key: cord-1012301-rcr7os9m
authors: Lamparello, Nicole A.; Choi, Sarah; Charalel, Resmi; Lee, Kyungmouk Steve; Kesselman, Andrew; Scherer, Kimberly; Harnain, Christopher M.; Browne, William F.; Pua, Bradley B.
title: Transforming Positive Pressure Interventional Radiology Suites to Treat COVID-19 Patients
date: 2020-06-30
journal: J Vasc Interv Radiol
DOI: 10.1016/j.jvir.2020.06.019
sha: b529f07c92988df516ae5aa2411953740f594e10
doc_id: 1012301
cord_uid: rcr7os9m

nan

During the COVID-19 pandemic, the role of interventional radiology (IR) became integral secondary to the minimally invasive nature of treatments, the efficiency of image-guided techniques, and the nominal reliance on inpatient hospital resources. IR divisions are forced to adapt to care for a growing population of coronavirus patients while maintaining a safe work environment and preventing cross infection. Since most procedural suites with fluoroscopic capability are positive pressure rooms, we describe our experience utilizing a positive pressure IR suite to create a safe, optimized environment for healthcare workers and patients. No IRB approval was required as human and animal subjects were not involved.

Procedure suites were chosen based on maximal potential air exchange, most direct patient transit path, and space for donning and doffing of personal protective equipment (PPE). Designated procedure suites were cleared of all non-essential, mobile equipment and the remaining equipment was covered in plastic to allow easy disinfection between patients. In consultation with hospital Infection Prevention and Control, the largest and most secluded IR suite was chosen for the treatment of COVID-19 patients (figure 1). If present, a small passageway connecting the procedure room and control room can be converted into an anteroom with the use of two plastic barriers secured to the ceiling and floor (figure 2). These barriers have zippers that allow one individual to safely enter and exit the space at a time.

Aside from the traditional IR suite, there are several other possible settings to perform interventional procedures. IR procedures can also be performed in the operating room suite, with or without an attached control room, which carries the advantage of superior exchange. Some procedures can be performed at bedside, with or without an anteroom. Bedside procedures minimize COVID exposure to hospital staff and patients by eliminating the need to transport patients. A standardized case-by-case approach was implemented for each inpatient consult to decide the safest and most efficient procedural location (table 1) .

In order to adhere to social distancing recommendations from the CDC, inpatients were transported directly into their assigned procedure room, and once procedure and recovery complete, back to their hospital room. The traditional consent process was also modified to minimize interaction with COVID-19 patients or PUI patients. Consent was either obtained in the procedure room with provider donned in appropriate PPE (decribed in recent literature) or via oral consent documented by the physician in the electronic medical record [1] .

Once the facilities are established, specific protocols and designated roles for each member of the procedure team were clearly delineated and simulated. Staff completed a required series of donning and doffing videos, and attended question and answer sessions with members of infection control.

During the early weeks of the crisis, a designated "observer" within the department monitored the workflow of each procedure team, and identified potential steps to streamline. Detailed donning and doffing sequences for each essential IR team member were created to keep individuals safe and hold each other accountable, including specific roles for "scrub" and "circulating" nurses and technologists. Each team also had a designated "clean" runner that stayed outside the immediate procedure suite to obtain additional equipment, receive specimens and call for aid if necessary.

Another critical component is to determine the appropriate wait times and cleaning protocols between cases. While COVID-19 is primarily spread by respiratory droplets, the exact amount of time for aeration of a room that has been occupied by a COVID positive patient is unknown but likely depends on multiple factors, including air circulation and procedure type [2, 3] . In our institution, the 45 minute wait time was based upon air exchange rates in our modified procedure room, and will vary depending on room size and layout ( figure 3) .

Strategies can be adopted in a traditional IR practice to safely and successfully perform procedures on COVID-19 patients, including but not limited to optimizing inpatient and outpatient workflow to minimize contact time and transit time, using appropriate PPE for essential staff, and following appropriate wait times and cleaning protocols between cases.

These low cost alterations require no permanent structural changes and can transform an existing positive pressure IR suite into a safe environment for patients and healthcare workers. 

Reorganizing Cross-Sectional Interventional Procedures Practice During the Coronavirus (COVID-19) Pandemic

Contribution of Interventional Radiology to the Management of COVID-10 patient

Interventional Radiology Procedures for COVID-19 Patients: Howe we Do It

Sarah Clock PhD Jean-Marie RN Matt Simon MD