Reliable Supply Chains When it Matters Most

The COVID-19 pandemic wasn’t the first time the demand for disposable personal protective equipment (PPE) increased sharply.  The Ebola Virus in 2014 and the H1N1 influenza pandemic in 2009 also triggered spikes in demand. But 2020 tested the limits of the healthcare industry and its suppliers in an unprecedented fashion. The supply crisis was particularly damaging for the U.S., the world’s largest importer of PPE.

Reusable textile suppliers stepped up to the challenge, quickly finding sources to fill providers’ needs, managing the associated logistical and operational issues and playing a critical role to support an industry in crisis.

Hospitals using reusable products say they found themselves much better prepared than those solely dependent on single use PPE, averting supply chain failures, wild fluctuations in prices, and quality control breakdowns that led to product recalls.

On Jan. 21, 2020, as word of the earliest cases of the novel coronavirus was coming out of China, Cardinal Health issued an Urgent Medical Device Recall of 9.1 million disposable Level 3 surgical gowns. Soon afterwards Cardinal, which says it supplies nearly 90% of U.S. hospitals with various products and services, announced that a Chinese gown manufacturer had been using an outside contractor not registered with the FDA. The subcontractor’s factory left surgical gowns exposed to air particulate and other contaminants.

Dublin, Ohio-based Cardinal, ranked number 14 in the Fortune 500, warned the gowns were potentially contaminated, increasing the risk of spreading infections to patients during surgery. By the end of January, the company also recalled 2.5 million of its Presource Procedure Packs containing the potentially contaminated surgical gowns, all manufactured between Sept. 1, 2018, and Jan. 10, 2020.

The recalls affected 2,897 hospitals, surgery centers and other facilities, mostly in the U.S., and created a sudden shortage that left some healthcare providers scrambling for supplies and rescheduling surgeries. Johnson City, Tenn.-based Ballad Health said it postponed about 200 elective surgeries in January 2020, rescheduling them shortly afterwards when it sourced surgical gowns from other vendors.

By mid March, the FDA issued a letter to healthcare providers warning that the demand for commonly used PPE items might outpace supply in the U.S. and offering surgical mask and gown conservation strategies. Among the FDA’s recommendations was the reuse of single-use gowns for multiple patients under certain conditions and continued use of surgical masks beyond their manufacturers’ recommended expiration date.

“I don’t know of any hospital that was able to reuse a disposable isolation gown,” said Julie Moyle, a practicing nurse and sustainability strategy manager for Practice Greenhealth, whose members total about 20% of U.S. hospitals.

Smaller and rural providers that couldn’t compete with large health systems for supplies were especially hurt, as were nursing homes, prisons and some medical practices shuttered due to lack of PPE. Healthcare workers protested the lack of  adequate supplies of masks, gowns and gloves, at the time their main line of defense against COVID. U.S. doctors created a volunteer organization called #GetUsPPE to marshal donations and make bulk purchases.

While many healthcare providers found the Cardinal recall left them without disposable gowns, the company’s quality issues weren’t unusual. Disposable PPE quality issues were rampant as many non-traditional suppliers began selling PPE using false claims.

On Nov. 5, 2020, ECRI issued a high-priority hazard alert warning U.S. healthcare organizations that more than half of the 34 disposable isolation gown models it tested failed to meet even AAMI’s lowest level for protection, putting healthcare workers at risk for blood and fluid exposure.

ECRI, an independent patient safety organization that conducts its own testing, also found that 50% of the tested gowns that claimed AAMI-level protection of disposable gowns did not meet AAMI’s PB70 standard, a system for the evaluation and classification of liquid barrier performance.

Meanwhile, competition over limited single-use supplies during the COVID-19 pandemic drove up costs to dizzying heights. In April, researchers at the Society for Healthcare Organization Procurement Professionals (SHOPP) reported that the  pandemic led to a 2000% price increase for isolation gowns, from $0.25 to $5 per gown. SHOPP compared pricing on April 17, 2020, to pre-COVID pricing, at multiple skilled nursing and assisted living facilities that treated COVID patients without funding for the additional costs.

Nurses at Mount Sinai West in Manhattan ran out of gowns and wore Hefty bags during COVID Crisis. In March 2020, this photo from the epicenter of the pandemic went viral on social media with captions that included, “NO MORE GOWNS IN THE WHOLE HOSPITAL” and “NURSES FIGURING IT OUT DURING THE COVID-19 CRISIS.” Healthcare workers protested the lack of  adequate supplies of masks, gowns and gloves, at the time their main line of defense against COVID. 

Reusable Textile Suppliers Play a Critical Support Role to an Industry in Crisis 

Providers using reusable products say they found themselves much better prepared than those solely dependent on single use PPE, averting supply chain failures, wild fluctuations in disposable gown prices, and quality control breakdowns.

Carilion Clinics, a nine-hospital system based in Roanoke, Virginia, converted from disposable to reusable isolation gowns in 2011 after disposable isolation gown suppliers weren’t able to meet the demand during the global swine flu pandemic caused by the H1N1 virus in 2009-2010.

In 2020, Carilion’s normal gown usage of 14,000-per-week tripled to 45,000 gowns and eventually demand soared to 70,000 gowns weekly. The healthcare system that serves one million people in Virginia and West Virginia was able to meet that demand by increasing the speed of its laundry services with four laundry pickups a day, creating a priority laundry service and other operational changes.

Thanks to the switch made a decade earlier, “We didn’t have a single PPE service failure at our hospitals during the (COVID-19) pandemic,” said Jim Buchbinder, Carilion Clinic director of laundry services.

UCLA Health, which completed a full conversion to reusable isolation gowns in all inpatient areas and emergency rooms at all four hospitals on its Ronald Reagan and Santa Monica campuses in late 2015, had a similar experience during the supply crisis that accompanied COVID-19.

“This program was instrumental in materials management’s ability to provide our clinical staff the protection they required throughout the pandemic,” said Victor Mitry, UCLA Health’s assistant director of logistics and materials management.

“We were able to meet the needs of our clinicians, never had to ration gowns, and avoided increased costs other health systems may have experienced due to the global supply shortage.” The costs of the disposable gowns UCLA Health had once purchased for 76 cents each rose fourfold to $2.95 during the COVID-19 pandemic, he said.