Three different national surveys revealed widespread shortages of personal protective equipment (PPE) and other critical hospital supplies, a situation the president of the American Nurses Association (ANA) compared to going into battle without armor.

“Our military does not send troops into battle without the equipment they need to stay safe,” ANA President Ernest J. Grant, PhD, RN, FAAN, said in statement. “As a former volunteer firefighter, I would never have been required to respond to a fire without the proper gear.”1

On March 20, the ANA began to survey nurses nationwide about their access to PPE and other work environment concerns. According to findings from more than 20,000 respondents:

  • 76% reported being extremely concerned about PPE;
  • 66% reported being out or short of N95 respirators;
  • 62% were out or short of full-face shields;
  • 61% were out or short of surgical masks;
  • 69% reported concerns about working short-staffed.

“Further, we hear disturbing reports that employers have retaliated against nurses and other healthcare workers for raising legitimate concerns about their personal safety and the safety of patients,” Grant stated. “Protecting the safety and health of nurses and other frontline workers is directly related to safeguarding the public and stemming the spread and impact of the virus.”

According to the ANA survey, 85% of nurses responding said they worry about keeping their families safe from infection.

“At this point, we can’t even measure the toll the pandemic will take on the mental health of nurses in the long term,” Grant said.

APIC, Inspector General Surveys

The Association for Professionals in Infection Control and Epidemiology (APIC), which conducted a national survey of infection preventionists (IPs), is demanding the federal government act to protect patients and frontline healthcare workers.

“This is simply unacceptable,” said APIC CEO Katrina Crist, MBA, CAE. “Shortages of critical PPE and disinfection supplies are jeopardizing our ability to safely treat patients and protect healthcare workers, who put their lives on the line every day.”

APIC issued a call to action along with its survey results at a March 27 press conference. “APIC is urging the federal government to act now,” Crist said. “We are asking for clear communication. We need clarity on when the supplies are coming — when and where. In addition to asking the federal government to use all of the powers at their disposal to increase the supply — especially of respirators — we need clear communication.”

Similar findings were revealed in a Department of Health and Human Services Office of Inspector General (OIG) report of a phone survey conducted in late March.

“Hospitals reported that widespread shortages of PPE put staff and patients at risk,” the report stated. “Hospitals reported that heavier use of PPE than normal was contributing to the shortage and that the lack of a robust supply chain was delaying or preventing them from restocking PPE needed to protect staff. Hospitals also expressed uncertainty about availability of PPE from federal and state sources and noted sharp increases in prices for PPE from some vendors.”2

Likewise, the OIG report found a demand for clear and consistent communication, as “inconsistent guidance from federal, state, and local authorities posed challenges and confused hospitals and the public.”

Hospitals reported that it was sometimes difficult to remain current with CDC guidance, which has been evolving as the dynamics of the pandemic change, the OIG report noted. Respondents to the OIG survey cited “conflicting guidance from different government and medical authorities, including criteria for testing, determining which elective procedures to delay, use of PPE, and getting supplies from the national stockpile. Hospitals also reported concerns that public misinformation has increased hospital workloads (e.g., patients showing up unnecessarily, hospitals needing to do public education) at a critical time.”

Although more rapid tests are coming to the market, the OIG survey reflected some of the confusion and mixed messaging on coronavirus testing, which has gone through a series of exasperating changes, from largely unavailable, announced, and delayed, and then rolled out as if anybody could be tested. A shortage of testing reagents, swabs, and viral transport media followed in some areas, exacerbated by concerns of using scarce PPE during testing that is needed by frontline staff.

“Hospitals reported that they were unable to keep up with COVID-19 testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests,” the OIG report revealed. “Additionally, hospitals reported frequently waiting seven days or longer for test results. When patient stays were extended while awaiting test results, this strained bed availability, PPE supplies, and staffing.”

The testing issue also created a bottleneck in the continuum, as some long-term care facilities refused to take in hospital discharges until they produced a negative COVID-19 test.

“Hospitals reported needing items that support a patient room, such as intravenous therapy poles, medical gas, linens, toilet paper, and food,” according to the OIG survey. “Others reported shortages of no-touch infrared thermometers, disinfectants, and cleaning supplies. Isolated and smaller hospitals faced special challenges maintaining the supplies they needed and restocking quickly when they ran out of supplies.”

The APIC survey of IPs was conducted between March 23 and March 25, netting 1,140 responses in all states and the District of Columbia. Of those, 233 reported their facilities were out of respirators, and an additional 317 said they were “almost out.” Nearly half of the respondents said they do not have enough face shields, and 13% are completely out. Regarding mask supply, nearly one-third of respondents are almost out or completely out.

“The federal government must act now to produce more PPE and coordinate distribution where it is needed most,” said APIC President Connie Steed, MSN, RN, CIC, FAPIC. “Every minute wasted puts more lives at risk. We are asking healthcare providers to risk their own health and their families’ health to care for us.”

REFERENCES

  1. Grant EJ. ANA’s president calls nurses “warriors without armor”— survey finds 66% lack adequate PPE. Nurse.org, April 15, 2020. https://nurse.org/articles/american-nurses-association-ana-ppe-president/
  2. U.S. Department of Health and Human Services Office of Inspector General. Hospital experiences responding to the COVID-19 pandemic: Results of a national pulse survey. March 23-27, 2020. https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf