By Tracey Chadwell, Senior Director, Advisory Solutions; Dan Wayman, Senior Director, Clinical Category Strategy; and Becky Lowe, Category Lead, Intalere
Personal Protective Equipment (PPE) shortages has been the lead story around the supply market during this pandemic, which has now manifested as significant pricing pressure on select PPE product lines.
We are anticipating price inflation with ISO gowns, caps and shoe covers due to a shortage of the material spunbond meltblown spunbond (SMS). Recently, we have received communication from suppliers that these increases may be between 300%-1100%.
PPE Product Alternatives
Alternative pieces of clothing can be considered as a last resort for care of the COVID-19 patients as a single use PPE. Consider wearing them over isolation or surgical gowns to extend their life. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured such as:
- Disposable laboratory coats
- Reusable patient gowns
- Reusable laboratory coats
- Disposable aprons
- Combinations of clothing: long sleeve aprons in combination with long sleeve patient gowns or laboratory coats
- Open back gowns with long sleeve patient gowns or laboratory coats
- Sleeve covers in combination with aprons and long sleeve patient gowns or laboratory coats
- Food service gowns
- Gowns and shoe covers made from Tyvek building material
Guidance on Reusable Gowns
Reusable gowns are made of polyester or polyester-cotton fabrics that can be laundered safely and are more cost effective than disposable gowns. Reusable gowns typically cost approximately $11 each and can be washed approximately 50 times. Reusable gowns can be used for Level 1-2, but not for level 3, therefore, you can’t use them for Chemo. These gowns are becoming more cost effective over a single use gown, which is estimated to go up in cost up to 10X due to the increase in SMS material. As supply shortages for disposable gowns increase, facilities are shifting to reusable gowns for use by hospital personnel. Positive features of reusable gowns include:
- Reduce waste
- Environmentally sustainable choice
- Provide adequate barrier protection and infection control
According to the Centers for Disease Control, and the Association for Linen Management, reusable gowns can be safely laundered according to routine laundry procedures, decontaminated, and maintained after and between uses. Laundry operations and personnel may need to be augmented to facilitate additional washing and cycles. A system to inspect, maintain (such as mending small holes or replacing fasteners) must be implemented as part of the facility policy and procedure manual.
Facilities should determine gown inventory and par level, then establish a supply chain to source product, whether it is provided by a laundry service or in-house procurement. Understanding the utilization rate will assist in determining par levels. The Personal Protective Equipment (PPE) Burn Rate Calculator can be used to calculate average PPE consumption rate or “burn rate.” The calculator estimates how many days a PPE supply will last given current inventory levels and PPE burn rate.
Managing Proper Utilization of Reusable Gowns
Adherence to effective wash process and infection measures will provide a safe inventory of reusable gowns. This practice will also ensure a safe working environment for healthcare workers.
- Do not shake dirty laundry. This minimizes the possibility of dispersing virus through the air.
- Wash items as appropriate in accordance with the manufacturer’s instructions. Continuing a reliable wash process that utilizes the combination of mechanical or agitation, heat, and chemicals, along with prescribed time to achieve antimicrobial action and cleanliness will render the reusable gown hygienically clean.
- Implement thorough cleaning of carts and linen transport containers and make sure to cover gowns and other textiles during transit.
- Consider outsourcing laundry services for reusable options.
NOTE: THERE ARE NO RECOMMENDATIONS FROM THE CDC OR ANY REGULATORY AUTHORITY TO DESTROY OR USE RED BAGS OR INCINERATE COVID-19 CONTAMINATED REUSABLE LINENS.
To learn more, view our Reusable Gowns Guidance document.
PPE Conservation Strategies
Potential approaches to conserve PPE supplies include:
- Implementing structured processes to ensure appropriate level of protection and avoiding use of more protective products when not necessary.
- Using expired products for training and fit testing.
- Centrally locate PPE inventory across their system to allocation based on internal needs.
- Utilize multi-sourcing strategies based on historical demand; keeping all channels open to secure products from multiple suppliers.
- Restrict the level of attendance for medical students and/or family members who require PPE products.
- Evaluate use of reusables as a last resort.
Example: Process used by Intermountain Healthcare for sterilizing N95 masks at larger facilities:
- Employee is issued a mask to be worn for the day.
- The employee uses a permanent market to write their name on it.
- At the end of the day the employee places it in a brown paper bag.
- Courier picks up the brown bags each night and takes them for reprocessing (600 at a time).
- Masks are returned in a white paper bag with the employee’s name on it.
- Masks can be reprocessed up to 50 times.
Example: Process used by Intermountain Healthcare for sterilizing N95 masks at smaller facilities:
- Currently using the Sterrad machine.
- Only allows for five masks at a time.
We Can Help
Intalere has recently partnered with TMG Health Technologies for rapid decontamination systems that allow you to decontaminate PPE products, N95 masks and other devices.
For more information on this subject, contact your Intalere representative or Intalere Customer Service at 877-711-5600.
Thanks also to Intalere Advisory Specialists Roseann Hoeye and Missy Hill for their contributions to this post.