Hi everyone,
we are all aware of the PIDAC, CDC and NiOSH standards for infection control and routine practices. All references can be found online for free and are used by our infection control departments when they develop your specific local policies.
I was wondering what others are doing for their routine precautions and if anyone is performing testing on patients with contact or droplet percautions.
We use the Roxon BodyBox (medi-soft) and do not routinely perform testing on patients in anything beyond routine percautions. As a result I do get challenged on why we are not able to accomodate these cleints and I wanted to start a discussion on this.
Our PFT lab performs a variety of testing protocols, complete PFT testing with body plethysmography, ABG's, 6MWT, exersice oximetry as well as methacholine provocation testing using the 2 minute tidal breathing protocol.
Any "aerosol generating" procedures require the use of proper room ventilation as well as the use of a surgical mask if within 2 meters of the patient as part of our local routine percautions. We have recently moved into a new facility with better air exchange, and our local policies have recently been updated by our infection control team.
The documention varies for recommendations between the resources I have listed, ranging from minimum 2 room air exchanges per hour (MSDS for methacholine) up to 12/hr for droplet percautions. Methacholine provocation testing does generate aerosol particles, induce couging in many and may even be considered by some to increase the risk of those in the same room, much like for sputum inductions.
We are in the process of installing fume extraction arms that can be directed over a patient undergoing methacholine provocations that is tied into the operating room scavenging system. I am still waiting to get the quote for what my rooms are able to exchange per hour with and without the arms installed.
So, I see a few issues with accomodating patients under droplet or contact percautions and I will try to list most of them here (off the top of my head).
1) Proper patient screening, health questionaire to identify those with FRI or ILI (febrile respiratory illness, influenza like illness)
2) PPE required for staff, patient, family or volunteers
3) air exchange required during testing
4) housekeeping requirements after testing, both routine and contact percautions...need to book as last case of day if patient under droplet percautions
5) equipment decontamination and disinfection - (virox 1:16 is recommended for cleaning after treating patients under droplet percautions)
I look forward to hearing from others to see what sort of issues and policies you have.
Regards,
Tony