The devastating effects of Hurricane Maria on Puerto Rico resulted in lives lost, untold property damage, and will take years to rebuild. One unexpected outcome is the impact on access to IV saline bags which has not only affected Puerto Rico, but also the mainland United States. The US Food & Drug Administration (FDA) has been working to combat shortages of IV fluids; however, the timing of these shortages could not be worse, as the Centers for Disease Control and Prevention (CDC) reported today
in a teleconference that, “overall hospitalizations [influenza] are now the highest we've seen, even higher than in 2014-2015, our previous high season,” and as a result, fluids and IV bags are in high-demand.
Even prior to Hurricane Maria, the United States was already battling challenges with meeting the demand for IV fluids; however, the storm crippled Puerto Rico-based manufacturing sites for materials. In a news release on January 16
, the FDA reported that they were taking additional steps to combat the shortages, such as “asking companies to submit data to extend expiration dates for these products.” They noted that, “if expiration dates can be safety extended [for these products], it would allow some near-expiry product that remains at the hospital level to be used.”
FDA commissioner Scott Gottlieb, MD, also released a statement on the saline bag shortage. Pointing to the issues surrounding the large volume saline bags, small volume IV saline bags, as well as empty IV containers used to compound IV saline, Dr. Gottlieb stated that the FDA is working to improve the bag shortage. Although the institution was able to extend the expiration date of certain products, they have also had to import products from foreign facilities.
Although providing an extended shelf life for IV solutions is a critical strategy
to combat the shortages, overall, it is a Band-Aid that does not solve the bigger supply issues. In his recent statemen, however, Dr. Gottleib noted
that, “[The FDA] has also been proactively engaging with providers, manufacturers, distributors and other partners to identify and address issues impacting other products—like the empty IV containers [previously] mentioned. By engaging with these partners, we can better identify the types of empty IV containers and other medical products that are most in demand.”
What does this really mean for medical providers in the context of patient care?
I sat down with Mary-Margaret Fill, MD, medical epidemiologist with the Tennessee Department of Health and former Epidemiological Intelligence Officer with the CDC. Dr. Fill stated that, “the ongoing IV fluid shortage can create significant challenges for patient care, especially in the midst of the current high-volume flu and norovirus season. Oral rehydration options or therapeutic alternatives may be considered for some patients to ensure that IV fluids are available for the patients that need them most. Other strategies, such as extending IV fluid ‘hang’ times, manually pushing medications and fluids instead of administering them through IV fluid bags or compounding IV fluid solutions may help preserve IV fluid inventories, but should be conducted under the guidance of experienced staff and with appropriate infection control procedures.”
In addition to the IV bag and fluid shortage, a severe flu season has also meant that health care providers are also being met with strains on antivirals and flu testing kits. The current proportion of outpatient visits for influenza-like illness (ILI) is 7.1%, according to the CDC, well above the national baseline of 2.2%. In the past 15 years, these numbers were only rivaled by the 2009 H1N1 flu pandemic which hit 7.7% and the 2002-2003 flu season at 7.6%.
With CDC leadership changes
and a recent announcement of drops in investment in global health security
the intersection of health, disaster, and pharmaceuticals is becoming more apparent and the impacts of one on the other, particularly in the case of natural disasters, can no longer be pushed to the back burner. If we do not take the time on the hospital level to focus on the measures we are taking to ensure we are following even basic hand-hygiene best practices, we will not be equipped to handle future epidemics when they crop up.