Keeping staff safe with an unprecedented PPE effort

Foster Auditorium at Cox South is now storage for more than a million masks.

"We have to be careful with our resources ... The days of using a mask for 15 seconds, disposing of it and not thinking twice are over." -- Jeff Hawkins

The conventional wisdom around personal protective equipment used to be simple: Keep 7-10 days of supply on hand. Plan for just-in-time deliveries, and don’t keep money and space tied up in inventory.

Look inside Foster Auditorium at Cox South and you can see COVID-19 has made conventional wisdom obsolete.

The space that used to host hundreds of staff for events is now a warehouse for more than a million masks and other PPE.

The maze of boxes stacked six feet high is the new normal as we prepare for potential waves of COVID-19 cases.

“We are committed to making sure staff have what they need,” says Jeff Hawkins, vice president of Clinical Services. “It has been a team effort with Patient Safety, Administration, Materials Management, Infection Prevention and more. I’m very proud to be part of an organization that can do that for employees.”

Over the last few weeks, we have taken unprecedented steps to get PPE. We have focused on careful use and conservation.

Even if COVID-19 subsides, the way we approach PPE has changed forever.

“The days of using a mask for 15 seconds, disposing of it and not thinking twice are over,” Hawkins says.

Rising from a PPE crisis

Since mid-March, Hawkins has served as logistics chief in CoxHealth’s Incident Command.

At each meeting, he shares the state of our PPE supplies. With Foster Auditorium full, he recently told Incident Command: “We are sitting pretty on PPE.”

No one could have made that statement a few weeks ago.

“It’s been quite a ride. Definitely stressful at times,” Hawkins says. “At one point, we got down to only four days of PPE on hand. That is scary.”

Hawkins and the team changed that with a non-stop effort to shore up supplies.

When the pandemic started to pick up steam in early March, the steady supply of masks, gowns and more dried up. Legitimate vendors started seeing outages in their products. Other vendors canceled orders.

N95 masks, which used to cost about 62 cents, were selling for $7.

Hospitals had to get creative. With short supplies and high demand, nontraditional vendors stepped in to fill the gaps.

“Two or three times a day we would get an email from someone who had a cousin or a friend with a connection,” says Elizabeth McKown. McKown, a data analyst in Patient Safety, has worked on the temporary warehouse for weeks.

The team chased down those contacts. They worked with suppliers in China and negotiated with a contact who had a trailer of N95s in South America.

McKown and Patient Safety Facilitator Janis Brown created a PPE warehouse. They sorted every piece of equipment and determined how it could be used.

The team had to verify the masks, to make sure they were up to the standards of traditional vendors.

They created A, B and C tiers. The A tier included top-quality N95s. A “B” rating meant PPE that would be good for non-COVID uses. The “C” tier was for masks that should only be used in a crisis.

“We did get burned one time,” McKown says of a batch of N95s that didn’t meet CoxHealth’s standards. “At least we were able to repurpose those and use them as procedure masks.”

Alongside the PPE we acquired, local businesses and the community stepped up to help.

Bass Pro and other businesses donated masks. Justice Furniture in Lebanon produced 300,000 isolation gowns. John Deere provided pallets of face shields.

“The donations really helped us get through that time,” Hawkins says.

By the numbers

The numbers tell the tale of how much things have changed in three months.

In March, CoxHealth had about 14,000 procedure masks and 6,640 N95s.

Incident Command set a goal of getting 90 days’ worth of supplies. The team met that goal and is now striving to expand that supply to 180 days on hand.

Hawkins has become well versed in the daily “burn rate” of masks and other supplies

In 2019 – a record year for procedures – the average burn rate of N95 masks was 57 per day. At the beginning of the pandemic, our rate was near 1,000. Now, it is closer to 200 per day.

As of June 2, we had 267, 916 N95s – about four years’ worth at the current burn rate.

In addition, CoxHealth has 2.3 million procedure masks on hand.

“That’s a little more than the 14,000 we started with,” Hawkins says. “There is always the possibility the virus will get worse. We need to have processes and things in place that will keep us from getting low on supplies.”

At a glance: Lessons learned

We have learned a lot from efforts to stock up on PPE. The experiences of the last few weeks will change our approach permanently, and make us better prepared in the future.

Here are a few of the top lessons:

Keep an eye on burn rates: The tracking of supplies will continue, even past a crisis. The process in place now gives us a better idea of where supplies go. “We know what units need which products and we will be looking closely at how we stock supplies,” Hawkins says.

Maintain our emergency cache: When we accessed our emergency supply of PPE this spring, leaders found that some of the equipment was no longer effective. Much of it was out of date and hadn’t been stored in climate-controlled conditions. Leaders are working on climate-controlled storage and detailed inventory lists for the future. Those lists will include calendar notes to rotate supplies as their expiration date nears.

Add warehouse space: We will be looking at expanding our storage, as our current warehouse is not large enough to meet the needs of having large quantities of PPE on hand. “We will rethink the just-in-time approach to PPE,” Hawkins says. “We will need to expand, build or rent additional space.”

Continue the wise use of PPE: Being careful with PPE has been one of the most important changes.

“Staff have been incredible at preserving PPE,” Hawkins says. “They have done a fantastic job.”

He says those changes in our habits need to become permanent. “We have to be careful with our resources – for safety, and for economic and environmental reasons.”