Study finds pandemic sorely tested hospital mask, respirator supplies

Aug 24, 2010 (CIDRAP News) – Researchers studying facial personal protective equipment (PPE) data at three Vancouver hospitals found that use of surgical masks and N-95 respirators during the 2009 H1N1 pandemic was seven times greater than earlier supply estimates and tested the plans hospitals had in place.

The group, from the University of British Columbia, found that, right before the peak of the pandemic, the hospitals were down to a 2-day supply of the most commonly used respirator, and one facility had an insufficient supply of masks. Their findings appeared yesterday in an early online edition of Infection Control and Hospital Epidemiology.

They collected data on patients admitted with flulike illnesses, facial PPE use, and employee absentee rates from Jun 28 through Dec 19, 2009, a time that corresponded to the area's second wave of infections. The three Vancouver Coastal Health facilities included a 644-bed tertiary hospital and two smaller community hospitals.

The Public Health Agency of Canada recommends wearing a surgical mask and protective eyewear within 2 meters of patients with influenza-like illness and an N-95 respirator during aerosol-generating procedures.

During the study period, 865 patients with suspected pandemic H1N1 infections were admitted to the three hospitals, of which 149 had lab-confirmed infections. Twenty-nine were admitted to intensive care units (ICUs), and 25 needed mechanical ventilation. Six deaths occurred. The mean duration of hospital stay for patients with confirmed infections was nearly 9 days, and the mean length of ICU stay was just slightly more than 9 days.

Compared with the previous two flu seasons, eyewear use increased 70%. Compared with seasonal flu periods in 2008 (weeks 27 through 51) and 2009 (weeks 1 through 14, before the pandemic began), mask use grew by 196% and 110%, respectively, with respirator use increasing 107% and 60%.

The hospitals experienced a 3.6-fold increase in absenteeism at the peak of H1N1 pandemic activity, which mirrored the community epidemiologic curve. At the peak of the pandemic, about 10% of salaried employees missed work, of which a quarter had flulike symptoms.

As the burden on hospitals became heavier, laboratory turnaround slowed, which increased the length of isolation days to between 5 and 7 at the peak of the epidemic.

The group said that an important lesson they learned was the importance of having adequate facial PPE reserves. "During the pandemic, supplies of FPE [facial protective equipment] became very tight because of increased demand nationally and internationally, and lead times for ordering increased from days to several months," they wrote.

A directive that the hospitals maintain a 10-week supply of facial PPE for use in the event of a pandemic did not seem to take into account changes in respirator and mask use during a pandemic or the increased use in patients with both suspected and confirmed infections.

For each confirmed patient with an H1N1 infection the hospital used 498 respirators and 494 masks, seven times what they had anticipated. The group said the 1:1 mask-to-respirator ratio likely reflects the aerosol-generating procedures conducted at the facilities. When combining both confirmed and suspected cases, the hospitals used about 10 additional masks and 10 additional respirators per patient each day above what they had allocated.

They concluded that though the pandemic was relatively mild, the impact on healthcare facilities was profound. Future pandemic planning estimates for facial PPE supplies should take into account not just possible severity, but also factors such as supply difficulties, the load of suspected and confirmed patients, lengths of hospital and ICU stay, and the burdens laboratories could face.

Murray M, Grant J, Bryce E, et al. Facial protective equipment, personnel, and pandemics: impact of the pandemic (H1N1) 2009 virus on personnel and use of facial protective equipment. Infect Control Hosp Epidemiol 2010 (published online Aug 23) [Abstract]

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