Hospitals use ‘extreme measures’ to find protective gear

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Indiana National Guard, INDOT, State Police, Indiana Public Health come together for distribution of urgently-needed medical supplies to state.

Indianapolis Star

In a room in the basement of the University of Kentucky hospital, a half-dozen members of the supply-management team spend long hours each day tracking what’s happening upstairs, across the commonwealth and around the world.

The long, wooden table in the center of the “war room” is filled with computers and notepads. The walls are covered in paper, detailing their options and efforts — with some crossed out and space for more.

Their mission? Track how much personal protective equipment — or PPE — the hospital has and figure out where they can get more.

It’s not an easy task. The spread of the coronavirus has created a worldwide shortage of PPE, with states competing against themselves and even other foreign governments for vital equipment such as masks, gowns, gloves and face shields.

In the meantime, UK’s health care system is taking “extreme measures” to conserve its existing PPE, reducing the number of surgeries and even reusing protective gear — an acceptable but not desirable practice.

Something similar is happening at hospitals throughout the commonwealth and the region as procurement officers, governors, mayors and more say they’re working non-stop to get what they can of the vital equipment that’s in short supply globally amid the coronavirus pandemic.

Collecting masks from far and wide: Hospitals brace for shortage of supplies

Some Indianapolis hospitals are even encouraging the donation of homemade masks for staff who don’t work directly with patients or if supplies should run out.

Franciscan Health has set up receptacles for the masks at its Indianapolis hospital. And Eskenazi Health, which operates the city’s public hospital, posted instructions on how to make masks from T-shirt material on its Facebook page.

Indiana Health Commissioner Kristina Box said Wednesday that Indiana recently received its second allotment of supplies from the strategic national stockpile and planned to distribute it to hospitals with the greatest needs in the next few days.

The supplies included gowns, masks, gloves and face shields.

“My understanding is, and we don’t really get any notice of when this is coming, but we did get four or five trucks in the last few days,” she said.

In other places, the community is being asked to make gowns. Some are researching how to make gowns out of garbage bags. 

The equipment is vital to keeping frontline medical workers such as doctors and nurses from being infected by the coronavirus.

“As they get sick, eventually you don’t have the people to be able to take care of the patients,” said Dr. Mark Newman, executive vice president for health affairs at UK. “… That’s why they’re on the top of our list on some of the testing that we do, so that we can keep a healthy workforce to be able to come in and take care of patients that are at risk.”

Officials at some hospitals in Louisville, Southern Indiana, Bowling Green and eastern Kentucky and the Cincinnati area told The Courier Journal earlier this week they had adequate levels of PPE now but are exploring any and all opportunities to get more.

The extent of any shortages is difficult to determine in Indiana, where officials haven’t provide much information. Box declined to say how long the state’s PPE supplies would last.

“There’s a lot of different factors that go into that,” she said, “so I can’t really answer that.”

Dr. Jason Smith, trauma surgeon and chief medical officer for the University of Louisville Hospital System, said this week they had a 28-day supply of PPE, which is less than normal. 

“We are burning through it more rapidly than usual,” he said. 

As of early Thursday evening, UK had about 15 days’ worth of PPE on hand, Newman said, in addition to the smaller-than-usual resupply orders coming in.

In most states and cities, the surge of COVID-19 patients has not yet arrived.

‘This is the world we’re living in’

Under normal circumstances, hospitals should have two sets of supplies, said Mike Schiller, senior director of supply chain at the Association for Health Care Resource & Materials Management.

One to meet their routine, daily needs and another — their surge inventory — for situations such as a natural disaster or the current pandemic, when a rush of patients strains not only hospital staff but also rapidly consumes the masks, gowns, gloves and swabs used to test and treat patients.

That system can work fine if there’s a statewide or regional increase in demand because the surge inventory gives hospitals time to restock through the supply chain or from other hospitals willing to send what they have, Schiller said.

But the demand now is global, and every hospital is preparing for a flood of patients.

Hospitals in Kentucky, Illinois, Indiana and Ohio are rationing masks, requesting donations and training staff how to safely reuse equipment, a practice the Centers for Disease Control and Prevention recently said is acceptable amid this unprecedented pandemic.

“This is the world we’re living in, and it’s hard to imagine,” said Dr. Maria Braman, chief medical officer for the Appalachian Regional Healthcare System, which runs health care facilities in Kentucky and West Virginia.

Just as Kentucky’s state government lost a bid for PPE equipment when FEMA swooped in and snatched it out from under them, Braman said she’s had similar things happen to her healthcare system’s purchases.

“Every time we have something where we think we have an accepted order, then they come back and they cancel it,” Braman said. “But, you know, it’s not just us. … And things are getting diverted, in fairness, as they should.”

She said they’ve had orders sent instead to Washington state or New York City, two of the hardest-hit areas in the country.

“And that should happen right now,” she said. “We certainly want to be good teammates. But we’re competing against each other. Hospitals. States.”

Making medical gowns out of garbage bags

Preparations and backup plans are in the works should resupply orders fail to arrive in time. 

Braman said she’s looked at how to make medical gowns out of garbage bags if it gets to that point.

“We’re hoping for the best and preparing for the worst,” Braman said. “And then if it really turns out to be the worst, you know, then we all just have to do the best we can —because there are pieces of it we can’t prepare for because there’s just not the resources and availability to provide us with what we need.”

‘These are extreme measures we’re taking’

Working in UK Hospital’s favor is the fact that they have their own lab to process testing, which gets results back quicker and means less protective medical gear needs to be used around a patient whose negative result comes back in a day instead of several days.

Those patients can be removed from isolation sooner.

UK Hospital also has cut back on outpatient visits and other procedural areas, said Colleen Swartz, the vice president for hospital operations. 

“These are extreme measure we’re taking to conserve personal protective equipment,” she said. “We’ve had a major reduction in our surgeries here. … So this is a big deal for us with a more than 50% reduction in our surgical schedule.”

St. Elizabeth Healthcare in the Greater Cincinnati region also has suspended elected surgeries, said spokesman Guy Karrick, who added that supply levels change throughout the day as items are used or resupplies arrive.

“The number of masks provided at 1 p.m. would not be accurate at 3 p.m.,” he said. “We currently have an adequate supply to care for our present situation.

“However, we do have contingency plans in place should we receive a surge in volume. In addition, we are accepting community donations of N-95 masks and other PPE to backfill our existing supply.”

Baptist Health, which has facilities in Kentucky and Southern Indiana, said Wednesday it was accepting donations of commercially made protective equipment.

Kit Fullenlove Barry, a spokeswoman for Baptist Health, said the system has an adequate inventory of equipment, but she declined to say how many days’ worth of PPE it had in its surge inventory or whether its hospitals had started dipping into that cache.

At Norton Healthcare in Louisville, spokeswoman Maggie Roetker said they’re still working with their normal suppliers and got support from the city’s emergency management services, which quickly released initial allotments of supplies.

Norton is most in need of masks, especially N95 respirators. It accepts donations and already received some from construction firms, schools and other medical providers.

The general public can help not just by donating, but by social distancing.

“Another way we can protect supplies is by minimizing those exposed to COVID-19,” Roetker said. “This means no play dates for your children, no dinner parties and no unnecessary shopping.”

Courier Journal reporter Andy Wolfson and Indianapolis Star reporter Tony Cook contributed to this story.

Matt Mencarini: 502-438-4319; mmencarini@courierjournal.com; Twitter: @MattMencarini.

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