Tech Tips: A Technologist’s View on Performing IONM During COVID-19

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By Nimesha Cheruku, MBBS, MS, MBA, CNIM 
 
Everything changed since that day! The pandemic that started in December 2019 has instilled fear and panic all around but much more vehemently in healthcare. The world around us is changing rapidly and the environment we, as neurophysiologists, work in has now become supercharged with anxiety and tension.  
 
Though our profession is accustomed to stressful events and changes that may happen at a moment’s notice, this new worry has left us with uncertainty as to how we can protect ourselves and our families while also providing quality care for our patients. We do know that this virus spreads primarily through respiratory droplets and possibly via contact with contaminated surfaces (CDC). To reduce the risk of transmission it is imperative we follow the guidelines proposed by CDC and the healthcare facilities. Detailed guidelines and levels of risk assessment can be found on the CDC website
 
The most important ones for our profession are:

  • Wearing a mask and following cough and sneeze etiquettes (cough into your elbow, sneeze into a tissue and discard it, sanitize your hands immediately)
  • Establishing good hand hygiene (frequent hand washing with soap and water/sanitizer)
  • Maintaining social distancing as much as possible
  • Informing your supervisors and self-quarantine if you experience any symptoms such as fever, cough or have been exposed to anyone with COVID-19. 

As many of us are aware, most hospitals are doing the COVID-19 screening at the entrances by taking temperatures and assessing level of exposure. We can further protect ourselves by taking precautions to minimize our exposure in the OR. Communication with the patient, OR team and anesthesia team will help you assess risk and prepare a plan to follow. It is best to assume every person is a carrier and proceed accordingly. Here are some tips:  

  1. Before entering the OR gather your PPE, sanitize your hands and follow steps 2-7 below. 
  2. First wear the PPE gown and tie it securely (PPE tips from the CDC) (PPE gowns may be dedicated for use only with COVID-19 positive patients in some places).
  3. Most hospitals have been great at providing an N95 mask to the technologists on request. Wear your mask, ensure a tight fit and tighten the straps. 
    • Due to the current shortage of PPE across the country, your facility may only issue one, so be diligent about using it.
    • Hang used respirators in a designated storage area or keep them in a clean, breathable container such as a paper bag between uses.
    • You may consider wearing a surgical mask over your N95 to increase its longevity.
    • Recently, methods to sterilize N95 masks for extended reuse have been mentioned on the CDC website. You can ask your company or hospital if that is possible. 
  4. Wear eye protection. Disposable goggles will usually be available near the mask or PPE station.
  5. If you are wearing only a regular mask, then wear a full-face shield to cover it. 
  6. Sanitize your hands before putting on gloves. 
  7. Wipe your equipment before entering OR, wipe down your OR table before loading the equipment on the table.  Use a Sani cloth (any solution with more than 60–70% alcohol, soap and water also work). 
    • Wipe the equipment even if it was covered and left at the hospital.
  8. Sanitize your hands after you remove the gloves too before touching anything.
  9. Keep your electrodes covered and away from the floor while waiting for the patient.
  10. If possible, leave the room during intubation and extubation or stay at least 2 meters (i.e., 6 feet) away.
  11. Sanitize your hands and wear gloves before touching the patient. 
  12. Use alcohol wipes on the patient before placing electrodes.
  13. Discard the gloves and sanitize your hands once you have set up the patient. 
  14. Be aware of bodily fluids contact. PPE gowns and eye protection help (especially if you have to go under the table to troubleshoot).
  15. Maintaining a distance of 6 feet is very difficult in an OR but try to avoid crowding where possible. 
  16. Follow same protective measures as noted above (sanitize, wear gloves) when you are removing the electrodes. Inform the nurses in the room that you will be removing needles so they can maintain a safe distance and reduce risk of getting pricked.  
  17. Discard gloves and needles in designated containers.
  18. Wear fresh gloves and wipe down your equipment including your keyboard, mouse, pens, etc., after each case. 
  19. Discard your PPE gown and gloves in the designated container. Your mask and eye protection can be reused. Wipe your eye protection with a Sani cloth (or per CDC recommendations). 
  20. Wear new PPE gown and gloves for your next case. 
  21. At the end of the day, always wipe down your equipment before you leave the OR and store it. 
  22. If you are leaving your equipment at the hospital, cover it with a plastic sheet. 
  23. At the end of the day, remove your mask only utilizing the loops and without touching the surface. Store it as mentioned earlier for future use. Sanitize your hands thoroughly.

These are some of my recommendations, gleaned through personal experience and referencing articles (links provided below). The CDC has useful guidelines and proper techniques of donning PPE. This ASET webinar also has some great information:  ASET COVID-19 and Neurodiagnostic Testing  
 
To summarize, keep your mask, eye protection and fresh gloves on throughout the case. Dispose of them at the end of each case appropriately. Wipe down your equipment and personal items like cell phones, pens, etc., regularly. Minimize wearing jewelry and taking personal items into the OR. 
 
I admire our colleagues for their courage and dedication to continue providing patient care during these tenuous times. In order to continue to do so, we need to be vigilant about our own well-being, physically and mentally. 
 
Keep in mind that everyone around you is as anxious and fearful as you are. Communicate with your management about your fears and what resources you may need to keep you safe. Check in on your colleagues and work together as a team to keep each other safe and sane. 
 
I am confident we will be there to continue providing essential care for our patients and will emerge stronger and brighter. Be proactive and stay safe!

References: 

  1. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
  2. Strategies for Optimizing the Supply of N95 Respirators
  3. ASNM COVID-19 Precautions
  4. Guidance for clinical neurophysiology examination throughout the COVID-19 pandemic. Latin American chapter of the IFCN task force – COVID-19
  5. ASET COVID-19 and Neurodiagnostic Testing
  6. Strategies for Optimizing the Supply of N95 Respirators
  7. Decontamination-Reuse Respirators 
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