OR Today COVID-19 Digital Supplement

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COVID-19 VIEW NOW

In the Midst of a Global Pandemic Healthcare Leadership Support on Hold PAGE 6

Organizations Provide COVID-19 Resources PAGE 14

Computer Model Enables Protective Ventilation PAGE 24


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To all healthcare workers on the front lines… we see you. We are inspired by you. You are at the heart of patient care and supporting your dedication and resilience is our promise to you. Preparing to begin again can be challenging and we offer our educational resources for SPD, the O.R., and endoscopy on our website at www.keysurgical.com/education. We are here for you, so you can be there for them.


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DIGITAL SUPPLEMENT TABLE OF CONTENTS P.6 In the Midst of a Global Pandemic Healthcare

P.17 Safely Resuming Elective Surgery as COVID-19 Curve

Leadership Support on Hold

Flattens

P.8 Largest COVID-19 Study of Hospitalized Patients in U.S. P.18 GE Healthcare Deploys Remote Patient Data Monitoring Links Comorbidities to Acuity

Technology to Support Most Critical COVID-19 Patients

P.9 ASP Granted FDA EUA Allowing Decontamination of

P.19 AAAHC Publishes New Resource for Adult Depression

N95 Respirators

P.11 Expert U.S. panel develops NIH treatment guidelines for COVID-19

P.21 Unique System for Using UVC Light to Sterilize Masks in Bulk Developed

P.22 Healthmark Offers New COVID-19 Signs

P.13 SIPS Consults Remains Here For You

P.24 Computer Model Enables Protective Ventilation

P.14 Organizations Provide COVID-19 Resources P.15 U.S. Army Doctors Invent COVID-19 Isolation Chamber

P.27 Sterile Processing Platform Address COVID-19

to Protect Hospital Staff

Pandemic

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WEBINAR SERIES

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COVID-19 Digital Supplement

In the Midst of a Global PandemicHealthcare Leadership Support on Hold By DAVID TAYLOR, MSN, RN, CNOR and BRIAN ARNDT, MBA, BSN, RN, CNML

For every major crisis that has occurred over the last 80 years, Gallup has studied how citizens’ around the world reacted to those crises. From every crisis one thing stood out more than anything else and that was leadership. Leadership that provides a clear path forward and assures their people that their contributions mattter.1 Yet, in the background of the COVID-19 pandemic, health care leadership recruitment is at a standstill. After speaking with representatives from two national health care organizations and several nursing recruiting agencies which specifically focuses on leadership roles, the message was the same, we are not hiring. A recent LinkedIn search uncovered over 65,000 vacant nursing leadership positions throughout the U.S. While numerous health care leadership

6 | OR TODAY | COVID-19 DIGITAL SUPPLEMENT

positions remain unfilled, nurses at the bedside are struggling to manage patient care activities while staying informed as hospitals rapidly change protocols to match the ever-escalating threat of COVID-19. Leaders are a conduit for communication and responsible for translating an organization’s response under these circumstances. However, without direct supervision of a tenured leader communication failures abound and under the current situation only 39% of U.S. employees found their employers were communicating clear and actionable goals.1 Across the country, health care workers are attempting to stay informed as hospitals rapidly change their protocols to match the ever-escalating threat of COVID-19. While

David L. Taylor, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and principal of Resolute Advisory Group LLC, in San Antonio, Texas. He may be reached at David@ResoluteAdvisoryGroup.com.

Brian Arndt, MBA, BSN, RN, CNML, is an independent consultant and health care leader with over 20 years’ experience in critical care. He may be reached at arndtbk1@gmail.com

sourcing and hiring available nursing leadership is at a standstill, it is no wonder 52% of employees feel their immediate supervisors are keeping them up-to-date about the organization as it relates to their lives in relation to the pandemic.1 Because health care organizations are so acutely focused on the disaster management and the ever-changing WWW.ORTODAY.COM


At a time when leaders need to increase their bandwidths and spend more time with staff, they are inadvertently limiting themselves. This crisis is without a doubt worth attention, but it also needs to be considered that businesses like health care – unlike traditional consumer goods –are continuous in their nature.

response to COVID-19 they are neglecting to fill the positions needed to support not only the leadership of the organization, but managing the care of those affected. Recruitment teams from health care organizations as well as recruitment agencies can work from home and source qualified candidates from across the U.S. to help during this crisis. Leaders can fill the gaps and provide insights and perspective to an ever-growing problem. They are nurses too, and can provide direct patient care as needed, provide respite to someone who has worked long past their shift. During times of crisis, courageous individuals come together to get the job done. Around the world, medical professionals are enlisting their services to lend a hand, even coming out of retirement. However, in Texas one large hospital system canceled all of its job requisitions for operating room (OR) personnel. Personnel that could provide services in other areas while the COVID-19 crisis escalates across the country. Those who come out of retirement during these stressful times may be willing to stay on after the crisis and help fill shortages organizations have had a hard time filling. Some of this may be in part due to the various state travel restrictions, social distancing, stay-at-home orders and closures that continue to evolve. Others are simply a response to budgetary concerns and the workload of current organizational leaders. MeetWWW.ORTODAY.COM

COVID-19

Digital Supplement

ing the immediate needs of the staff and patients have filled every vacant minute in the day, and that they don’t have time to fill the positions required to give themselves a breather. At a time when leaders need to increase their bandwidths and spend more time with staff, they are inadvertently limiting themselves. This crisis is without a doubt worth attention, but it also needs to be considered that businesses like health care – unlike traditional consumer goods –are continuous in their nature. A specific company may be purchased or dissolved, but the business of caring for the public health is never ending. The COVID-19 crisis will eventually end. There is a finish line to the crisis, but at the end the health care teams will have to immediately resume normal operations and must have the resilience in leadership to lead the staff from crisis to normality. If we exhaust our leaders, they will not lead effectively and the organization will suffer. As the crisis drags on frequent feedback sessions, communication and hands-on support from leaders may be as important as rest and protective equipment.2

In addition, leaders can provide a watchful eye and close monitoring of staff and other leaders to help minimize the effects of prolonged stress. Active leadership involvement in the inpatient and support areas is essential. The organization’s health, financial and otherwise, depends on its leaders. Well-meaning leaders in a time of crisis can neglect filling the very positions that increase their leadership range and allow them to better connect with staff.

Takeaways

2. Supporting the Health Care Workforce During the COVID-19 Global Epidemic. https://jamanetwork.com/journals/jama/articleabstract/2763136

During times of crisis, leaders provide stability and provide calm during the most arduous times of our lives. They also provide direction and can begin preparing for life post crisis.

References 1. COVID-19: What Employees Need From Leaders Right Now. https://www.gallup.com/ workplace/297497/covid-employees-need-leaders-right. aspx?utm_source=workplacenewsletter&utm_ medium=email&utm_ campaign=WorkplaceNewsletter_ Apr_04072020&utm_ content=whatemployees-cta-1&el qTrackId=456fed5f0c59447fb42 b47e5250b2cc4&elq=9459fc656 337435ca931db33ea493891&elq aid=3735&elqat=1&elqCampaign Id=818

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COVID-19 Digital Supplement

Largest COVID-19 Study of Hospitalized Patients in U.S. Links Comorbidities to Acuity Analyzing the electronic health records (EHR) of coronavirus disease 2019 (COVID-19) patients hospitalized at New York State’s largest health system, a team of researchers uncovered several comorbidities as a key factor in the acuity of the disease, according to a report in The Journal of the American Medical Association (JAMA).

The Northwell Health COVID-19 Research Consortium, with support from the Feinstein Institutes for Medical Research, described the clinical course and outcomes of 5,700 Northwell patients hospitalized with COVID-19 – the largest hospitalized patient cohort to date from the United States – between March 1 and April 4. The Northwell Health Covid-19 Research Consortium’s findings, published in JAMA, demonstrate that hypertension (57 percent), obesity (41 percent) and diabetes (34 percent) were the most common comorbidities in the COVID-19 patients studied. Patients with diabetes were more likely to have received invasive mechanical ventilation, received treatment in the intensive care unit (ICU) or developed acute kidney disease.

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Of the 2,634 hospitalized patients for whom outcomes were known, 14 percent were treated in the ICU, 12 percent received invasive mechanical ventilation and 3 percent were treated with kidney replacement therapy. Twenty-one percent passed away while 88 percent of individuals receiving mechanical ventilation died. To read the JAMA paper – for which Safiya Richardson, MD, MPH, assistant professor at the Feinstein Institutes, is the first author – click here. “New York has become the epicenter of this epidemic. Clinicians, scientists, statisticians and laboratory professionals are working tirelessly to provide best care and comfort to the thousands of COVID-19 patients in our Northwell hospitals,” said Karina W. Davidson, PhD, MASc, professor and senior vice president at the Feinstein Institutes. “Through our consortium, we will share our clinical and scientific insights as we evolve the ways to care for and treat COVID-19 patients.” The majority of patients in the study were male, and the median age of all patients being treated was 63 years old. At triage, about of third of all patients (1,734) presented with a fever, 986 had a high respiratory rate and 1,584 patients received supplemental oxygen. On average, patients were discharged after four days. The mortality rates were

higher for male patients than female at every adult 10-year age interval. The data were collected from the enterprise electronic health record reporting database and also consisted of patient demographic information, home medications, triage visits, initial laboratory tests, initial electrocardiogram results, diagnoses during the hospital course, inpatient medications, treatments (including invasive mechanical ventilation and kidney replacement therapy), and outcomes (including length of stay, discharge, readmission, and mortality). “Dr. Davidson and the Northwell Consortium research team provide a crucial early insight into the front line response to the COVID-19 outbreak in New York,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes. “These observational studies and other randomized clinical trial results from the Feinstein Institutes will improve the care for others confronting Covid outbreaks.” Research conducted at the Feinstein Institutes would not be possible without philanthropic support. In this most challenging moment in health care, we rely on supporters to provide resources for physicians and scientists to better understand COVID-19 and conduct research that benefit our patients. To support our research efforts, please click here. WWW.ORTODAY.COM


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ASP Granted FDA EUA Allowing Decontamination of N95 Respirators Advanced Sterilization Products (ASP) has received Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA) for the use of STERRAD Systems to decontaminate compatible N95 respirators.1 Utilizing equipment already available onsite in many U.S. hospitals, STERRAD Systems could collectively reprocess millions of compatible N95 respirators daily. The EUA designation was granted based on ASP’s reprocessing protocol that allows single-use compatible N95 respirators to be decontaminated and reused twice after initial use. The FDA-authorized fact sheet, health care facility and health care professional instructions for use (IFU) are available on the company’s COVID-19 resource hub to ensure the efficient implementation of the reprocessing protocol amid the COVID-19 crisis. In addition to the U.S., emergency use status has been obtained for the use of STERRAD Systems to decontaminate compatible N95 respirators and equivalents in the European Union, New Zealand, Canada and Japan. “We are pleased to have received EUA for the use of STERRAD Systems – a technology that is readily available across many sites throughout WWW.ORTODAY.COM

the country and provides an effective solution to the PPE shortages that our health care providers are facing,” said Dominic Ivankovich, president of ASP. “Our hope is that this will make an immediate impact for all our heroes at the frontline of this pandemic.” ASP sterilization systems and disinfectant solutions have been tested against enveloped viruses, the family of viruses that includes coronavirus, and have been demonstrated to be efficacious against those viruses. To determine whether compatible N95 masks/respirators can be reprocessed in STERRAD Systems and maintain their functionality, while remaining safe for use after hydrogen peroxide vapor exposure2, ASP (in partnership with key N95 respirator manufacturers) initiated testing on functionality (filtration plus form/fit) and to ensure H2O2 residuals did not pose risk to the wearer after decontamination. Those results indicated form, fit and function of tested N95 respirators was maintained through two (2) cycles of reprocessing in STERRAD Systems and cycles.3 Health care professionals struggling with PPE shortages may already have access to STERRAD Systems each capable of reprocessing over 400 compatible N95 respirators per day. Millions of compatible respirators could be decontaminated onsite at U.S. health care facilities each day to help

health care professionals combat the spread of COVID-19. Visit asp.com for complete and up-to-date information on PPE reprocessing, including an updated list of compatible masks and instructions for use of the compatible N95 respirators reprocessing protocol.ASP STERRAD Sterilization Systems have neither been cleared or approved for the prevention of COVID-19 infection. ASP STERRAD Sterilization Systems have been authorized by FDA under an EUA. ASP STERRAD Sterilization Systems are authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of the ASP STERRAD Sterilization Systems under section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner. 1. Testing showed after 60 minutes in an open pouch, H2O2 residuals were <1ppm, a generally accepted exposure limit (OSHA Standard Number 1910.1000 Table Z-1 and NIOSH Pocket Guide to Chemical Hazards). 2. https://multimedia.3m.com/ mws/media/1824869O/decontamination-methods-for-3m-n95respirators-technical-bulletin.pdf

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Expert U.S. panel develops NIH treatment guidelines for COVID-19 “Living document” expected to be updated often as new clinical data accrue. A panel of U.S. physicians, statisticians, and other experts has developed treatment guidelines for coronavirus disease 2019 (COVID-19). These guidelines, intended for health care providers, are based on published and preliminary data and the clinical expertise of the panelists, many of whom are frontline clinicians caring for patients during the rapidly evolving pandemic. The guidelines are posted online (covid19treatmentguidelines. nih.gov) and will be updated often as new data are published in peerreviewed scientific literature and other authoritative information emerges. The guidelines consider two broad categories of therapies currently in use by health care providers for COVID-19: antivirals, which may target the coronavirus directly, and host modifiers and immune-based therapies, which may influence the immune response to the virus or target the virus. The panel’s conclusions about treating COVID-19 with various agents that fall into these two classes of therapies are distilled in summary WWW.ORTODAY.COM

recommendations. Subsequently, the document provides background information about each agent — such as clinical data about its use, ongoing clinical trials, and known interactions with other drugs — that forms the basis for the recommendation. Tables briefly outline the same information. The guidelines also describe the evaluation and stratification of patients based on their risk of infection and severity of illness. Recommendations in this section address best practices for managing patients at different stages of infection, for example: Outpatients who are either asymptomatic or who have mild to moderate symptoms and are self-isolating Inpatients with severe illness or critical disease Special considerations for pregnant women and for children who are infected are also included. A comprehensive section of the guidelines addresses a range of considerations for clinicians caring for the most critically ill hospitalized patients. This section includes multiple recommendations for patients needing critical care, including infection control procedures, hemodynamic and ventilatory support, and drug therapy.

Finally, the guidelines include recommendations concerning the use of concomitant medications. These include statins; corticosteroids; nonsteroidal anti-inflammatory drugs; and certain drugs used to control hypertension, known as ACE inhibitors and ARBs. The treatment guidelines panel is co-chaired by Roy M. Gulick, M.D., chief of the Infectious Disease Division at Weill Medical Hospital of Cornell University, New York City; H. Clifford Lane, M.D., clinical director of the National Institute of Allergy and Infectious Diseases, National Institutes of Health; and Henry Masur, M.D., chief of the Critical Care Medicine Department at the NIH Clinical Center. Members of the guidelines panel, appointed by the co-chairs, were chosen based on their clinical experience and expertise in patient management, translational and clinical science, and/or the development of treatment guidelines. They include 30 experts drawn from U.S. health care and academic organizations, federal agencies, and professional societies. For more information about NIH and its programs, visit www.nih.gov.

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SIPS Consults Remains Here For You By the numbers, survivors of the coronavirus (COVID-19) pandemic exceed 516,675 worldwide. These amazing success stories were made possible because healthcare professionals did their job. You and your colleagues put your own families and lives on hold while you tended to the sick and needy, you dug deep within your very soul to muster the strength and endurance to return to a place that you

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recently left only a few hours ago. You internalized the pain and hurt of many and gave them hope to fight. The compassion you bestowed gave your patients a fighting chance, and we at SIPS want to thank you for your amazing efforts. As we return to elective surgeries and the post-COVID-19 scheduling, SIPS Consults remains here for you. Whether via staffing, consulting, outsourcing, or education, we are aware that things may remain challenging as we transition

out of crisis mode. We appreciate you remaining in this fight and remaining on the front lines. In an effort to provide SPD support during this time, we have created a 24/7 complimentary helpline with subject matter experts readily available to support your department. We encourage you to call us with any SPD questions or inquiries. To speak with one of our dedicated consultants, please give us a call at 214-862-3664 or 917-858-5276.

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COVID-19 Digital Supplement

Organizations Provide COVID-19 Resources Staff report

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in December 2019 in China and has since spread globally. The World Health Organization (WHO) declared the 2019-20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) on January 30, 2020 and followed that by declaring it a pandemic on March 11, 2020. There are more than 2 million confirmed cases worldwide with more than 867,000 confirmed cases in the United States that have resulted in at least 48,900 deaths. Common symptoms include fever, cough and shortness of breath. Other symptoms may include fatigue, muscle pain, diarrhea, sore throat, loss of smell and abdominal pain. The time from exposure to onset of symptoms is typically about five days. While the majority of cases result in mild symptoms, some progress to viral pneumonia and multi-organ failure. The virus is primarily spread between people during close contact, often via small droplets produced by coughing, sneezing or talking. While

these droplets are produced when breathing out, they usually fall to the ground or onto surfaces rather than being infectious over long distances. People may also become infected by touching a contaminated surface and then their face. The virus can survive on surfaces for up to 72 hours. It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease. Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), covering coughs and sneezes with a tissue or inner elbow, and keeping unwashed hands away from the face. Currently, there is no vaccine or specific antiviral treatment for COVID-19. Management involves treatment of symptoms, supportive care, isolation and experimental measures. The COVID-19 pandemic is a strain on the world’s health care systems and workers. Many organizations, including some within the U.S. government, provide online resources to empower the public and health care professionals. Websites with helpful information and links include:

14 | OR TODAY | COVID-19 DIGITAL SUPPLEMENT

• World Health Organization (WHO) https://www.who.int/emergencies/diseases/novel-coronavirus-2019 • United States Government https:// www.coronavirus.gov/ • Food and Drug Administration (FDA) https://www.fda.gov/emergency-preparedness-and-response/ counterterrorism-and-emerging-threats/ coronavirus-disease-2019-covid-19 • Centers for Disease Control and Infection (CDC) https://www.cdc.gov/ coronavirus/2019-ncov/whats-new-all. html • CDC (for healthcare professionals) https://www.cdc.gov/coronavirus/2019ncov/hcp/index.html • ECRI https://www.ecri.org/coronavirus-covid-19-outbreak-preparednesscenter • AAMI https://www.aami.org/newsresources/covid-19-updates • The Joint Commission https://www. jointcommission.org/covid-19/ • Johns Hopkins University & Medical https://coronavirus.jhu.edu/map.html • APIC https://apic.org/covid19/ • IAHCSMM https://www.iahcsmm. org/resources-covid19 • ASCA https://www.ascassociation. org/home • AAAHC https://www.aaahc.org/ • OR Today https://ortoday.com/

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U.S. Army Doctors Invent Isolation Chamber to Protect Hospital Staff Credit US Army illustration via TechLink

Army doctors working at hospitals within the Defense Health Agency have prototyped an isolation chamber that can be placed over the head and chest of patients diagnosed with COVID-19. The Agency has asked the FDA for an emergency use authorization, paving the way for rapid implementation to help protect health care providers on the front lines of the pandemic. The “COVID-19 Airway Management Isolation Chamber” is a barrier device constructed by draping clear plastic sheeting over a box-like frame made of common PVC piping. The chamber captures and removes viral particles emitted from a patient’s nose and mouth using a flow of air or oxygen, which comes in through holes in the piping on one side and is sucked out by a vacuum on the other. Vacuum lines are common features in hospitals, but even if one is not available, a vacuum pump and HEPA filter can be easily connected to the device. The chamber was invented to supplement standard personal protective equipment used by doctors and nurses by creating a safer environment for performing airway management from examination to intubation. Intermediary airway management represents those options a health care provider might use prior to intubation. In making these intermediary options safer and more available, the WWW.ORTODAY.COM

Two ports are used in this version of the

use of the CAMIC may allow invention. The first port is connected to a patients to avoid the need for positive-pressure air or oxygen source. A secintubation altogether. ond port is connected to a vacuum line. The Among the inventors, are vacuum line may feed into an in-line HEPA Maj. Steven Hong, Cpt. Timofilter or to the building’s exhaust system. thy Blood, and Cpt. Jonathan Perkins at the Walter Reed National Military Medical Center; Maj. U.S. Patent and Trademark Office. Douglas Ruhl, at Madigan Army Medical “It was impressive to see several Center; Nathan Fisher at the Army’s DOD departments understand the Telemedicine & Advanced Technology importance of this concept and make it Research Center; Maj. Charles Riley at a priority to help expedite reviews and Fort Belvoir Community Hospital; and approvals,” Ruhl said. 2nd Lt. Joseph Krivda at the Uniformed TechLink, the Department of DeServices University of the Health Scifense’s national partnership intermediary ences. for technology transfer, is seeking U.S. “Clinicians at both hospitals spent companies and entrepreneurs to review many sleepless nights and weekends and license the invention for manufactoying with designs and testing models,” turing from the U.S. Army. Ruhl said. “The device can also contain Quinton King, senior technology infective particles during other airway manager at TechLink, is facilitating the treatments, like high-flow oxygen, a licensing process in direct support of the nebulizer, or a CPAP, and hopefully Army. An emergency use license will decrease the need for ventilators.” be offered to expedite the use of this The device was modeled and tested at technology against COVID-19. Walter Reed and Madigan with comput“This invention allows intermediary er modeling at TATRC. To measure the airway management prior to intubaeffectiveness of the invention, smoke was tion and hopefully avoiding intubation used as a proxy for airborne viral parwhile keeping medical personnel safe,” ticles and a particle counter was used to King said. “Because this device can be measure distribution within and around produced relatively cheap and fast, we’re the prototype. The study was submithoping this technology can be quickly ted for publication in the New England delivered to those battling COVID-19 at Journal of Medicine. medical facilities around the country and In addition to the emergency FDA around the world. This technology could authorization, the Army has filed two help save the lives of patients, and the provisional patent applications with the doctors and nurses treating them.” COVID-19 DIGITAL SUPPLEMENT | OR TODAY |

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Safely Resuming Elective Surgery as COVID-19 Curve Flattens As the COVID-19 surge wanes in different parts of the country, patients’ pent up demand to resume their elective surgeries will be immense. To ensure patients can have elective surgeries as soon as safely possible, a roadmap to guide readiness, prioritization and scheduling has been developed by the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN) and American Hospital Association (AHA). In response to the COVID-19 pandemic, the groups joined the Centers for Medicare and Medicaid Services (CMS) and praised their thoughtful tiered approach to postponing elective procedures, ranging from cancer biopsies to joint replacement, that could wait without putting patients at risk.

Readiness for resuming these procedures will vary by geographic location depending on local COVID-19 activity and response resources. A joint statement, developed by ACS, ASA, AORN and AHA, provides key principles WWW.ORTODAY.COM

and considerations to guide health care professionals and organizations regarding when and how to do so safely. The statement notes facilities should not resume elective procedures until there has been a sustained reduction in the rate of new COVID-19 cases in the area for at least 14 days. The facility also should have adequate numbers of trained staff and supplies, including personal protective equipment (PPE), beds, ICU and ventilators to treat non-elective patients without resorting to a crisislevel standard of care. The timing for resuming elective surgery is one of the eight principles and considerations to guide physicians, nurses and facilities in their resumption of elective surgery care, for operating rooms and all procedural areas, factoring in: timing, testing, adequate equipment, prioritization and scheduling, data collection and management, COVID-related safety and risk mitigation surrounding a second wave and other issues including the mental health of health care workers, patient communications, environmental cleaning and regulatory issues.

Highlights include: Implement a policy for testing staff and patients for COVID-19, account-

ing for accuracy and availability of testing and a response when a staff member or patient tests positive. Form a committee – including surgery, anesthesiology and nursing leadership – to develop a surgery prioritization policy, which factors in previously canceled and postponed cases, and allot block time for priority cases, such as cancer and living donor organ transplants. Adopt COVID-19-informed policies for the five phases of surgical care, from preoperative to post-discharge care planning. Collect and assess COVID-19 related data that will be used to frequently re-evaluate and reassess policies and procedures. Create and implement a social distancing policy for staff, patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity. ACS, ASA, AORN and AHA continue to monitor COVID-19 to evaluate and manage its impact on members, the health care community, patients and staff. Additional important information on patient care in the COVID-19 pandemic will be regularly updated on ACS, ASA, AORN and AHA websites.

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COVID-19 Digital Supplement

GE Healthcare Deploys Remote Patient Data Monitoring Technology to Support Most Critical COVID-19 Patients GE Healthcare has introduced a new software solution to support clinicians and health systems in the treatment of COVID-19 patients. The company is bringing its Mural Virtual Care Solution, which is designed to give hospitals a broad view across their ventilated patient population and help identify patients at risk of deterioration, to the highly secure and trusted Microsoft Azure cloud platform. This is the latest step in the ongoing collaboration between GE Healthcare and Microsoft. As more patients enter health systems for COVID-19 treatment, hospitals face increased demands on clinical resources. The Mural Virtual Care Solution1,2 helps ease this pressure by enabling clinical surveillance of intensive care unit (ICU) patients – including those on mechanical ventilation – in a central place, giving a comprehensive view of each patient’s data across the hospital network. “As both large and small hospitals treat the growing number of COVID-19 patients, the strain on healthcare providers and systems will be unprecedented,” said GE Healthcare President and CEO Kieran Murphy.

“Not only is GE Healthcare providing critically important medical devices to address this global challenge, but we are also rapidly scaling technologies to aid clinicians in delivering safe, effective and efficient care. We are excited to have a partner like Microsoft to help us arm clinicians with the software tools they need.” A Mural installation across a 100bed multi-site ICU network is monitored by three senior nurses and two intensivists around the clock. With a potential shortage of intensivists and bedside caregivers, Mural supports these teams by enabling additional oversight of patients across the hospital network. Bringing together near real-time data3 from ventilators, patient monitoring systems, electronic medical records, labs and other systems, Mural allows one clinician to monitor several patients at once, supplementing existing monitoring devices in patients’ rooms. Remote surveillance may also reduce clinicians’ exposure to COVID-19, while maintaining a broad view of patients across the hospital. “Now more than ever we need to manage a greater number of ventilated patients with limited resources. Mural Virtual Care on Microsoft Azure allows for remote management and surveillance of ventilated patients at

18 | OR TODAY | COVID-19 DIGITAL SUPPLEMENT

scale,” said Microsoft Global Chief Medical Officer Dr. David Rhew. In addition to real-time remote management, Mural also enables health systems to activate care protocols relevant to treating COVID-19 patients and help caregivers ensure those protocols are being followed. Customized with hospitals to provide data and calculations based on their care protocols, Mural can also help identify patients needing intervention. This includes ventilation and lung injury management for patients on extended mechanical ventilation support. The technology can be used by hospitals or health systems of any size, and Oregon Health & Science University (OHSU), for example, has deployed the solution. “Facing the daunting outlook of a COVID-19 surge, it is imperative that I and my fellow health care workers use virtual ICU technology to safely monitor and care for our sickest patients while preserving PPE,” said Matthias Merkel, M.D., Ph.D., OHSU’s Chief Medical Capacity Officer, Vice Chair of Critical Care Medicine, and Professor of Anesthesiology and Perioperative Medicine. “Remaining closely connected and supported through technology enables us to progress our patients’ care across WWW.ORTODAY.COM


COVID-19

Digital Supplement

AAAHC Publishes New Resource for Adult Depression The Accreditation Association for Ambulatory Health Care (AAAHC) has released an updated Adult Depression Toolkit for primary care providers. With the ongoing COVID-19 crisis, now more than ever, this toolkit provides essential information for treating patients with the virus and people affected by the quarantine. As depression has become one of the most commonly encountered conditions in the primary care setting, this toolkit addresses health care issues facing millions of U.S. adults. a geographic distance that we would otherwise be unable to manage.” By powering Mural with Azure, GE Healthcare will give health systems access to an affordable and highly secure solution that can be deployed and scaled quickly. Through January 31, 2021, GE Healthcare is waiving Mural software subscription charges. More information can be found at: www.gehealthcare.com/mural.

1 Enabled by DECISIOInsight® - a standalone medical device. 2 The Mural Virtual Care Solution COVID-19 offering does not provide all options available in the Mural Virtual Care Solution. Refer to the website for additional details. 3 Near real-time data requires HL7 data feed from connected devices.

This toolkit is especially relevant during and in the aftermath of the COVID-19 pandemic, which has not only caused new high levels of social isolation, but also decreased protections against domestic and child abuse. Job loss and job stress for essential workers, as well as concerns about infection and critical supplies, may also contribute to anxiety and depression. Additionally, the symptoms, treatment, and deaths associated with the disease may be linked with substantial increases in post-traumatic stress disorder (PTSD) in survivors and their significant others. Research indicates that 60% of people treated for depression receive their care from a primary physician.[1] The Adult Depression Toolkit outlines the importance of comprehensive screening for mental health in the primary care environment, as well as recommended courses of action when patients may benefit from referrals to behavioral health specialists. The toolkit further guides primary providers on depression screening tactics, including approaches for suicide screening. “Using tested, established questionnaires and other well researched guidance, our toolkit is designed to help providers systemize evaluation and coordinate next steps for patient care depending on the issues the patient is presenting,” said Naomi Kuznets, PhD, vice president and senior director of the AAAHC Institute for Quality Improvement. “AAAHC Behavioral Health Standards call for integration of behavioral health care into the overall care of the patient,” added Kuznets. “Ensuring patients are properly and consistently screened for depression, as well as managed or referred to specialists as needed, is vital to patient wellness.” “Our toolkits and other educational offerings assist organizations with developing best practices and improving patient outcomes,” said Renee Greenfeld, MBA, senior vice president of marketing and business development for AAAHC. “All of our toolkits underscore the many ways AAAHC works with accredited organizations to help them be 1095 Strong, quality every day, for the 1,095 days of the accreditation term.” To order the updated Adult Depression Toolkit, visit: https://www.aaahc.org/ quality/patient-safety-toolkits/. [1] Barkil-Oteo A. Collaborative Care for Depression in Primary Care: How Psychiatry Could “Troubleshoot” Current Treatments and Practices. Yale J Biol Med. 2013 Jun; 86(2): 139–146. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670434/. Accessed July 2019.

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COVID-19

Digital Supplement

Unique System for Using UVC Light to Sterilize Masks in Bulk Developed The shortage of critical personal protective equipment (PPE) has been a persistent problem for medical and other frontline workers as they battle the COVID-19 pandemic at close range day after day. A team of researchers at Rensselaer Polytechnic Institute has developed a potential solution: a machine that uses ultraviolet (UVC) light to sterilize thousands of protective masks each day, rendering them safe for reuse. “At Rensselaer, we are focused on solving global challenges, and the COVID-19 pandemic is certainly among the most significant of these in our lifetimes,” said Rensselaer President Shirley Ann Jackson. “Our interdisciplinary approach, combined with the passion and ingenuity of our researchers, enables us to contribute solutions in this crisis that will continue to be helpful even after it has passed.” You can watch the development of this system here. This project began at the request of longtime research partners at Mount Sinai. As the pandemic worsened in New York City, and the shortage of WWW.ORTODAY.COM

https://youtu.be/NHIAyV0v8rg

PPE deepened, they asked if Rensselaer could develop a way to make critical resources last longer without losing their effectiveness. The speed with which the Rensselaer team devised and built this solution expedites the possibility that it will be helpful in the fight against the pandemic. A design and construction process that often takes months, or even years, was completed in a matter of weeks. “These are anxious moments for all of us as we look at what’s going on in the country and also across the world,

and we all want to do something to make a difference,” said Deepak Vashishth, the director of the Center for Biotechnology and Interdisciplinary Studies (CBIS) at Rensselaer. The UVC sterilization system, developed by a multidisciplinary team of engineers from across Rensselaer, stands about eight feet tall and about eight feet long. Two UVC lamp fixtures, each containing two UVC tubes, are attached vertically across from one another so that masks – hung on a series of hooks that are part of a motorized belt system – can pass in between

COVID-19 DIGITAL SUPPLEMENT | OR TODAY |

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COVID-19 Digital Supplement

the two UVC sources. The speed of that belt determines the dose of radiation that the masks receive. According to Bob Karlicek, the director of the Center for Lighting Enabled Systems & Applications (LESA) at Rensselaer, the system is unique because of its vertical setup, which allows light to disinfect the masks from both sides. “Since UVC radiation is a line-of-sight disinfection process, if there’s any shadow from the mask or any material blocking the access of UVC radiation to the mask, you’re not going to disinfect that part,” Karlicek said. “We elected to come up with a system that allowed us to run the masks vertically so we could simultaneously expose the masks from both the front and the back without blocking any UVC radiation.” Karlicek designed and built the machine with Mohammed Alnaggar, an assistant professor of civil and environmental engineering, and Arunas Tuzikas, a senior staff engineer within LESA. They worked with Mattheos Koffas, a professor of chemical and biological engineering, as well as senior research staff within CBIS – including Brigitte Arduini, Jason Davis and Sergey Pryshchep – and doctoral students Deepika Vaidyanathan and Sneha Gopal. As members of the lab run by Jonathan Dordick, a professor of chemical and biological engineering, Vaidyanathan and Gopal worked remotely to analyze data as it was gathered, accelerating the team’s efforts to calibrate the system to the proper UVC dose. “If the dose is too high, the UVC radiation can damage the elastic straps, causing them to break after a number of disinfection cycles. We also didn’t want the dose to be too low, because then we wouldn’t be able to disinfect the mask,” Karlicek said. The efficacy of this system will be tested at Mount Sinai on masks that have been infected with the virus that causes COVID-19. That information will help Rensselaer engineers adjust the speed of the belt for better results. From there, this system still needs to be approved for use by the Food and Drug Administration. “Normally these things take a very long period of time, but given the national situation, I think there is an understanding at all levels that we need to look for solutions which are stable, good, and safe, and are delivered quickly,” Vashishth said. “I think this is an example of where we came together to deliver a solution, and hopefully, this is going to be useful to the health-care professionals and front-line workers.”

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Healthmark Offers New COVID-19 Signs Healthmark has launched new customized signs to help health care facilities communicate important messages during this challenging time. In order to encourage and remind individuals of necessary steps to practice during this pandemic, Healthmark released COVID-19 Floor Signs. These signs have been designed to catch the attention of health care workers and visitors. There are a variety of designs for specific purposes, from labeling an area that is in quarantine, to a reminder to practice safe social distancing, to instructing personnel to don the proper PPE. The COVID-19 Floor Signs have high visibility, can handle heavy foot traffic, but are semi-adhesive for convenient removal. Additionally, released in concert are the COVID-19 Wall Signs. The different wall sign options serve as reminders to personnel to wash hands, practice safe social distancing, don the proper PPE or to alert personnel of a quarantine area. Healthmark can also design and produce custom signs to meet the individual needs of facilities. WWW.ORTODAY.COM


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COVID-19 Digital Supplement

Computer Model Enables Protective Ventilation The use of mechanical ventilation can save lives – and not just for COVID-19 patients who develop severe respiratory problems. But at the same time, the ventilation pressure puts immense stress on delicate lung tissue. Especially for patients with preexisting lung damage, the use of ventilators can prove deadly. A computational lung model that’s been developed by the Technical University of Munich (TUM) can be used to reduce damage caused by mechanical ventilation – and could increase survival rates for patients significantly. For patients suffering from acute lung failure (Acute Respiratory Distress Syndrome, ARDS), mechanical ventilation is a life-saving treatment. But the situation is paradoxical: at the same time that medical teams employ ventilation to keep a patient’s lungs open to ensure the continuous exchange of oxygen and CO2, the ventilation pressure can cause such severe damage to the lungs that it results in the patient’s death. Doctors treating patients for acute respiratory problems have a limited range of parameters to work with when determining the best protocol for mechanical ventilation – pressure

limits, oxygen level and air flow, for example. But the lung is a complex organ, and the amount of pressure necessary to keep all parts of the lung open to airflow can actually cause damage to some parts through overdistention of the tissue. Additionally, doctors need to minimize repeated recruitment and derecruitment of parts of the lungs during mechanical ventilation, since both can irritate the lung tissue and trigger inflammation. Making the invisible visible According to researcher Wolfgang Wall, professor for computational mechanics at TUM, “The real crux of the problem is that when we’re treating a patient using mechanical ventilation, up until now, there hasn’t been any way to detect overdistention of the lung tissue. From the main bronchial tubes through to the tiniest structures in the lungs, there are more than 20 levels of branching. Currently, there’s no method for measuring what’s happening in the smallest, microlevel branches of the lung during artificial respiration.” Although some medical texts still – inaccurately – portray the lung’s air sacs (alveoli) as similar to grapevines and bunches of grapes, lung tissue actually has a more sponge-like consistency. And it’s through this fine-walled

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tissue where the exchange between the air and the bloodstream occurs. Breathing comprises an extremely complex mechanical interaction between the different types of tissue, the liquid film on the tissue and the flow of air. For several years, TUM researchers have been working to develop evermore sophisticated models to simulate the behavior of lung tissue and airflow. Together with improved methods of micromechanical testing on lung tissue samples, their research has resulted in the creation of a computational lung model. This model is the basis of a computer program which can calculate the local strains which would be placed on the lung’s microlevel tissues by different ventilator settings. Having this data at hand, medical staff and doctors can adjust the ventilator settings accordingly to provide a protective ventilation.

Using artificial intelligence to interpret the data The current clinical standards guiding treatment with mechanical ventilation use a patient’s body weight to determine optimal ventilator pressure settings. However, the program developed by Wall and his team models the actual lung based on data compiled WWW.ORTODAY.COM


COVID-19

Digital Supplement

https://youtu.be/KvzY5foV0oQ

Photo Left: Prof. Wolfgang Wall and Dr. Biehler at work on their virtual lung model.

from a CT lung scan. It even considers the condition of individual areas of the lung that have already been damaged by the disease or previous injuries. By measuring the changes in pressure and volume that occur during an inhalation and exhalation cycle, the digital lung model calculates the individual mechanical characteristics of

the patient’s lungs. The result: a digital “twin” model of the patient’s lungs. It is so precise, that it can accurately predict which ventilator settings will cause damage to the patient’s lungs.

From the research lab to the hospital Parallel to continuing his working group’s research together with clinical

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partners, Wall and three former colleagues founded the company “Ebenbuild” to bring their research into clinical practice as quickly as possible. A key step in realizing this goal was automating the generation of lung models using artificial intelligence (AI). Wall and his team have harnessed the computing power of AI to developed a digital tool that can “map” a patient’s lungs – and which can even be used for early detection of COVID-19 infections. “More than 80 percent of COVID-19 deaths are the result of acute lung failure,” says Wall. “And with long-term mechanical ventilation, the survival rate for our most critically ill patients drops to only 50 percent. The goal of our work is that in the future, at each ventilation site a digital lung model helps to optimize the ventilation to the patient’s needs so that we can significantly increase the chance of survival.”

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COVID-19

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Sterile Processing Platform, oneSOURCE, Creates Free Database to Address COVID-19 Pandemic Recently, oneSOURCE, a healthcare management solution, announced a new database to assist healthcare professionals during the COVID-19 (novel coronavirus) pandemic. The COVID-19 database will be available to new and current users at no cost and will feature tools that include instructions for use (IFUs) to help protect healthcare workers, reduce community spread and maintain patient safety related to ventilators, respirators, bypass machines, and reusable surgical gowns. “With health care facilities in the midst of a crisis, infection control and proper sterile processing practices are of the utmost importance to managing COVID-19. The implementation of a platform like oneSOURCE will increase efficiency and provide healthcare workers with the tools they need to successfully decrease the spread of COVID-19,” said Jack Speer, co-founder and president of oneSOURCE. “This free e-library will be continuously updated and support those on the frontlines to get the information they need to manage any potential growth of the virus from equipment and protective gear as quickly as possible. These are unprecedented times and we’re working diligently with our partners to help manage this global emergency through preventative measures and continue to facilitate the demands of our industry during this critical time.” Along with featuring key IFUs, the complimentary COVID-19 database will also include vital information regarding ventilators, bypass machines, respirators, surgical gowns and other related equipment that is being used to create safer environments for both patients and medical professionals. oneSOURCE users will also receive free tutorials on how to use the platform and up-to-date information about the COVID-19 crisis. “Tools like oneSOURCE are imperative when it comes to providing healthcare workers with the resources to fight diseases like COVID-19,” said Heather Thomas, CMO and executive VP of sales and marketing of oneSOURCE. “We recognize the severity and struggle our world is facing and felt it was our responsibility to arm those on the frontlines of this medical crisis with ways to effectively execute their WWW.ORTODAY.COM

duties in the safest way possible. As we continue to use our platform’s key benefits to address the concerns and needs of our industry, building a database that provides biomedical and sterile processing professionals with the materials necessary to do so was a top priority to our team.” oneSOURCE has a track record of using its platform to address the needs of the medical industry and provide the proper tools to promote the highest level of patient safety. As a resource for top healthcare organizations such as Mayo Clinic, Sutter Health, VHA and HCA, the range of databases reaches from facilities maintenance to surgical instruments to dental. oneSOURCE currently dominates the sterile processing market with more than 80 percent saturation. The free, segmented database is available now at onesourcedocs.com/covid-19-database and will be updated with necessary IFUs for the duration of the pandemic. For more information on becoming a subscriber to the full suite of databases, visit onesourcedocs.com/contact. COVID-19 DIGITAL SUPPLEMENT | OR TODAY |

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