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Survey: Isolation Gowns Replace N95 Masks as the Top Shortage Concern Among Hospitals, Health Systems

Premier Inc. has released survey results finding that isolation gowns surpassed N95 masks as the top personal protective equipment (PPE) shortage concern among healthcare workers treating COVID-19 patients. Up from 56 percent last month, 74 percent of survey respondents said securing a reliable supply of isolation gowns was their top worry. In contrast, concern about N95 masks was cited by 67 percent of respondents, down from 73 percent last month.

In the absence of a reliable supply of isolation gowns, health systems have resorted to alternatives, including coveralls (used by 43 percent of respondents), Tyvek suits (32 percent) and ponchos (14 percent). In addition, 22 percent are turning to alternative suppliers in adjacent industries, striking innovative partnership deals such as LifeBridge Health’s agreement with Under Armour to produce gown alternatives.

Since Premier data first documented N95 respirators as going into widespread shortage, the government has granted a series of waivers or emergency use authorizations allowing providers to reuse and reprocess N95s, access alternative KN95 masks and use masks beyond their recommended date, as temporary measures to address shortages during the COVID-19 crisis. These government-approved conservation measures are now being followed by a majority of survey respondents.

Survey findings show 79 percent of respondents caring for COVID-19 patients are extending wear of N95 respirators, up from the 60 percent reported just last month. In addition, 70 percent of providers are reusing N95s (up from 40 percent last month); 59 percent are using N95s beyond their recommended date (up from 29 percent); 67 percent are using industrial versions (up from 31 percent); and another 47 percent are using KN95 products, a measure that was approved at the beginning of April by the U.S. Food and Drug Administration (FDA) to allow providers to use masks produced and approved by Asian regulators.

In addition to conservation measures, manufacturing capabilities increased globally over the last month to meet the demand for face masks and respirators. While this was universally lauded, it did produce an unintended consequence for isolation gown supply, as N95s and many isolation gowns are made using the same spunbond and meltblown textile processing capabilities (also known as SMS textiles). As manufacturers prioritized capacity to produce face masks and respirators, the supply for isolation gowns compressed.

“Ramping up the production of face masks and respirators appears to have affected the material supply needed for isolation gowns, easing one shortage only to exacerbate another,” says Premier President Michael J. Alkire. “It’s just as important that we stabilize the supply of isolation gowns because these products are so central to providing routine patient care. While N95s offer protection from respiratory infections such as COVID-19, isolation gowns are used daily in all manner of procedures.

“The good news coming out of this survey is that we now have a better understanding about how the ramp-up to produce additional face masks and respirators affected other areas of PPE,” continues Alkire. “Armed with this early warning about the next shortage on the horizon, manufacturers can adjust the materials used to produce isolation gowns, relying less on the spunbond and meltblown material needed for N95s in favor of alternatives.”

Until manufacturing adjustments can be made, the U.S. Centers for Disease Control and Prevention (CDC) has provided conservation protocols for isolation gowns that providers can follow immediately, including shifting to reusable gowns and extending use of existing gowns – many of the same measures that are working to protect the supply of N95s. Premier is also calling upon the CDC to issue guidance on acceptable reprocessing and decontamination methods that would support the reuse of scarce isolation gowns.

According to the Premier survey, other areas of PPE shortage concern included surgical masks, cited by 69 percent of respondents treating COVID-19 patients, up from 64 percent last month. This was followed by viral swabs (61 percent, up from 56 percent last month); face shields (59 percent, down from 63 percent last month); ventilators (50 percent, essentially level with 49 percent last month); and hand sanitizer (43 percent, down from 64 percent last month).

Reduced concern over face shields and hand sanitizer is likely due to the fact that many health systems have found alternative suppliers to produce these products for them. For instance, 43 percent of respondents are working with alternative suppliers to produce face shields, including 3D printers, and 33 percent are working with alternative suppliers like local distilleries to make hand sanitizer.

Survey Methodology

Premier’s survey was conducted from April 11-15, 2020, and sent to a representative portion of the Premier membership. Approximately 700 unique hospitals accounting for 103,000 beds across 42 states responded. Not every respondent answered every question. Approximately 80 percent of the respondents reported having at least one confirmed COVID-19 case being treated at their facility, up from 42 percent last month. Premier has not independently verified the data submitted in response to the survey.

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