key: cord-295322-9kye4w9g
authors: Kumar, Parmeshwar; Killedar, Makhdoom; Singh, Gagandeep
title: Adaptation of the ‘Assembly Line’ and ‘Brick System’ techniques for hospital resource management of personal protective equipment, as preparedness for mitigating the impact of the COVID-19 pandemic in a large public hospital in India
date: 2020-05-22
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2020.05.029
sha: 
doc_id: 295322
cord_uid: 9kye4w9g

nan

The Covid-19 pandemic had a slow start in India due to strict restrictions and screening imposed on foreign travel, but by the first week of March 2020, it was clear that the surgical store of our hospital needed to rapidly ramp up its inventory of Personal Protective Equipment (PPE), well ahead of an anticipated increased transmission. PPE items provided by our regular vendors were not available as complete kits. In addition, some important items such as coveralls were not being routinely procured. Logistical delays from the nationwide lockdown, financial constraints like fluctuating pricing and demands for advance payment as well as regulatory pressure due to caps imposed on purchase quantity and pricing, made it difficult to procure PPE. The supply chain disruption consequent upon limited supply of raw material with manufacturers and export bans imposed by other countries added to the complexity of the issue. Managing the supply chain of PPE in this scenario was difficult and made it necessary to evolve new systems and guidelines to mitigate these conditions. Our hospital responded by bringing together a team consisting of hospital administrators, microbiologists, and clinicians. An equitable model for appropriate use of PPE in various healthcare settings was created, which also reassured and boosted the morale of healthcare workers. It was decided to assemble PPE kits in-house from piecemeal purchases of individual items of appropriate quality. An assembly line was put in place where components of the PPE kit were added in sequence until the final completed product was packed and ready for distribution.

The processes adopted involved the following principles.

The reputation of our institute, large size of advance orders and extensive reach available from previous history of purchases allowed us to attract a choice of vendors. A few components not routinely available in adequate numbers, like hood caps and long shoe covers, were custom-made by reliable manufacturers.

The patient waiting hall was reconfigured to become the staging area for incoming vendor inventory (Figure 1 ). Data Entry Operators and Patient Care

Coordinators were enlisted as assembly line workers. Faculty members volunteered to be assembly line supervisors. 

In the Indian armed forces, a 'Brick System' has been in vogue since the colonial era. A brick is an operationally self contained box for a manpower based unit. It is typically used inventory management of the personal kit issued to each fighting unit and also used by the United Nations Peace Keeping Forces (The UN Brick) [1] . The system also envisages different types of kits required at different levels. This method was modified by a hospital administrator having previous experience in the Indian Army Medical Corps. The number of beds in a given medical unit and the human resources needed to operationalise it were considered a functional unit. The number of PPE kits required per day was ascertained. For laboratories, the monthly requirement was considered. The requisite number of in-house PPE kits for the various wards were then assembled into one brick(a carton) and supplied to that unit on a daily basis. The brick system aids in inventory management by rationalising the indents, keeping track of future requirements and projecting the purchasing of components far ahead of time.

Bricks of varying sizes and levels help in rationing of PPE between different wards based on differentiating essential and elective patients. Availability of smaller bricks helps in downsizing of certain wards in terms of patient admissions or rostering of health care workers based on PPE availability. Computerised records of each brick helps in storage, retrieval, issue and consumption patterns.

Keeping the system ready for all eventualities, based on reports from other countries [2] , disinfection and reuse scenarios were envisaged. Modifications to a number of hospital rooms were carried out for disinfection of different kit components, if found necessary in future. Hydrogen peroxide vapour based disinfection rooms [3, 4] 

Revenue Procurement Practices in the Indian Army. Institute for Defence Studies and

Pursuit of PPE

DuPont Personal Protection Covid-19 supply update (rev 3/25) and fact sheet downloads at

Evaluation of five decontamination methods for filtering facepiece respirators