California's newly adopted H1N1 rules requiring widespread use of N-95 respirators by healthcare workers—perhaps the strictest in the country—has hospital officials "extremely nervous, because there's a nationwide shortage of these masks," says a spokeswoman for the California Hospital Association.
"Hospitals are expressing concern that if the pandemic is as bad (this season) as some people predict, hospitals could go through literally hundreds of thousands of these (N-95 respirators) a week, and you can't replace them because of the manufacturing shortage," says Jan Emerson, CHA's vice president for external affairs.
"We have one large Northern California Hospital that said they could easily see themselves going through 70,000 of these masks in one week," says Emerson, whose Sacramento organization represents more than 450 hospitals and health systems throughout the state.
"Hospitals now each have a supply," Emerson says, "but they don't know how many they're going to need. With CAL/OSHA's standard, it would likely increase the number of masks necessary. What I've been told is that a lot of hospitals have been told to get their orders in now to make sure that if they need them, they will be able to get them."
The concern is compounded because on Sept. 8 Cal/OSHA, California's version of the National Institute for Occupational Safety and Health, issued specific interim recommendations requiring use of the respirators in the process of caring for patients with suspected or confirmed pandemic H1N1 influenza in both outpatient and inpatient settings.
In theory, that means physicians in their clinical practices would have to adopt the use of the masks as well.
The recommendations say respirators such as N-95s, "should be used for hospitalized H1N1 suspected, probable and confirmed cases." And it "requires use of respirators when entering or working in areas where those patients are located."
Hospital officials for Northern California's Kaiser Permanente's Regional Infection Control Committee said in a recent paper that, "using methodology for calculating the current use of N-95 respirators and determining the current supply available to each medical center . . . we have determined that an extreme shortage of N-95 respirators exists at all medical centers."
The paper was signed by Stephen Parodi, MD, chief of infectious diseases and co-chair of the Kaiser Regional Infection Control Committee; David Witt, MD, chair of the National Healthcare Continuity Management; and Pancy Leung, RN, of the Regional Infection Control Committee.
For Bei Bei, those certifications or model numbers were listed as: TC-84A-4390, TC-84A-4391, TC-84A-4392, TC-84A-4520, TC-84A-4525, TC-84A-4560, and TC-84A-4562. "As of July 1, no Bei Bei Safety Company LTD (BBE) respirator model can be listed as NIOSH approved" and Bei Bei's respirator products "can no longer be manufactured, assembled, sold or distributed," NIOSH wrote in a July 1 notice.
For JTN, those certificates were numbered TC-84A-4244, TC-84A-4245, TC-84A-4380, TC-84A-4381, TC-84A-4382, TC-84A-4384, TC-84A-4385, TC-84A-4386, TC-84A-4389, TC-84A-4406, TC-84A-4407, TC-84A-4408, TC-84A-4490, and TC-84A-4501.
"As of June 22, 2009, no JTN respirator model can be listed as NIOSH approved," and no respirators with those numbers can no longer be manufactured, assembled, sold, or distributed," NIOSH said in a July 1 notice.
It could not be determined how many Bei Bei or JTN respirator models or products were recalled, or whether those products were sold under another brand name, or who purchased them and whether they are being replaced.
In Cal/OSHA's recommendations, N-95 devices should "generally be disposed of each time they are removed." If the employer is unable to assure a sufficient supply of respirators, "the employer should implement and document in writing the attempts to obtain respirators and measures the employer is implementing to conserve the respirator supply, which may include re-donning."
The masks are to be worn during "high hazard procedures including bronchoscopy, sputum induction, intubation and open circuit suctioning," Cal/OSHA added.
On the sixth day of the debate in the Senate Finance Committee, Chairman Max Baucus (D-MT) declared that his panel has the votes to approve a package of reforms that would extend coverage to more than 30 million Americans who lack insurance. He and Sen. Charles E. Grassley (Iowa), the ranking Republican on the panel, said they expect to finish the bill by October 2.
In the scramble to find money to overhaul the healthcare system, Senate Democrats have been eyeing the most generous insurance "Cadillac" plans as a lucrative target to tax. But as the competing proposals are debated, few people can agree on exactly what constitutes a Cadillac plan, according to the Washington Post.
Audits of select Massachusetts businesses suggest that a substantial number may not be providing workers the health coverage required by the state's insurance law. Of the 426 companies audited so far, 40% had violated the law's requirement that most employers contribute a portion of their workers' insurance premiums or pay a penalty. Business leaders say the problem is that the rules are so confusing that many employers are having a hard time understanding what is required of them.
Researchers examining 84,730 people who underwent inpatient surgery at 186 hospitals from 2005 to 2007 found that death rates varied widely from hospital to hospital, from 3.5% to 6.9%. But complication rates did not vary significantly: 24.6% of patients at the high-death hospitals experienced complications after surgery, compared with 26.9% of the patients at the hospitals with the lowest death rates. The discrepancy suggests that how a hospital responds to complications may be even more important than the frequency of complications, according to the report prepared by the Michigan Surgical Collaborative for Outcomes Research and Evaluation.
The recession is driving up enrollment in Medicaid at higher than expected rates, threatening state budget gaps even as Congress and the White House seek to expand the government health insurance program, according to a survey. The annual survey of state Medicaid directors, conducted for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, found that the program had been spared the worst effects of massive state budget shortfalls because of federal aid in the stimulus package. But it also revealed concerns about what will happen when that relief ends in 2010, reports the New York Times.
The Washington state Hospital Association wants the state Health Department to require every hospital employee to get flu shots.
Mandatory shots are opposed by the Washington State Nurses Association and the Service Employees International Union. A spokeswoman for the hospital association, Cassie Sauer, told the Associated Press that the percentage of hospital workers who get annual flu shots is "abysmal."
President Barack Obama announced a plan to spend $5 billion to create new jobs for medical and scientific research, medical supplies, and improved laboratory capacity. The funds, to come from the $787 billion economic stimulus package, will pay for "cutting-edge medical research in every state across America," the White House said in a statement.
Blue Cross and Blue Shield of Illinois is the latest health insurer to launch programs that involve medical homes, rolling out pilot programs with Pronger Smith Medical Care and Elmhurst Clinic. The two are Chicago-area doctor groups that have both primary care physicians and specialists. Under the medical home model, treatment and referrals are coordinated centrally as a way to keep costs down.
Vaccine against swine flu will not be widely available in Massachusetts until mid-November, the state's public health commissioner warned, even as specialists fear that cases of the viral disease will increase markedly in coming weeks. The Department of Public Health expects the first vaccine doses to arrive in the state no later than Oct. 12, but that initial shipment is expected to include only about half as many doses as originally anticipated.
