequency X Number of Employees = Estimated Total
In addition to ensuring you have the right mix on hand, it is important to work closely with your PPE providers to understand their supply chain and the plans they have in place to minimize the impact to their customers (and the patients relying on them for care) should any unforeseen disruptions occur. For example, many PPE products are sourced from overseas, which can mean a delay in response and availability in the case of an emergency, outbreak, or higher-than-expected demand.
Consider working with a supplier who sources locally to help avoid these delays. Additionally, be sure to have ongoing, collaborative dialogue with your PPE partners so you can understand and establish expectations for how quickly they can respond and prepare accordingly.
The Strategic Supply Is Established — Now How to Manage?
Once all the analysis and work has been done to establish a strategic supply of PPE, organizations must take careful steps to maintain and protect it until needed. To start, an organization’s strategic supply should be kept in a clean, secure environment with the ability to utilize controls to maintain a proper temperature. Damp areas or environments that experience extreme temperatures can impact the quality and integrity of the PPE, putting wearers at risk.
When stocking items, be sure to keep a careful record of each product’s shelf life and storage conditions. This way, where possible, you have the data needed to incorporate product rotation so that oldest items are used first.
Delegate some accountability to your strategic suppliers to annually review your stock quantity and expirations, and task your supply partners with recommending stock adjustments in annual reviews based on trend analysis in your region.
Even with the best planning, some materials are often in limited supply. When this is the case, consider a regional plan with neighboring hospitals or other in-network facilities and healthcare organizations to share inventory. After all, both seasonal and pandemic flu surges are felt regionally, so protecting one organization’s staff in many ways protects others locally as well.
Lastly, proper training for staff on PPE selection as well as donning and doffing procedures can ensure both proper utilization and protection and reduce waste of your strategic supply.
Strategy And Preparation Are Key
The World Health Organization reported almost 100 infectious disease outbreaks from flu to bubonic plague in 2017 alone, so whether thinking of seasonal flu or the potential for something more serious, preparation is critical.
Though it can be a daunting task to prepare for both seasonal flu as well as broader pandemics, through a combination of careful analysis of your own organization and its needs, an ongoing dialogue with your suppliers to understand their supply chain and set expectations, and careful tracking and education around your strategic supply, you can help to ensure the safety of not only those within your organization, but those relying on it for care as well.
Jason Burnham has 21 years of healthcare experience in systems and solutions design with Lean Six Sigma principles. At Kimberly-Clark and O&M Halyard, he led teams that developed technologies to reduce patient readmissions and improve visibility of workflow in hospitals. Recently he pivoted to re-engineering Halyard’s flu season readiness systems. His team is currently developing pandemic solutions with the U.S. Office of the Assistant Secretary for Preparedness and Response.
A version of this article appears in the November/December 2018 issue of Surgical Products.