TLC with PPE

Kootenai Health being cautious with mask use

Leaders at Kootenai Health say the fight against the coronavirus is a multi-front battle that includes hygiene awareness, screenings and other strategies that have little to do with headlines’ hot-button acronym: the PPE.

“We think personal protective equipment is super-important,” said Amy Ward, infection prevention manager at Kootenai Health, “but they play just one role in a larger model to deal with this problem.”

That model — an organizational pyramid Kootenai Health is using to stave off the coronavirus — details the building blocks of developing adaptive standards long used to combat infectious disease. It includes straying from normal practices, restricting visitor access and eliminating elective procedures.

“We’ve really worked hard to implement environmental controls during all of this,” Ward said. “We’ve reduced visitation. We’ve reduced the number of people coming into patient rooms. It means the screening of entrances [and] giving masks upon entry into the hospital to people who are symptomatic.”

Those masks are part of the PPE inventory. Gowns, gloves, goggles and — in particular — masks have become part of the trending term that has hospitals in Seattle, California and New York scrambling to replenish into their shortened stockpiles as the coronavirus continues to spread across the country.

So far, Kootenai Health has been immune from that shortage, a feat that requires careful control of the hospital’s resources along with continual communication. It’s a process that begins with a daily count.

“We update our PPEs every single morning,” said Trevor Bober, director of Kootenai Health’s supply chain operations. “… We have a lot of partnerships throughout the country, and we have a lot of vendors we’re communicating with.”

Ordering PPE replenishments during the midst of a pandemic isn’t like shopping on Amazon. Vendors in part allocate how many masks will go to a particular hospital based off their previous years’ usage, a strategy designed to prevent hoarding.

Even with the pressure a pandemic places on the health care system, Bober said rationing isn’t Kootenai Health’s biggest challenge.

“Our biggest challenge is the unknown,” he said. “Not knowing what will happen next, and then trying to fill that gap. It’s a real challenge.”

That unknown also has Kootenai Health canceling elective procedures. Hospital officials estimate those cancellations are saving thousands of masks that grow in value by the minute.

“Masks are typically a single-use item, depending on the mask,” Ward said. “We have the yellow surgical masks. And then we have the respirator masks … You can prolong the use of those masks through a number of different cleaning techniques.”

Those techniques at Kootenai Health’s disposal include disinfectants, vaporized hydrogen peroxide and the use of UV light.

“We’re using and developing these ideas in case the supply chains run dry,” Ward said.

The hospital’s continuing strategy includes a re-usable mask — if you want to call it that — called the computerized air purifying respirator. It’s known industrywide by its acronym, the CAPR. Ward calls it the Stormtrooper helmet, and her invoking the image of the gear found in “Star Wars” lore isn’t wrong.

“It has a face shield on it,” she said. “It blows filtered, clean air, so it creates a small, positive-pressure environment. We utilize those, and they’re a great asset to have.”

Kootenai Health has 26 Stormtrooper helmets in its inventory, with more on the way, but they’re not enough. For the time being, to maximize the hospital’s resources, along with the CAPRs and cleaning techniques, masks are being rationed.

Only high-risk patients, including patients with respiratory concerns or patients exhibiting coronavirus symptoms, will be given masks.

Only employees who work with high-risk patients will use a mask.