Necessity Made COVID-19 the Mother of Inventions

COVID-19 rocked the world of health care so much that the system turned not only to the government but also to private industry for help. Many businesses wanted to contribute in some way with the cleaning and disinfecting of products, masks, and other personal protective equipment (PPE). Bars started making hand sanitizers when there was a shortage. Oil companies in Texas supplied barrels of hand sanitizer to rural critical access hospitals, which could have harmed health care workers. Storing 50 gallons of hand sanitizer in a hallway rather than in a fire-rated cabinet could cause it to explode under certain conditions because of the amount of alcohol it contains. It is unclear whether hospitals were checking the ingredients of the hand sanitizer that had been donated to them. As months went by, the US Food and Drug Administration (FDA) banned some hand sanitizers because they contained toxic chemicals, such as methanol/1-propanol, or because the alcohol level was found to be too low to be effective.¹

However, the overarching question remains: How does a hospital, nursing home, or surgical center decide what infection prevention products they need to invest in to improve or maintain patient safety? More products than ever are being promoted as a way to decrease infection rates within health care settings since the arrival of COVID-19. Some products have been approved under the FDA’s Emergency Use Authorization (EUA). Under an EUA, “the FDA allows the use of unapproved medical products or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.”²

Reprocessing Masks

On April 11, 2020, the FDA issued an EUA for decontaminating compatible N95 or N95-equivalent respirators using Advanced Sterilization Products STERRAD Sterilization Systems, enabling health care facilities to conserve their supply of respirators during the COVID-19 pandemic.³ This EUA came with specific instructions on how masks were to be handled. There was only 1 company that was paid $400 million to offer their services to hospitals. It is yet to be determined whether this process posed any harm to health care workers.⁴ The outstanding question is: Will the reprocessing of N95 masks receive full FDA approval post COVID-19?

Contact Tracing

The contact tracing of thousands to millions of people throughout the country went from a discussion to a reality almost overnight. No one, except the Centers for Disease Control and Prevention, had experience in contact tracing millions of people. Health care systems scrambled to develop a system to contract trace employees who developed a COVID-19 infection and who may have exposed patients or other coworkers. The number of patients in the emergency department waiting for an intensive care unit (ICU) bed were tracked daily. Many contact tracing companies appeared on the market.⁵

Many hospital infection preventionists (IPs) and employee health or human resource departments utilized Microsoft Excel to track all health care exposures as well as patient and family member exposures. This is a very inefficient use of time. This is an area that IT departments should assess post COVID-19 to develop or purchase a system that will help IPs collect and analyze data during an outbreak or pandemic. This should become part of emergency preparedness programs. Look at technology for improving infection prevention programs and patient safety that hospitals can vet and implement when COVID-19 recedes. Products that can clean the air in buildings, protect staff, and improve cleaning and maintenance of medical equipment and the environment.

Real-Time Tracking

One such product is a real-time tracking system for medical equipment. Real-time tracking systems can alert staff when they are using equipment that has not been cleaned prior to another use. It will give the department responsible for cleaning this equipment information related to where dirty equipment is located, giving them the ability to retrieve the dirty equipment and clean it. Technology leverages the ability to track equipment, monitor availability of equipment, hand hygiene adherence, contact tracing, and environmental cleaning techniques. Currently, with the pandemic, the health care industry has had to deal with an exponential demand for resources, overcrowding, and increased lack of good quality PPE, as well as a lack of ventilators and extracorporeal membrane oxygenation machines. Having a real-time tracking system would enable facilities to locate available equipment, noting whether the equipment is being used in a quarantine room and where the equipment has been. It will give facilities the ability to determine if the equipment needs to be cleaned at the point of use or changed out for anything from filter changes to other internal parts that need to be cleaned or sterilized to maintain their safety. Real-time tracking helps to optimize resources by creating a more streamlined workflow during a time of massive stress and usage of critical equipment.

Environmental monitoring is crucial. Monitoring and recording temperatures, humidity, and air pressure needs to be done in patient rooms, surgical suites, and sterile processing areas. During the pandemic, many clinics or areas of facilities that closed could have benefited from the ability to monitor temperatures and environmental conditions that fell outside of safe ranges.

Real-time monitoring alerts staff that immediate action is necessary. Clinics that closed during the pandemic that did not have alert systems found themselves spending thousands of dollars remodeling and disposing or reprocessing patient care products because temperature and humidity levels were not maintained during closure, which led to mold growth. Things like proper storage of vaccines and lab specimens need to be continuously recorded and tracked remotely to reduce the likelihood of decreasing patient and employee safety.⁶ This is an investment health care professionals have talked about for years, but now we see this is necessary for the future of quality health care to survive.

Vital Signs Monitoring

The ViSi mobile system is a newer system that has been available for some time but has received more publicity in light of COVID-19. For years, patient monitoring was done by Episodic Vital Sign Collection, which, unlike Continuous Vital Sign Monitoring (cVSM), cannot provide a continuous comprehensive view of a patient’s physiologic status, which prevents early intervention when a patient is deteriorating. Systems like ViSi Mobil give clinicians a constant stream of data to help identify early signs of deterioration, which could help prevent adverse events. These systems monitor SpO2, respiratory rate, heart rate, skin temperature, and continuous noninvasive blood pressure readings for ambulatory patients. Up to 75% of adverse events and preventable deaths occur outside of the ICU, where cVSM is not currently used.

These systems empower clinicians to detect early signs of deterioration in virtually all care settings, saving lives and decreasing the need for rapid response calls. A study review of 849 patients in a 32-bed orthopedic, orthopedic-spine, and trauma general care unit showed that, by using the ViSi mobile system, there was a significant reduction in risk of developing complications, fewer transfers to the ICU, and increased adherence using the system by staff.⁷ Studies have also shown there has been a reduction in nonactionable alarms decreasing alarm fatigue, but there was a nonsignificant reduction in ICU transfers and unplanned deaths.⁸ If these systems were implemented in health care prior to COVID-19, it would have eased the burden of short staffing in non-ICU patient care areas during the pandemic. In non–COVID-19 times, this system may decrease the need for high-cost monitoring systems in the ICU for some patients. The benefit of this kind of technology is staff do not have to enter the patient isolation room to know what the patient’s vital signs are, thereby saving time and resources, which saves money. Health care would benefit from this type of monitoring system should the country see the rise of a COVID-19 variant that is resistant to the current COVID-19 vaccines. These systems could decrease the times health care workers would have to enter a patient isolation room, which would decrease their exposure to the COVID-19 variant but still provide safe patient care when used correctly.

Ultraviolet Disinfection

Ultraviolet C (UVC) radiation is a known disinfectant for air, water, and nonporous surfaces. UVC radiation has effectively been used for decades to reduce the spread of bacteria, such as tuberculosis. For this reason, UVC lamps are often called “germicidal” lamps. UVC radiation has been shown to destroy the outer protein coating of SARS-CoV, which is a different virus from the current SARS-CoV-2. The destruction ultimately leads to inactivation of the virus. UVC radiation may also be effective in inactivating SARS-CoV-2. However, there are limited published data about the wavelength, dose, and duration of UVC radiation required to inactivate SARS-CoV-2. In addition to understanding whether UVC radiation is effective at inactivating a particular virus, there are also limitations to how effective UVC radiation can be at inactivating viruses in general.

Direct exposure: UVC radiation can only deactivate a virus if the virus is directly exposed to the radiation. Therefore, the deactivation of viruses on surfaces may not be effective because of blocking of the UV radiation by soil, such as dust, or other contaminants, such as bodily fluids.

Dose and duration: Many of the UVC lamps sold for home use are of low dose, so it may take longer exposure to a given surface area to potentially provide effective inactivation of a bacteria or virus. UVC radiation is commonly used inside air ducts to disinfect the air. This is the safest way to employ UVC radiation because direct UVC exposure to human skin or eyes may cause injuries, and installation of UVC within an air duct is less likely to cause exposure to skin and eyes.⁹

Reinventing Scrubs

Another technology to keep an eye on is antimicrobial scrubs. Currently, there are 2 types on the market. They include antimicrobial fabric and silver-impregnated fabric. Many health care workers are not aware of these new technologies that can provide extra protection.

With the many increases in multidrug-resistant bacteria and viruses, medical personnel can now add an extra protection to their workday. With the addition to the market of Vestex antimicrobial material and X-static silver technology, workers now have options.

Vestex makes antimicrobial scrubs that have been reviewed, assessed, and given a 510K number by the FDA, meaning they are considered a medical device and are safe for use by health care workers. Not only are the scrubs antimicrobial, but they are also fluid resistant and stain resistant, which meets the Occupational Safety and Health Administration regulations for PPE. The FDA is currently reviewing data about whether these scrubs can kill SARS-CoV-2, so health care workers have a decreased chance of taking bacteria and viruses home every day.

These scrubs have proven to reduce 99.99% of methicillin-resistant Staphylococcus aureus (MRSA) when compared with nonantimicrobial scrubs.¹⁰ This material is also used for scrub jackets, lab coats, and T-shirts. Gone are the days of taking scrubs off and throwing them in the trash before entering your home.

Vet New Technology

Vetting new technology and products is a complicated endeavor that takes hours if not weeks before a decision can be made as to whether to bring products into a health care facility. The COVID-19 pandemic did not give health care the luxury of time. This must be built into any future emergency preparedness programs. Better yet, hospitals and other health care facilities should install robust purchasing and infection prevention departments, so health care professionals will know what they’re using is not only safe, but there are also backups that have been vetted. Staying up-to-date on new technology—whether you invest in it now or not—is important.

References:

1. FDA hand sanitizer recall list 2021.FDA. Accessed October 25, 2021. https://bit.ly/3pD0L5s 
2. Emergency use authorization for vaccines explained. FDA. November 20, 2020. Accessed October 26, 2021. https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained
3. Use the correct cycle and compatible N95 respirators when decontaminating respirators with STERRAD sterilization systems – letter to health care providers. FDA. June 30, 2021. Accessed October 26, 2021. https://www.fda.gov/medical-devices/letters-health-care-providers/use-correct-cycle-and-compatible-n95-respirators-when-decontaminating-respirators-sterrad
4. Hohman M, Dunn L, Nguyen V. ‘It’s dangerous’: is the decontamination of N95 masks hurting health care workers? Today. December 5, 2020. Accessed October 26, 2021. https://www.today.com/health/ppe-shortages-does-decontaminating-n95-masks-actually-work-t197417
5. Contact tracing software. Sourceforge. Accessed October 26,2021. https://sourceforge.net/software/contact-tracing/
6. Thompson, C. Technology applications for infection control. Healthcare Facilities Today. April 30, 2020. Accessed October 26, 2021. https://www.healthcarefacilitiestoday.com/posts/Technology-applications-for-infection-control--24210
7. Conferences. Institute for Healthcare Improvement. Accessed October 26, 2021. http://www.ihi.org/education/conferences/APACForum2012/Documents/12_Presentation_Diagnostics_Haraden.pdf
8. Brown H, Terrence J, Vasquez P, Bates DW, Zimlichman E. Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. Am J Med. 2014;127(3):226-232. doi:10.1016/j.amjmed.2013.12.004
9. UV lights and lamps: ultraviolet-c radiation, disinfection, and coronavirus. FDA. February 1, 2021. Accessed October 26, 2021. https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/uv-lights-and-lamps-ultraviolet-c-radiation-disinfection-and-coronavirus
10. Bearman GM, Rosato A, Elam K,. et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infect Control Hosp Epidemiol. 2012;33(3):268-275. doi:10.1086/664045