In different medical settings, Personal Protective Equipment (PPE) is regarded as a critical element of contagion or infection management and control. PPE is used to protect healthcare workers, patients, and visitors from infections by mechanically preventing the spread of germs and viruses. In healthcare facilities, there is a high risk of exposure to bacteria and viruses due to the direct contact with microorganisms, and large groups of medical workers and patients become vulnerable populations in this context (Kamerow, 2020). Therefore, all the medical employees who work with blood or other bodily fluids are required to use such PPE as gloves, masks, eye protection shields, gowns, aprons, head covering, and special shoes (Harrod et al., 2020; Ranney et al., 2020). From this perspective, the use of PPE is an essential component of occupational safety to protect the health of medical workers and prevent the spread of diseases in communities.
The current global healthcare situation associated with the spread of the COVID-19 pandemic has accentuated the importance of using PPE in hospitals and other medical facilities. The outbreak of the pandemic has emphasized the unique demand for PPE and the inability of governments in the United States and other countries to satisfy it (Burki, 2020; Patel et al., 2017). The problem is that US hospitals suffer from the shortage of PPE because of inadequate PPE supply, and this situation directly affects the safety of healthcare providers and the quality of patient care in facilities. As it is stated by the Centers for Disease Control and Prevention (2020), additional specific crisis capacity strategies are required in order to resist PPE shortages. It is possible to focus on identifying certain gaps in the PPE supply chain and determining how healthcare organizations can address the situation because there is a risk that hospitals are not yet ready for such emergencies as the rapid spread of the virus because of the PPE shortages.
The purpose of researching the identified problem of the PPE shortage in hospitals under the circumstances associated with the spread of COVID-19 is to increase the awareness of the issue with reference to identifying possible solutions to the issue. It is also important to determine whether problems associated with the PPE supply chain should be viewed as the primary causes of shortages and how it is possible to address them effectively. The importance of researching this topic is that medical professionals are at a significant risk of being infected because of shortages of PPE. As a result, they represent a vulnerable category being involved in direct interactions with patients and causing the spread of viruses if the lack of PPE is observed (McGarry et al., 2020; Ranney et al., 2020). From a larger perspective, the spread of diseases and mortality caused by the absence of PPE can extend to endangered demographics in communities (Livingston et al., 2020). The research on this topic is critical to prevent the future PPE shortage in medical facilities by reconsidering supply chains and associated barriers.
Thus, the current state of global health care related to the COVID-19 pandemic has made researchers and practitioners examine how the shortage of PPE in hospitals can depend on supply chains and lead to negatives changes in the quality of care and the epidemiological situation in communities. The current healthcare emergency situation has created new difficulties regarding PPE supply in underequipped hospitals (Patel et al., 2020). Additional research on PPE is required to increase the awareness of the issue and discern gaps in knowledge regarding supply chains in hospitals. Thus, the stated problem should be discussed from scientific, analytical, ethical, and cultural perspectives. In spite of the fact that currently the PPE supply issue in US hospitals and worldwide seems to be partially resolved, there are still needs for finding out the effective ways of responding to the situation of shortages and reducing its negative epidemiological effects.
Scientific Perspective of Inquiry
The pandemic situation in the world, associated with COVID-19, has led to the development of a specific problem related to the shortage of PPE supply in hospitals. It is important to start discussing this problem from the scientific perspective and focus on the following research question related to Level 1 inquiry: What are the anatomical, physiological, pathological, or epidemiological issues? This inquiry will be supported by the Level 2 research question: What are the alternative sources or types of PPE that can contribute to preventing the worsening of the epidemiological situation? The answers to these questions will be helpful to present possible solutions to the problem of the shortage of PPE supply in hospitals in the scientific context.
Anatomical, Physiological, Pathological, and Epidemiological Issues
If there is no enough PPE in a hospital (in the form of face masks, respirators, face shields, gloves, and gowns), risks of spreading infectious diseases increase significantly because of the impossibility to prevent the transmission of infections and protect both medical workers and patients. During the COVID-19 pandemic, the usage of PPE can be regarded as critical for the medical staff in order to be able to stop the spread of the disease in clinical settings and guarantee individual safety (Livingston et al., 2020; Patel et al., 2017). If access to different types of PPE in healthcare facilities is inadequate, healthcare providers face significant physiological and pathological threats of being infected.
The risks of transmitting COVID-19 in hospitals are assessed as significant because patients in these settings are vulnerable to infections. When referring to the example of COVID-19, it is important to note that the disease can be spread due to contact and droplet transmission, and in many cases, due to airborne transmission (Ip et al., 2020). Researchers state that the risks of being infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provoking the development of the coronavirus disease are higher in comparison to other viruses because currently people have no immunity to oppose the virus (Centers for Disease Control and Prevention, 2020). In this situation, PPE is critically important to protect medical workers and avoid being infected with the coronavirus (Kamerow, 2020; Patel et al., 2017). It is possible to conclude that, from the epidemiological perspective, the shortage of PPE in hospitals can negatively affect the situation and lead to the further spread of the infection among patients.
Alternative Sources of PPE
The most recent literature on the problem of PPE supply in hospitals presents researchers’ and practitioners’ opinions and results of studies on the availability of alternative sources of different types of PPE to prevent the further worsening of the epidemiological situation. The key solutions discussed in the literature include new approaches to sterilization and disinfection of PPE, the use of robots when it is possible, and the minimization of contacts with patients, among others (Ip et al., 2020; Livingston et al., 2020). The key focus in this case is on reusing PPE when it is guaranteed that the equipment is sterilized and on repurposing different protective items.
The reason for adopting such measures is that the reuse and repurposing of PPE allow for overcoming shortages in clinical settings while minimizing dependence on supply chains and associated barriers. Thus, researchers and practitioners proposed to use different types of face masks (not only medical ones) to protect eyes, noses, and mouths and increase safety (Ip et al., 2020; Rajak, 2020). Furthermore, alternative sources of face shields and gowns are also discussed in the literature (for example, sports eye protectors and helmets, plastic bags) (Burki, 2020). The ways of making PPE reusable and recyclable are also analyzed in scholarly articles as quite effective approaches to contribute to making protective devices more accessible for healthcare professionals. Therefore, researchers are inclined to find the solution to the PPE shortage problem in focusing on utilizing reusable and recyclable materials, as well as alternative protective equipment.
To conclude, from the scientific perspective, the two important research questions to answer are associated with the nature of anatomical, physiological, pathological, or epidemiological issues related to the problem. The focus is also on the types of PPE that can prevent the worsening of the epidemiological situation. The research indicates that the authorities’ interest should be in providing all the staff with PPE that can be offered in the form of common medical masks, gloves, gowns, and other equipment, as well as non-traditional devices used to protect healthcare providers’ faces and bodies.
Mathematical/Analytical Perspective of Inquiry
The application of the analytical perspective to the discussion of the research problem is also critical. Therefore, the Level 1 research question that is associated with this perspective is the following one: What are the economic issues involved? The Level 2 research question will help collect more information on this problem: How can economic issues influence PPE supply chains? The answers to these specific questions are presented in detail in the sub-sections below.
Economic Issues Related to the Problem
The coronavirus pandemic has resulted in a variety of economic issues that are associated with the usage of different types of PPE in hospitals. The key problem is linked to the necessity of spending more resources on personal protective equipment and finding new sources of these items to be used in remote areas. According to Ranney et al. (2020), the administration in hospitals in the United States and worldwide faced the economic burden associated with the necessity of addressing the shortage of PPE because the prices for masks, gloves, and shields increased significantly. As it is stated by Burki (2020), “the price of surgical masks had increased sixfold, the price of N95 respirators had trebled, and the price of surgical gowns had doubled” (p. 785). These data are reported in comparison to the prices that were noted when the pandemic started. Thus, it is possible to state that the development of the pandemic has led to critical economic problems related to guaranteeing adequate PPE supplies in hospitals.
It is important to note that hospitals and other healthcare facilities faced the challenge associated with not only overcoming the lack of protective equipment but also with its costs. Low supplies of PPE are observed even today, and one of the key economic barriers and challenges at this stage is the establishment of production of masks and gloves, as well as other PPE locally (Rowan & Laffey, 2020). This measure is viewed by researchers and authorities as most appropriate to overcome the shortage of PPE in healthcare settings at local levels because addressing the demand and minimizing costs (Burki, 2020; Ranney et al., 2020). The stabilization of prices for PPE along with access to all the types of protective devices is required in order to ensure that the spread of the infection in hospitals is prevented.
Economic Issues Influencing PPE Supply Chains
It is stated in the literature on the topic that one of the key economic issues associated with the PPE supply in hospitals is the lack of effective supply chains. Currently used supply chains for addressing healthcare facilities’ demands for protective equipment are not efficient. The problem is that the limited trade and transportation between cities and countries affect the PPE supply significantly. As a result, researchers and analysts propose some alternative approaches to addressing the problem (Ranney et al., 2020). These solutions are oriented toward revising currently applied PPE-related supply chain models in the healthcare sector.
One of the offered solutions is the necessity of making supply chains shorter and based on local producers, if it is possible. Before COVID-19, China produced about 20 million masks daily, but this number was not enough in order to efficiently address global needs when the pandemic started (Burki, 2020). Currently, the global supply chain that is based on PPE produced in China should be replaced with local supply chains in spite of the fact that China has increased the manufacturing of masks and gloves recently (Burki, 2020; Ranney et al., 2020). Furthermore, the focus should also be on supporting local factories in producing more PPE to be used in hospitals and other clinical settings without dependence on wider supply chains that include many actors.
Governments in different regions of the world have focused on controlling PPE supply in hospitals with reference to sponsoring the production and purchase of cost-efficient and environment-friendly PPE. The communication lines between different suppliers and representatives of medical organizations should also be improved in order to avoid the shortage of PPE. The reason is that the demand for masks and gloves will increase, as it is forecasted by Burki (2020), and 2.2 billion masks, 1.1 billion gloves, and 8.8 million face shields will be used in the world by the end of 2020. In this context, the potential solution to the problematic PPE supply in the United States and globally is the creation of local supply chains, the extension of supply using local resources and alternatives ways, and the effective management of supply, selecting reusable and easily distributed items (Burki, 2020; Ip et al., 2020). All these solutions are proposed in the currently available academic literature on the problem of the shortage of PPE supply in hospitals with reference to the analytical perspective and the economic aspect.
As a result, from the analytical and economic perspective, the questions have been posed regarding the economic issues involved in the problem and the role of supply chains in addressing it. It has been found that the prices of PPE represent a significant economic burden for hospitals in the United States and globally. However, one should note that more attention should be paid to refocusing on locally based supply chains in order to guarantee easy access to PPE without depending on global supply chains as it was typical for the healthcare sector before the pandemic.
Ethical Perspective of Inquiry
When discussing the issue of the PPE shortage in US hospitals from the ethical perspective, it is essential to find the answers to the following Level 1 research question: What ethical obstacles affect how the medical community addresses the issue? While referring to the specifics of applying PPE in the healthcare context, it is also important to formulate Level 2 research question that covers ethical issues: How can the lack of PPE affect the quality of services? The focus on these questions is critical for understanding what ethical issues can be associated with the problem of the inadequate PPE supply in healthcare facilities that has been observed since the outbreak of the COVID-19 pandemic.
Ethical Obstacles Affecting the Medical Community’s Response to the Issue
One of the ethical challenges that are associated with the PPE supply in hospitals in the era of COVID-19 is the decision of medical workers to continue performing their duties and responsibilities in the situation of the lack of masks, gowns, and gloves. If there is a shortage of PPE in a hospital, healthcare providers are expected to resolve the ethical question and perform their duties being unprotected from the risks of contamination (Maguire et al., 2020). The problem is that medical employees have a specific ethical duty to deliver high-quality care to patients, in spite of the fact that the lack of PPE creates additional challenges and risks for both the staff and patients (Patel et al., 2020). As a result, in the situation when patients require healthcare providers’ assistance, the response of the medical community to the shortage of PPE can be negative.
Another ethical obstacle is associated with certain legal issues and obligations of medical workers. On the one hand, if medical employees provide care and need to work with patients without PPE, they break the infection control norms and standards, and this is the case for disciplinary and legal actions (Binkley & Kemp, 2020). On the other hand, in the situation of the shortage of the PPE supply in hospitals, physicians and nurses have to use different shields and masks that have no qualities typical of special medical PPE (Maguire et al., 2020). In this case, it is possible to state that the personnel avoids breaking ethical and legal norms, but the quality of services decreases significantly, and the risk of catching and transmitting the infection can still be discussed as high. Thus, there are high possibilities that healthcare professionals will be unable to effectively interact with patients infected with the coronavirus if the provided PPE is of low quality or absent.
The Lack of PPE Affecting the Quality of Services
It is important to note that, if healthcare providers have no access to enough PPE in order to protect themselves, this shortage in the PPE supply results in decreasing the quality of care provided to patients. On the one hand, medical workers violate ethical and legal norms and break the protocols related to infection control in hospitals (McGarry et al., 2020). On the other hand, when being unprotected, healthcare providers contribute to transmitting the disease in a clinical setting, causing the growth in the rate of infected patients (Binkley & Kemp, 2020). The quality of services tends to decrease if healthcare professionals were previously infected and diagnosed with a certain disease that can prevent them from performing their duties.
The absence or inadequacy of PPE leads to provoking the situations of transmitting infections from patients to the medical staff and from the staff to patients. As a result, the quality of care decreases significantly, as time is needed in order to understand the level of the transmission risk because test results are available not immediately (Gurses et al., 2019). From this perspective, the ethical issue is observed when the demand for PPE declared by the staff in a hospital is not addressed, and this problem begins to influence the quality of services provided in a clinical facility (McGarry et al., 2020). The shortage of the PPE supply does not give medical workers an opportunity to prevent the transmission of infections, and physicians, nurses, and patients remain vulnerable and unprotected in this ethically problematic situation.
It is possible to conclude that the ethical perspective allows for posing the following questions: what ethical obstacles can affect the medical community’s response to the issue and how the lack of PPE can affect the quality of services. The answer presented in the academic literature is that ethical and legal aspects include the obligation for medical staff to perform their duties in different critical situations and follow the infection control procedures strictly. Therefore, medical workers are expected to use available PPE to protect themselves and guarantee high-quality care for their patients, minimizing risks of infection transmission.
Cultural Perspective of Inquiry
The resolution of the problem of the PPE supply in healthcare facilities requires the analysis of the issue from the cultural perspective. In order to complete this analysis, it is necessary to pose the following major Level 1 question: Which cultural values and/or norms influence the issue? Furthermore, for the purpose of ensuring that the analysis of the cultural aspects is complete, one should set an additional Level 2 question: How can healthcare professionals’ cultures and views influence their usage of PPE? Despite the fact that the PPE supply is guaranteed in most hospitals today, certain cultural issues can influence the problem because of challenges associated with healthcare providers’ views regarding the use of PPE, as well as their specific cultural traditions.
Cultural Values and/or Norms Influencing the Issue
The representatives of different cultures have various ideas regarding the medical clothes they wear in order to protect their bodies and patients from infection. The problem is that medical workers as the members of certain cultural communities can ignore some rules regarding the usage of PPE if these norms and principles contradict their personal, cultural, or religious views (Patel et al., 2020). When working in both clean and contaminated settings, some people can break the standards and remove their PPE or devices that are used instead of PPE in the situation of the shortage of necessary equipment (Gurses et al., 2019). Therefore, much attention should be paid to educating healthcare providers regarding the risks of removing gloves, masks, face shields, and respirators when working with patients, especially in the context of the coronavirus pandemic (Harrod et al., 2020). When doffing PPE because of their specific cultural and personal views and ideas, medical workers contribute to the transmission of diseases, and they can be unaware of real threats associated with their actions.
In remote areas and developing countries, the risks of doffing PPE are the highest ones because of the cultural factor and the lack of protective equipment to be used effectively by all the medical staff. If healthcare providers lack the required competency and education regarding the utilization of PPE, they can demonstrate doffing modes and become vulnerable and unprotected (Gurses et al., 2019). This situation leads to increasing infection rates in these areas (Centers for Disease Control and Prevention, 2020). Healthcare professionals are highly exposed to the threats of catching and spreading viruses, and they need to follow infection control standards and rules in order to prevent transmission of viruses and bacteria in spite of their personal beliefs and perceptions (Patel et al., 2020). However, the specifics of the daily contacts of medical workers with patients and the patterns of doffing PPE lead to ignoring safety standards, which is a risky behavior in the context of the PPE shortage caused by the COVID-19 pandemic. Therefore, some traditions and routines adopted in remote clinical settings and typical of some healthcare providers can be regarded as threatening and ineffective.
Healthcare Professionals’ Views Influencing the Usage of PPE
Although all healthcare providers usually receive training regarding the use of PPE during the pandemic and in other cases to prevent the transmission of infections, their personal factors, including their individual views, cultural norms and beliefs, can influence their usage of PPE. Even if all the medical workers in a hospital are provided with masks, respirators, and gloves to protect their faces and hands, they can wear or use then incorrectly, demonstrating the lack of knowledge or their specific position (Harrod et al., 2020; Maguire et al., 2020). It is reported by researchers that the cases of doffing PPE by healthcare providers are extremely frequent in medical settings (Gurses et al., 2019). Individual cultures and views regarding the contacts with patients can influence the usage of PPE and negatively affect persons’ compliance with all the norms and rules adopted in a hospital significantly (Binkley & Kemp, 2020). As a result, the risks of self-contamination as well as the further spread of the infection in a hospital increase significantly, emphasizing the inability of medical workers to guarantee safety for patients.
To conclude this section, it is necessary to state that the cultural perspective is taken into account when posing the following questions: which cultural values and norms can influence the PPE supply issue and how healthcare professionals’ cultures and views can influence the usage of PPE. As it is stated in studies and other academic literature on the problem, the risks are observed when medical workers doff their PPE because of certain cultural and personal views that may contradict hospital safety protocols. As a result, these cultural issues need to be addressed in order to guarantee the effective usage of PPE even in the situation of its shortage in US hospitals and worldwide.
Conclusion
The problem that has been identified for researching is that today many US hospitals suffer from the shortage of PPE supply, resulting in negative effects on the safety of healthcare providers and the quality of patient care in medical facilities. Therefore, the purpose of this project has been formulated as the necessity to increase the awareness of the PPE supply shortages and to identify possible solutions to the issue under the circumstances of the spread of the COVID-19 pandemic in the world. The analysis of the problem, as well as the discussion of a range of available solutions, has been realized from scientific, analytical, ethical, and cultural perspectives. This approach has allowed for identifying certain gaps in the PPE supply chains in the United States and finding out how healthcare organizations can address the situation when evaluating other options.
The current PPE supply in hospitals has been assessed in the context of the COVID-19 pandemic, and the shortage of the PPE supply is reported in the academic literature depending on the necessity for healthcare providers to use gloves, face masks and shields, respirators, and gowns in all situations when working with patients. Many hospitals and other healthcare facilities worldwide have recently faced the challenge of inadequate PPE supply in order to be able to guarantee the safety of medical workers and prevent the transmission of viruses. The analysis of the PPE shortages in healthcare settings from four different perspectives has indicated a list of potential solutions that can be used to address the PPE supply problem in US hospitals.
In order to solve the problem of the PPE shortage in healthcare settings within the shortest period of time, it is necessary to concentrate on using available alternatives to PPE, as it is stated in the scholarly literature. Thus, specific PPE is proposed to be changed with various non-medical masks, gowns, gloves, as well as face shields that can protect the staff from transmitting the infection. In this case, it will be possible to overcome epidemiological issues that are associated with the spread of COVID-19 in hospitals because of the lack of adequate and quality PPE. Another solution is associated with reconsidering the approach to organizing healthcare supply chains. The outbreak of the pandemic has demonstrated the ineffectiveness of complex supply chains and outsourcing for PPE in the context of emergencies. Therefore, it is recommended for healthcare facilities to organize supply chains with fewer actors and using local resources.
More solutions are also required in order to address ethical and cultural issues that can be related to the problem of the lack of PPE supply in medical settings. The key solution that has been identified is the necessity to provide the healthcare staff with required training courses and education regarding the correct use of PPE and safety and infection control protocols. These measures are important in order to guarantee that all physicians and nurses in hospitals and other healthcare facilities effectively utilize PPE when interacting with patients to guarantee their safety and provide high-quality care. Additionally, these training and education are critical for avoiding the situations of doffing protective equipment because these cases were often reported in studies on the problem. As a result, one should state that the problem of the lack of PPE in hospitals can be addressed when applying a complex approach and focusing on the combination of several solutions and different actions covering scientific, analytical, ethical, and cultural areas.
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