Demand soars for Ebola supplies as cost and safety concerns rise

When the University of Iowa Hospitals & Clinics began training nurses how to don and doff the jumpsuits, hoods and coveralls necessary to treat patients with Ebola, everyone noticed how difficult it was to remove the hood from the nurses' heads without touching their skin.

Within weeks, hospital workers came up with their own design and had an in-house seamstress create a prototype hood they now plan to use.

The hoods now on the market are an example of the challenges facing hospitals ramping up orders of personal protective equipment, or PPE, and choosing which products will best protect healthcare workers against a virus that never was previously seen inside American hospitals.

“We've never needed to have personal protective equipment be so fail-proof,” said Dr. Michael Edmond, chief quality officer at the University of Iowa Hospitals & Clinics, Iowa City.

As hospitals increase PPE orders, some experts are concerned that demand will lead to price gouging, supply shortages, and in some cases, hoarding by hospitals. “There is the right opportunity to misuse the situation,” said Jeffrey Lerner, CEO of ECRI Institute, which is tracking PPE price information through its new Ebola PPE Price Index. Suppliers “may charge more or sell things that are not appropriate.”

There have been some examples of temporary supply shortages, but none related to price increases or hoarding, said Amanda Forster, spokeswoman for Premier, a Charlotte, N.C.-based group purchasing company. Premier has resolved any such shortages by reallocating supplies, she added.

PPE products are some of the cheapest medical supplies that hospitals buy. ECRI found that equipment such as boot covers can cost as little as 32 cents. Of the nine product types that ECRI plans to track, only one product—coveralls—costs an average of more than $1 an item.

But most hospitals and clinics are increasing PPE spending in anticipation of Ebola cases. That means higher costs regardless of whether a hospital ends up treating an Ebola patient.

For example, a hospital planning for a team of two nurses, one safety-protocol observer, physicians and a respiratory therapist will need at least 35 PPE suits each day, Forster said. Costs of the total disposable PPE for the group could run about $175 to $210 a day. Using a powered-air purifying respirator may add up to $1,500 in additional costs to each kit. In training, some hospitals reuse PPE suits to keep costs down.

A hospital in Kansas recently placed an order for $100,000 in jumpsuits, hoods and respiratory devices that it says would be needed to treat one patient for two weeks.

Suppliers say PPE orders are way up. Medline Industries, based in Mundelein, Ill., makes all of the products recommended by the Centers for Disease Control and Prevention's safety protocols. After the first Ebola infection in the U.S., demand for facial-protection products such as fluid-resistant masks and face shields increased 40%. Demand for isolation gowns rose 50%, said Stephanie Pasko, Medline's vice president of preventive care. The privately held company does not release sales numbers.

Bio-Medical Devices, based in Irvine, Calif., which makes a powered-air purifying respirator preferred by some clinicians over an N95 mask, has received 10 times as many orders as it did a month ago. The product is now on back order.

“We're adding shifts and adding equipment to our lines,” said Allan Schultz, the company's director of marketing and product development.

Lakeland Industries, a Ronkonkoma, N.Y.-based supplier of industrial protective gear, said in a securities filing in October that it sold shares of common stock in part to support increased demand for its Ebola-related safety products.

But some experts question whether the current equipment is adequate to protect against Ebola. In an Oct. 28 opinion piece in JAMA, Edmond and his colleagues called for improvements in protective equipment technology. Compared with other infections such as methicillin-resistant Staphylococcus aureus, Ebola presents a much greater risk to the healthcare worker.

“It is clear that re-engineering of PPE is required, both in U.S. hospitals but more critically for the outbreak zones in Africa,” the authors wrote.

Such safety questions took a legal turn last week when law firm Eagan Avenatti filed a class-action lawsuit in U.S. District Court in Los Angeles alleging that Kimberly-Clark Corp.'s claims that its protective medical gowns shield clinical workers from Ebola are false. The suit, filed on behalf of Dr. Hrayr Shahinian, a skull base surgeon in California, seeks $500 million in damages.

A Kimberly-Clark spokesman said the company “stands behind the safety and efficacy of our products.”