Health Supply PPE Preparedness

Considerations for Creating a PPE Stockpile (Part 1 of 2)

Preparing for Seasonal Flu and Flu Pandemic

The COVID-19 crisis has created a global shortage of PPE and we understand the importance of bringing our stockpile numbers up. The White House states a Core State Preparedness Responsibility for reopening the United States is the”ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need.” This post, part of a two-part series, covers the best advice available from the CDC when creating PPE stockpiles for seasonal influenza and a possible influenza pandemic. Though we hope for the best, continued preparedness will be critical in the occurrence of another spike in COVID-19 cases.

Seasonal flu epidemics are caused by various strains of influenza A and/or B and can spread widely and swiftly among the human population 1.  Influenza A viruses have the potential to infect both human and non-human animals, which, as epidemics such as Avian Flu illustrate, can create wide-spread disruption and demand for Personal Protective Equipment (PPE) when a novel form of influenza A emerges in the human population, often from a zoogenic source 2.  Influenza virus is spread when patients expel spitules as they cough, sneeze, and breathe, making PPE the only effective means of protecting doctors, nurses, hospital support staff, and visitors from infection 3.  This blog discusses an overview of CDC and OSHA essential considerations for essential PPE healthcare administrators may consider when preparing a stockpile for both seasonal flu and an influenza pandemic.

Personal Protective Equipment is required to protect caregivers in any given contact situation with any individual known or suspected to be infected with flu 4.  FDA-approved surgical masks come in various styles, including those with ear-loops or ties.  Some also have pliable metal clasps at the bridge of the nose to ensure a better fit.  Other masks feature protective eye shield extensions, although full-face shields are independently available and can be worn in conjunction with any mask 4.  A fitted N95 disposable respirator mask with a full face shield is recommended for maximum protection during any intimate contact with patients.  Whenever possible, the patient should also wear a cloth face mask to reduce the risk of spreading flu virus.  Gloves, gowns, and eye protection are advised when performing tasks that may result in splashing, aerosol-generating procedures, or intubation 4.

When stockpiling PPE in advance of the seasonal flu, consider what items may have recently experienced increased demand and anticipate scarcity or supply delays.  Always check with your supplier to ensure that the supplies you expect to receive are approved by the CDC 6 7.  Consider also how many staff members, support staff, and visitors may have contact with infected patients and require some minimal level of protection.  Staffing demands and rotations will put additional demands on employees as well as the available supply of protective equipment.

When stockpiling PPE in preparation of a potential flu pandemic, keep in mind the basic elements of PPE will essentially stay the same as those needed for seasonal flu, but one should consider that a greater quantity of PPE will be needed and a far greater number of employees, visitors, and staff may be at risk of exposure.  Consider also the outbreak will be of an extended duration.  OSHA assumes a flu pandemic will sweep a given community in two separate waves, each lasting approximately 12 weeks 9.   In addition to recommended PPE for seasonal flu, gowns are also strongly advised whenever performing any close-contact tasks with flu pandemic patients 9.  To account for how much PPE would be required in such extraordinary circumstances, OSHA recommends each facility should assess the individual exposure risk for a given classification of employee and associated tasks and classify the associated risk as very high, high, medium, and low, then base the estimated need for each type of PPE based on the number of employees in each category 9.  In addition to the above, it will be important to consider that many other essential surgeries and other hospital procedures will need to continue concurrent with the pandemic, placing additional strain on stockpiles 10.