The Nation’s Infection Control Leaders Warn of Alarming Shortages of Personal Protective Equipment

March 28, 2020
In a press briefing announcing the results of their survey of infection control professionals nationwide, APIC leaders sounded the alarm on the increasingly desperate shortages of personal protective equipment

In a press briefing on Friday morning, March 27, leaders of the Arlington, Va.-based Association for Professionals in Infection Control and Epidemiology (APIC) released the results of a survey of APIC’s membership, which is revealing tremendous shortages of personal protective equipment (PPE), as well as of hand sanitizers and disinfecting cleansers, in U.S. hospitals, nursing homes, and other patient care organizations.

APIC’s leaders released the highlighted results of the survey in a press release Friday morning, on the association’s website, and then spoke to the press through a telephone press briefing.

As the press release noted, “Nearly half (48%) 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, according to a national survey of infection prevention experts conducted March 23-25, 2020 by the Association for Professionals in Infection Control and Epidemiology (APIC). The online survey asked APIC’s U.S.-based infection preventionist members to categorize their supply of personal protective equipment (PPE) and other items including hand sanitizer and cleaning products on a 5-point scale from having “plenty” to “none.”  Of the 1,140 infection preventionists who completed the survey, 233 (20.46 %) reported their facilities have no respirators; an additional 317 (27.83%) say they are almost out of these critical devices used to protect healthcare workers caring for patients with COVID-19 and other infectious diseases.”

What’s more, APIC found, “Nearly half of the respondents (560 or 49.16%) said they do not have enough face shields: 416 (36.52%) are almost out; 144 (12.64%) are completely out. Regarding mask supply, nearly one-third (31%) of respondents are almost out, or completely out. Hand sanitizer is also in short supply at more than 1 in 4 facilities surveyed (322 respondents or 28.27%): 292 respondents (25.64%) are almost out; 30 respondents (2.63%) are completely out.”

And, the press release stated, “APIC calls on the federal government to immediately activate the Defense Production Act and any other means at its disposal to get the supplies needed to safely treat COVID-19 patients and protect healthcare workers at the front lines of this pandemic. ‘Immediate action is needed to protect healthcare workers and save lives – every minute matters,’ said 2020 APIC President, Connie Steed, M.S.N., R.N., CIC, FAPIC. ‘Healthcare providers need clarity, not confusion. They need to know when exactly they can expect desperately needed supplies to arrive so they don’t have to turn to unproven crisis methods for PPE. There have been grim reports from health officials about the supply shortage for weeks and we’re not getting any answers. This is unacceptable.’”

As the press release notes, “Infection preventionists develop evidence-based practices to prevent the spread of infection, including protocols for hand hygiene and the proper use of PPE.”

And Katrina Crist, MBA, CAE, APIC’s CEO, stated in the press release that, “As the COVID-19 pandemic continues to sweep the country and place an extreme burden on the U.S. healthcare system, shortages of critical PPE and disinfection supplies will severely jeopardize our ability to safely treat patients and protect healthcare workers who are putting their lives on the line to fight this disease. As it stands now, infection preventionists are being forced to recommend unproven measures for PPE,” Crist said, “Some healthcare workers have even resorted to do-it-yourself approaches, adding more risk.”

As the press release noted, “Nearly 30% of survey respondents (599 or 29.35%) have accessed supplemental PPE through state or local sources; a quarter (501 or 24.55%) have received private donations of supplies. Roughly 17% (351 or 17.2%) have created their own PPE solutions such as sewing masks. Only 12.25% (250 respondents) report receiving supplies from the Strategic National Stockpile.  Among survey respondents, more than two-thirds (765 or 67.05%) have only one or less than one full-time equivalent infection preventionist on staff to devise safe protocols for protecting against COVID-19.”

And the press release quoted Steed as noting that “Hospitals and health facilities with fewer than one full-time person on staff to direct infection prevention activities may have been disadvantaged even before the COVID-19 pandemic. I am concerned that many facilities will not be able to protect healthcare workers and patients from not only COVID-19, but also MRSA, C. diff and other antibiotic-resistant infections,” Steed said.

Infection control leaders express major concerns

At the outset of Friday’s telephonic press briefing, Katrina Crist told the press that “The Association for Professionals in Infection Control and Epidemiology is urging the federal government to act now to secure critical equipment, especially respirators [face masks]. We’re experiencing dire shortages of respirators, masks, gowns, and other supplies needed to protect patients and healthcare workers,” she emphasized.

Crist noted that, “In the online poll, conducted March 23-25, 1,140 infection preventionists responded to sour survey. We received responses from all 50 states and the District of Columbia. The results paint a distributing and alarming picture. Nearly half of organizations surveyed are already out of or almost out of respirators. Out of that 48 percent, 28 percent are completely out of respirators—N-95 filters and devices. 37% are almost out of face shields, 26% are almost out of hand sanitizer. This is simply unacceptable. Shortages of PPE and supplies are jeopardizing our ability to keep people safe. We must act and act now.

Anne-Marie Pettis, R.N., B.S.N., CIC, FAPIC, who is the APIC president elect and who works at Highland Hospital in Rochester, New York, said that “I work in New York state, which is obviously the epicenter currently for COVID-19, and cases and deaths are rising by the day. Given how rapidly this is spreading, other cities and states will face this situation. Our survey shows that these shortages are widespread. And are putting HC workers at unnecessary risk. The situation now is causing healthcare personnel to lose faith in our guidance as infection professionals, and in the healthcare system at large.”

Pettis went on to say that “Adequate PPE can mean the difference between having enough staff or not. In New York hospitals, we’re being overrun with COVID-19 patients, and as infection prevention specialists, our days are spent frantically running down PPEs, teaching staff how to reuse PPE or even how to make their own, which goes against everything we’ve ever taught.”

And APIC 2020 President Steed, who practices at Prisma Health in Greenville, South Carolina, said that “I think we all know that time is critical. The federal government must act now to gather and coordinate supplies. Every minute counts. We’re asking healthcare providers to risk their own health and their families’ health, to care for us. We have to keep them safe.” Indeed, she said, “How can we ask healthcare workers to take care of us, when we really aren’t taking care of them? Everyone needs to do their part. We need to wash our hands often, keep our distance, stay home, and stay safe. APIC is calling on the federal government to activate the Defense Production Act and any other means. APIC is calling for transparency around delivery dates for these critical supplies. We need them immediately.” In addition to the critical need for PPE, the critical cleansing supplies, Steed said, are hand sanitizer and cleaning and disinfecting supplies. “The Government needs to use every tool at its disposal to get PPE, hand sanitizer and cleaning supplies to hospitals, nursing homes, and all patient care organizations,” she said, adding that “I know as a front-line infection control specialist how vital this role is. It’s our job to make sure everyone practices proper hand hygiene and understands all the steps in safe patient care. But if we can’t get the proper supplies, we can’t ensure safety. And every minute counts.”

Steed responded to a question from the press about whether airborne or droplet precautions should be followed—based on the fact that, initially, the Centers for Disease Control and Prevention (CDC) had set out the more stringent airborne precautions, in contrast to the recommendation that the World Health Organization had set out, that patient care organizations should routinely follow droplet precautions—a policy difference that would make an enormous difference in the speed at which supplies of PPE might be used up. “We have to remember that this is a novel virus,” Steed said. “And what the CDC did was, in an abundance of caution, develop very conservative guidance initially, with the use of airborne precautions. With a reduction in supplies, they decided that it needed to be expanded to surgical masks, due to the loss of N-95 availability. What needs to be understood is that the WHO has never recommended airborne precautions or N-95s. WHO’s recommendations call for droplet precautions and N-95s only for aerosolized procedures. This virus is transmitted by droplets. The surgical mask, with distancing, is acceptable to prevent its spread.”

And in response to a question about whether she and her colleagues would accept the hand-crafted masks that volunteers across the country are beginning to send to patient care organizations, Pettis said, “That’s a good question. We have had an outpouring in our community here in Rochester, New York, with seamstresses making masks and donating them. We’re accepting everything, but at this point, we are holding onto those with the idea that our first use would be for loved ones coming in to see patients, or we would send patients home with homemade masks, and we would launder those before we would hand them out. We’re holding onto them because fortunately we’re not at that point yet. A lot of places are putting surgical masks over N-95s to protect those. Eventually we might have to come to the point of using homemade masks; we would love to not have to do that; but certainly, if we got to that point, it would be better than nothing.”

And, asked by another member of the press about the difficult choices that some patient care organization leaders are already having to make regarding which staff members are provided masks and which aren’t, Steed responded, “That’s a realistic question. You have to look at where the risk is highest. We’re prioritizing those providers involved in aerosol-generating procedures. We’re conserving N-95 masks for those procedures, and surgical masks are used for all others. Another group is our emergency department. Our ED teams are receiving a lot of individuals into the hospitals for assessment and triage, and it’s felt there’s a need to protect them. So we are making some decisions, but are doing it in the safest possible fashion, using CDC guidance to assist us.”

Added Pettis, “One of the things we’re in the process of doing in our hospitals is, as this ramps up, our staff is getting understandably more and more fearful. So a couple of days ago, we decided that anybody who wants to wear a mask—we’re making one mask available per staff member per day. By the weekend or Monday, we’re also going to provide one N-95 mask to anybody who would like one. And in addition, we are probably going to offer every staff member one new mask a day to every staff member, whether they’re taking care of COVID-19 patients or not. It’s not scientific, but we have to make them safe. So this is changing by the hour, in terms of what we feel we must do.”

Added Steed, “And in our part of the country, we’re in the process of developing a similar strategy. Again, not scientific; but when you want to make HC providers feel safe, you have to make some decisions, and that’s what we’re doing.”

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