1. Be prepared for the unexpected.

If the global pandemic has taught us anything, it’s to be ready for the number and extent of infection surges.

In fact, that is the No. 1 reason why long-term care facilities continue experiencing chronic PPE shortages even as access to supplies has never been better, said Connie Steed, MSN, RN, CIC, FAPIC, 2020 president of the Association for Professionals in Infection Control and Epidemiology and director of infection prevention at Prisma Health in South Carolina.

Moreover, as an APIC survey found recently, more than 750 infection preventionists (IPs)reported being concerned about their facility’s surge capacity and only slightly less about their facility’s ability to provide safe care entering the so-called “twindemic” season of flu and COVID-19. 

With heightened expectations also comes constant risk assessment. The day-to-day stress has led to what she called “PPE fatigue.” She warned that caregivers need to avoid complacency with their own protection needs outside work. 

2. Focus on the most critical PPE.

“With all the recent studies that have come out in support of SARS-CoV-2 being aerosolized, respirators and surgical masks are the most critical PPE for providers,” said Karl Seagren, senior product consultant, Environmental, CIC, for Direct Supply. “To preserve the still limited supply, priority should be placed on N95 respirators for staff who have direct contact with residents, while often all others can wear procedure or surgical masks.” 

Seagren noted, meanwhile, that until the supply chain for N95s is back to full strength and the Emergency Use Authorizations are revoked, “most providers can continue to use KN95s or other NIOSH-approved respirators that meet or exceed the filtering criteria of N95s.”

3. Employ sound acquisition tactics.

This requires a refresher course on how supply chains work, noted Mike Bowman, senior product manager for Direct Supply.

“Start with your primary medical supplier but realize that most distributors and manufacturers have placed significant limits on the quantity of PPE that an individual provider may purchase,” he said. “These allocations are almost never enough to meet the needs of the organization.”

For that reason, Bowman strongly advises establishing a purchasing relationship with and weekly commitments from at least a second PPE distributor.

Mary Madison, RN, RAC-CT, CDP, clinical consultant, LTC/Senior Care for Briggs Healthcare, urged administrators and staff IPs to monitor PPE par levels several times a day, “or at a minimum, once each shift.”

Even many established vendors have been forced to charge “exorbitant prices” because of high demand, said Cristina Crawford, public affairs manager for the American Health Care Association. To keep PPE costs down, Joe Kramer, VP of sales for Geri-Care Pharmaceuticals Corp., suggested negotiating auto-replenish agreements with suppliers. 

Everyone tells facilities to be firm. Jodi Eyigor, director, Nursing Home Quality and Policy for LeadingAge, urged facilities to report PPE shortages to their local health departments. She reminded that CMS requires nursing homes to track their PPE resources and to report that through the Centers for Disease Control and Prevention’s National Healthcare Safety Network. A common tool is the PPE burn rate calculator.

4. Be frugal, yet smart, with limited supplies.

Bowman advised limiting the number of staff who interact with residents infected with, or suspected of having, COVID-19.

“Dedicating staff to care for all COVID-positive residents can more easily allow for extended wear of PPE to slow the rate at which PPE is consumed,” he added. This could mean nurses doing light cleanup and taking away dining trays, if needed.

In addition, Crawford urged all workers to fit test respirators every time they are donned.

5. Avoid sourcing mistakes.

Some operators have been forced to take extraordinary measures to get PPE — and at considerable potential peril. Numerous instances of “parking lot purchases” have been noted. In all cases, better vetting is needed beforehand.

Seagren advises buyers to take additional precautions with “newer” suppliers, which opened new lines of business with PPE when the pandemic began, but many of whom lack experience detecting counterfeit products.

“Others do not have stable supply chains and/or direct relationships with vendors and, therefore, may not be able to meet your needs at a later date,” he added.