Managing Personal Protective Equipment Costs – Without Compromising Safety

You're listening to the Phil Klein Dental Podcast. When it comes to buying your dental supplies, everyone is looking to save money. Everybody wants a good deal. But when you're shopping for a medical device like a dental glove or mask, you have to be extremely cautious about whom you're actually buying from. Do you completely trust your vendor? And are you sure you're actually getting PPE that has gone through the rigorous quality control that's part and parcel with an FDA approved and medical grade device? And for those large practices, it's certainly very tempting to order PPE from a distributor like eBay or Amazon that offers the lowest prices. But in the long run, is it really a good deal? How good are those gloves? Were they stored improperly for long periods of time, causing them to deteriorate more quickly? Are they uncomfortable to wear and lack ergonomic design? And also, what are the liabilities that you may face if you order PPE that is not actually medical grade and someone gets ill in yourmary practice through the transmission of a bloodborne pathogen? To help us better understand how to manage the cost and quality of our PPE are two incredibly knowledgeable people, Linda Harvey and Mary Govoni. They are arguably among the best educators, authors, and speakers on the topic of infection prevention and control. Linda, Mary, thanks for joining us on our show. Phil, thanks for having us. Great to be here, Phil. Thank you as well. Yeah, to have the two rock star infection control experts on the same show, it's an honor to me. So we're really very happy to have you both. So Linda, let me start with you. What is driving the cost increases? I find it at this point hard to believe that PPE prices continue to be high as a result of the unprecedented supply shortages caused by the COVID pandemic. I mean, that's now over for several years, but prices are still high. So what's actually going on in the background? As you mentioned, who doesn't remember that supply chain shortage and the associated cost increase? There was a lot of interruption that we saw back during the time of the pandemic. And one of the things that came out of that during the peak of the pandemic and the public health emergency was that there were things that the CDC approved, as well as the Food and Drug Administration, for us to use and kind of bridge the gap. For example, we had a temporary approval to use KN95 masks because of the cost and the lack of. N95 masks in this country, and that was made available through the Food and Drug Administration's Emergency Use Authorization. So what we're seeing now is that there is still some, every now and then you see different shortages in different parts of the country, but I think it's different brands in different areas. They may not be able to get their particular brand this week, but it's not that there's the same crisis that we felt during COVID. But we do know that there are things that can happen outside of our country that impact our prices. For example, China tariffs, they may play a factor in pricing for some of those products that are made overseas. And I can remember for a while, Phil, that receiving newsletters from glove manufacturers talking about sanctions that the U.S. would place on other markets, such as Indonesia, for example, because of their labor practices. And when that would happen, then there would be an interruption in our supply chain as well. So we're seeing a few of those things, not as many as before, but I think there's some increase in costs. is starting to level out a little bit. Yeah. And unfortunately, when you say level out, that means kind of stay where they are. It doesn't mean they come back down to what they were pre-COVID. And this is exactly what's happening in the grocery store. We have an inflationary period and food prices go up. The Fed tries to do everything they can to rein that in by raising interest rates. But the reality is the prices in the grocery store are going to still stay high. They've reached this new level. And as long as consumers are paying for it, the manufacturers, vendors, and distributors will continue to maintain that price until, of course, competition forces them to lower it a bit. I think that's kind of the same situation we're in now with PPE. Although COVID as a pandemic is in the rearview mirror, we're still at a higher price target. I think that's a valid statement, Phil. I certainly do. I think there's not going to be a change in the immediate future. Mary, your thoughts on this? I completely agree with Linda. And I think Linda would agree with me that we see is some of this is perception on the part in terms of supply shortage or some practices will say when we're doing compliance training or compliance evaluations, well, I can't use those N95 respirators if I'm supposed to because I can't get them. Or the perception is that they cost so much more and there still is the misperception that you can reuse them. So there's a lot. of little nuances there. So let me ask you this, Mary, you know, as we all know, getting supplies to the office requires a distributor. And, you know, for the longest time, we had three major distributors, I guess we can call the legacy distributors. And then there were some smaller dealers that you could order your supplies from. So what's happening? in that space? What's the trend right now? And how does that change the playing field as far as getting access to PPE supplies from different sources? We've heard and we've seen some reports that some of the legacy suppliers are seeing a downward trend in sales, not major, but I think that they're aware that they're losing some of their sales to other smaller vendors we also see the trend in sometimes the name brand of supplies gloves for example so instead of a halyard brand glove someone's looking for something that maybe is a private labeled brand or a lesser known brand that they'll use because they are less expensive they're looking at decreasing their costs but they don't necessarily always get the same quality if they like a particular type of glove and it's the one that really fits them best and and doesn't you know they don't experience punctures and those types of things then in the past many of our practitioners out there were willing to stick with that brand and it wasn't until the cost went up so much that they said oh well I guess I just have to do away with that and now go to a lesser kind of a brand. And one of the things that Linda and I have both noticed is that there is just a plethora of new online dental suppliers that they seem to be just coming out of nowhere. Now, it doesn't mean that they're not. credible that they're not good businesses to work with. But I think for someone from a dental practice who's trying to really keep their PPE costs down, if they're strictly buying on price and they don't really know, is that an offshore company? Is it a U.S. company? What would happen to them if they had to return the goods? Do they have to pay for shipping? So the price may be lower. than what I might pay at one of the big three, as you say. But I might also, as a preferred customer with one of the big three, get reduced or maybe even free shipping on my goods. So again, there's all those little nuances that are happening out there. But it's a little scary to see all these little suppliers out there selling products that we don't know are necessarily legit, FDA cleared that they may not be a gray market copycat kind of product. Yeah. And one of the things, and I'm going to get to you in a second, Linda. But one of the things that's really important for dental practice to understand is that sometimes the packaging of these, for instance, let's use gloves, for example. The box comes, looks exactly the same, but that manufacturer is sending these empty boxes out for bid to 12 different companies in China, for instance, or other countries to pack those boxes up. to the best specifications that they can to meet what the manufacturer is looking for. But of course, the quality control as compared to the better brands may not be as good and often is not as good. Some boxes come back to the dental practice and they're pretty good. And then others are not. So it does take a little bit of time for that practice to realize that the quality of their PPE is not consistent. And I think that's what Halyard and other companies like Halyard and quality distributors, who you can trust, bring to the table. Linda, did you want to mention something? Phil, I want to say the quality and going further into the comfort is the ergonomics. So are you compromising your physical health and your long-term career in our profession over inexpensive gloves that aren't legitimate? So Mary, what do quality manufacturers like Halyard do to ensure that, of course, the glove serves as a excellent barrier protecting the operator from bloodborne pathogens and so forth and maintains its integrity during the procedures, but also is comfortable and ergonomic, which is so important for the operator to practice dentistry. That depends on the manufacturer. And I know that Halliard and a couple of others are very dedicated to making sure that when those gloves are manufactured, they use the type of form or a mandrel that they put that material on that forms the glove has actually the hand in a flexed position. So if the hand that the model or the mandrel that they use has the hand perfectly flat, then there's really very little flex that can happen in the glove without causing pressure, especially at the base of the thumb. So if it's in a little more flex, not quite a claw-like position, then you've got the flex already built in. And that's what... don't even realize that that's there, that that's built into the glove, if you will. But they can tell immediately when they put them on, oh, wow, this fits good. It doesn't constrain my hand. Linda, talk to us about the online retailers that sell dental supplies. And I know Mary mentioned the legacy. the large, you know, multi-billion dollar distributors that we're also used to over the last number of decades. And now Amazon and eBay are now selling dental products. And not that long ago, some of the legacy distributors were concerned about Amazon really, really eating their lunch. That didn't really materialize where that's a big deal. And part of it is service. The major dealers provide service for the practices. How do these Ebays and Amazons of the world fit into the equation of buying PPE for dental practice? Phil, this is a huge concern of mine. And the fact that any online retailer, non-dental retailer can sell, supposedly sell, I would say allegedly sell dental supplies. We don't know if they're legitimate or not. And once again, the packaging may look the same, the boxes may look the same. And if we can use the analogy of... down the street in New York City and there's folks on the corner selling Louis Vuitton handbags and other brand names. You can't hardly tell the difference, perhaps, if you don't really know the product. So are the lot numbers legitimate? You know, are these really credible products? And so we really should not be trusting sources like that to purchase PPE or, in my humble opinion, other dental supplies. When you think about, I looked up something the other day on Amazon just to kind of get an example of what was there. And I saw some. one of the top name brand cassettes being sold there. I know it's not PPE for the sake of our conversation, but as just a general example, I'm thinking it doesn't even list the manufacturer. Who are you actually buying this from? So why would you choose to buy something that looks like the real thing when you really don't know and there's no warranty behind it? So you go back to the original manufacturer that you think made that product, that PPE, that cassette or whatever the product is, and there's not going to be anything behind it. So if you have a product liability issue with the patient, and the patient's injured or claims injury, or there's some allergies or some unknown outcome, then you won't have a credible leg to stand on. And that's what I call lack of defensible documentation. Yeah. And I think this is a good point because we all have to realize that Amazon, a hugely successful operation, primarily their fiduciary responsibility is to the vendor, not the consumer. And people don't realize that. They're out there listing these items by the gazillions. And they're out there to make the vendor money and incentivize vendors to participate in their program. And of course, it's consumer beware, as far as I'm concerned, when you buy from Amazon. But for the most part, the things we're buying on Amazon are safe to buy. And you can return them and no harm done. But when you're talking about a medical grade product, that's a whole different ballgame. Because like you said, Linda and Mary. There is liability involved. And for you not to be able to prove that this is not a gray market item is going to be difficult. I'm not sure how prevalent gray market or fake items are. We talk about it a lot. Does anybody know the pervasiveness of these kinds of products that are actually marked 3M, for instance, but 3M had nothing to do with it? I don't think we have, again, any quantifiable evidence, but I do know that I've talked with several manufacturers in the last couple of weeks that have said, like Linda said, they found their products out on eBay and Amazon, but they don't know how they got them. There are a couple of them that have actually ordered restorative materials that came. And they were packaged in, again, the legit package. And it's sort of like the analogy that you used earlier with the gloves. They had the legit packaging, but then they opened up the packages and it was not their restorative material. Or it's in another language. They cannot read the instructions. There are just all kinds of... things that are happening. And when we don't know where these products are sourced from, that becomes a huge liability. And what also is concerning is if there's a recall on a medical grade product, like a glove or a mask, for whatever reason, if you purchase it from a reputable distributor, you obviously will be notified in a very timely fashion. They'll take it back. I'm not sure how that would work on a non-dental online entity. Amazon's pretty good about that, but with these kinds of medical-grade products, I'm not sure. There's no guarantees that the buyer will be notified that these products have a defect in them and they have to be recalled. So tell us more, Mary, about the concerns on the infection control level when you're using PPE products specifically that have not undergone quality control measures. up to the level that reputable companies provide. If these products have not been FDA cleared and, or they may have an FDA clearance for use in another setting, in another type of setting, you then are not using. what is appropriate, what you are legally required to use in conjunction with patient care, that it is FDA cleared as a medical device. So a mask, gloves, those types of things or pouches. That's another thing that, you know, folks are just. going to all different kind of retailers and shopping on price on pouches not understanding that perhaps the indicators that are built into the pouches may not be effective or they may not be even, again, FDA cleared or they may not even function. And so they buy these things in big quantities because they got such a good price. And then they find out maybe even that the products are expired. They're no longer effective. So there's all kinds of issues, liability issues related to that, that I think many practices, if they're only shopping on price are not thinking about, is this authorized? If I bought a sterilizer, for example, from eBay, how do I know that it's been FDA cleared? How do I know? And I certainly am not going to get any kind of a warranty when I buy it. And I'm not necessarily going to take a chance on something like that. I wouldn't. Many practices do. But even things like handpieces. a management consultant a while ago who was in a client office wanting to know if I could contact a manufacturer that I work with and ask why this ultrasonic scalar tip kept bending when they were using it. It was brand new. They took it right out of the packaging that looked like it came from a manufacturer. However, it was purchased. on amazon and it was truly a fake it was made to look like a name brand product but it was not so this is truly a buyer beware situation um and i would question you know if you bought this PPE or again, in this big quantity, how much aggravation are you going to have to go through now to return it? Are they going to take it back? And how much money are you out waiting to get a refund if you're even going to get one for buying all of those products? And I also want to bring up efficiency. When you're buying a premium product, you are... able to take advantage of the product where it actually brings you efficiency in your practice. For instance, the cassette wraps that are made by Halliard, for instance, I think they're the only ones available. They are double lined and they're not much more expensive than anything you would get anywhere else if you were buying on price. So that wrap that goes around the cassette, you only have to wrap at one time. So if that product is the same price or even less expensive than some of the other products available that you think you're getting a great deal on, you have to use twice as much. So there's efficiency factors involved when making these purchasing decisions as well. It is a Halyard product and the price differential is not that great. And in many cases, there are practices that don't know, they don't research to see. First of all, they don't know that they need to have either two-ply or two separate wraps, and so they may only be using one, so then they're using it incorrectly. They're not necessarily protecting the sterility of their instruments when they go into storage, but that's a huge advantage with that halyard wrap that it is two-ply and I can wrap once and I'm done. Those are things that you have to start looking at when you're talking about quality products and return on investment, especially for the larger practices that go through tons of this PPE. But for many large practices, the incentive is to buy on price because they use so much PPE. So what are some of the strategies, Linda, that large practices can utilize in order to keep their costs down and also continue to use premium PPE products? So one of the things these large group practices can do, and even our individual practices, is sit down and negotiate with your current supplier, your favorite supplier, the one you've been working with for a long time, or maybe it's that supplier that helped you open your practice and they've been a trusted resource for you for a long time. Don't just walk away because of price. Sit down and have that conversation. It might be difficult, but you never know what kind of flexibility there can be there when that happens. So sticking with the brand names is very important. If they're going to buy online, make sure that they have... vetted the support, the online supplier. Don't just rely on third-party endorsements. Do your own research. I'm a really big fan of that. Do your own research. Make sure that even if they're backed by an organization or association that you trust, you just never know. I know they try to do their due diligence, but I want to take us back to a time during the peak of the pandemic when even the Washington State Hospital Association got fooled. They thought they were buying a quality, N95 masks in bulk. They thought they had vetted the distributor. They took possession of the product and found out they were all fake. Now, here's a big hospital association saying there were tens of thousands of masks for all their hospitals who so critically needed N95 masks. So that's a huge example. So you have to be very, very careful. Always research, always research. Don't just buy on prices. Mary and I have been talking about. Make sure you understand that the gray market is not a safe market. Yeah, I think the CDC during COVID, correct me if I'm wrong, had some website listing legitimate mask numbers or something. They had some NIOSH approved list. They did. Yeah, that some people didn't look at. But it said, listen, if your mask doesn't have these numbers on it, they're fake. Is that what was going on back then? They did have that. And they had a list of FDA. approved KN95 mask under the EUA. And when the Food and Drug Administration first published that list, it was a very long list. I'm going to say nine pages are longer, Mary might remember exactly. And then all of a sudden, when they went back and started doing more research on these companies, that list shrunk tremendously because they realized that those products, many of them were fake. They didn't meet any requirements at all. So they had to go back and retract. So there was a lot of things that were happening at once that were very confusing. So in the five minutes that we have left, let's start with you, Linda. Give us a verbal cheat sheet for some of the things we can do to get quality products, quality PPE, and not overpay. So right off the bat, there's two things that I would suggest. And that is create a short list of your trusted brands. Shop for those at different places if you need to, like the halyards of the world. And second tip is... The dental knowledge. Who's driving the expenditures in the practice? Is it someone that truly understands what infection control is all about? Or maybe is it your CPA who's saying, oh, your supply costs, this is where you need to cut money? Or is it somebody who you've trusted in your practice who's brand new to dentistry and doesn't have the background? So know who's driving the expenditures in the practice. Mary, your thoughts on this? Well, I always tell practices, don't look at cutting infection control costs first if you're looking at cutting supply costs. Look at other things. Can we cut back on office supplies? Do we need to do so much printing and use so much ink? There's a great way to cut back on some supplies. But infection control shouldn't be where we start because that's the backbone of... patient safety that we provide, but it's also the backbone for our safety to continue to be able to provide that oral care, oral health care to patients. Many of the state dental organizations and other groups out there are establishing buying groups. And so if that's something to look at, but then does the buying group vet the vendors? And so there's there's a little bit of risk there. So you have to vet the buying groups and vet the vendors, but just... on price. It doesn't matter. There are some people that think a glove is a glove is a glove. And I agree with what you said earlier, Linda, that they may not be the appropriate person. Maybe it's the infection control coordinator or the OSHA coordinator who takes charge of the PPE orders so that we know we get appropriate things and that maybe they're incentivized in some way, if that makes sense for. the hard work that they do to research and vet and find the best prices on the products that we like. It seems to me that there needs to be someone held to account, like the ICC, the Infection Control Coordinator, to make these decisions because, like you said, if you put an accountant up to it or an office manager, nothing disparaging against an office manager, but if their goal is to save the office money, if that's their incentive on buying supplies, they're going to be looking strictly on price. But if the ICC is involved, like you just mentioned, and they're held to account on the quality of the supplies for PPE, they're going to be looking at price. But they'll also say we can't cross this red line because there's too much risk. We're treating patients. We have employees. We must focus on patient safety, employee safety, and minimize the risk of bloodborne pathogens. There's too much at stake. So excellent discussion. I think you covered a lot of great points and really do appreciate both of you coming on together to do this. It's a very important topic. Thank you so much. Thank you, Phil. Thank you, Phil.