infection control measures during ecmo for covid-19 · hospital to shorten turnaround time. any...
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Infection Control Measures during ECMO for CoVID-19 RamanathanK.RSingapore
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Ideal PPE to be used when managing confirmed/ suspected COVID-19 positive intubated patient with ECMO
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• WorldHealthOrganizationguidelines:DROPLETprecautionsforroutinecareofCOVID19patients.AIRBORNEprecautionsforaerosol-generatingprocedures(e.g.intubation,extubation,bronchoscopy,andtracheostomy).• UnitedStatesCDCpreviouslyrecommendedusingAIRBORNEprecautionswhenmanagingCOVID19patients.
CDCrecentstatement:surgicalfacemasksacceptablewhenN95masksrunout.• ANZICSrecommendsAIRBORNEprecautionsbeusedforcriticallyillpatientswithCOVID-19.
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Vs
Acknowledgement:PeterLai,HongKong
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N95 Vs PAPR Vs Standard mask
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Hospital/ Local Health
Authority guidelines
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Infection Control Practices for ECMO patients
• Essentialcomponents• ECMOcentresshouldrevisittheirexistinginfectioncontrolguidelines• EnsurethatallmembersoftheECMOteamreceiveadequatetraining.• PersonnelperformingECMOcannulationanddecannulationmustwearsterileattireinadditiontopersonalprotectiondevices.
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Desirable• ECMOcentresshouldconsiderdevelopingfacility-levelplanstogroupsuchpatients.
• Harmonisedinfection-controlpracticesinregionalhospitals:standardizedapproachtopersonalprotectiondevices.
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Feasibility of remote monitoring/control during the ECMO run
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Transport of COVID-19 ECMO patients
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Interhospitaltransport• Eligibilitycriteria(specifictothecurrentoutbreak)forinter-hospitaltransfer.
• RapidityofdiseaseprogressionfromdyspnoeatoARDSisshort:recommendearlytransfer(eg,aftertrachealintubation)toanECMOcentre,iffeasible.
• IfECMOneedstobeinitiatedinaperipheralhospital,theECMOteamshouldbeawareofthelocalresources.
• Guidanceforpreparingthepatientshouldbeforwardedtothelocalhospitaltoshortenturnaroundtime.Anyrate-limitingstepsshouldbeidentifiedearly.
Intrahospitaltransport:(Cathlab,CTscans,OperatingRoom)• Risk-benefitprofile:possibilityofdiseasedisseminationtohealth-careworkersandthepublic.
• Strictcontinuousadherencetoinfectioncontrolpolicieswithimmediatedisinfectionoftherouteandtransportvehicles.
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Evidence for viral load and risk for infections transmission through blood and other body fluids
Courtesy:www.nurse.com
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• COVID-19couldbetransmittedviarespiratory,fecal-oral,orbodyfluidroutes.
• Doublebagged,transportedinaspecialboxtothelabbyhand
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Questions?
Acknowledgement:Dr.SomaniJyoti,IDleadCOVID,NUH