Global Demand Puts Pressure on Healthcare Supply Chains

In the midst of rising demand, panic buying, hoarding, and misuse during the COVID-19 coronavirus outbreak, the global supply of personal protective equipment (PPE) is at risk, according to the World Health Organization (WHO) on 3 March. Shortages of PPE such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons could put doctors, nurses, and other frontline workers at risk, WHO said.

Prices have surged for PPE—surgical masks have seen a six-fold increase since the start of the COVID-19 outbreak—but production is not rising to meet demand.

“Without secure supply chains, the risk to healthcare workers around the world is real,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “Industry and governments mut act quickly to boost supply, ease export restrictions, and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first.”

WHO estimates that PPE manufacturing must increase by 40 percent to meet rising global demand. In the meantime, WHO guidance calls for the rational and appropriate use of PPE in healthcare settings and the effective management of supply chains.

Healthcare security professionals can take additional steps to protect these newly high-value items and shore up supply chain vulnerabilities. Security Management (SM) discussed the issue with Bryan Warren, president and chief consultant for WarSec Security. Warren, who has more than 31 years of experience in healthcare security, safety, and emergency management, is a longtime member of ASIS and a past president of the International Association for Healthcare Security and Safety (IAHSS).

SM: How are supply chain vulnerabilities related to COVID-19 affecting healthcare institutions?

Warren: Supply chain security can be a complex issue, and in the current situation the supply chain for healthcare-related items is being impacted at the source as well as after delivery. Certain items which were wholly or in part manufactured in areas that have seen production slowdowns due to quarantine issues or workforce disruptions (such as certain pharmaceuticals) are examples of a healthcare supply chain vulnerability at the source.

This was pointed out in October 2019 by Dr. Janet Woodcock, the director of the U.S. Food and Drug Administration (FDA) Center for Drug Evaluation and Research, when she testified before Congress that the United States “has become a world leader in drug discovery and development, but is no longer in the forefront of drug manufacturing.” She went on to say that 72 percent of API manufacturing takes place outside the U.S., and that the number of facilities making APIs in China has more than doubled since 2010 and the use of foreign-sourced materials “creates vulnerabilities in the U.S. supply chain.” 

As is the case with any supplier issue, appropriate personnel at healthcare institutions should actively monitor for the potential of any such disruptions and have contingency plans and auxiliary vendors at the ready. They should also have secondary and tertiary plans already formulated in the event that there is a shortage of a certain item and have suitable measures in place for replacement or substitution.

Another supply chain issue is at the delivery and point of storage area. This is based upon basic supply and demand concepts; as certain items rise in demand, they increase in value, especially if appropriate security measures are not being implemented. While materials management and supply areas have often been overlooked as not security sensitive in risk assessments, it’s time to reconsider these areas when conducting assessments of healthcare facilities.

SM: What sort of equipment or supplies are at risk? Which supplies should be considered high-value items?

Warren: Certain healthcare stocked materials have always been a target for theft and shrinkage due to their commercial value for resale or personal use (such as diapers and Enfamil for example). Up until a few months ago, N95 masks and bottles of hand sanitizer were considered low-value items and not worth consideration as targets of theft or diversion. This is no longer the case, and with retail stores selling out of such items, this is driving the demand (and the profitability) of such onetime common supplies.

Those responsible for security in healthcare organizations or at storage facilities should stay up to date regarding the inventory of materials and what items are being impacted by public response to the current situation. Items that are considered high risk should be afforded additional protections based upon the risk of not only their loss but also the inability to easily replace such items due to supply chain issues.

SM: How can hospitals and healthcare facilities secure their access to and stores of PPE like facial masks or respirators?

Warren: As mentioned previously, there have always been high-value items in healthcare organizations, and such items are usually given some additional measure of physical safeguards (such as having a separate locked area inside a warehouse or designated storage areas with access controls and surveillance video or alarm capability to deter theft). If such areas already exist, it should be simple to recategorize those items that are now considered higher value and relocate them to a better protected space. If not, then provisions need to be made to secure such items to prevent their loss.

SM: What is security’s role in working with materials management personnel on this process? What other stakeholders should be involved?

Warren: One of the most important things that such a multidisciplinary group can accomplish in this situation is the identification of any items that may be impacted and how they can best be secured without seriously disrupting their availability when needed.

Items like masks are needed constantly throughout the day, and any security measure that is seen as inconvenient will soon find itself being circumvented by staff.

Security leaders should seek out not just materials management personal but also have a dialog with clinical staff to reiterate the importance of any temporary security measures being implemented and work with Human Resources to make certain that violations of such processes have consequences.

If a policy is created but there are no penalties to those who violate it, then what real purpose does it serve?

SM: How can healthcare organizations improve loss prevention or shrinkage around high-value PPE items?

Warren: First, the appropriate personnel need to be assembled and determine which PPE items are now considered high value in today’s current situation. Once identified, such items should be inventoried and provided with reasonable security based upon the risk of theft or loss. The process for distributing such items should likewise be reinforced to prevent diversion or shrinkage by staff, a concept similar in nature to how controlled medications are secured.

The primary driver for such a program will be leadership’s support and focusing on a culture of security and safety when it comes to protecting such items so that patient care is not compromised.

SM: What other loss prevention aspects should healthcare security personnel consider around the COVID-19 outbreak?

Warren: Security personnel should be on the lookout for any behavior that might indicate the theft of supplies, even if they are not considered a traditionally high security items. For example, disinfecting wipes are a very common item used by environmental services personnel, but anyone carrying a case of such wipes outside of the building or backing a personal vehicle up to a loading dock to load supplies into it might be an indicator that something is amiss.

Situational awareness is something that every healthcare security professional should always practice; they just need to make sure that they broaden their definition of what “suspicious activity” might include based upon the current circumstances.

An old but true adage of patrol work is knowing who someone is, what they do, and when they do it. Anything outside of the norm—a dayshift emergency medical services (EMS) worker seen in a materials management storage area during night shift, for example—should be investigated because this should be considered unusual behavior, and behavior is the basis of which any investigation should begin.

How are you shifting operations in your organization to address the COVID-19 coronavirus outbreak? Let us know by emailing [email protected].

Find more COVID-19 resources on the ASIS Disease Outbreak Security Resources page.