Abstract
The infection prevention and control (IPC) workforce is central to ensuring adequate preparation in the interepidemic period—the period between epidemics—and a robust control response in outbreak settings. 1 Supply chain management issues including supply security, inventory management, and stockouts became evident when a shortage of personal protective equipment (PPE) threatened to hamper the outbreak response to Ebola virus disease in West Africa in 2014-2016 and, more recently, with the COVID-19 pandemic.2,3
While interest in the supply chains of more complex health technologies such as vaccines and oxygen has grown, supplies such as alcohol-based hand rub/sanitizer and PPE have garnered less attention. The IPC workforce is a critical contributor to clinical operations and provision of supply chain data. IPC teams use early case detection and surveillance to sound alarms, inform public health entities, and act on early signals that can inform and activate supply chain streams. Unfortunately, this workforce is often neglected in interepidemic periods. In 2017, the World Health Organization outlined the urgent need for IPC capacity building and the underutilization and integration of IPC into the United Nations Sustainable Development Goals. 4 All of these components are critical for early epidemic infection prevention efforts.
The purpose of IPC is to highlight the need for and manage supplies and processes related to hand hygiene, PPE, sterile supplies, functional disinfection programs, biohazard waste disposal, and facility engineering controls. Hand hygiene is the most effective method to decrease and prevent most disease transmission. Consistency and durability in “subcomponent” supply chains is essential to building a functional hand hygiene program. The 2013 African Partnerships for Patient Safety Local Production of Alcohol Based Hand Rub Training Workshop highlighted difficulties in procurement of raw materials, dispensers, and access to methodologies of cleaning nondisposable dispensers. 5 The IPC workforce can ensure availability of hand hygiene supplies and subcomponents by informing warehouses of district- or state-level supply chain data.
PPE as part of transmission-based precautions, and supply chains of medical devices and the equipment required to sterilize them are critical to stemming further exposure to high-consequence pathogens. The IPC workforce understands the elastic supply chains needs of their healthcare system and can help hyperlocal mobilization of resources as efforts are made to move from a “just-in-time” to “just-in-case” inventory management system. 6 Similar to technical issues of cold chain management and vaccine supply, nondisposable PPE requires laundering services, while disposable PPE requires biohazardous waste disposal. 7 The IPC workforce is uniquely poised to audit and provide feedback on these processes and to inform the flow of such specialized goods.
When Kasese, Uganda, was threatened with an Ebola virus disease outbreak in 2019, a hospital administrator lamented, “I wish we could coordinate,” regarding PPE needs. 8 With continued underinvestments in IPC personnel, global supply chains that are vital to outbreak response remain fragile with uninformed and incomplete information. While laboratory capacity, epidemiologic data sharing, surveillance, and governance are all necessary elements for preparedness, there is no substitute for informed human capital. Until we view an investment in an IPC workforce and supply chains for IPC goods as an investment in global health security, we will remain vulnerable to future threats.