Lima Memorial Health System pharmacy technician Holly Wieging prepares medication to be administered to a patient via syringe.
Craig Kelly | The Lima News
LIMA — It has been more than a month since Hurricane Helene left a trail of devastation from the Florida panhandle through Georgia and into the Carolinas and Tennessee, including severe flooding that resulted in numerous fatalities and left houses, roadways and entire communities wiped out.
While recovery and relief efforts persist in those affected areas, a less noticeable impact from the hurricane has been felt not just in the Southeast but nationwide, including Ohio.
Deerfield, Illinois-based healthcare supply company Baxter International operates a manufacturing facility in Marion, North Carolina, about 45 miles northeast of Asheville. During the hurricane, the facility, which is the largest manufacturer of intravenous solutions and peritoneal dialysis solutions in the United States, was damaged by flooding, leading to a shutdown of production.
“We are committed to helping ensure reliable supply of products to patients,” Baxter Chair, President and CEO José Almeida said in a Sept. 29 statement. “Remediation efforts are already underway, and we will spare no resource — human or financial — to resume production and help ensure patients and providers have the products they need.”
The North Carolina plant supplies the majority of these fluids used nationwide, but especially in Ohio.
“So Baxter in North Carolina supplied 60 percent of the national IV fluid solutions and about 85 percent of the solutions that supply Ohio hospitals,” Mercy Health-St. Rita’s Chief Clinical Officer Dr. Matt Owens said.
According to the U.S. Food and Drug Administration, fluids currently in shortage include dextrose solutions in five, 10 and 70 percent concentrations. These are used to help hospitalized patients receive nutrients and carbohydrates. There are also shortages in lactated ringers, a solution used to replenish water and electrolytes, peritoneal dialysis solutions, saline solutions and sterile water.
Outside of hospitals, these solutions are also used in other facilities that use IVs, such as surgical centers or cancer treatment centers.
“It’s not just [for] administering medications,” Lima Memorial Health Systems Chief Medical Officer Dr. Susan Kaufman said. “It’s also used for flushing out a contaminated wound or irrigating the urinary bladder during a surgical procedure or even arthroscopies, like if you’re doing a knee joint and you need to flush out that fluid.”
Given the widespread impact of this shortage, the U.S. Department of Health and Human Services has been working to help mitigate this loss temporarily, including working with Baxter to import IV solutions from additional facilities they have overseas and invoking the Defense Production Act to help get Baxter’s North Carolina facility cleaned and reopened. The HHS has also worked with the U.S. Food and Drug Administration to ease restrictions on compounding certain drugs that are in short supply to help meet the immediate need.
For now, facilities are continuing to work to conserve the supply of fluids they have, which may mean some different approaches to working with patients. This could include providing oral hydration solutions, such as Gatorade or Pedialyte, using smaller IV fluid bags and administering medications via injection, since that uses less fluid.
“Hospital systems collectively have been sharing ideas, resources, documents and plans on how to appropriately conserve some of these solutions so that we can still provide care to those who need it most,” Owens said.
“Our overarching strategy has been to adopt at least a 50 percent reduction in utilization of IVs with a primary goal of maintaining elective procedures,” Lima Memorial Pharmacy Director Brett Randolph said. “Over the past two weeks, we’ve gotten more and more aggressive in our conservation strategies, and we’ve been able to extend our days on hand [supply] and keep us out of that critical nature.”
OhioHealth, which operates the hospitals in Van Wert and Kenton, is also taking “aggressive measures” to conserve its IV fluid inventory, according to a statement from Media and Public Relations Representative Lindsey Gordon.
“The Pharmacy team is working with providers and clinicians to modify existing processes to eliminate waste and preserve inventory and is engaging other health systems and alternative vendors to develop a sustainable mitigation strategy,” she said in the statement. “Patient care has not been impacted.”
Allocations through HHS efforts have also helped to mitigate some of the losses, but both Lima Memorial and St. Rita’s are still running below normal supply levels.
“We’re already tracking that our use of IV solutions has decreased by about 30 percent,” Owens said. “With all of that said, right now, depending on which solution type we’re talking about, we’re receiving anywhere between 40 and 60 percent of what we’re normally purchasing.”
To this point, St. Rita’s has not yet come to the point where minor elective surgeries are being rescheduled, according to Owens, while Lima Memorial is starting to push some of its elective surgeries back where possible to avoid overtaxing the fluid supply.
To that end, especially as flu season is set to ramp up, healthcare providers are encouraging the public to take what they see as common-sense steps to avoid having to go to an urgent care center or an emergency room for treatment.
“Vaccinations are important,” Kaufman said. “They help prevent all that nausea, vomiting and diarrhea from influenza and they help prevent pneumonia.”
Kaufman also recommended staying home when becoming ill to prevent the spread of any ailments and using anti-nausea medications to help keep fluid levels where they should be.
“Of course, they have to consider any chronic medical illnesses they might have,” Owens said. “Some people can tolerate fluids better or worse than others, but the important thing is to be working with their primary care provider to figure out what their hydration strategy should be at home when they’re recovering from an illness.”
Work has resumed at the Baxter facility, but production is not expected to return to full levels until the beginning of the year.
