Like most doctors, Megan Ranney, MD, MPH, grabs a wipe to disinfect her stethoscope every time she examines a patient who might have an infectious disease.
But the usually ubiquitous canisters of commercially-made wipes have been in shorter supply during the past few months.
Reflecting that shortage, the cost of wipes spiked up to seven times their usual price in August, and in October, wipes were the most-requested item from the nonprofit GetUsPPE. According to the group's most recent data in mid-November, 67% of facilities requesting personal protective equipment (PPE) reported they needed wipes, and 34% were completely out.
While coming up short on wipes may not seem as catastrophic as a lack of other PPE at first glance, being forced to limit the use of wipes can endanger both healthcare workers and patients, said Ranney, an emergency medicine physician in Rhode Island who is also a cofounder of GetUsPPE. "In healthcare settings, we're dealing with not just the risk of COVID, but all the other diseases that are out there. They're still there."
Most of the wipes used in medical settings differ from the Lysol or Clorox wipes available to consumers: "We need to make sure they kill the most hardy of pathogens," Ranney said, including Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA).
The Environmental Protection Agency (EPA) regulates disinfectants and tracks which products are approved for different pathogens. At the beginning of March, there were 59 wipes approved to kill SARS-CoV-2. Now that more manufacturers have made it through a months-long approval process, there are 510. But the supply chain may not catch up until January.
In the meantime, some hospitals have made their own wipes in their in-house pharmacies, and some have reprioritized when and where to use wipes. And, just as some healthcare workers brought their own masks from home early in the pandemic, some providers have started toting wipes to and from work.
"In the setting of coronavirus you have to be flexible," said Preeti Malani, MD, chief health officer and a professor of medicine in the Division of Infectious Diseases at the University of Michigan, Ann Arbor. "You have to prioritize — maybe in some places you don't have to use the wipes."
Instead of wiping down a patient table, for example, a healthcare worker could spray it with disinfectant. But when supplies are abundant, that's usually not the first choice.
"There are many different choices of surface disinfectants, and we tend to pick the ones that work best that are fastest, safest, and cheapest," said David Weber, MD, MPH, a professor at UNC Health in Chapel Hill, North Carolina.
Most often, that's a disinfectant wipe. "We use them to wipe down medical equipment monitors, cords, our stethoscope, an ultrasound machine, EKG machines," Ranney said. Some of these devices can be damaged by other products, such as spray.
In other cases, wipes are preferable because they may disinfect better, Weber said. If using a liquid solution and a washcloth to clean a patient table, the healthcare worker has to dilute the disinfectant's concentration to the correct amount, date the diluted bottle, and make sure to stop using it when it expires. They also must get the correct amount of liquid on the cloth, which varies depending on the fabric, or spray a uniform layer of disinfectant on the surface to be cleaned, which is challenging. If any of those protocols aren't followed, the result could be subpar.
"Microbes are killed in two ways: by the chemical itself, and the physical removal," Weber said. "Wipes accomplish both. Plus, you throw them away when you're done so there's no chance of transporting pathogens from one room to the next."
At his hospital, which has managed to maintain enough wipes so far, wipes are used for almost everything in patient rooms except floors and fabric surfaces, such as privacy curtains, Weber said.
Pre-COVID, the type of wipe that kills SARS-CoV-2 could be saved for rooms in which patients were suspected to have C diff or a drug-resistant bacteria, Ranney said. Now, in addition, they're used in every room with a suspected case of COVID.
That's why some hospitals in short supply have compounded their own. And while the homemade wipes get the job done, they're messier and make you appreciate the commercial variety, Ranney said: The perfect perforation separating each wipe, the even spread of moisture, the canister itself.
"The commercially manufactured ones are lovely," she said. "When you pull one out it's perfectly wet, not sopping, and it's easy to detach."
Her hospital ended up giving up on the in-house variety and making its own spray instead.
Smaller Clinics Hardest Hit
With the recent surges of COVID-19, more and more facilities — especially smaller practices and nursing homes — are requesting wipes from places such as GetUsPPE as a last resort. Even for hospitals, supplies of wipes can't be replenished as rapidly as other forms of PPE.
Before the pandemic, most hospitals kept about 3 weeks' worth of supplies such as disinfectant wipes on hand, said Richie Hecker, managing director of Traction & Scale, an import/export company and medical supplier. When supplies started getting depleted more quickly, there wasn't an easy way to catch up, Hecker said.
Wipes are heavy and flammable, and the canisters they come in are bulky, so they tend to be shipped from China via sea — and there's no way to put a rush delivery on a sea order. Plus, quaternary ammonium chloride, one of the chemicals used in some of the most popular wipes, was in short supply and caused delays in the supply chain.
Because larger hospitals and clinics order disinfectant wipes by the truckload — about 20,000 canisters of wipes — smaller practices (including pediatricians and dentists, which may need only 60 canisters per year) have had an especially challenging time getting wipes. Some minimum orders require a purchase of around 700 canisters.
"The small guys get screwed," Hecker said.
The good news is that new supplies are finally hitting the market, Hecker said. The peak wipe-out period was probably the last week of August, when prices hit 20 cents apiece, up from 3-10 cents. As of early November, prices had stabilized back to about 7-12 cents for most hospitals, he says.
"It's correcting," he says. "My prediction is that wipes will be readily available in most hospitals by January."
There are also signs that lessons have been learned. "Most people are stockpiling 3 months now instead of 3 weeks," Hecker said.
Are you having trouble stocking PPE in your practice? How are you dealing with it? Tell us about it in the comments.
Sheila Eldred is a freelance health journalist in Minneapolis. Find her on Twitter @MilepostMedia .
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Cite this: Small Practices Wiped Out of Disinfectant Wipes - Medscape - Nov 18, 2020.