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COVID-19 Resurgence in Ohio Threatens Providers’ PPE Supply

The Akron Beacon Journal last week reached out to three local health-care systems and Summit County public health officials for an update, asking each the same nine questions about PPE supplies, cost and reuse.

by Amanda Garrett, Akron Beacon Journal / July 20, 2020
AP

(TNS) — When the pandemic began to unfold in Ohio and around the globe earlier this year, there was widespread concern about acquiring enough personal protective equipment (PPE) to prevent health care workers and others from becoming infected with COVID-19 and to stop them from passing it on.

Those worries seemed to ease here after Ohioans stayed at home for much of the spring, flattening the pandemic curve.

But now that cases are on the rise again — Summit County remains at state Level 3 (red), with very high exposure and spread — are area hospitals, health care systems and others still able to buy the N95 masks, gowns and other PPE they need?

The Akron Beacon Journal last week reached out to three local health care systems and Summit County public health officials for an update, asking each the same nine questions about PPE supplies, cost and reuse.

The answers below come from:

  • Lisa Aurilio, chief operating officer, Akron Children's Hospital
  • Steve Abdenour, chief operating officer, Cleveland Clinic Akron General
  • Dr. Donald Dumford, medical director for infection prevention, Cleveland Clinic Akron General
  • Chris A. Barker, Summit County Public Health's emergency preparedness/compliance supervisor who also coordinates preparedness for the Northeast Central Ohio Regional Healthcare Coalition (NECO), a collaboration among hospitals and health care systems and their partners in Summit and 13 surrounding counties.

Summa Health did not respond to individual questions, but did provide a general statement about PPE, which follows the questions and answers below.

Q: As COVID-19 cases are again on the rise, how is the supply of PPE in your health system and/or public arena (nursing homes, day care centers, etc.)?

Aurilio: We continue to work on our supply chain and developing a secure, reliable supply chain for our hospital. We are increasing our supply in expectation of surge needs that are typical for the pediatric population in the fall.

Abdenour: At this time, we have sufficient PPE to meet the needs of our caregivers and patients.

Barker: In general, the availability of PPE has improved since the onset of the pandemic, but many private distributors are still providing material based on priority allocations (allocating to critical infrastructure/health care organizations). Requests are either partially filled or fulfilled in full based on the original request. It depends on the product request.

Q: How many weeks of supplies do you have, and are you confident that the supply chain can provide every item you need to maintain adequate supplies of all items at all times?

Aurilio: We have four or more weeks' worth. We partnered with several vendors that have shown a reliable source to meet our needs.

Abdenour: We are confident in our supply chain. We don't have a time frame to provide inventory.

Dumford: As a provider who spends about 85 to 90% of [his] time seeing patients in the hospital, I've felt very comfortable in the hospital and confident in how our supply chain is handling the pandemic.

Barker: The volume of resource requests have dropped since the onset of the [pandemic]. This is a positive indicator overall as organizations are procuring PPE through various means. This picture could change, however, based on national and international factors.

Q: Are there any particular items, like N95 masks, in short supply?

Aurilio: We have continued to acquire the PPE needed to safely protect our patients, families, and staff. None of the PPE are in an endless supply, but we review our current and projected use daily/weekly to ensure that our patient/family/staff needs are met.

Abdenour: N95 supplies are sufficient.

Barker: Shortages for specific types of PPE have ebbed and flowed since the onset of the pandemic. Face shields, surgical masks and isolation gowns were some notable products that had been challenging to procure, but coordination with the state and private resource providers has helped address these product gaps. At present, N95s continue to be a challenge when seeking specific makes/models of respirators. Emergency-use respirators are available, but many agencies are seeking specific makes and models of respirators as their staff are "fit tested" on these products. (A "fit test" fits the seal between a respirator face piece and someone's face, according to the federal Occupational Safety and Health Administration.)

Q: Has the cost of PPE risen? If so, could you give some examples?

Aurilio: Prices have both decreased and increased depending on the item. For example, early in the pandemic, the cost of N95 was above $5 each. This has come down closer to 90 cents each. However some items, like gowns, have actually gone up from 43 cents to over $2 each.

Abdenour: We are part of the Cleveland Clinic enterprise that handles the sourcing and price negotiations of all products we use, including PPE.

Barker: (Deferred to the hospital officials because they have more experience with direct procurement and purchasing.)

Q: Are any PPE items now or soon to be rationed or limited? Some hospitals, for instance, allow health care workers only one N95 mask per shift. Also, if there are limits, is that entirely due to supply, or is cost a factor, too?

Aurilio: We have continued to use appropriate PPE based on screening questions, clinical symptoms and types of procedures. Currently, no rationing of PPE. I'm not sure that I consider one N95 per shift "rationing" per se.

Abdenour: We have put practices in place to help us control the proper use of PPE per CDC [U.S. Centers for Disease Control and Prevention] guidelines in order to be responsible in our consumption.

Dumford: We have strategies to be good stewards of our supplies. This isn't because we're concerned about our supply right now, but because we want to make sure we have supplies three, four or five months from now. This situation is going to go on for a long time and hospitalized COVID-19 patients require a lot of resources, so health care providers everywhere have to do their best to conserve what we have.

Barker: Rationing of PPE is still a factor. Rationing ebbs and flows based on specific products being requested from distributors/vendors. PPE reuse is still in place for certain products [like N95 masks] and follows CDC guidance.

Q: Have you changed suppliers or otherwise changed how you stock/supply PPE since the pandemic began? Has it proved successful?

Aurilio: We have used multiple suppliers, both US and international — but we have used only those N95 clinically that meet the National Institute for Occupational Safety and Health (NIOSH) standards. Changing suppliers has required us to revisit and update fit testing — with the new N95s specifically — this has proven to be quite time and labor intensive, but again a process that had to be undertaken due to variability in supply of certain mask types/manufacturers.

Abdenour: We are part of the Cleveland Clinic enterprise that handles the sourcing and distribution of PPE supplies. The system of ordering and allocation has proved successful.

Q: Are you getting any supplies from Ohio and/or U.S. manufacturers who began making PPE only after the pandemic began?

Aurilio: The supply from the Ohio stockpile continues to be limited but we do on occasion get a distribution. Distribution is based on numbers of COVID patients treated. As we have had few pediatric patients admitted to the hospital, we get lower amounts of supplies from the stockpile than other hospitals that have treated more patients. We are now getting our supply of N95s out of Texas, where we previously received these from Asia.

Abdenour: We are working with several Ohio companies that retooled to supply products including gowns, face shields and cloth masks.

Barker: Yes, the state is providing material through the Ohio Department of Health. I can't speak as to how the material is procured at the state or federal level, but the products are provided through various manufacturers, including organizations which transitioned into PPE production.

Q: Early on in the pandemic, Gov. Mike DeWine praised Battelle machines that sterilize N95 masks for reuse. Has your hospital/health system used this (or similar) technology to reuse any of its PPE? And are you confident this technology and/or system (labeling masks, etc.) works?

Aurilio: We have resterilized through Battelle but have set those aside and have not reused. We would use if we have no other choice.

Abdenour: Cleveland Clinic created its own vapor phase hydrogen peroxide system (which would be similar to the Battelle device) to sterilize appropriate PPE. Used products are collected weekly for this purpose.

Barker: Summit County Public Health provided organizations with information regarding Battelle. We use them internally for N95 [mask] cleaning.

Q: What does the public need to know about PPE at this stage of the pandemic crisis?

Aurilio: COVID-19 has continued to be a disease that predominantly affects adults — so the frequency of COVID in our patients continues to be quite low, with even fewer that require hospitalization. That said, we have continued to acquire the PPE needed to safely protect our patients, families, and staff in case parents/family members/caregivers are symptomatic and to protect against asymptomatic COVID infections in our patients or family. None of the PPE are in an endless supply, but we review our current and projected use daily/weekly to ensure that our patient/family/staff needs are met.

Dumford: They should know that we're feeling safe in the hospital. PPE is there to protect health care workers from getting infected and subsequently to protect our patients, colleagues, friends and family from getting exposed to us. As someone who spends nearly all his time seeing patients in the hospital, I have felt very safe. The public should remember, too, that PPE should be for reserved for front-line health care workers. I encourage you all to save N95s and surgical masks for the nurses, nurses' assistants and doctors who are working with COVID-19 patients. For the general public, the most important preventive measures are social distancing, masking in public places and good hand hygiene.

Barker: PPE is still a concern and organizations should be closely monitoring PPE needs and resources as this crisis has not ended.

Summa Health's response to questions: Summa Health has and will continue to provide PPE for employees. Depending on the level of patient interaction, this may include cloth masks, N95 masks, goggles, shields and gowns. We monitor our supplies daily and should PPE supplies become limited, we will work with our county and state health care partners and continue following CDC guidelines to keep our employees, patients and visitors safe. Throughout the pandemic, Summa Health has received generous PPE donations from local businesses and community members and we are thankful for their support.

Reporter Amanda Garrett can be reached at agarrett@thebeaconjournal.com or follow her on Twitter @agarrettABJ.

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©2020 the Akron Beacon Journal (Akron, Ohio)

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