| A Baxter International manufacturing plant that was flooded from Hurricane Helene at the end of September is back online and it's ramping up production. The outage caused massive shortages of intravenous fluids across the country, sending hospitals into a state of crisis. But it also showed us that health care facilities could make changes to their procedures in order to use fewer IV bags. In addition to its own US manufacturing, Baxter is also importing IV bags from overseas and other companies have increased production. The US government has also helped. Still, over a month later, some hospitals are getting fewer supplies than normal. The lessons learned during this crisis are likely to have a lasting impact on medical practice just as they did during other emergencies, such as Hurricane Maria or Covid-19. The plant made 60% of IV bags used in US hospitals, which serve myriad functions — they're necessary for surgeries, help feed patients who can't eat by mouth and aid in administering antibiotics and another drugs. After the hurricane, hospitals scrambled, postponing some procedures and figuring out how to conserve supplies. Some of those conservation methods demonstrate that hospitals may have been using more than they needed to in the first place. At Inova Health System in northern Virginia, the number of bags used each day plummeted over 50% at the beginning of October, dropping from about 2,100 to just 1,000, says Sam Elgawly, Inova's chief of resource stewardship and hospital medicine, who has been helping to lead the system through the shortage. Despite this drop, Elgawly says that Inova hasn't postponed elective surgeries, like many others have. Doesn't that mean Inova was using twice as much IV fluid as it needed to?
"Not exactly, but that's not entirely an unreasonable thing to say," Elgawly says. Some of the changes Inova is making to manage the crisis might continue after it's over, Elgawly says. For example, medical staff are now more intentional about how long they administer IV fluids. And some medicines that were previously administered as IV drips — where a bag sits on a hanger and the fluid slowly flows into the body — could be given instead as IV pushes — where the medicine is injected directly into the IV line, without the need for a bag. Inova has been doing that with some antibiotics and acid blockers, Elgawly says. "A good portion of this stuff is here to stay," he says. — Ike Swetlitz | 
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