When we think of essential products in hospitals, many products may come to mind, but saline and sterile water are rarely at the top of our lists. Critical for replenishing lost fluids, flushing wounds, and delivering medicines, saline & sterile water are experiencing some of the most severe supply chain shortages in the industry. Especially useful during this time of year where respiratory infections peak, medical experts say they only have roughly 70% of their typical supply. Given their wide usage, these products have been labeled “unsung heroes” by many hospital and medical professionals - one single hospital reported using over 2000 saline flushes in one day.
Just as we seemed to be taking the first steps towards a semblance of pre-2020 normalcy, the Russia - Ukraine war has further levied constraints on saline and sterile water. The war has led to a number of production and resource reallocations that threaten oil, natural gas, and in turn, the production of plastic for saline bags. As input costs increase while supply decreases, it is no wonder that the largest saline producers are on backorder. Adding to the woes, the ongoing vaccination initiative has led corporations like Pfizer, a producer of both a COVID-19 vaccine and saline vials, to divert hundreds of thousands of their vial supply to support mass vaccinations.
Not our first rodeo
Interestingly, the healthcare supply chain is not unfamiliar to saline and sterile water supply chain shortages given Hurricane Maria’s impact on Puerto Rico in December of 2017. One of the biggest saline and sterile water providers to the United States, Baxter International, bases many of its production lines in Puerto Rico. The factories experienced losses of power, short staffing, and transportation blockages that created a backup in production.
While the Hurricane’s impacts seem less relevant today, it is important to establish some context for how these types of events leave lasting effects on global trade. Prior to the hurricane, neighboring countries heavily relied on sea travel to import saline to their shores. Weather disruptions in Puerto Rico and South Florida prompted a need for buyers to extend far beyond their local regions, relying more on air travel for their goods. The behavior persisted as a means of diversification for some which caused new issues at the start of the 2020 due to the global pandemic. Whereas manufacturers were generally able to export goods on commercial and cargo planes, the shutdown of these services required producers to secure planes specifically for their transport needs. This process increased transport costs up to 600% for some suppliers.
What are the alternatives to saline?
Luckily, there were significant lessons learned from the 2017 shortage, which have helped to lessen the blow on medical settings. Firstly, hospitals can consider using pharmacy prepared infusions to circumvent the reconstitution process. Some medicines can be reconstituted with 0.9% sodium chloride (saline) instead of sterile water, and this remains an option when one product has higher supply than the other. Also, hospitals have explored using alternate routes of administration – in fact, approximately 84.5% of hospital workers indicated that they were using subcutaneous or intramuscular injections and oral medications instead of intravenous infusions. There are also suggestions to switch to premixed drugs that do not require reconstitution at all. Solutions that still use saline note that an alternative to small saline vials is larger saline bags, but even now, those have run out. Hospitals have been forced to sterilize entire rooms to fill syringes with saline, which is not only wasteful, but inefficient, as large bags of saline are only usable for approximately one hour after opening.
What’s the risk in all of these solutions? Doctors are saying that this shortage is not only causing mass inconvenience, but is causing serious safety concerns because saline is known to reduce the risk of bloodstream infections. Short supply is leading pharmacy workers to unsafely prepare flushing syringes in environments that are potentially septic, posing more risk for vulnerable populations. Ultimately, the need to diversify manufacturers and supply chains is more important now than ever, and hopefully these efforts can help to curb the dire impacts of both saline and sterile water shortages.
As ever, it’s critical for supply chain professionals to diversify their supplier base given the uncertainty in global production. Organizations like Inzuri have managed to continuously deliver constrained saline and sterile water products by forming relationships with international manufacturers who are less prone to acute disruptions in the market.
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