Blog | Thursday, April 16, 2020

Lessons from a pandemic


We are in the early stages of the COVID-19 pandemic, but it's already very clear that the infection prevention community in the U.S. has never faced such an enormous challenge. Reflecting back on the past few weeks, we have learned many things that will make us better prepared for the long term. My goal is to keep track of these in this blog. So here we go:
We are far too reliant on single-use disposable products. Having a large supply of cloth surgical gowns and isolation gowns that can be laundered is essential. I'll comment on disposable face masks below. Less reliance on disposables will also be better for the environment.
The supply chain for medical products needs geographic diversification. It wasn't all that long ago that we had numerous shortages of medications and IV fluids due to the hurricane in Puerto Rico, and now we have this crisis due to concentration of manufacturing in China.
Just-in-time inventory management is not a great idea in healthcare, particularly when the supply chain is rooted in a single geographic area. Most hospitals, especially larger ones, have some strategic stockpile of products, but it's unlikely that any have inventory levels to manage an outbreak that lasts for many months. Hospitals and government (both at the state and federal levels) have a lot of work to do in this area.
We have a new standard for evaluating personal protective equipment (PPE). In the old days (like last year), the standard for evaluating a new PPE product was: is the new product better than currently available products? Today's standard is: is the new product (let's say a bandana to cover your nose and mouth) better than nothing? I'll push that a little further and argue that the new standard should be: is the bandana no worse than nothing? Health care workers are very afraid, and I'll freely admit that I'm one of them. We all want to proactively protect ourselves. Even if the bandana is minimally protective, if it provides some level of psychological safety, we need to respect that and allow our workers to wear “homemade” PPE.
Going forward, the new attire standard for health care workers should be hospital-laundered scrubs. These should be donned after hospital entry and doffed prior to leaving. This will require that hospitals construct adequate changing and shower facilities. And scrubs should be coupled with a bare-below-the-elbows approach to patient care.
To the greatest extent possible, no-touch technology should be built into hospital design. Sensors that detect a hand wave for door opening are a great advance.
Face shields should and will replace face masks. They provide greater facial coverage and make it physically impossible to touch your face. And I find them more comfortable than face masks. Sturdier models can be wiped down and reused. I suspect that every healthcare worker will purchase one, just like they purchase a stethoscope. For this outbreak, I am advocating that face shields be worn for every patient encounter since many patients with COVID-19 are minimally symptomatic. It should become a new component of standard precautions.
The community really wants to help us. I have received numerous forwarded emails from colleagues who have friends and relatives who want to sew masks or isolation gowns, donate their face shields and N95s, or whatever they can do to play a part in making things better. This is beautiful.
Infection Preventionists are true heroes. They are working around the clock to keep hospitals functioning. These people are the salt of the earth. They work in the background with little recognition and are some of the most committed people I have ever met. Thank you, thank you, thank you!

These are my initial thoughts. More to come. Get some rest and stay well!

Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on improving the quality and safety of health care, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.