BACKGROUND: Current research shows that recommended standardized measures for respirator use and supply in hospital settings have been lacking. Evaluation of respiratory protection programs is important during routine times as well as during emergent situations. Assurance that programs are functional, properly stocked, and have trained personnel is an ongoing effort and is critically important from a public health perspective. Recent healthcare-associated Ebola infections among health care personnel have demonstrated the need for stockpiles of personal protective equipment (PPE), as well as individuals trained in its use. Adequate surveillance of the supply and factors impacting effective use, determination of which factors are predictive of effective programs, and understanding the interaction of these factors within the hospital workflow, as well as among other components of the infection control hierarchy, are immediate needs.
METHODS: This project builds upon a CDC-funded public health practice pilot that identified measures for monitoring the use and supply of respirators in an acute care hospital setting. Conducted at Vanderbilt University Medical Center, Duke University Medical Center, Emory University Hospital, and Cleveland Clinic, and using iterative interviews with participants, the pilot validated the value, availability, and accuracy of respirator data elements, designed measures derived from these data, and provided recommendations for frequency of data collection, programmatic responsibility for data, and process improvement. While these recommendations were developed for respirator surveillance, they also informed the development of the Preparedness, Response, and Outcomes (PRO) PPE Surveillance tool, with a broader focus on PPE used in the management of Ebola and other special pathogens (including aprons, gowns, hoods, gloves, coveralls, boot covers, face masks, and face shields). For the purpose of this project we used the OSHA definition for PPE, i.e., “specialized clothing or equipment, worn by an employee for protection against a hazard”.
RESULTS: Interviews with subject matter experts yielded a list of desired features for the PRO PPE Surveillance system, broadly categorized into three themes: 1) PPE supply and availability; 2) PPE selection, training, and use; and 3) other measures indicative of occupational health and a hospital’s infection control.
CONCLUSIONS: The proposed measures can be used to estimate PPE demand in routine and emergent situations and to refine standardized terminology to communicate the PPE needs of healthcare facilities at regional, state, and national levels. The proposed system will help to assess PPE readiness to care for Ebola patients and will inform national and international PPE-related guidance and standards.