Industry Leaders Examine PPE in a Post-COVID Landscape

Oct. 27, 2023
Healthcare Purchasing News looks back at the height of the pandemic and two industry leaders comment on the current challenges associated with personal protective equipment

Personal protective equipment (PPE) practically became a household name during the COVID-19 pandemic. Those in the healthcare industry were always aware of the importance of PPE, of course, but the news of PPE shortages hit mainstream headlines during the height of the pandemic.

On March 3, 2020, the World Health Organization (WHO) published a news release on the shortage of PPE endangering healthcare workers worldwide.

The press release stated, “The World Health Organization has warned that severe and mounting disruption to the global supply of personal protective equipment (PPE)—caused by rising demand, panic buying, hoarding and misuse—is putting lives at risk from the new coronavirus and other infectious diseases.”

Further, “Since the start of the COVID-19 outbreak, prices have surged. Surgical masks have seen a sixfold increase, N95 respirators have trebled, and gowns have doubled.

“Supplies can take months to deliver and market manipulation is widespread, with stocks frequently sold to the highest bidder.

“WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries, but supplies are rapidly depleting.”

In 2021, Healthcare Purchasing News (HPN) wrote about the struggles of the ongoing shortages. We wrote, “‘Nearly half of U.S. healthcare facilities surveyed are already out of, or almost out of respirators to use in caring for a patient with COVID-19,’ reads an APIC March 27 press release. ‘Lack of N-95s, masks, face shields threaten health workers in facilities in every state, in every size facility.’”

“When reflecting on 20-plus months of supply uncertainty—and lessons to take away moving forward—the themes expressed across the industry are similar: More diversity must be built into a company’s lineup of PPE manufacturers, with an emphasis on production closer to home; More visibility and transparency must be built into the system so that clients and other stakeholders can track products and share information,” we continued. “And in order to be successful in the supply chain of tomorrow, a company will need to maintain flexibility and be able to shift gears quickly.”

PPE in 2023

Cheron Rojo is currently the senior clinical education specialist for Healthmark. Rojo is a CRCST (Certified Registered Central Service Technician), CIS (Certified Instrument Specialist), (CER) Certified Endoscope Reprocesser), (CFER) Certified Flexible Endoscope Reprocesser, CHL (Certified Healthcare Leader), and FCS (Fellow Central Service).

Rojo commented to HPN on the current attitudes toward PPE in a “post-COVID” world. He said, “Post-COVID attitude toward PPE is a humbling one since no one thought that facilities would  not have access to the plentiful array of PPE out in the marketplace. I think we all in some sense took PPE for granted assuming that it would always be available, except for the occasional backorder here and there. Also, there is a more respective attitude towards reusable PPE, which wasn’t really considered before the pandemic.” [Editor’s note: See the last section of this article for current insights on reusable PPE.]

Another major challenge hospitals are facing right now is finances. It should come as no surprise that hospitals are being challenged financially well into 2023.

Chad Flora, RN, BSN, CNOR, clinical director, Gloves Business Area, Mölnlycke, spoke with HPN about financial struggles as they relate to PPE. Flora said, “According to an article from Becker’s Hospital Review, hospitals are facing intense financial pressures across today’s healthcare landscape—more than 50% currently operate on negative margins. An article from the AHA [American Hospital Association] said that with a heightened focus on finding savings within the supply budgets, hospitals are now refocused on providing quality care while maintaining profitability. OR managers face unprecedented challenges in driving staff and patient safety while still achieving optimum savings. The post-pandemic impact of staffing shortages and inflationary impacts only further exacerbate these challenges.”

“The traditional approach to identifying hospital savings is to focus on purchase price savings,” He added. “This approach does not always consider the total cost impact to the facility of swapping out products for lower-priced alternatives. By recognizing hospital purchasing power as a driving force for total value impact, a value-based purchasing (VBP) approach combined with the LEAN methodology can help OR managers achieve the outcomes that matter—at the lowest possible price. [C J O’Connor (2018). The Healthcare Supply Chain: Best Practices for Operating at the Intersection of Cost, Quality and Outcomes (2nd Edition). New York, NY: GNYHA Ventures, Inc.]

Flora continued, “Fundamental to applying LEAN principles is understanding and reducing ‘waste.’ Importantly, waste isn’t limited to what goes unused or is thrown away in the hospital setting. The LEAN model takes a more holistic view to include anything that absorbs personnel, resources or time but does not add value to the overall process or to the end user of the given service or product within the hospital [CimaRR, Brown MJ, Hebel JR, et al. Use of LEAN and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center J Am Coll Surg. 2011;213:83-94.]. Opportunities for waste reduction can be found across every area of the procurement process, including transportation, inventory, overprocessing, overproducing, defects, and skills [NEJM Catalyst, What is Lean Healthcare? August 2023].” 

When HPN asked Rojo about potential funding problems from hospital leaders, he said, “Due to increasing cost for PPE post-COVID, decisions for purchasing PPE have been impacted, which could lead to subpar quality of materials of PPE.” 

An important matter to discuss with hospital leadership is standards, Rojo commented. He said, “In January of this year, ANSI/AAMI PB70 (protective barriers) revision was released for users to purchase. Even though the standard is mainly a manufacturer document, there is vital information for users in the selection of protective barriers like gowns. The document has numerous changes from labelling to additional specific protective barriers e.g., decontamination gown. In section A. decontamination gown it states, ‘Due to the nature of the environment for which decontamination gowns will be worn the critical zones have a minimum barrier performance of at least Level 3.’ This new verbiage helps users know that a level 1 or 2 gown is not sufficient for the type of task being performed and consideration for the ‘OPIM (Other Possible Infectious Material) is most likely to occur.’ [ANSI/AAMI PB70:2022, Liquid Barrier Performance and Classification for Protective Apparel and Drapes Intended for Use in Healthcare Facilities. Association for the Advancement of Medical Instrumentation. Arlington (VA): AAMI; 2022.] 

Surgical gloves 

Regarding standards, Mölnlycke’s Flora added, “Surgical gloves are an essential item for any OR, and thus are often a focus of cost-reduction measures. However, focusing on waste reduction, rather than price per unit cost containment can yield long-term savings. Three key areas for potential cost-in-use savings include examining glove quality, glove materials, and glove practices. Low glove quality can increase glove waste both in materials and time. Standardizing to a streamlined selection of high-quality gloves can result in total cost-in-use savings [Utilizing the Lean Process in Surgical Glove Standardization, Samuel E. Sullivan RN CNOR, Published Poster, AORN 2020]. Certain glove materials such as natural rubber latex can result in latex-related costs such as staff and patient allergies and treatment costs [Wharton, Kurt R., Thomas J., Henderson P., Phillippe, “Can converting to synthetic surgical gloves lower hospital operating room costs? OR Manager, May 2016]. Although synthetic gloves have a higher purchase price, eliminating latex can avoid costly OR teardowns due to late discovery of patient allergies. Finally, glove practices such as double-gloving can protect healthcare workers from exposure to bloodborne pathogens from needlestick injuries, each of which can cost an estimated $4,838 to treat [O’Malley EM, Scott RD 2nd, Gayle J. Dekutoski J. Foltzer M. Lundstrom TS, et al. Costs of management of occupational exposures to blood and body fluids. Infection control and hospital epidemiology 2007;28(7):774-82]. 

He continued, “A price-only-based approach to savings is too short-term to meaningfully address hospital budget challenges [C J O’Connor (2018). The Healthcare Supply Chain: Best Practices for Operating at the Intersection of Cost, Quality and Outcomes (2nd Edition). New York, NY: GNYHA Ventures, Inc]. and choosing quality will allow hospitals to reduce waste and improve OR efficiency.  Choosing the right glove vendor partner and having strong communication is vital to the success of a value-based procurement system to ensure a hospital is maximizing value and savings, while minimizing total waste.” 

Looking forward 

It’s clear that cost is a major concern for hospitals and health systems today, yet there are those out there working to improve cost alongside healthcare worker safety, as well as waste reduction. 

A recent article from American Laundry News, said that TRSA, the association for linen, uniform, and facility services, confirmed sponsors for The Healthcare Worker Safety and Sustainability Act in New York state. The act requires a 50% threshold of reusable PPE in healthcare facilities. 

The article stated, “In the state legislature, Assembly Member Amanda Septimo (D-84th District) introduced the bill (AB 6995) and Sen. Cordell Cleare (D-30th District) initiated the Senate companion measure. The legislation amends the New York public health law to require healthcare facilities to maintain this threshold of textiles as provided by a hygienically clean laundry service provider.” 

TRSA, according to the article, has been stressing that legislation is needed to improve healthcare employee safety and reduce waste healthcare facilities are sending to landfills. 

“The linen, uniform and facility services industry made up for the shortfall of disposable healthcare items by stepping in to provide hygienically clean reusable products,” said Joseph Ricci, president and CEO of TRSA.