Infection Control Measures during ECMO for CoVID-19 RamanathanK.RSingapore

Ideal PPE to be used when managing confirmed/ suspected COVID-19 positive intubated patient with ECMO

• WorldHealthOrganizationguidelines:DROPLETprecautionsforroutinecareofCOVID19patients.AIRBORNEprecautionsforaerosol-generatingprocedures(e.g.intubation,extubation,bronchoscopy,andtracheostomy).• UnitedStatesCDCpreviouslyrecommendedusingAIRBORNEprecautionswhenmanagingCOVID19patients.

CDCrecentstatement:surgicalfacemasksacceptablewhenN95masksrunout.• ANZICSrecommendsAIRBORNEprecautionsbeusedforcriticallyillpatientswithCOVID-19.

Vs

Acknowledgement:PeterLai,HongKong

N95 Vs PAPR Vs Standard mask

Hospital/ Local Health

Authority guidelines

Infection Control Practices for ECMO patients

•  Essentialcomponents•  ECMOcentresshouldrevisittheirexistinginfectioncontrolguidelines•  EnsurethatallmembersoftheECMOteamreceiveadequatetraining.•  PersonnelperformingECMOcannulationanddecannulationmustwearsterileattireinadditiontopersonalprotectiondevices.

Desirable•  ECMOcentresshouldconsiderdevelopingfacility-levelplanstogroupsuchpatients.

•  Harmonisedinfection-controlpracticesinregionalhospitals:standardizedapproachtopersonalprotectiondevices.

Feasibility of remote monitoring/control during the ECMO run

Transport of COVID-19 ECMO patients

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.

Evidence for viral load and risk for infections transmission through blood and other body fluids

Courtesy:www.nurse.com

• COVID-19couldbetransmittedviarespiratory,fecal-oral,orbodyfluidroutes.

• Doublebagged,transportedinaspecialboxtothelabbyhand

Questions?

Acknowledgement:Dr.SomaniJyoti,IDleadCOVID,NUH