were able to improve quality without having to risk bringing them into the inpatient setting thus allowing us to minimize their risk of infection .
Question 3
And why ?
Regarding nebulizers and inhalers ( MDI ), which do you believe is 1 .) more effective and 2 .) safer ?
●All patients that were ordered on aerosolized therapy were first assessed for MDI use . If not able to perform MDI appropriately , they were placed on The BAN nebulizer in patient activated mode with an expiratory filter in place . This minimized staff exposure .
●We switched rapidly to metered dose inhaler use for non-vented patients . The reason for the change was not due to effectiveness , but for the saving staff time during the administration , distance , and minimization of fugitive aerosols in any area . Any patient receiving aerosol therapy due to inability to coordinate use of an MDI , was placed in a negative pressure room .
●The most effective aerosol-generating device is the one that maximizes medication deposition within targeted airways . Patient characteristics are paramount .
●The variability among key performance characteristics between different types and brands of nebulizers is striking . When nebulizers come up in clinical discussions , it is often without any understanding of the importance of these variables , or even how the device in use in a particular situation stacks up . There is a difference between nominal dose by weight put in the nebulizer reservoir and amount of drug emitted , respirable mass fraction which is affected predominantly by particle size , and nebulizer design .
●Standard jet nebulizers or updraft designs waste a lot of the starting dose of medication and ‘ treat the environment ’ as much or more than the patient . There are ways to try to capture escaping aerosol with valves and filters in different products or added on , but source reduction when possible is the most effective strategy . With COVID risk , nebulizer safety also depends on device selection . With standard jet nebulizers and co-mingling of inspiratory and expiratory gas streams there is more aerosol generation and dispersion in the environment during the expiratory phase , which can include greater dispersion risk of bioaerosols . Breath-actuated design is ideal for source reduction of fugitive medical aerosols , as well as therapeutic efficacy in other key areas .
●When properly performed with a valved holding chamber , an inhaler is effective by providing delivery of aerosols in the therapeutic range . Therapy can also be provided in less time which is always beneficial during a staffing crisis / pandemic . However , in patients that were in severe respiratory distress and unable to use proper technique , the better option is the nebulizer .
●Regarding these devices , the option that is most effective for the patient , and the one they will be most compliant with , is the most effective .
Question Were Infection Control / Prevention professionals
4 engaged regarding procedure / device changes ?
●We had daily huddles with our infection control team , medical director , and administration daily to discuss revision in practices and policies .
●Infection control played a vital role in our administrative covid 19 task force , meetings were conducted daily , and in some cases , several times a day to discuss and make adjustments to our action plans based on the most current recommendations .
●Yes . We very much appreciate their support and trust in us as we collegially have navigated these uncharted waters together .
●Infection control was great about keeping staff updated on the latest information related to the pandemic . They were able to visit various patient care areas and alleviate stress and concerns of staff about our PPE utilization .
●Absolutely . Our infection preventionists were tireless partners and advocates . They were incredibly collaborative throughout the entire COVID-19 pandemic . They were quick to pull in a variety of interdisciplinary content experts to ensure we were making the safest decisions possible at the time .
Question Regarding the changes you made , what impact did
5 they have or were influenced by availability , cost , product quality , RT labor , or documented outcomes ?
●With disruption in supply availability , we had to adapt to a variety of products outside of our normal use
●With respect to quality and outcomes , our aerosol delivery device selections must be evidence-based and backed by the largest pool of laboratory and clinical literature available in the industry . Our contributions as RTs are our specialized knowledge .
●Cost did not factor into decisions that I was a part of and not a driving factor from higher levels of leadership within the organization . There was a real focus on doing what was right . Availability of product and product quality became major factors in decision-making activities . We were able to maintain our commitment to utilizing high-quality products , but that often meant that we needed to delay acquisition , stockpile supplies , and be judicious in usage .
Question As a result of monitoring these changes , did you
6 make any changes to the new process ? If so , what changes did you make ? Do you foresee these changes being permanent or have you resumed previous protocols with non-COVID patients ?
●Any changes made to processes during the pandemic have continued to be used . Our goal is to always provide the best care for our patients . We made changes partially to necessity , but also in the best interest for the patients . We will continue to always look for new opportunities to provide the best quality of care for our patients so there will be opportunities for us to modify protocols and therapy in the future .
●It appears many of our previous protocols have resumed , but as a collective team , we are much more willing to challenge the norms and plan for a future that looks different than it did pre-COVID .
In summary , the pandemic posed both a serious challenge as well as an opportunity for RTs to reexamine respiratory care practice . Clinical services , including oxygen therapy , medicated aerosol delivery , lung expansion / secretion clearance , pulmonary function testing , and mechanical ventilation were all impacted .
While RTs have always embraced hygiene and safety , I believe that RTs have been more fully engaged with their fellow professionals to ensure that the services they provide are both evidence-based as well as safe for clinicians and patients .
Garry Kauffman , RRT , FAARC , MPA , FACHE , is principal of Kauffman Consulting and is a member and active participant of various committees for the Association of Healthcare Value Analysis Professionals ( AHVAP ).
www . healthcarehygienemagazine . com • june 2022
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