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even before the first case of COVID-19 in the U.S. However,
the severity and scale of this infectious disease outbreak is like
nothing we have dealt with in modern times. We are now
burning through resources at a high rate while manufacturing
has slowed down significantly across the world.
MS: Healthcare organizations always stand poised and
ready to face challenges like COVID-19 for both their patients
and their frontline healthcare heroes. A reduction in the
level of manufacturing and production of PPE, coupled with a
global demand for PPE has exacerbated the availability of these
critical supplies.
HHM Are just-in-time (JIT) inventory practices being
replaced with practices that facilitate better stockpiling in
case of emergency?
LEC: There is certainly a place for both practices. Just-in-time
inventory practices are absolutely appropriate for high-cost
supplies in elective lower-volume settings. There are many
strategies that can be employed to ensure appropriate supply
availability in times of emergent need. Different supplies may
be necessary in different emergency situations (e.g., natural
disasters vs. infectious outbreak), so multiple strategies need to
be employed to ensure readiness for emergencies.
MS: JIT practices are used to support the day to day operations
and management of on-hand inventory levels which are adjusted
based upon usage trends. Strategic surge supplies are for
pandemic events. As with surge events in the past, healthcare
organizations will reassess their inventory processes, mix and
levels based on lessons learned and adjust accordingly.
HHM How is COVID-19 exacerbating trends such as
consolidation and cost reduction that have already plagued
the health care supply chain?
LEC: It’s presented an interesting challenge in that the
strategic sourcing and contracting strategies that we have used
to reduce cost don’t apply in this pandemic. The most vulnerable
supplies are the ones that are sole or single sourced. As supplies
run short, supply chain departments are looking to all sources
for product. While this is most obviously impacting PPE today,
COVID-19 has crippled manufacturing and vendor consolidation
may not be an option for equipment and medical devices until
the supply chain and clinical practice are back galloping at their
pre-pandemic pace.
HHM What’s your best advice for weathering this outbreak
in the face of so many unknowns?
LEC: Collaboration and communication between supply
chain and clinical leaders are key. There are many moving parts
and departments must move in a coordinated way to best serve
our communities in time of greatest need.
MS: Healthcare organizations are encouraged to work with
their suppliers, understand product shortages and allocations
they may be facing or expect to face, identify and implementing
conservation measures, and work with their state and local
emergency management agencies.
www.healthcarehygienemagazine.com • april 2020
of Business. “Suppliers that provide the raw materials
needed to make such items have to increase their capacity
in order to deliver more materials to manufacturers. This
could take time and may not be feasible if the suppliers
are located in other parts of the world and are currently
crippled by the coronavirus.”
Researchers in academia as well as in manufacturing
scientific R&D, have been exploring the irradiation of
N95 respirators and face masks to help mitigate the PPE
shortage. However, the concept is not new; responding to
the availability of NIOSH-certified N95 filtering facepiece
respirators (FFRs) during an influenza pandemic, research-
ers in 2009 published a paper that examined reuse of FFRs
following a biological decontamination process to render
infectious material on the FFR inactive.
At the time, Viscusi, et al. (2009) acknowledged that
little data existed on the effects of
decontamination methods on respirator
integrity and performance. The research-
ers evaluated five decontamination
methods [ultraviolet germicidal irradia-
tion (UVGI), ethylene oxide, vaporized
hydrogen peroxide (VHP), microwave
oven irradiation, and bleach] using nine
Suppliers that
models of NIOSH-certified respirators
provide the raw
(three models each of N95 FFRs, surgical
N95 respirators, and P100 FFRs) to materials needed to
determine which methods should be make such items
considered for future research studies. have to increase
Following treatment by each de-
contamination method, the FFRs were their capacity in
evaluated for changes in physical order to deliver
appearance, odor, and laboratory more materials to
performance (filter aerosol penetration
manufacturers.”
and filter airflow resistance). Additional
— Kaitlin Wowak
experiments (dry heat laboratory
oven exposures, off-gassing, and FFR
hydrophobicity) were subsequently conducted to better
understand material properties and possible health risks to
the respirator user following decontamination; however,
this study did not assess the efficiency of the decontam-
ination methods to inactivate viable microorganisms.
Microwave oven irradiation melted samples from two
FFR models. The remainder of the FFR samples that had
been decontaminated had expected levels of filter aerosol
penetration and filter airflow resistance. The researchers
reported that the scent of bleach remained noticeable
following overnight drying and low levels of chlorine gas
were found to off-gas from bleach-decontaminated FFRs
when rehydrated with deionized water. UVGI, ethylene
oxide (EtO), and VHP were found to be the most promising
decontamination methods; however, concerns remain
about the throughput capabilities for EtO and VHP.
As the researchers observe, “The effects of the various
decontamination methods on the laboratory performance
(filter aerosol penetration and filter airflow resistance)
and physical appearance of FFRs were found to be
model-specific. The respirators tested have differences in
their design, materials of construction, and hydrophobicity
of their layers (including the filter media layers). Microwave
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