We have compiled question and answers regarding coronavirus clinical practices from radiology community leaders and medical imaging forums. Here’s what people are asking and the responses from our fellow imaging professionals.
COVID19- CT Downtime for Disinfecting – AHRA Forum Responses
How are your organizations preparing for the downtime due to disinfection requirements if you treat a patient with suspected COVID19?
“We are being told that if a suspected patient has a CT, we need to shut the room down for at least 1 hour before the next patient can be brought into the room and we have to use UV technology to disinfect the room.”
Assistant Administrative Director of Radiology
Holy Name Medical Center
“A terminal clean of the room and to honor the wet time, same as if cleaning for a patient with C-Diff, scabies, etc.”
Director, Radiology & Radiation Oncology
Harris Health System, Houston, TX
“Terminal Cleaning followed by 1 Hour before the next patient. UV Technology is performed weekly or as needed mainly in ICU’s, Critical Areas or in some cases throughout Radiology.”
Radiology Quality Compliance & Education Manager
Jackson Health System
“The WA Department of Health has endorsed the WHO guidelines. For patients that meet criteria we are using modified droplet precautions which include (mask, face shield, gown and gloves). We are using airborne precautions for aerosolizing procedures such as bronchoscopy. All of our disinfecting cleaners are effective against the Coronavirus and we are performing standard room cleaning with focus on high touch point areas.”
Imaging Services Manager
MultiCare Good Samaritan Hospital
“A terminal clean similar to how we would treat TB. Shut down of room for 1 hour with UV.”
Assistant Director, Imaging Services
El Camino Hospital
Los Gatos, CA
What is your facility doing or planning on doing if/when Covid-19 is active in your hospital? Do you have a plan for who will provide portable imaging and the cleaning process for your portable units?
Here is our latest communication regarding Covid-19 from our facility in conjunction with the CDC.
Moving forward, health care workers involved in the direct care of patients should use the following PPE: gown, gloves, surgical/procedural mask, and eye protection (goggles or face shield). Glasses are not sufficient for eye protection
When should Airborne Precautions be added?
Due to increased risk of respiratory pathogen transmission, the following aerosol generating procedures must add Airborne Precautions:
- Intubation and related procedures
- Cardiopulmonary resuscitation and related procedures
Due to possible increase in risk of respiratory pathogen transmission, the following aerosol generating procedures should add Airborne Precautions:
- Non-invasive positive-pressure ventilation and bilevel positive airway pressure
- High-frequency oscillating ventilation
*Note: Some aerosol-generating procedures have been associated with an increased risk of transmission of other coronaviruses (SARS-CoV and MERS-CoV) such as tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy. Based on the information available, this may hold true for COVID-19.
What is the literature for this change?
Quality, Training, & Safety Supervisor – Diagnostic Imaging
Providence Regional Medical Center Everett
Our facilities are setting up tents/booths to screen patients/visitors as they enter our pavilions and will have two components: an epidemiological screen and clinical screen.
- The epidemiological screen is travel to one of the current listed countries within the last 14 days, contact with someone who may have traveled to one of those areas in the last 14 days, or direct exposure to someone who is suspected of having COVID19 in the last 14 days.
- If positive, the individuals are masked and sent to a secondary screening location that is also outside. Everyone who is visiting with the patient is assessed as a group, so if one is positive, the entire group is sent to the secondary screening).
- The clinical screen is a fever and indications of a LOWER respiratory infection (note: this may change)
- At this secondary screening location, the individual(s) are then screened for clinical symptoms. If negative, the nurse determines the visit need and works with the daily assigned provider to address immediate needs (e.g. medication refill). The individual(s) are then given instruction and advised to self-quarantine for the recommended period, where the patient may then return for an in-person visit. If the clinical screen is positive, 911 will be activated and the patient sent to our main pavilion ER.
- Additionally, our IT team is working to implement an Infectious Disease flag in Epic Radiant. These will appear on both the Technologist and Protocol Worklists. They have added an alert icon in the list and an alert banner to the report.
Director, Radiology & Radiation Oncology
Harris Health System, Houston, Tx
MRI Safety Group – Facebook 22.7K contributing members
Related to COVID-19 patients in MRI…
What are your decontamination protocols for a possibly infected patient? Under your current protocols, what is the maximum number of potentially contagious patient exams you could decontaminate after before it started to reduce your daily patient capacity?
Clean with Bleach then UV lamp used just like for TB patients.
I was told our scan room has to sit for 2 hours after scanning a contaminated patient before scanning the next one. 2 hours gives the room enough time to cycle the air 12 times.
Questions from response – what about droplets on surfaces that don’t get pulled out by HVAC? And most building HVAC systems recycle the overwhelming majority of the air they pull out, and unless you have some biocontainment lab-level filtration or UV decontamination in your air handlers, much of the airborne material follows the recycled air.
- What wipes or disinfectants will kill the novel Coronavirus, and be benign to the MRI equipment?
- What U/V systems might be suitable for MRI room and/or bore?
- What surfaces should be cleaned (and under what circumstances)?
- What do people use to clean the hard-to-reach inner bore?
- Does your building’s HVAC system filter or kill the Coronavirus, or recirculate it?
- What waiting period is appropriate (before the next patient) with the different cleaning options?
Really depends on the type of contamination. Droplet only (Flu), just about the same time as wiping down the room after each patient (virtually identical cleaning). Airborne, we’re down for a hour for air exchange (TB). GI bugs (ecoli, VRE, Cdiff) probably 30 minutes extra cleaning time (if nothing “bad” happens while GI patient is in there). Contact precautions (staph infections) maybe a additional 15 minutes cleaning. Ebola……very long time….at least half schedule shutdown!
Our facility plan is to N95 and PPE techs and spray and wipe down room (friction clean) then let room sit empty for 1 hour. Then N95 and PPE techs again and clean/wipe down room again. Using the “wand” cleaning tool to clean the inside of the bore really well both times. The only problem I am running into now is finding N95’s that will fit my techs and not have metal (i.e nosepiece) that will deflect away from their face while cleaning the bore or near the scanner, as most masks that I have tested so far have ferrous nose pieces and staples that hold the straps on to hold to your face.
My admin has already acknowledged that this will drastically decrease patient volumes, but are hoping to utilize a Phase 1,2, and 3 which will alter our MRI schedules anyway and would fall in line with allowing for decontamination time of the room.
Straight from our Voyager Manual