10 Questions to Ask Before You Stockpile

4. What types of PPE do we need to prepare for a pandemic flu outbreak?

The types of PPE appropriate for pandemic flu are similar to those for seasonal flu, including surgical masks, face shields, isolation or surgical gowns, and exam gloves (see Question 2, above). Additionally, respiratory protection (e.g. N95 surgical respirators) may be a key component of your pandemic flu PPE protocols. Compared to seasonal flu, more staff and tasks may be considered high risk in pandemic flu.

OSHA does make a distinction⁴ regarding gowns when caring for pandemic flu patients:

Wear an isolation gown when you are at risk of soiling your clothes or uniform with blood or other bodily fluids, including respiratory secretions. However, Health and Human Services (HHS) states that most routine pandemic influenza patient encounters don’t require the use of gowns. Examples of when a gown may be needed include procedures such as intubation or when closely holding a pediatric patient. Gowns should fully cover the areas of your body requiring protection.

www.osha.gov/SLTC/pandemicinfluenza/pandemic_health.html

Important Tip: Research your current PPE manufacturer’s supply chain. The farther away these items are produced, the longer it will take to fill large emergency orders. HALYARD* face masks and respirators are primarily manufactured in North America, which enables us to respond faster in emergencies and outbreaks

5. How much PPE should we stockpile for a pandemic flu outbreak?

In pandemic flu, the quantity of PPE required may be significantly more than seasonal flu. More employees may be considered at very high or high risk. Also, the duration of a pandemic may be longer than seasonal flu. OSHA suggests acommunity can assume two waves of a pandemic, each 12 weeks (24 weeks total).5

The US Department of Labor (DOL) and HHS encourage employers to stockpile facemasks and respirators in advance of an influenza pandemic. Manufacturing capacity at the time of an outbreak would not meet expected demand during the pandemic. HHS estimates that a pandemic outbreak would require at least 90 million N95 respirators in just a 42-day period.6

According to OSHA, the hospital should assess the occupational exposure risk for each job (not all hospital employees provide patient care) and work task (e.g., aerosol-generating medical procedures). Categorize risks as very high, high, medium, and low, then estimate the number or percentage of employees who fall into each category to estimate the types and amounts of PPE you need.5

6. How should we prepare for a pandemic involving a unique pathogen such as the Ebola virus?

It is impossible to prepare for pandemics caused by every conceivable unique pathogen, but there are some guidelines for the Ebola virus (EVD) that may apply in other situations.7 For example, the Tiered Approach classifies each hospital by the role they will play in a pandemic:

• FRONTLINE hospital –Most acute care acute care hospitals, urgent care clinics and critical access hospitals
• ASSESSMENT hospital –facilities prepared to receive, isolate, and care for a Person Under Investigation (PUI) until a diagnosis can be confirmed or ruled out.
• TREATMENT hospital –prepared to care for patients with confirmed EVD throughout the course of their illness.

For more about the Tiered Approach, see

https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/supplies.html

7. What types of PPE should be used in outbreaks of unique pathogens such as Ebola virus?

Based on experience with the Ebola outbreak, the CDC provides recommendations for appropriate PPE depending on the status of the patient:

For managing patients who are under investi-gation (PUI) for Ebola who are clinically stable and do not have bleeding, vomiting or diarrhea:7

• Single-use (disposable) fluid-resistant gown† that extends to at least mid-calf or fluid-resistant coveralls without an integrated hood
• Single-use full face shield
• Single-use face mask
• Single-use exam gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs

† NOTE: In section 6 of the CDC Guideline “Selecting PPE for Healthcare Workers Who Care for Patients with Ebola”, impermeableindicates that the material and construction have demonstrated resistance to synthetic blood andsimulated bloodborne pathogens. In contrast, fluid-resistant indicates a gown that has demonstrated resistance to water or a coverall that has demonstrated resistance to water or synthetic blood.7

For details on the required testing for fluid resistance and resistance to bloodborne pathogens, see Table 1 in the following:

www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html

For managing patients with confirmed Ebola who are clinically unstable or have bleeding, vomiting or diarrhea.7

• Single-use (disposable) impermeable gown† extending to at least mid-calf, Single-use impermeable coverall. (preferably without an integrated hood).
• Respiratory Protection: In case a potentially aerosol-generating procedure needs to be performed emergently, use either
  • a PAPR (a hooded respirator with a full face shield, helmet, or headpiece) covered with a disposable hood, or
  • a disposable, NIOSH-certified N95 respirator mask combined with single-use surgical hood and a single-use full face shield.
• Disposable exam gloves with extended cuffs. Two pairs of gloves should be worn so that a heavily soiled outer glove can be safely removed and replaced during care.
• Single-use boot covers that extend to at least mid-calf. In addition, single-use ankle-high shoe covers (“surgical booties”) worn over boot covers may be considered to facilitate the doffing process.
• Disposable apron that covers the torso to the level of the mid-calf should be used over the gown or coveralls

NEED HELP ESTIMATING STOCKPILE QUANTITIES?

To help you estimate PPE requirements for seasonal flu and pandemic events, contact your Halyard representative.

NOTE: CDC Guidance on Ebola virus also highlights the need for a trained observer to ensure the PPE protocol is adhered to properly, including proper donning and doffing of the PPE ensemble.

Based on existing OSHA and CDC guidance, OSHA has developed this detailed PPE Selection Matrix to help employers select appropriate PPE for workers who may be exposed to unique pathogens such as the Ebola virus.8

OSHA PPE SELECTION MATRIX FOR OCCUPATIONAL EXPOSURE TO EBOLA VIRUS