Serving patients in a skilled nursing facility (SNF) is a highly rewarding endeavor for all involved—yet, it’s challenging even under the best of circumstances. Today, as the coronavirus (COVID-19) pandemic continues to evolve, its impact on SNFs of every size and scope cannot be understated. During this time, infection prevention and control efforts are more important than ever—and having adequate supplies of personal protective equipment (PPE) on hand is vital. After all, PPE plays a big role in keeping residents and nursing staff safe. Without it, or with inadequate PPE, safety is put at risk.

Unfortunately, facilities around the country continue to face acute PPE shortages, and there appears to be no end in sight. According to a recent McKnight’s Long-Term Care News flash survey, “…more than 77% of respondents said their facilities were experiencing personal protective equipment (PPE) shortages. Nearly 3 in 5 (59%) said their locations were using homemade or improvised PPE, or reusing it. Masks, gowns, gloves and shoe covers are just some of the infection control products falling under the PPE label.”

PPE shortages are real, at least for the foreseeable future. So, what should your facility be doing to help ensure adequate stocks of PPE in the months ahead?

Consider six strategies:

1. Optimize equipment and leverage creativity. Everyone on your staff, clinical or otherwise, should feel empowered to devise, recommend and potentially deploy creative yet practical ways to essentially create new PPE supplies through nontraditional channels. Many facilities have collaborated with Facebook communities which sprang up earlier in 2020 to sew and produce facemasks. Efforts to date have been fruitful and helped reduce critical mask shortages. In some cases, SNFs have even shared exact dimensions for facemasks with Facebook communities. One in particular included dimensions for a pocket which could hold a filter.
   In other cases, local sports franchises have been donating logo-adorned ponchos to hospitals and SNFs, which do actually work as improvised gowns.
   In short, people outside the long-term post-acute care (LTPAC) realm are looking to help. If your facility can spearhead or align with a social media effort to produce certain PPE within specified guidelines that you establish, it could bear fruit and help stem shortages.
    
2. Import if necessary – and do so carefully in several ways. Overseas PPE suppliers are a resource, and many SNFs are utilizing them to bulk up PPE stocks. That said, domestic PPE suppliers ramped up production during the second quarter of 2020 after the pandemic’s initial outbreak here in the U.S., and it’s expected that they’ll be able to meet demand in the coming months. Additionally, domestic PPE no longer is an expensive proposition relative to once-cheaper imports, so domestic suppliers are well worth considering. Still, if you’re thinking about using an overseas supplier, you should try, to the extent possible, to work with those that can deliver in a timely manner based on terms specified in your agreement. Shipping involves risks, and there’s little use in ordering PPE from a Far East provider if it takes eight weeks to arrive at your facility when you need it in 30 days. Finally, recent evidence has determined that N95 masks from some overseas carriers do not meet required specifications here in the U.S., so if you do pursue overseas supplies, do so carefully and make absolutely sure that the PPE you purchase meets accepted U.S. standards and specifications.
    
3. Leverage other nontraditional PPE sources. These can include dentists, veterinarians, salons, industrial clean labs—even construction companies and farms. That said, you may want to consider establishing relationships with entities outside your immediate geographical area. Why? If your facility is impacted by, say, a natural disaster, it’s likely local and/or regional sources could be impacted as well, so try to cultivate domestic sources in nearby towns or adjoining states.
    
4. Reuse existing PPE to the extent possible. As the pandemic has unfolded, we’ve learned things, and one thing in particular is that certain PPE can be reused multiple times once it’s disinfected. For guidance on this, we recommend the Centers for Disease Control website—it’s a trusted resource with helpful information and links.
    
5. Reduce patient contact and utilize technology to the extent possible. Less human contact means less immediate need for PPE. In a SNF, residents need physical care, so this can prove difficult. Yet, it is possible – and advisable in this current pandemic – to limit unnecessary touchpoints. For example, for residents who are alert and oriented, tablets and other electronic devices that use applications such as FaceTime are helpful in checking on their status.
    
6. Maximize PPE storage. This might seem like an oddball in this list, but in most nursing homes (especially older ones), space is at a premium. There’s little room for executive and clinical offices, let alone bulky boxes. Take control of your storage areas, eliminate those bulky boxes and organize spaces to maximize room for additional PPE. Particularly if you order PPE in advance as part of a disaster plan strategy, you’ll need the extra room.
   One important note about this: If you utilize outside/exterior space to store your PPE, you must at all costs ensure that your PPE stocks are protected from the elements, including everyday elements (e.g., sun, rain, moisture/humidity) and extreme elements (e.g., thunderstorms, hurricanes, tornadoes, floods). In all cases, PPE storage should be climate-controlled.
    

Related article: Emergency Preparedness for Long-Term Post-Acute Care Facilities: The Time Has Come to Add a Personal Protective Equipment Component

Most industry experts agree that until an effective vaccine is widely available, COVID-19 could be active for another 12-18 months. Yes, PPE is in short supply, and it likely will be in the months ahead. But that doesn’t mean it’s not completely out of reach. Rather, it’s up to you and your staff to take the reins and be proactive in securing it through well-conceived and implemented avenues. The time to act is now.

To aid you in promoting infection prevention and control and other issues surrounding COVID-19, we have developed a COVID-19 Resource Center for skilled nursing facilities which will be regularly updated with the latest information.

Contact Richter’s Skilled Nursing Facility Consultants

Do you have questions about procuring PPE for your skilled nursing facility, or other LTPAC clinical challenges? Call Richter’s skilled nursing facility consultants at 866-806-0799 to schedule a free consultation.

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