Hospital News October 2020 by Hospital News

Inside: From the CEO’s Desk | Evidence Matters | Long-term Care

SPECIAL FOCUS: Infection Control

October 2020 Edition

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COVID-19 isn’t the first time nurses have been called upon to meet a health-care crisis, and it certainly won’t be the last. But this pandemic has stretched many of them to the limit and put their lives and the safety of their families at risk. Doug Ford has called nurses heroes, but his legislation treats them unfairly and disrespects their value. As professionals who are always there for others, nurses are asking who will be

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Contents October 2020 Edition

IN THIS ISSUE:

Ending the stigma around substance abuse

▲ Cover story: Protecting cancer patients from COVID-19

▲ CovidCARE Peer Support Program

▲ Corticosteroids reduce risk of death in COVID patients

COLUMNS Editor’s Note ....................4 In brief .............................6

Infection control .............23 Evidence matters ...........30 From the CEO’s desk .....34 Safe medication ............34 Long-term care ..............36

▲ N95 reprocessing program

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Special focus: Infection control

▲ Sounding alarm on delays in children’s healthcare

Engineering our way through a pandemic By Mary Wells and Abbey Israel s the first wave of the COVID-19 pandemic abates, we have a chance to catch our breath and reflect on the rapid changes our lives have experienced over the past six months. This includes both our work and social lives, and our dependence on science and technology to help us cope in a world where we must remain vigilant as we reopen our shuttered economies and control a second wave. Understandably, most of the attention on innovation so far has been focused on the important work coming out of the health sciences – the hunt for a vaccine or an effective antiviral medication. But many other disciplines have been working toward important ideas and solutions as well. Canadians may be unaware of the many critical projects that rely on work in collaboration with various branches of engineering and science. To understand how Canadian engineers are contributing to the fight against COVID-19, Engineering Deans Canada conducted a national survey on engineering research activities specific to addressing this pandemic and in preparation for future pandemics. The survey confirms that Canadian engineering professors and their students have rapidly adapted their research to develop COVID-specific diagnostic, treatment and tracking solutions, as well as exploring the best way to restart a shuttered economy safely. The survey results show close to 300 engineering research projects underway across Canadian Universities – many of which have leveraged existing research projects but adapted them to focus on this health crisis. Electrical and computer engineers are applying models and computational methods to understand how the infectious disease is spreading, optimizing the curve and

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learning from the data to make predictions on the pandemic status. In some cases, these models can be detailed enough to take into account the unique transmission and susceptibility rates for every individual based on age, transportation habits (cars or public transit), shopping patterns and health status. Mechanical and mechatronics engineers are examining the development of anti-viral surface coatings but also the use of the 3D printers to cover the ever-increasing need for personal protective gear and other equipment, such as N95 masks, face shields, hands-free door openers and ventilator components. Chemical Engineers are creating self-cleaning surfaces from advanced polymer coatings and composites. They are exploring nanotechnology to make antimicrobial coatings that can kill bacteria, fungi and viruses, and superhydrophobic self-cleaning surfaces that can repel liquid droplets – even those troublesome ones that become airborne when someone sneezes. Biomedical engineers are accelerating and scaling up the production of vaccines and the way they are delivered. They are also involved in formulating a better understanding of the interactions between our bodies and the molecular entities that exert the therapeutic effects of medicines. A significant challenge for any vaccine will be the scalability of production to generate sufficient doses. An example of this is the development of a dual-modality DNA-based COVID-19 vaccine that could be delivered through a nasal spray. And they are working to prepare the production and supply-chain delivery process that will efficiently manufacture and dispense the billions of doses needed to ensure populations are quickly protected. Continued on page 5

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Monthly Focus: Technology and Innovation in Healthcare / Research /Patient Experience/ Health Promotion: Digital health advancements and new technology in healthcare. An overview of current research initiatives. Programs and initiatives focused on enhancing the patient experience. Programs designed to promote wellness and prevent disease including public health initiatives, screening and hospital initiatives.

Monthly Focus: Year in Review/Future of Healthcare/Accreditation/Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2020 and a look ahead at trends and advancements in healthcare for 2020. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators and successful initiatives hospitals have undertaken to measure and improve performance.

+ SPECIAL MEDTECH 2020 SUPPLEMENT + CSHP SUPPLEMENT THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News. 4 HOSPITAL NEWS OCTOBER 2020

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

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NEWS

Words matter: Taking action to end the stigma around substance abuse yan knew he had a problem. As a teen he had experimented with drugs. That experimenting had quickly escalated into an addiction, and he needed help. But as a popular boy growing up in a tight-knit community, he was worried about what people would think. Like most of us, Ryan had been exposed to negative stereotypes about addiction, compounded by language like “junkie” and “crackhead”. “In trying to get support and help in the community, he was very concerned that people would know his secret and treat him badly. He’d grown up hearing those words. He had friends whose parents worked in health care and he was terrified that they would find out,” says Ryan’s mother Sandra Tully, cochair of Addiction Matters Kamloops. “I was desperate. I finally convinced him to go to into treatment. I got in touch with the intake nurse and, sure enough, it was someone we knew. I started to cry. I was so happy he could get in and get help, but at the same time I was terrified to tell him she would be there, because I thought then he wouldn’t go. He would be too embarrassed.” “He went and was so relieved when she just gave him a big hug and told him it was going to be ok. That is what we need,” says Sandra. Sadly Ryan’s battle was short-lived. He died of an opioid overdose at just 22 years old. It was 2016, the year B.C.

Sandra Tully, co-chair of Addiction Matters Kamloops. declared the ongoing overdose crisis a public health emergency. Since then in B.C. more than 4,500 lives have been lost. Ending the stigma around substance use and drug-related deaths is a major focus of Interior Health and its Mental Health and Substance Use Network. “We know that the stigma associated with substance use continues to impact individuals and families, preventing them from reaching out for help and accessing life-saving services and treatment. We also know that language can play a significant role in either perpetuating stigma or ending it,” says Interior Health Practice Lead and Addiction Matters Kamloops co-chair Jessica Mensinger. “One of the easiest

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Continued from page 4 Civil engineers are using their knowledge around transportation, city planning and risk management to help us understand the impact on disruptions of supply chains on the everyday lives of people as well as our heath care systems. Network science, machine learning, systems analysis, and multi-objective optimization linked to our physical and infrastructure and the ways people interact in these spaces are being developed to help guide decision makers around re-opening of our facilities. Environmental engineers are examining the persistence of coronavirus in our environment and the efficacy of measuring its presence in our water systems as a marker for coronavirus in our communities. Wastewater can reveal the presence of the virus even before cases are confirmed in a community, since those who haven’t been tested, with mild or no symptoms, still shed the virus through urine and feces. This knowledge can be translated into the use of early warning systems that will alert public health authorities about an outbreak before people start to show symptoms. Engineers are our “scientists in action” who have responded swiftly to help fight COVID-19. Let’s not forget them when we examine the many initiatives Canadians are undertaking to make our country function in this new reality. We all have a role to play and CanaH dians are rising to the challenge. ■ Mary Wells is Dean at the Faculty of Engineering, University of Waterloo. Abbey Israel is a first-year biomedical engineering student at the University of Waterloo.

FREE

Erin Toews is a Communications Consultant at Interior Health.

things we can do as a community is to consider the words we are using when talking about substance use.” This is why Interior Health is joining the Addiction Matters coalition in inviting people everywhere to come together in an effort to use language that is compassionate and non-stigmatizing. Staff and physicians across the health authority have been taking the pledge. The team at Southhills Tertiary Psychiatric Rehabilitation Centre in Kamloops was among those to quickly jump on board, challenging colleagues to do the same. Take the online pledge to choose person-first language and language that reflects the medical nature of substance use. Instead of “addict” or “abuser” consider using “person with a substance use disorder.” Avoid slang or idioms like “dirty” or “clean” test results and use “positive” or “negative” test results instead. And use language that promotes recovery. Instead of referring to someone as “clean”, use “maintained recovery” instead. “Words matter. When you say the word ‘addict’, what is the image that comes to mind?” Sandra says. “Substance use can impact anyone. Your best friend could be using substances.” Visit www.AddictionMatters.ca to learn more and take the pledge. Download a selfie card to post and share on social media. Invite your colleagues, friends and families to join. Together H we can end stigma. ■

Engineering our way

OCTOBER 2020 HOSPITAL NEWS 5

Stroke

can be the first presenting symptom of younger patients with COVID-19 ince the start of the COVID-19 pandemic, researchers have been working to better understand and characterize the varied symptoms of the disease. One of the most concerning symptoms is the development of large blood clots that can cause blockages in the arteries that lead to the brain causing stroke. Researchers at Western University and Lawson Health Research Institute led by Dr. Luciano Sposato have been investigating the relationship between COVID-19 and stroke to better understand the risk in patients and aid in treatment planning. In a new study published in the September 15, 2020 online issue of Neurology, the medical journal of the American Academy of Neurology, the research team reports that approximately two in every 100 patients admitted to hospital with COVID-19 will suffer a stroke, and 35 per cent will die as a result of both conditions. Researchers reported that in patients under 50 years old, nearly 50 per cent had no other visible symptoms of the virus at the time of stroke onset. They also found that

the interplay of older age, other chronic conditions and the severity of COVID-19 respiratory symptoms are associated with an extremely elevated risk of death. “One of the most eye-opening findings of this study is that for patients under 50 years old, many were totally asymptomatic when they had a stroke related to COVID-19. This means that for these patients, the stroke was their first symptom of the disease,” says Dr. Sposato, Associate Professor and the Kathleen and Dr. Henry Barnett Chair in Stroke Research at Western’s Schulich School of Medicine & Dentistry, and Scientist at Lawson. Sposato says understanding the interplay between COVID-19 and stroke is important for treatment planning, especially in areas where COVID-19 is actively circulating in the community. “The take-home message here for health care providers is that if you are seeing a patient with a stroke, particularly in those under 50 years old with large clots, you need to think of COVID-19 as a potential cause even in the absence of respiraH tory symptoms,” says Dr. Sposato. ■

IN BRIEF

Heart disease in young people linked to diabetes exposure in the womb eart disease in young adults and teenagers may be related to exposure to diabetes in the womb, according to new research published in CMAJ (Canadian Medical Association Journal). A study of young adults and teenagers in Manitoba, Canada, whose mothers had diabetes during their pregnancies found the offspring had a 50 to 200 per cent higher risk of developing heart disease before age 35 than those who were not exposed in the womb. “These observations support our hypothesis that cardiovascular disease morbidity in adolescence and early adulthood is related to exposure to maternal diabetes in utero,” writes Dr. Jonathan McGavock, Children’s Hospital Research Institute of Manitoba and Associate Professor at the University of Manitoba, Winnipeg, Manitoba, with coauthors. Researchers looked at data on more than 290 000 children born to almost 190 000 mothers in Manitoba between 1979 and 2005. Of the total children, 2.8 per cent were exposed to gestational diabetes and 1.1 per cent to pre-existing type 2 diabetes. Exposure to both types of diabetes became more common during the study period, a trend seen elsewhere in the world.

The three most frequent diagnoses among offspring exposed to diabetes were high blood pressure (8713 people), type 2 diabetes (3568 people) and ischemic heart disease (715). “Using data for nearly all children born in Manitoba over a period of 30 years, we found that children born to mothers with diabetes in pregnancy were 30–80 per cent more likely to develop a heart condition and 2.0 to 3.4 times more likely to develop a heart disease risk factor (e.g., high blood pressure, diabetes) than children born to mothers without diabetes in pregnancy,” says Dr. McGavock. Furthermore, heart conditions and risk factors were diagnosed two years earlier in the children exposed to diabetes in the womb. Previous studies have documented the increased risk of type 2 diabetes, but not cardiovascular disease, from in utero exposure to diabetes. The authors suggest these findings may be useful for preventive health practices. “Screening children with in utero exposure to diabetes for cardiovascular disease risk factors might help to evaluate the future burden related to cardiovascular disease in the populaH tion,” the authors conclude. ■

CMA launches Physician Wellness Hub n an effort to drive change in the culture of medicine and promote health and wellness in the medical profession, the Canadian Medical Association (CMA) has launched the CMA Physician Wellness Hub (the Hub), an online platform that provides key resources, virtual community as well as confidential support and counselling to physicians, learners and their families. The Hub aims to improve physician wellness at the individual but also the

system level, and promote a collaborative approach to physician health and well-being by: • Offering day-to-day strategies physicians can use to build resilience or how to start institutional wellness programs; • Creating a safe virtual community for physicians and learners to connect with others interested in wellness; and • Providing immediate and confidential support and counselling through the Wellness Support Line. Continued on page 7

6 HOSPITAL NEWS OCTOBER 2020

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IN BRIEF

Exponential growth of COVID-19 poses major risk to hospitals’ ability to care for Ontarians ith Ontario reporting 700 new COVID-19 infections in one day, the Ontario Hospital Association (OHA) is calling on the Government of Ontario to immediately intensify public health measures in certain areas

of the province, including Toronto, all regions of the Greater Toronto Area (GTA) and Ottawa. A return to Stage 2, with restrictions on indoor dining and bars, places of worship, weddings, gyms, movie theatres, and other non-essential businesses, is needed

New study will attack SARSCov2 where it multiplies teroid drugs are anti-inflammatory medicines that are used to treat a wide range of conditions, and one of them – oral or intravenous dexamethasone – was found effective in improving the survival of patients with severe COVID-19. Could other drugs from the same family show potential to treat milder cases of COVID? A team of researchers at the Research Institute of the McGill University Health Centre (RI-MUHC) believes so. On September 14, 2020, they started testing the efficiency of ciclesonide, an inhaled and nasal steroid drug currently used for asthma and nasal rhinitis. Laboratory studies have already shown that treatment with ciclesonide can decrease viral replication of SARS-Cov2, the virus responsible for the disease. This placebo-controlled randomized trial will confirm if the administration of inhaled and nasal ciclesonide can reduce the severity of respiratory symptoms among mild cases of COVID-19 and potentially avoid the need for hospitalization and oxygen.

“We know the COVID-19 virus starts by multiplying in the nose and progresses downwards to the lower parts of the airways and lungs. We hope that targeting the site of viral replication with inhaled and nasal ciclesonide will reduce early viral replication and decrease severity of COVID-19 illness,” says the principal investigator in this study, Dr. Nicole Ezer, who is a junior scientist in the Translational Research in Respiratory Diseases Program at the RI-MUHC and an assistant professor in the Department of Medicine at McGill University. Approved by Health Canada in 2008 and regularly prescribed by family doctors and lung specialists, ciclesonide deposits in the nose and lung and acts locally without entering the blood system. It has relatively few and mild side effects that disappear when the drug is stopped. The most common one is oral thrush (candida); which occurs in less than one percent of patients and can be avoided by using an aeH ro-chamber. ■

now to keep schools open and prevent a further acceleration of infections. Ontario hospitals have been the anchor of Ontario’s pandemic response, opening assessment centres, conducting laboratory testing and deploying staff to assist in long-term care, but they are gravely concerned that the current rate of spread will mean that hospitals will be unable to fulfil these roles while delivering life-saving care. Without public health measures in place to limit opportunities for disease transmission, Ontario will soon see higher numbers of hospitalizations, admissions to intensive care units (ICUs), and more deaths. We’ve seen in jurisdictions around the world how acute care capacity can be easily overwhelmed if the number of positive cases rises too sharply. While Canada’s health care system has many strengths, our capacity is limited, and we can no longer retain a false sense of security and belief that this will not happen to us. At this rate, Ontario

hospitals are facing a direct threat to their ability to continue delivering the highest quality of care to Ontarians. Hospital occupancy levels are rising quickly in Ontario. A great deal of the stand-by capacity created at the onset of the pandemic last spring has already been filled. Currently, the acute care occupancy rate is 89 per cent with several hospitals hovering around the 100 per cent level. While the number of patients in Ontario hospitals waiting for an alternate level of care (ALC) dropped significantly in March and April 2020 as hospital beds were cleared, ALC cases rose significantly throughout May and June, reaching a historic high of more than 5,300. Moving forward, as longterm care homes appropriately try to limit the use of three- and four-bed rooms to safeguard residents, ALC rates will continue to climb quickly, jeopardizing elective surgeries from continuing for the duration of the H pandemic. ■

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Continued from page 6

“Yesterday’s medical culture needs to evolve. Today, physicians and medical learners face unique pressures and we need to ensure that they care for themselves as they care for others,” says Dr. Ann Collins, CMA President. According to the 2017 CMA National Physician Health survey, nearly one-third of doctors, residents and medical students report burnout and www.hospitalnews.com

depression at some point in their career. The Hub offers a collection of over 275 physician health and wellness resources, spanning 22 topics. Resources include original CMA content and curated information from other trusted sources on issues such a burnout, depression, resilience, conflict management, organizational wellness H and more.■

Advocacy. Knowledge. Benefits.

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NEWS

World-first clinical trial

aims to protect cancer patients from COVID-19 By Amelia Buchanan urgeon-scientist Dr. Rebecca Auer is leading a world-first clinical trial that she hopes will protect cancer patients from COVID-19 and other respiratory infections by boosting their immune systems during treatment. The trial was funded in part thanks to donor support to the COVID-19 Emergency Response Fund. “A cancer diagnosis is scary at the best of times, but the pandemic has made it even worse,” says Dr. Auer, surgical oncologist and Director of Cancer Research at The Ottawa Hospital and associate professor at the University of Ottawa. “Cancer patients have weakened immune systems, which makes them more likely to get severely ill from COVID-19.” At best, a severe infection could delay a patient’s cancer treatment. At worst, it could kill them. Patients receiving cancer treatments are the most at risk because the treatments further weaken their immune system. This at-risk population is quite large – over 90,000 people received radiotherapy or chemotherapy treatments in Ontario alone in 2019. “While there are many promising vaccines for COVID-19 in the works, they won’t be available for at least a year,” says Dr. Auer. “Cancer patients need protection now.”

BOOSTING THE IMMUNE SYSTEM DURING TREATMENT

Dr. Auer and her team at The Ottawa Hospital came up with the idea of testing whether boosting cancer patients’ immune systems during their treatment could help prevent COVID-19 and other respiratory infections. In collaboration with scientists at the Ontario Institute of Cancer Research, they explored an immune-stimulator called IMM-101. Then she worked with Canadian Cancer Trials Group at Queen’s University to design and run the clinical trial 8 HOSPITAL NEWS OCTOBER 2020

Dr. Rebecca Auer speaks with a colleague. at nine cancer centres across Canada. The researchers will recruit 1,500 patients currently receiving cancer treatment to this clinical trial. Patients will be randomly assigned to receive either regular care, or regular care plus IMM101. This preparation of harmless heatkilled bacteria had been developed as an anti-cancer therapy because it stimulates the immune system. It has already been safely given to 300 advanced cancer patients in earlier trials.

TRAINING THE INNATE IMMUNE SYSTEM

This trial takes advantage of a lesser-known aspect of the immune system – innate immunity. This first-response arm of the immune system plays a key role in detecting viruses. Innate immune cells recognize features that are common to many viruses, allowing them to attack viruses the

body has never seen before. This is different from the adaptive immune system, which only recognizes viruses the body has already encountered through prior infection or through a vaccine. The research team hopes that because the IMM-101 treatment can train the patient’s innate immune system, it will help to fight off the COVID-19 virus, in addition to other viruses that cause respiratory infections. “There is good data to suggest that the reason some people have no symptoms from COVID-19 while others get very sick is their innate immune system’s ability to respond early and quickly to the virus,” says Dr. Auer. “This made us consider whether we could use an innate immune booster to prevent COVID-19 infections.” Based on data from other immune stimulators, it’s likely that this im-

mune-boost would be temporary. But researchers hope it will last long enough to get a patient through their cancer treatments. Once the treatments have ended, the patient’s immune system would return to its regular strength and be strong enough to fight off viruses on its own.

PROTECTION FROM MORE THAN COVID-19

The advantage of this immune-boosting approach is that it could help cancer patients fight off all sorts of viruses while they are undergoing cancer treatments and are at their most vulnerable. “The treatment we’re using trains the immune system to do a better job fighting the next viral infection,” says Dr. Auer. “It’s not specific to COVID-19, but actually applies to any viral respiratory illness.” Continued on page 10 www.hospitalnews.com

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Protecting cancer patients from COVID-19 Continued from page 8 If successful, IMM-101 could also offer benefits to people with other chronic illnesses or compromised immune systems who are similarly at a heightened risk of serious outcomes from COVID-19. It could also help protect people with cancer from other respiratory infections like the seasonal flu.

PREPARING FOR FUTURE PANDEMICS

“In 20 years, we’ve had three coronavirus epidemics or pandemics –SARS, MERS and COVID-19 – so it’s likely that we’ll see another,” says Dr. Auer. “Harnessing innate immunity could be one of our best weapons for fighting COVID-19 and could be easily adapted to tackle future pandemics.” The trial has been approved by Health Canada and will run at cancer

centres across Canada. The researchers expect to see preliminary results in about nine months. Cancer patients undergoing active treatment who are interested in participating in this trial should speak with their cancer specialist. The Ottawa Hospital Foundation provided seed funding for this project through the COVID-19 Emergency Response Fund, funded by generous donors in the community. Additional funding and in-kind support for this trial have been provided by the Canadian Cancer Society, BioCanRx, the Ontario Institute for Cancer Research, The Ottawa Hospital Academic Medical Organization, ATGen NK Max Canada, and Immodulon Therapeutics, the manufacturer of H IMM-101. ■

Dr. Auer speaks with one of her patients

THERE IS GOOD DATA TO SUGGEST THAT THE REASON SOME PEOPLE HAVE NO SYMPTOMS FROM COVID-19 WHILE OTHERS GET VERY SICK IS THEIR INNATE IMMUNE SYSTEM’S ABILITY TO RESPOND EARLY AND QUICKLY TO THE VIRUS. THIS MADE US CONSIDER WHETHER WE COULD USE AN INNATE IMMUNE BOOSTER TO PREVENT COVID-19 INFECTIONS.

Amelia Buchanan is the Senior Communications Specialist at The Ottawa Hospital.

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Unexplained Bleeding:

Have you considered acquired hemophilia (AH)?

77-year-old man arrives in the Emergency Department with a painful hematoma on his left chest. It is seemingly superficial but is actually fluctuant, and he exhibits no other bleeding stigmata. Initial diagnosis leads the healthcare team to perform a hematoma evacuation and send the patient home, resulting in an immediate return to the Emergency Department with ongoing blood loss. After further investigations examining bleeding parameters and a search for a coagulation factor inhibitor, the diagnosis of Acquired Hemophilia (AH) is made.

ABOUT AH

AH is a rare and potentially life-threatening bleeding disorder that impacts an estimated one to two people per million in Canada every year.i The condition is an autoimmune disorder which occurs when the immune system produces antibodies against specific clotting factors, most often Factor VIII.ii While recognition of AH is growing, it is not to be confused with the more commonly known congenital hemophilia which is an inherited bleeding condition. Often AH presents unexplained in patients and often with significant bleeding, therefore, it is typically an emergency physician who is the first person to evaluate these individuals. Prompt recognition and appropriate management of AH is critical in reducing the risk of excessive bleeding related morbidity and mortality. AH can impact both men and women, and while it can occur at any age, it primarily affects the elderly.iii It is also known to be associated with pregnancy.iv

Common symptoms can include severe bleeding and large bruises. AH can present at any time with spontaneous bleeding in the joints and muscles, in bodily fluids or through the mouth or nose. It can also occur in the setting of mild or major trauma such as a surgery or a fall.v Diagnosis is often delayed as initial symptoms are not easily recognized as a bleeding disorder. This could result in suboptimal treatment and additional complications.vi For this reason, awareness of AH and a general understanding of the condition will help expediate diagnosis and may ultimately save lives.

DIAGNOSING AND TREATING AH

The first clue to the existence of AH is the detection of a prolonged partial thromboplastin time (PPT). If the PTT is elevated, the following steps, often under the guidance of a hematologist, is to obtain a mixing

test as well as a Bethesda test, which will indicate the concentration of inhibitors in the patient’s system. Once the diagnosis has been established, the health care team has two objectives: control the bleeding and following AH diagnosis, eradicate the inhibitor and treat the underlying disease (if applicable).vii

THE ROLE OF THE ER PHYSICIAN AND HEMATOLOGISTS

Hemophilia and blood clotting disorders are a specialized niche within general hematology and effective management of AH requires coordination between the Emergency Department and the Hematology Team. Bleeding is a common Emergency Department presentation and is often attributed to the widespread use of antiplatelet and anticoagulant medication often prescribed to older patients. While the role of the emergency physician is to manage

critical medical complications and to abide by the mantra “airway, breathing, circulation” - once stabilized, it is important for the healthcare team to consider an underlying bleeding disorder on the differential diagnosis. Ensuring a PPT is included in the assessment of unexplained bleeding and more importantly, not allowing a prolonged PPT to go explained is key to an emergency physician’s role. Hemophilia patients require effective collaboration between emergency physicians, and hematologists for optimal – life saving - treatment. Written by Dr. Eddy Lang, Department Head for Emergency Medicine at the Cumming School of Medicine, University of Calgary and with Alberta Health Services. As the national voice of emergency medicine, The Canadian Association of Emergency Physicians (CAEP) provides continuing medical education, advocates on behalf of emergency physicians and their patients, supports research and strengthens the emergency medicine community. In co-operation with other specialties and committees, CAEP also plays a vital role in the development of national standards and clinical guidelines. CAEP keeps Canadian emergency physicians informed of developments in the clinical practice of EM and addresses political and societal changes, that affect the delivery of emergency health care. This space was provided by Novo Nordisk Canada Inc. in partnership with the Canadian Association of Emergency Room Physicians (CAEP). No honourarium was provided, instead a donation was directed to the CAEP Advancement H Fund. Q

Canadian Hemophilia Society. Acquired Hemophilia. https://www.hemophilia.ca/files/Acquired%20hemophilia%202017.pdf. Accessed: September 2020 National Organization for Rare Disorders. Acquired Hemophilia. https://rarediseases.org/rare-diseases/acquired-hemophilia/. Accessed: September 2020 Canadian Hemophilia Society. Acquired Hemophilia. https://www.hemophilia.ca/files/Acquired%20hemophilia%202017.pdf. Accessed: September 2020 iv BJOB. An International Journal of Obstetrics and Gynaecology. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2012.03469.x#:~:text=Acquired%20haemophilia%20A%20 (AHA)%20is,personal%20history%20of%20abnormal%20bleeding. Accessed: September 2020 v Canadian Hemophilia Society. Acquired Hemophilia. https://www.hemophilia.ca/files/Acquired%20hemophilia%202017.pdf. Accessed: September 2020 Collins P, et al. Blood 2012;120:47 vii Tiede. Semin Thromb Hemost 2014;40:803–811. i

iii

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OCTOBER 2020 HOSPITAL NEWS 11

NEWS

CovidCARE Peer Support Program at Halton Healthcare By Zita Raponi hile no one can change the realities of COVID-19, staff and physicians at Halton Healthcare are finding comfort and strength through a Peer Support Program called CovidCARE. This unique program has helped them connect and build strong support systems so they can face the unique challenges of healthcare, amid the COVID-19 pandemic. In April, 2020, Dr. Jonathan Sam, a Pediatrician at Oakville Trafalgar Memorial Hospital noticed that his co-workers were struggling with all the sudden changes brought about by COVID-19. “I realized that there was a growing sense of fear and uncertainty amongst staff and physicians – I call it a shadow pandemic – that was even more contagious than the Coronavirus itself,” explains Dr. Sam. “I have a background working with teams to improve their performance in acute care situations through simulation and debriefing so I decided to facilitate some candid discussions with the care teams on the Maternal Child/Pediatrics Unit to see how I could help.” “Dr. Sam cut through all the confusion and very effectively eased the fear and anxiety in the room. He patiently answered all our questions, showed us how to sort through the new regulations and protocols, and armed us with some coping and self-care strategies,” explains Tracey Fuller, Clinical Resource Nurse on the Maternal Child Unit, who attended some of these initial sessions. “He also provided us with simple preventive measures on how to protect ourselves, each other and our families.” “Our healthcare teams were looking for a human connection and Dr. Sam recognized this. He listened to their concerns, talked them through their fears and showed them how they could support each other,” adds Dr. Zeba Ansari, Chief of Pediatrics,

Left to Right: Louisa Nedkov, Program Coordinator of Kailo, Halton Healthcare’s Wellness Program; Dr. Deb Marshall; Dr. Jonathan Sam, and Dr. Meghan Daly. Missing from picture: Dr. Saroo Sharda and Nicole Cemkov, RN.

COVIDCARE HAS MADE A BIG DIFFERENCE IN TERMS OF BOOSTING MORALE BY SPREADING POSITIVITY, TOGETHERNESS AND RESILIENCE ACROSS HALTON HEALTHCARE Halton Healthcare. “Word spread quickly, and soon he was getting invitations to department meetings and team huddles from all corners of the organization. CovidCARE was born in response to this overwhelming need for support.” The CovidCARE Peer Support Program is a team of seasoned de-briefers with members from all three Halton Healthcare hospitals. Led by Dr. Sam, this team includes Dr. Saroo Sharda, Dr. Meghan Daly, Dr. Deb Marshall and RN Nicole Cemkov, and is supported by Louisa Nedkov, Program Coordinator of Kailo, Halton Healthcare’s Wellness Program. These de-briefers attend department meetings and unit huddles, by invitation, to guide group discussions and help teams build resilience.

“Different teams have different concerns,” explains Dr. Sam. “Healthcare providers and support staff on the frontlines in the ER or ICU may be worried about how to care for patients or contracting the virus while others are still struggling in adapting to their ‘new norm’. Acknowledging teams for the great work they do – especially when they are feeling particularly vulnerable can be very powerful,” explains Dr. Sam. “Some staff also have personal problems at home that makes it very difficult for them to work – and we address those too.” CovidCARE has made a big difference in terms of boosting morale by spreading positivity, togetherness and resilience across Halton Healthcare. “We cannot change the outcomes or even say that everything will be ok,

but we can certainly help people connect, encourage them to share their struggles, and take care of each other –and we can do it all with bravery,” concludes Dr. Sam. “By sharing their experiences, staff realize that they are not alone and, in fact, often, the best people to help them are their colleagues, because they are facing the same challenges.” The CovidCARE Peer Support Team has facilitated over 70 sessions and has reached over 1,500 clinical and non-clinical staff throughout Halton Healthcare’s hospitals to-date. The program is offered live, live/virtual or entirely virtual. Sessions take from 20 to 60 minutes depending on the needs of the team. Dr. Sam was recently the recipient of the Halton Healthcare VIP (Values Inspired Performer Award) for his leadership in establishing the CovidCARE Peer Support Program. The award recognizes individuals who exemplify the Halton Healthcare values of compassion, accountability, and H respect. ■

Zita Raponi works in communications at Halton Healthcare. 12 HOSPITAL NEWS OCTOBER 2020

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Analysis of seven trials

corticosteroids reduce risk of death by 20 per cent in critically ill COVID-19 patients n inexpensive, widely available class of drug called corticosteroids reduces the risk of death among critically ill COVID-19 patients by 20 per cent, an analysis of seven trials published in the Journal of the American Medical Association (JAMA) found. The World Health Organization (WHO) announced it is updating its COVID-19 treatment guidance as a result of the findings. The meta-analysis of seven international trials, co-ordinated by the WHO and with analyses by researchers from St. Michael’s Hospital of Unity Health Toronto and the National Institute for Health Research (NIHR) at the University of Bristol, assessed mortality over a 28-day period after the start of treatment. The review found that treatment of the most severely ill patients – those in an ICU – with dexamethasone or hydrocortisone reduced mortality from 40 per cent to 32 per cent, a relative reduction of 20 per cent. Corticosteroids are a class of drug that lowers inflammation and reduces immune system activity. The analysis is the result of collaboration between study teams, guideline developers and journals in response to the global pandemic. This meant results could be shared between research teams and with guideline developers before they were published. “Even beyond the clear evidence of benefit for an inexpensive and widely available medication, the process of this work – pooling data across seven trials conducted over a period of only three months – highlights the willingness of researchers around the world to share data in a new research model that can bring reliable evidence rapidly to improve the care of patients with COVID-19,” says Dr. John Marshall, Senior Scientist at the Li Ka Shing

Dr. John Marshall, Senior Scientist at the Li Ka Shing Knowledge Institute at St Michael’s Hospital of Unity Health Toronto, and Co-chair of the WHO Working Group on Clinical Characterization and Management.

THESE TRIALS SPANNED FIVE CONTINENTS AND INCLUDED SOME OF THE COUNTRIES HARDEST HIT BY COVID-19. Knowledge Institute at St Michael’s Hospital of Unity Health Toronto, and Co-chair of the WHO Working Group on Clinical Characterization and Management. The team behind the review includes the lead researchers from Brazil, Canada, China, France, Spain, the UK and the USA. The work is part of the WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) initiative. The researchers reviewed data from seven randomized control trials that had recruited 1,703 critically ill patients in total. These trials spanned five continents and included some of the countries hardest hit by COVID-19. They also included critically ill patients from the RECOVERY trial, which reported its findings in

June 2020, and patients from the REMAP-CAP trial, the Canadian arm of which was led by Dr. John Marshall of St. Michael’s Hospital. Unity Health Toronto’s Arthur S. Slutsky, a scientist at St. Michael’s Hospital, was also an author on the review paper. Data from three of the seven trials in the meta-analysis, including the REMAP-CAP trial, were also published in JAMA. The mortality results were consistent across the seven trials with two types of corticosteroid, dexamethasone and hydrocortisone, giving similar effects. Too few patients were included in trials of methylprednisolone to allow its effect to be estimated with precision. There was evidence of benefit from corticosteroids regardless of wheth-

er patients were receiving invasive mechanical ventilation at the time they started treatment. The benefit appeared greater among patients who were not so sick that they needed medicine to support their blood pressure, although the results were not definitive in this regard. The effect of corticosteroids appeared similar regardless of age, sex or how long patients had been ill. “Our review is good news in the effort to treat COVID-19, and provides important new information that builds on the findings of the RECOVERY trial,” says Jonathan Sterne, Professor of Medical Statistics and Epidemiology, University of Bristol and Deputy Director of the NIHR Bristol Biomedical Research Centre (NIHR Bristol BRC). “Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by COVID-19. The results were consistent across the trials and show benefit regardless of age or sex.” Janet Diaz, Lead, Clinical response for COVID-19, WHO Emergency Programme added: “WHO is committed to transforming science to policy in order to save lives. The COVID-19 pandemic has challenged us to work faster, but not to sacrifice quality and standards. The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group demonstrates how, in solidarity, science and public health can come together quickly for a common cause. The milestone of pooling of trial data before publication, using that data to inform clinical guidance development and then simultaneous publication of the evidence, evidence synthesis and guidance is unprecedented. I am privileged to have been part of this tremendous H wcollaboration.” ■

This article was submitted by Unity Health Toronto. 14 HOSPITAL NEWS OCTOBER 2020

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Strengthening mental health and wellness during COVID-19 ecognizing the heightened pressures being confronted by Ontario’s health care workers and other critical support staff working in the province’s hospitals, the OHA has put together a number of easily accessible mental health resources from various leading sources (international, national and provincial), such as the World Health Organization and the Centers for Disease Control and Prevention (CDC) in the U.S, as well as a number of resources from Ontario hospitals. These are only some examples of available resources.

RESOURCES

AbilitiCBT AbilitiCBT is an internet-based Cognitive Behavioural Therapy (iCBT) program developed to address anxiety and depression related to the pandemic, as well as general anxiety and depression. Morneau Shepell has partnered with the Government of Ontario to provide the AlibitiCBT program for free to Ontarians aged 16 and over. For more information visit myicbt.com/home Big White Wall This is a free, peer-to-peer community offering a proven way to get better together through anonymous conversation. It is based out of the UK and supported by Ontario’s Ministry of Health. Discussions are moderated 24/7 by trained practitioners and no referral is needed to participate. Find out more at www.bigwhitewall.com. CAMH The Centre for Addiction and Mental Health offers information and suggestions about how best to cope during this difficult time on their COVID-19 Resource Page at camh.ca. CAMH also developed ECHO Coping with COVID, designed for Hospital-Based Healthcare Providers and Residents responding to the 16 HOSPITAL NEWS OCTOBER 2020

COVID-19 pandemic. Participants are invited to join ECHO sessions virtually through multi-point videoconference technology to share and learn about ways to build resilience and overall wellness through didactic lectures and case-based discussions. CAMH also launched a new hub that will house a growing list of evidence-based resources for health care workers and other front line responders to manage their own mental health, and support their patients and families at this time. Visit the health care worker hub or www.camh.ca/ covid19HCW. The site will be updated often as new resources are developed. A self-referral for healthcare workers can be found online. CAMH is providing access to mental health and addiction supports for health care workers who might be impacted by the COVID-19 pandemic. These supports will include access to resources, psychotherapy and psychiatric services. CMHA CMHA Waterloo-Wellington chapter created a mental health service website for healthcare workers. It provides free, immediate mental health care for HCW and was created in partnership with other support services. CMHA Ontario and Mental Health Works are supporting Ontario’s healthcare workers and professionals through a series of webinars on mental wellness addressed specifically to the health care setting. Occurring weekly, the webinars will explore topics relevant to both hospitals and clinics, as well as telehealth professionals and those who work to support patient outcomes such as custodial staff, security professionals, and administrators. For more info visit cmhaww.ca/here4healthcare/ CMHA also developed Online Resources for Social Connection and

Mental Wellness During COVID-19 which includes apps to help with increasing social connection, apps to help with mental wellness and more online resources for mental health and addictions help. It also includes tips for managing your mental health during COVID and for supporting a loved one. For more info visit cmhahamilton.ca Ementalhealth.ca Ementalhealth.ca is a non-profit initiative of the Children’s Hospital of Eastern Ontario (CHEO) dedicated to improving the mental health of children, youth and families. It provides anonymous, confidential and trustworthy information, 24 hours a day, 365 days a year. Ontario Psychological Association The Association recently shared a resource via Twitter specifically targeted at frontline providers during #COVID19. Developed by Dr. Mélanie Joanisse, the workbook is an easyto-read written guide to wellness. Ontario Shores Centre for Mental Health Sciences Health Care Worker Assist* was created to support healthcare workers with increased anxiety and depression. Services offered include system navigation, crisis planning, psychoeducation, brief individual therapy, primary care phone consultation guidance and referral to Prompt Care Clinic for most high risk individuals. Referrals are accepted from individuals (self), health professionals, family physicians, nurse practitioners, or current psychiatrists, through the Central Intake department at 1-877-767-9642 (Monday to Friday 8:30 a.m. to 4:30 p.m.) For more info visit ontarioshores.ca #MindVine #MindVine is the social media home of Ontario Shores. It is a hangout which encourages conversations

on the topics of mental health, mental illness and stigma. Recent posts have been related to supporting mental health and well-being during the COVID-19 pandemic. Mt. Sinai and University of Toronto (UofT) Dr. Robert Maunder and Dr. Jonathan Hunter, psychiatrists at Mount Sinai Hospital and professors at UofT Created a 7.5-minute youtube video on how to cope with COVID-19 for health care workers. Ontario COVID-19 Mental Health Network An emerging network of Ontario-based mental health professionals dedicated to supporting frontline COVID-19 workers through teletherapy. They are re doing this as a temporary measure during the crisis to help reduce friction, offer fast mental health support. Find out more at covid19therapists.com/ The Royal COVID Frontline Wellness* is a resource developed by The Royal to support healthcare workers with maintaining their mental wellbeing during COVID-19. The portal offers simple, fast access to supports and tools using an online form located on The Royal’s website theroyal.ca. Registrants will be contacted by a clinician to discuss their needs and connect them with appropriate supports. These may be services offered by The Royal or other community partners. Waypoint Centre for Mental Health Care COVID Frontline Wellness* connects health care and frontline workers and first responders with supports and access to services to help them enhance resilience during these stressful times and help manage mental health challenges. This service is available by self-referral – simply complete the

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self-referral form at right and a clinician will contact you. This should only take about 5-10 minutes. Alternatively, call Waypoint’s Central Intake at 705-549-3181, ext. 2308 or 1-877-3414229, ext. 2308. For more info visit waypointcentre.ca *Five hospitals in Ontario are partnering with the Mental Health and Addictions Centre of Excellence at Ontario Health to provide assessment and referrals to frontline health care workers from across the province. For more information on these different resources, please visit Ontario.ca

NATIONAL RESOURCES

Alberta Health Services: Text4Hope Alberta Health Services created Text4Hope, a free, supportive text messaging service. Subscribers receive a daily text message of support and encouragement to ease the stress and anxiety they may be feeling. These

texts might remind subscribes to focus on positive thinking or suggest actions to help them manage their mood. For more info visit mentalhealthfoundation.ca/text4hope/ Mental Health Commission of Canada (MHCC) The MHCC developed a worksheet to create a self-care and resilience plan that is quick, and easy-to-use. It also includes mental health resources by province. It can be downloaded on their website. The MHCC also published an article, Choosing sources of information carefully is critical to COVID-19 mental well-being, that shares some important tips on supporting your mental well-being that include: • Be selective about news sources • Consider practical value of information • Don’t discount the power of language

• Set boundaries on news consumption Best Practices for Supporting the Mental Health of Healthcare Workers During Covid-19, is an intervew with a wellness specialist at Michael Garron Hospital available on the Mental Health Commission of Canada’s website. For more info visit www.mentalhealthcommission.ca/English

INTERNATIONAL RESOURCES

CDC – Emergency Responders: Tips for taking care of yourself This resource shares important tips and links to other supports for first responders who often face challenging situations on a daily basis, such as witnessing human suffering, risk of personal harm, intense workloads, lifeand-death decisions, and separation from family. Stress prevention and management is critical for responders to stay well and to continue to help

THE 2020 LEGAL GUIDE TO

PRIVACY & INFORMATION MANAGEMENT IN HEALTHCARE In this constantly evolving arena, it has never been more critical to be on top of the latest developments. This timely OsgoodePD program will provide you with a comprehensive understanding of the most pressing issues, including: privacy challenges in the midst of a health pandemic; primer on AI in healthcare; Ontario Health and information sharing; data de-identiﬁcation risk assessments; cyber attacks in the health realm, and much more.

in the situation. The CDC offers steps responders should take before, during, and after an event that include identifying and understanding burnout and secondary traumatic stress, developing a buddy system, self-care techniques and more. For more info visit emergency.cdc.gov/coping/responders.asp to access this resource. TakeCare19 This website is a compilation of accessible – mostly free or low-cost, and inclusive resources to help cope and support mental wellness through COVID-19 (and beyond). This project started out as a small crowdsourced Google Doc that has since grown and been shared through various networks. It is now in its next evolution as a website to help create a better and easier way to search for more relevant resources, and to expand to other locations. For more info H visit takecare19.com ■

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OCTOBER 2020 HOSPITAL NEWS 17

New study examines cost-effective imaging that protects patients and health care workers from COVID-19 exposure By Christy Janssens ow can we keep COVID-19 patients and their care teams safe while taking chest scans to monitor their wellbeing? One group of researchers at St. Michael’s Hospital of Unity Health Toronto studied an innovative technique to do just that. A study led by Dr. Shobhit Mathur, a physician at St. Michael’s, examined a new radiology process for obtaining chest images through glass doors of isolation rooms. This technique helps to avoid exposure to the virus, while providing clinicians the information they need to treat patients. Different teams came together to swiftly and safely adopt this technique. This study’s findings were recently published in Investigative Radiology and Canadian Association of Radiologists Journal. We sat down with Dr. Mathur to learn more about this work. Q: What is this new technique and how does it differ from conventional imaging techniques? A: Chest radiograph is a low-cost and widely available medical imaging tool commonly used to detect chest problems in patients with possible and confirmed COVID-19 infection. In conventional bedside radiography, two technologists must enter a patient’s isolation room with a machine to perform the imaging. This can increase the chances of exposure to a virus. Of course, when entering a COVID-19 patient’s room, both technologists also need to put on personal protective equipment (PPE) during the procedure and clean the machine afterwards. Chest radiography through glass, however, is a novel technique that allows imaging through the protection of a glass wall. In this scenario, only one of the two technologists is required to enter the isolation room, while the

Dr. Shobhit Mathu is a physician at St. Michael’s Hospital. other operates the machine from outside the room. While this technique has many benefits and was suggested by the Radiological Society of North America during the pandemic, no scientific evidence existed about the best way to use it. We believe that this is an important factor limiting its widespread adoption. Q: What are the benefits of this technique? A: This technique limits healthcare personnel and patient exposure to COVID-19, conserves PPE (only one technologist needs to wear PPE) and decontamination resources, and reduces equipment downtime by eliminating the need to clean the machine after every use. All of this enhances the protection of the patient and their care team, increases hospital efficiency, and reduces health-care costs. Q: What were your key findings? A: Our research project evaluated the feasibility, image quality and radiation safety of this technique in non-clinical and clinical settings. Radiographic image quality is a complex interplay of several techni-

Christy Janssens works in communications at Unity Health. 18 HOSPITAL NEWS OCTOBER 2020

cal and patient factors. Through our research, we showed how technical parameters can be optimized to obtain good quality images while ensuring the least possible radiation to patients. We also found minor backscatter radiation, a small amount of radiation that deflects from the glass and goes the opposite way of the target, which suggests that the technologist outside the room should use lead shielding or maintain appropriate distance from the glass door. This does not affect the patient being imaged. Our research also found that we could save an estimated $50,000 annually in our Emergency Department by adopting this technique. Q: What is next for this research? A: We hope that our experience and results will help other hospitals adopt this technique. Our next step is to enhance collaboration with the industry to make this technique more user friendly. Looking ahead into the future, the ease and benefits of implementing this technique make a strong argument for its continuation in the post-COVID-19 era. This technique has the potential to prevent infection transmission while caring for patients isolated for other infectious illnesses requiring similar precautions. This work was made possible through the collaboration of many different teams at St. Michael’s, including: the Radiology Department (Archana Rai, Darren Liu, Noah Ditkofsky, Djeven Deva, Tim Dowdell, Kate MacGregor, Bryce Hunt, Margaret Dubrawski, David Bristow, David Nelson); the Emergency Department (Alun Ackery); Procurement (Mark Linsao); and the Planning/Development department (Dominic Gascon). A faculty at Michener Institute, Alex Gontar, also worked with the St. Michael’s researchers to support H this project. ■

NEWS

World-first cardiac procedure offers new treatment for

high-risk patients By Selma Al-Samarrai world-first occurred at St. Michael’s Hospital of Unity Health Toronto when Drs. Neil Fam, Mark Peterson and Géraldine Ong performed a catheter-based tricuspid valve replacement through the femoral vein in a patient’s leg. The first patient to undergo this procedure, 76-year-old Mir Hasan Ali, says his health improved within 48 hours. One year later, his health remains markedly improved.

GOING THROUGH THE FEMORAL VEIN MEANS THE RISK OF COMPLICATIONS IS DRAMATICALLY LOWER.

The team used the EVOQUE tricuspid valve replacement system. Prior to using the femoral approach, tricuspid valve replacement procedures were done through open heart surgery or a thoracotomy, meaning the incision occurred through the patient’s ribs. The surgery was effective but invasive, so it posed a greater risk of complications for older patients. “Going through the femoral vein means the risk of complications is dramatically lower. Doing tricuspid valve replacements through the femoral approach is a game changer, as it opens up treatment options for patients with heart failure who are too sick to undergo surgery, or are not good candidates for tricuspid clipping,” explains Dr. Fam, an interventional cardiologist and the Director of Interventional Continued on page 19 www.hospitalnews.com

NEWS Dr. Neil Fam and patient Mir Hasan Ali. Continued from page 18 Cardiology and Cardiac Catheterization Labs at St. Michael’s. Prior to the procedure, which occurred on May 23, 2019, Ali explained that low-effort tasks such as getting out of the car or making the short walk from the bedroom to the bathroom proved too difficult. After the procedure, he could resume these tasks and many other daily activities with great ease. “In April and May of last year, I was terrible. Taking just a few steps meant I had to sit down. I was always so drowsy, tired and irritable,” explains Ali. “When Dr. Fam explained the procedure to me, my sixth sense said yes on the spot. I trusted completely that he could do it, and I was right.” The St. Michael’s Structural Heart Team has since performed several more tricuspid valve replacement procedures using the femoral approach, with the patients reporting significant improve-

ments in their health. To date, 25 patients worldwide have undergone the EVOQUE tricuspid valve replacement, and the results are very encouraging. With further studies planned. The EVOQUE heart valve was first used for mitral valve replacements only. Just over two years ago, Dr. Fam approached the manufacturer Edwards to discuss if EVOQUE might be effective for tricuspid valve replacements as well, and this led to a great partnership to bring this idea to reality. For the past five years, St. Michael’s has been a world leader in transcatheter tricuspid valve interventions, where tricuspid valves are repaired using MitraClip and PASCAL repair systems. However, some patients’ tricuspid valves were irreparable, and the challenge was to then develop a safe and effective procedure to entirely replace the tricuspid valve.

Ali says he is grateful to Dr. Fam and the Structural Heart Team at St. Michael’s for their excellent care and attention. “Every single day, I pray for two people: one is my son, and the other is Dr. Neil Fam. He’s like family to me now,” says Ali.

“Fourteen months after the procedure and I’m still feeling great and trying my best to maintain my health. The pandemic was a challenge, my rehab was cancelled, but the procedure provided me the opportunity to live again, and I am taking all the precautions to H maintain my healthy lifestyle.” ■

Selma Al-Samarrai works in communications at Unity Health.

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Respiratory therapists vital for patients in rehab after COVID-19 By Michael Oreskovich atients recovering from lengthy battles with COVID-19 face many obstacles, even when free from the disease. In addition to being weakened from confinement in a bed for weeks or months, their breathing capacity is compromised, making it extremely challenging to regain strength and mobility. At Runnymede Healthcare Centre, respiratory therapists play a vital role in helping these patients – like Bibi – to achieve their rehabilitation goals. Bibi overcame a 44-day battle with COVID-19 before being admitted to Runnymede for rehabilitation in July 2020. During her stay in acute care, Bibi suffered severe respiratory failure and was put on a ventilator in an intensive care unit. Extreme measures were needed to help her survive, including support from a machine that oxygenated her blood outside her body. “I can’t remember much from what happened while I was in the ICU, except that I had tubes all around me, and I couldn’t talk, or even eat or drink,” Bibi says. “It was horrible. My family told me later that the doctors didn’t know if I would make it.” But Bibi persevered, and like many recovered COVID-19 patients, her harrowing ordeal in acute care left her unable to safely return home. Her muscles were deconditioned due to her long hospital stay. The intense pressure that was on her heart and lungs left persistent trauma. Upon admission

to Runnymede, Bibi was unable to get out of bed or walk without help. “It’s common for patients who have gone through COVID-19 to face additional obstacles to recovery compared to other patients in our rehabilitation programs,” says Geeta Grewal, director of patient care at Runnymede. “Their capacity to breathe effectively is often much lower, which results in an elevated heart rate, shortness of breath and a tendency to become exhausted very easily. All of this makes it challenging for these patients to have a rapid recovery.” Bibi entered Runnymede’s slow stream rehab program, which delivers low-intensity rehabilitation to patients who can’t cope with the pace of more active rehabilitation. The hospital’s physiotherapists (PTs) and occupational therapists (OTs) created a patient-centred plan to help restore Bibi’s independence so she could return home. The treatment plan was challenging to execute because Bibi could not tolerate exertion without extreme fatigue. The hospital’s staff respiratory therapist (RT) was essential in ensuring her therapy would succeed. “Our RT supports therapy by being at the patient’s side to monitor their heart rate and oxygen saturation while PTs and OTs provide therapy,” explains Grewal. “The RT administers supplemental oxygen as it’s needed so patients can get the maximum benefit from therapy sessions before they become too tired to safely continue.”

Bibi on the day of her discharge from Runnymede Healthcare Centre. She was admitted for rehabilitation after surviving a harrowing battle with COVID-19. Runnymede’s RT also supported Bibi by educating her about breathing strategies that conserve oxygen. For example, Bibi learned how to break up activities so they are shorter and require less exertion. She was also taught how to perform diaphragmatic breathing, which helped strengthen her respiratory muscles. A week and a half after Bibi’s admission to Runnymede, these strategies paid off: her endurance had improved to the point that she was able to complete her exercises without needing supplemental oxygen. Around the same time, she became less reliant on her walker and could walk independently for short distances. Her therapy continued with weight training to further build strength, balance and flexibility. She learned to adapt to everyday tasks like wash-

ing, dressing, and taking stairs. On August 5, 2020 – three weeks after her admission to Runnymede, and 70 days after her initial hospitalization for COVID-19 – Bibi was discharged home. Her recovery journey will continue while at home, where she will practice the breathing exercises taught to her by Runnymede’s RT. She is also committed to keep as active as she can in order to maintain and build on her strength. “I’m the kind of person who always wants to get around and move and do things, so when this happened to me, I was so devastated at first,” Bibi said the day of her discharge. “I wanted to get back to my family and my job and the team here helped me get there – I’m so happy to be going back H home again.” ■

Michael Oreskovich is a communications specialist at Runnymede Healthcare Centre. 20 HOSPITAL NEWS OCTOBER 2020

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Sounding the alarm on wait times, delays in children’s health care ntario’s pediatric hospitals and mental health care providers have come together to sound the alarm about excessive wait times and delayed care for children and families in Ontario, which has been exacerbated by the COVID-19 crisis. Even before the pandemic, more than 28,000 Ontario kids were on waitlists for mental health services, sometimes waiting up to 2.5 years for specialized treatment. Meanwhile, an additional 80,000 children are waiting for rehabilitation and child development services in the province. Over 30,000 hospital surgeries, appointments and procedures are backlogged or cancelled altogether. Some kids will wait an astonishing two and a half years for surgeries — far beyond what is clinically acceptable, says the Children’s Health Coalition. In addition to CMHO, the group includes more than 15 leading children’s health care providers in Ontario such as the Hospital for Sick Children, Holland Bloorview Kids Rehabilitation Hospital, Addictions and Mental Health Ontario and the Ontario Hospital Association and more. Mental health care for children and youth has had a growing issue with access to timely services and has strained hospitals due to increasing emergency visits by children and youth. “The pandemic has exposed the already frayed and inadequate health care system for children in Ontario,” says Kimberly Moran, CMHO’s CEO. “COVID-19 disrupted children from their routines, amplified pre-existing mental health conditions and is creating a catalyst for new ones. Without proper care, the deterioration of our children’s mental health can be a matter of life or death.”

UPTICK IN MENTAL HEALTH AND ADDICTIONS CASES

Mental health and addictions care providers at hospitals and in the community are doing their part to serve families during the crisis, but providers www.hospitalnews.com

are already seeing a significant uptick in demand for services. A recent poll by CMHO and Ipsos shows that since COVID-19, 59 per cent of parents have noted behavioural changes in their child, ranging from outbursts or extreme irritability to drastic changes in mood, behaviour or personality. Other impacts include difficulty sleeping/altered sleeping patterns, persistent sadness and more. These kinds of significant changes can be signs of mental illness. Health Canada, using conservative data based on SARS, estimates that over 11 million Canadians will experience increased levels of stress during the COVID-19 outbreak, and over two million Canadians will show signs of traumatic stress.

FAMILY IMPACT OF CARE SHORTAGE CAN BE DEVASTATING

One family impacted by COVID-19 is the Diamond family in Toronto. Jessica Diamond is a mother of 10-year-old Isaac who has been diagnosed with agitated depression and anxiety and who requires intensive services and live-in

treatment. While waiting more than six months to access services, Isaac became suicidal; with every passing day on the waitlist, Jessica feared for her son’s life. “I was so relieved when we finally secured services in March, but within two weeks COVID-19 hit and his treatment was put on hold,” says Jessica. As COVID-19 infections rise again, Jessica worries Isaac’s treatment plan may be further derailed.

HOSPITALIZATION OF CHILDREN FOR MENTAL ILLNESS CONTINUES TO BE HIGH

Newly released CIHI data shows that Ontario hospital utilization rates for children with mental illness continue to be high. Young people making emergency department (ED) visits for these concerns in Ontario has increased 64 per cent since 2008/2009; the number who were hospitalized increased by 71 per cent while hospitalizations for other disorders have decreased by 26 per cent. “Every day counts in the life of a child. Their developing brains, growing bodies and mental health are all

impacted by the decisions we make,” says Alex Munter, President and CEO, Children’s Hospital of Eastern Ontario (CHEO). “We cannot afford for young people in our province to be collateral damage, especially since COVID-19 will be with us for some time. We need to organize health services around their reality.” CMHO and our partners have outlined some solutions to the delays in care for children, youth and families including: • Building integrated care that wraps around the mental, physical and developmental needs of children and families. • Redeploying additional clinical workers to cover staff shortages. • Focused investments in a wait time strategy • Expansion of technology and digital solutions to continue to provide high-quality, confidential services. • Improved navigation so families can easily find the help they need. • Immediate investments in specialized and live-in treatment services for those with the most complex needs. • Deploying funds directed to the ongoing overdose crisis (need for increase in safe consumption sites, for example). • Building of community health care teams to respond to young people in crisis rather than taking a law enforcement response approach. • Focusing on the immediate mental health needs children and youth will have as they re-enter or change their engagement with the school system. CMHO and its Children’s Health Coalition partners are calling for immediate investment in children’s health care to address wait times for mental health, child development and rehabilitation, hospital surgeries and procedures, and to support pediatric home care solutions to alleviate the suffering of 160,000 kids and their families. “Now more than ever, our children deserve all partners at the table, ready to provide H solutions and take action.” ■ OCTOBER 2020 HOSPITAL NEWS 21

NEWS

Researchers unravel two mysteries of COVID-19

By Robert DeLaet team from Lawson Health Research Institute and Western University has made significant steps forward in understanding COVID-19 through two back-to-back studies published recently in Critical Care Explorations. In one study, the team has identified six molecules that can be used as biomarkers to predict how severely ill a patient will become. In the other study, they are the first to reveal a new mechanism causing blood clots in COVID-19 patients and potential ways to treat them. The studies were conducted by analyzing blood samples from critically ill patients at London Health Sciences Centre (LHSC). They build on a growing body of work from the team who were first in the world to profile the body’s immune response to the virus by revealing a separate six molecules that could act as potential targets to treat hyperinflammation in critically ill patients. “We’ve begun answering some of the biggest COVID-19 questions asked by clinicians and health researchers,” says Dr. Douglas Fraser, lead researcher from Lawson and Western’s Schulich School of Medicine & Dentistry, and Critical Care Physician at LHSC. “While the findings need to be validated with larger groups of patients, they could have important implications for treating and studying this disease.”

PREDICTING WHICH COVID-19 PATIENTS WILL GET WORSE

With no proven therapies, many COVID-19 patients admitted to intensive care units (ICUs) do not survive. “When a patient is admitted to ICU, we normally wait to see if they are going to get worse before we consider any risky interventions. To improve outcomes, we not only need new therapies

Dr. Douglas Fraser, Researcher from Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry but also a way to predict prognosis or which patients are going to get worse,” explains Dr. Fraser. The researchers identified six molecules of importance (CLM-1, IL12RB1, CD83, FAM3B, IGFR1R and OPTC). They found that these molecules were elevated in COVID-19 patients who would become even more severely ill. They found that when measured on a COVID-19 patient’s first day of ICU admission, the molecules could be used to predict which patients will survive following standard ICU treatment. “While further research is needed, we’re confident in these biomarkers and suspect these patterns may be present even before ICU admission, such as when a patient first presents to the emergency department,” notes Dr. Fraser. “These findings could be incredibly important in determining how severely ill a patient will become.” The team measured 1,161 plasma proteins from the blood of 30 participants: 10 COVID-19 patients and 10 patients with other infections admitted to LHSC’s ICU, as well as 10 healthy control participants. Blood was drawn on set days of ICU admission, processed in a lab and then analyzed using statistical methods and artificial intelligence.

The team notes that predicting a patient’s disease severity can help in a number of ways. It could allow for medical teams to have important conversations with family members, setting goals of care based on the patient’s health and personal wishes. Medical teams could use the knowledge to mobilize resources more quickly. If they know a patient is at higher risk of death, they may consider intervening sooner despite associated risks. The team also hopes the findings can be used to better design COVID-19 clinical trials by grouping patients based on their risk. This could allow for stronger results when examining potential treatments for the disease.

UNDERSTANDING WHY BLOOD CLOTS OCCUR AND HOW TO TREAT THEM

A major complication occurring in most critically ill COVID-19 patients is clotting in the lung’s small blood vessels which leads to low oxygen levels in the body. “The reason for this clotting has been unclear. Most suspect the clotting mechanisms in our blood are put into overdrive and so many clinicians have been treating with anticoagulant

therapies like the drug heparin,” says Dr. Fraser. “But we’ve uncovered an entirely different mechanism.” The team further analyzed the blood samples from their 30 participants, and found evidence to suggest that the inner linings of small blood vessels are becoming damaged and inflamed, making them a welcoming environment for platelets (small blood cells) to stick. They discovered that COVID-19 patients had elevated levels of three molecules (hyaluronic acid, syndecan-1 and P-selectin.) The first two molecules are products broken down from small hairlike structures (the glycocalyx) which line the inside of the blood vessels. Their presence suggests the glycocalyx is being damaged with its breakdown products sent into the bloodstream. The presence of P-selectin is also significant as this molecule helps to make both platelets and the inner lining of blood vessels adhere to one another. “The glycocalyx keeps platelets from touching the inside wall of the blood vessel and helps facilitate the production of nitric oxide, which has an important role in preventing platelets from sticking,” explains Dr. Fraser. “We suspect the body’s immune response is producing enzymes that shear off these little hair-like structures, inflaming blood vessels and making them a welcoming environment for platelets to form clots.” The team suggests that two therapies may hold promise for treating blood clots in COVID-19 patients: platelet inhibitors to stop platelets from sticking and molecules to protect and restore the inner lining of blood vessels. “By exploring these therapies as potential alternatives to anticoagulant therapies, we may be able to improve patient outcomes,” says Dr. Fraser. “Through our combined findings, we hope to provide tools to predict which patients will become the most severely ill and treatments for both hyperinflamH mation and blood clots.” ■

Robert DeLaet works in Communications and External Relations at Lawson Health Research Institute 22 HOSPITAL NEWS OCTOBER 2020

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2020 Infection Control

INFECTION CONTROL 2020

Infection Prevention and Control (IPAC)

yesterday, today, and tomorrow Barbara Catt eflecting on the initial early news from December 31, 2019 about a pneumonia-like illness of an unknown cause detected in Wuhan, China, I was thinking a coronavirus much like the 2003 SARS virus. On January 12, China shared the genetic sequence of the novel coronavirus so that countries could prepare and develop specific diagnostic kits. As more cases appeared and transmission was apparent, the World Health Organization (WHO) declared a public health emergency of international concern on January 30, 2020 in order to support countries with weaker health systems and then on March 11, 2020 WHO declared the COVID-19 outbreak as a pandemic. Who knew we would reach

over thirty-one million cases globally and still counting! There is still much to learn about SARS-CoV-2, the coronavirus that causes COVID-19 infection and/or disease. At a recent virtual workshop, Dr. Jay C. Butler (Deputy Director for Infectious Diseases, CDC) stated that “COVID-19 spreads more efficiently than influenza and not as efficiently as measles.” This statement speaks to the transmission of COVID-19. With regards to transmission, there is still so much we do not know. What we do know is that it can spread from an infected person’s sneeze or cough. But what about transmission via speech or exhaled breath? What is an infectious dose? How long do infectious particles linger in the air

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and how far can they travel? What is the role in transmission with other body fluids that may contain SARSCoV-2? To understand transmission of SARS-CoV-2, there are additional challenges such as what is the role with presymptomatic, asymptomatic and superspreader individuals and/or superspreading events. These many unanswered questions cause decision-makers to find a balance. That balance being precautionary principal to prevail in some cases. Our new norm for the public has become a combination and reinforcement of the following: • staying home when unwell • physical distancing • hand hygiene • respiratory etiquette • wearing masks when in closed indoor spaces • regularly cleaning and disinfecting common surfaces • self-monitoring for symptoms So many conferences were canceled because of this pandemic and included IPAC Canada’s National Education Conference titled, “2020 Vision, What’s on the Horizon?” As we prepare for the 2021 conference in developing a theme, IPAC Canada’s Executive Director stated so eloquently, “2021 Vision, Didn’t See it Coming!”;

however decided there would be too many words and left it as “2021 Vision, Now What’s on the Horizon?” Many Infection Prevention and Control Professionals (ICPs) are preparing for National Infection Control Week from October 19-23, 2020 with the focus of this year’s theme as “Infection Prevention and Control Beyond the Horizon.” In Canada, Infection Control Week originated in 1988 with the purpose to highlight infection control efforts in Canadian hospitals, long-term care facilities and within communities. Infection Control Week provides an opportunity for ICPs to educate staff and their community about the importance of infection prevention and to promote their important work in a visible and fun way. Then in 1989 the federal government proclaimed Infection Control Week as an annual event. Infection prevention and control has always been an important part of public health and safety and we are continually reminded of its significance as we fight COVID-19. As we continue to prepare and move into the second wave, it is apparent to take the time to acknowledge the dedication and professionalism of the many ICPs across Canada. Take a moment or two H and do just that! ■

Barbara Catt RN BScN MEd CIC is President of Infection Prevention and Control Canada (IPAC Canada) – www.ipac-canada.org. www.hospitalnews.com

INFECTION CONTROL 2020

Nurses pen light-hearted poem on COVID-19 The Swabbers’ Rhyme Big nostrils, small nostrils, some in between. We’re trying to help, not just “to be mean.” This virus is sneaky, it likes to hang out – Right in the back of your finely-formed snout.

By Sherri Gallant ere’s looking up your nose! – with The Swabbers’ Rhyme Collaboration lies at the heart of assessment and testing measures for COVID-19 across South Zone and all of Alberta. Public Health, working alongside Environmental Public Health and Community Infection and Prevention Control, have played a major role in Alberta Health Services’ (AHS) responsive and co-ordinated efforts across the region. Building upon their experience with the vaccine-preventable disease outbreaks that have occurred in the south, their quick action and familiarity with the process led to quick turnaround times for Albertans in need of a swab.

We insert the swab and give it a twirl – The swab tip’s quite tiny – like a small pearl. We send off the sample, kept cool on some ice. Please stay very still; we don’t want to swab twice.

On cold and snowy days through the winter and into the rainy spring and hot summer days, their staff have tirelessly conducted parking lot drivethrough swabbing at 13 sites across the zone – allowing rural Albertans the opportunity to be swabbed in their own communities closer to home. The close work of these teams – both on the frontlines and

among South Zone leadership – has allowed for testing that helps us monitor health and protect residents. Their concentrated efforts have also inspired a bit of light-hearted poetry, The Swabbers’ Rhyme, penned by three talented nurses – Laura Miller, Lori Zeiber and Stasha Donahue – as a means to get their H COVID-19 safety message out.■

We know this is awkward, we get that it’s weird. We understand that corona’s a thing to be feared. So bend your head back, let’s get this thing done. And you can get back to your quarantine fun. Remember your safety and keep yourself well. Hand-washing, protective coughing and physical distancing are swell. One day this will be over, but up until then – We hope not to look up your nose once again. Photo credit: Alberta Health Services

Sherri Gallant works in communications at Alberta Health Services.

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OCTOBER 2020 HOSPITAL NEWS 25

SPONSORED CONTENT

The truth about Healthcare-associated infections. Healthcare-associated infections (HAIs) are infections that patients get while receiving treatment for medical or surgical conditions. Many HAIs are preventable.1 Where do they happen?

In the news. Some infectious diseases that start in the community such as severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS) and COVID-19, the cause of the current pandemic, may also spread in healthcare facilities. 2

HAIs occur in all types of care settings, including acute care hospitals, ambulatory surgical centres, dialysis facilities, outpatient care facilities (e.g., physicians’ offices and healthcare clinics), and long-term care facilities (e.g., nursing homes and rehabilitation facilities).1 According to the Canadian Nosocomial Infection Surveillance Program (CNISP), one in 217 patients acquired an infection while in hospital in 2017. While some HAIs were reduced over time, such as Clostridium difficile infections which were reduced by 25% from 2013 to 2017, other HAIs such as vancomycin-resistant enterococci (VRE) infections increased by 25%. 3 Device-associated infections, such as ventilatorassociated pneumonia, catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs) associated with a prosthetic implant and central line–associated bloodstream infection (CLABSIs), accounted for 35.6% of all health care-associated infections in 2017.4

Common types of HAIs.

Prevention is critical.

Common types of HAIs include:2 • Central line-associated bloodstream infections (CLABSI) • Catheter-associated urinary tract infections (CAUTI) • Surgical site infections (SSI) • Clostridium difficile infections • Methicillin-resistant staphylococcus aureus (MRSA) infections • Vancomycin-resistant enterococci (VRE) infections • Carbapenem-resistant Gram-negative bacterial infections

Environmental cleaning and disinfection is a critical strategy for HAI prevention. According to the Provincial Infectious Disease Advisory Committee (PIDAC), environmental cleaning in the healthcare setting must be performed on a routine and consistent basis to provide for a safe and sanitary environment.7 Cleaning and disinfecting products must be approved by environmental services, infection prevention and control and occupational health and safety.7 Disinfectants must have Health Canada approval and should be compatible with surfaces, finishes, furnishings, items and equipment to be cleaned and disinfected.7 Additionally, they must be used according to the manufacturer’s recommendations and be effective against the microorganisms encountered in the healthcare setting.7

The burden of HAIs. HAIs constitute a significant burden to society, as they cause significant morbidity and mortality in hospitalized patients. More than 200,000 patients are infected every year while receiving healthcare in Canada and estimates suggest that HAIs are linked to between 8,500 and 12,000 deaths per year, making these infections the fourth leading cause of death for Canadians (behind cancer, heart disease, and stroke). 5 Treatment costs for HAIs are high as the cost of containment and control of these outbreaks can really add up.6 Additionally, after discharge, patients with HAIs have significantly higher personal medical costs than uninfected patients. They require more visits from community nurses, greater reliance on hospital outpatient and emergency services, and more visits to their family doctor. 2

Researchers estimated that about 70% of some types of HAIs could reasonably be prevented if infection prevention and control strategies are followed. 8 Make CloroxPro™ part of the process. CloroxPro™ offers multiple Health Canada–registered disinfectants based on three categories of active disinfectant ingredients – quaternary ammonium compounds (or “quats”), chlorine releasing compounds (such as bleach), and peroxygen compounds (such as hydrogen peroxide), to help meet your healthcare facility’s unique needs.

Learn more about how Clorox Healthcare® Spore Defense™, a sporicidal solution designed for use with the Clorox® Total 360® System, kills C. difficile spores and can help in preventing the spread of HAIs at CloroxPro.ca References: 1. Healthcare-associated infections. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections Accessed March 10, 2020. 2. Evaluation of healthcare-associated infection activities at the Public Health Agency of Canada 2012-13 to 2016-17. March 2018. https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/evaluation/HAI_evaluation-eng.pdf Accessed March 12, 2020. 3. Healthcare-associated infection rates in Canadian hospitals. Public Health Agency of Canada. Canadian Nosocomial Infection Surveillance Program (CNISP). https://www.canada.ca/content/dam/canada/public-health/services/publications/science-research-data/healthcare-associated-infection-ratescanadian-hospitals-infographic/CNISP-2013-2017-infographic-eng.pdf Accessed March 13, 2020. 4. Mitchell R, et al. Trends in healthcare-associated infections in acute care hospitals in Canada: An analysis of repeated point-prevalence surveys. CMAJ 2019;191(36):E981-8. 5. Health care associated infections: A backgrounder. Canadian Union of Public Employees, 2009. https://cupe.ca/sites/cupe/files/healthcare-associated-infections-cupe-backgrounder.pdf Accessed March 9, 2020. 6. Dik J-W H, et al. Cost-analysis of seven nosocomial outbreaks in an academic hospital. PLoS ONE 2016;11(2):e0149226. 7. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health care settings. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; 2018. 8. The Chief Public Health Officer’s Report on the state of public health in Canada 2013: Infectious Disease – The Never-ending Threat. https://www.canada.ca/content/dam/phac-aspc/ migration/phac-aspc/cphorsphc-respcacsp/2013/assets/pdf/2013-eng.pdf Accessed March 16, 2020.

The invisible guardian.

Everyday sporicidal protection now available for the Clorox Total 360® system. In addition to our current line of disinfection formulations and products, CloroxPro™ offers a new Spore Defense™ formulation, exclusively for the Clorox Total 360® system. This powerful new chemistry is Health Canada-approved to kill:

Clorox Total 360® system with Spore Defense™, when used regularly, provides your facility with invisible yet effective outbreak prevention.

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Ƈ C. difficile in 5 minutes Ƈ 42 out of 47 pathogens in just 1 minute, including MRSA, VRE, measles & polio

INFECTION CONTROL 2020

Scratching the surface

One year simulated in CL

Spray-on

Untreated

CIS

to protect against microorganisms

research team tested the antimicrobial efficacy of solid copper (integral), spray-on copper and copper-impregnated surfaces over time. These results were compared with a control surface of stainless steel, which has no innate antimicrobial properties. Researchers worked with the UBC Materials Engineering Department and medical microbiologists from Vancouver General Hospital to simulate one year of cleaning action and cleansers on the surfaces using a Wiperator machine. The Wiperator performed 365 cleaning rounds on the test and control surfaces with microfiber cloths presoaked in common disinfectants: five per cent sodium hypochlorite (bleach),

You are making a world of difference We are here to support you The demands of COVID-19 are causing your healthcare needs to change ever-rapidly. We are doing everything we can to help you do what only you can in the fight against the pandemic. Thank you for all your efforts. You mean the world. Please visit bd.com/en-ca/COVID19 for information on BD resources that can help.

28 HOSPITAL NEWS OCTOBER 2020

Test alloys lost an average mass of 0.25 per cent by the end of the Wiperator simulation. Integral copper lost the least mass at 0.19 per cent – similar to the control stainless steel.

Stainless steel

opper can help reduce the spread of disease, and new research shows which varieties are more effective. Countless people move through hospitals, touching and spreading microorganisms to multiple surfaces each day. Copper’s natural antimicrobial properties can help combat the spread of diseases such as COVID-19 and Methicillin-resistant Staphylococcus aureus (MRSA), and new research identifies which combination of copper alloys and cleaning practices pack the best microbe-destroying punch. The study, led by Vancouver Coastal Health Research Institute researcher, Dr. Elizabeth Bryce, and her

Integral

By Carrie Stefanson

accelerated hydrogen peroxide or quaternary ammonium solutions. After the simulation, the surfaces were disinfected and exposed to two bacteria known for having antibiotic-resistant variants commonly found on hospital surfaces. Staphylococcus aureus (SA) bacteria often cause skin infections and can lead to pneumonia or toxic shock syndrome1. Pseudomonas aeruginosa (PA) can lead to pneumonia, as well as infections in the blood and other parts of the body. Bryce and her team found that integral and spray-on copper surfaces did a better job than copper-impregnated surfaces and the control surface at killing PA bacteria – a gram-negative organism with a thinner cell wall than SA. None of the copper alloys were able to meet sanitization requirements for SA, although integral copper outperformed the other three alloys when it came to cutting down the bacteria’s numbers. A prime application for copper’s antimicrobial properties is the hospital setting, in which hospital-associated infections are a significant concern. A 2019 study of select Canadian hospitals found that hospital-associated infections affected almost eight per cent of patient cases in 2017.

“Because of the costs associated with installing copper surfaces, it is important to accurately determine their effectiveness, including the impact of common cleaning practices,” says Bryce. Her study found that spray-on copper’s effectiveness against SA increased slightly when combined with quaternary ammonium cleansers. However, bleach reduced the efficacy of all test alloys over time. Test alloys lost an average mass of 0.25 per cent by the end of the Wiperator simulation. Integral copper lost the least mass at 0.19 per cent – similar to the control stainless steel. Bryce notes that the study’s results show that copper could be a complement to regular cleaning protocols, not a replacement. And because copper has multiple mechanisms to kill bacteria, it is unlikely that bacteria exposed to it on a regular basis would develop copper resistance. “Copper punches holes in membranes, interferes with key enzymes, affects the transport of chemicals into the cell and activates superoxide radicals, among other things that kill bacteria,” notes Bryce. “This helps it evade antibacterial resistance better H than many antibiotics.” ■

Carrie Stefanson works in communications at Vancouver Coastal Health. www.hospitalnews.com

INFECTION CONTROL 2020

N95 reprocessing program

Each N95 respirator goes through a series of inspections as part of the reprocessing program. (Photo: UHN)

By Ana Fernandes OVID-19 has put enormous pressure on healthcare systems and sharpened focus on emergency preparedness. At UHN, that has led to development of an unprecedented process to ensure a healthy stockpile of a key piece of personal protective equipment – N95 respirators, which are being reprocessed and stored for possible use if a second wave of the coronavirus leads to supply shortages. “We need to be prepared for any future shortages that may arise,” says AnnMarie Tyson, Director of UHN’s Medical Devices Reprocessing Department (MDRD).

“As a leading academic hospital, we have to think ahead and prepare for every scenario,” says Dr. Fayez Quereshy, Interim Vice-President and Site Lead at Toronto General Hospital (TGH). “Among the many lessons to be learned during this pandemic, a very important one is that emergency preparedness is absolutely critical.”

DEVELOPING THE PROGRAM

N95 respirators were originally designed for single use, so reprocessing them was entirely new territory. “It’s something that has never been done before,” says AnnMarie.

UNPRECEDENTED INITIATIVE A KEY STEP IN ENSURING A HEALTHY SUPPLY OF THE RESPIRATORS IN CASE OF SECOND WAVE OF COVID-19 WAVE OR ANY EMERGENCY SCENARIO. “This system, as novel as it is, is something we can all feel confident in, and proud of.” The reprocessed respirators are not being used now, explains AnnMarie, “but are being processed and then stored away by size and manufacturer type should we need to access them.” N95 respirators are high-level facial protection for the nose and mouth, which should only be worn in healthcare settings. When used properly, they filter more than 95 per cent of particles that may be present in the air, protecting the healthcare worker from potential infections. The demand for N95 respirators grew exponentially in earlier stages of the COVID-19 pandemic, creating uncertainty of supply in many countries, including Canada. UHN procurement efforts have guaranteed there’s a minimum 30-day supply on hand. Still, leadership decided it was important to be prepared. www.hospitalnews.com

“We’ve developed best practices in setting up our respirator reprocessing labs and continue to apply scientific rigour through testing and investigation as we build our program. “We are also collaborating with governing and regulatory bodies to guide our work, so we can be confident we have a safe process in place for storage and retrieval, if we need to.” With the greenlight from Health Canada and Ontario Health, and in consultation with suppliers, UHN has already reprocessed and stockpiled more than 2,300 N95 respirators of various sizes. Given the unprecedented nature of this work, there’s no set shelf life for the reprocessed respirators. Frequent tests are done to assess their efficacy in case they are needed.

BEHIND THE SCENES

Staff wearing an N95 respirator have been instructed to examine it

when they take it off. If there are missing parts, broken bands, makeup residues or any signs of bodily fluids, it’s thrown out. UHN has two N95 respirator reprocessing labs, one at TGH and one at Toronto Western Hospital. Once the respirator arrives at a lab, it goes through three inspection tables where it is further checked under a magnifying glass and light for visible gross soils and damage. If

the respirator passes these inspections, it’s considered a candidate for reprocessing. The N95 respirator is then packaged, sealed and processed in the same machine used to sterilize delicate medical instruments. After the process is completed, the N95s pouch is cracked open and allowed to aerate, resealed, labeled, stamped for quality control, and safely H stored away.■

Ana Fernandes works in communications at University Health Network.

The real cost of outbreaks. Infectious disease outbreaks at healthcare facilities are a major problem for healthcare institutions as the cost of containment and control of these outbreaks can really add up.1 The usual culprits. Significant savings The two predominant outbreak culprits seen with prevention: are seasonal influenza (flu) and norovirus. $99,363 – Savings Influenza and norovirus outbreaks are more resulting from prevalent in winter months due to changes increased surface in environmental conditions and in human disinfection following behaviour.2 an outbreak of just five cases of Think prevention. norovirus4 According to a report by the Provincial $104,273 – Savings Infectious Disease Advisory Committee resulting from enhanced hand (PIDAC), 20% of healthcare-associated hygiene measures infections could be prevented through following an outbreak infection, prevention and control (IPAC) of just five cases of strategies.3 The report also shows that norovirus4 IPAC programs are both clinically effective and cost-effective.

Learn more about how the CloroxProTM Health Canada-registered disinfectants can help meet your facility’s unique needs at CloroxPro.ca References 1. Dik J-W H, et al. Cost-analysis of seven nosocomial outbreaks in an academic hospital. PLoS ONE 2016;11(2):e0149226. 2. Norovirus NoroSTAT Data. Centers for Disease Control and Prevention. https://www.cdc.gov/norovirus/reporting/norostat/data.html. Accessed January 14, 2020. 3. Ontario Agency for Health Protection and Promotion. Provincial Infectious Diseases Advisory Committee. Best Practices for Infection Prevention and Control Programs in All Health Care Settings, 3rd edition. Toronto, ON: Queen’s Printer for Ontario; May 2012. 4. Lee B, et al. Economic value of norovirus outbreak control measures in healthcare settings. Clin Microbiol Infect 2010;17(4):640-6.

OCTOBER 2020 HOSPITAL NEWS 29

INFECTION CONTROL 2020

The secret in the salt?

Salt-coated masks and air filters to potentially slow the spread of COVID-19 By Deba Hafizi likely to have a significant impact on health care in Canada. Salt is a natural substance that inhibits the growth of bacteria and has long been used in food preservation, flavouring, pharmaceuticals, agriculture, and at-home remedies. The theory behind salt’s potential ability to inhibit SARSCoV-2 is that when droplets containing virus particles encounter a salt-coated surface, the water in the droplets dissolves some of the salt. When the water evaporates, the salt recrystallizes and the jagged salt crystals pierce the virus membrane, ultimately killing it. This method has been tested against influenza viruses and bacteria and has been proven to be effective. Compressed salt is therefore being investigated as an antimicrobial for use on high-touch surfaces – such as door push plates, bed rails, and taps – by an Alberta company, Outbreaker Solutions Technologies. Pilot evaluations of Outbreaker

he latest potential safeguard to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, can be found in almost every kitchen pantry – salt! Canadian and international researchers are examining whether coating masks, air filters, and high-touch surfaces with sodium chloride (salt) might help prevent the spread of SARSCoV-2 and other viruses and bacteria. In a recent issue of Health Technology Update, CADTH looked at the latest research on compressed salt surfaces for reducing the transmission of viruses and bacteria. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. The CADTH Health Technology Update newsletter describes new and emerging health technologies that are

Using social media to treat COVID-19 patients remotely By Martin Qiu s the Canadian healthcare system prepares for a potential second wave of COVID-19, there are lessons to be learned from a recent study published in the Journal of Medical Internet Research about a telemedicine practice in Wuhan, China that employed a social media app to monitor patients in the early days of the pandemic. In January 2020, Wuhan’s local medical capacity was quickly overwhelmed by the large number of

patients who swarmed to hospitals for help. Many health-care workers were infected with COVID-19 and medical care supplies were depleted. To prevent the health-care system from collapse, China advocated for infected patients with mild symptoms to stay home and self-quarantine. A small percentage of home-quarantined patients – approximately one to four per cent – eventually developed severe or critical conditions, yet those patients did not exhibit different onset symptoms.

30 HOSPITAL NEWS OCTOBER 2020

Continued on page 32

products (compressed salt-coated surfaces) have been carried out at several Alberta facilities. A 2016 pilot study found that a compressed sodium chloride surface reduced contamination with the methicillin-resistant Staphylococcus aureus (MRSA) bacteria by 94 per cent within the first 60 seconds compared with 71 per cent to 73 per cent for copper surfaces. Outbreaker is currently investigating whether these salt-coated surfaces will have a similar impact against SARS-CoV-2. Other salt-related developments are also underway, including salt-coated facial masks and air filter materials, as well as a saltwater soaking solution for household materials and cloth masks. A team from the University of Alberta found that salt-coated facial masks effectively deactivated influenza virus aerosols and bacteria bio-aerosols and is currently investigating whether it will also protect against SARS-CoV-2, which has a similar morphology to other tested viruses. Elsewhere, a research team in Boston investigated whether saltwater-soaked materials – such as paper towels and surgical masks – were able to filter out particles the size of viruses in droplet testing. The investigators found that there was a decrease in bacterial growth on masks they had contaminated with E. coli, especially in portions with higher salt saturation. These findings suggest that salt-water treated kitchen paper towels could be an inexpensive and accessible way to add an additional layer of protection for people wearing homemade cloth masks or for health care workers who need to extend the life of their personal protective equipment, or PPE. While these technologies show promise, they have not been tested

against SARS-CoV-2 nor have they been vetted or recommended by any federal or public health authorities for use on surfaces or facial masks. While salt may have antimicrobial properties when applied to surfaces and materials, this doesn’t mean that injecting it or spraying it up the nose can prevent or cure COVID-19. Much like bleach, which has antimicrobial properties and is used on everyday surfaces in your home, it does not mean it will have the same effect in the body; in fact, ingesting bleach can be harmful! Salt, on the other hand, is generally safe for consumption and is often found in your favourite dishes, however, at high temperatures it can produce a vapor that is an eye irritant, and ingesting high doses can be toxic to humans and animals. While there is currently no evidence that certain surfaces or surface coatings can halt or inhibit the growth of SARSCoV-2, Health Canada has compiled a list of hard-surface disinfectants with evidence against the virus. Investigation of new technologies continues as we learn more about the virus. As schools and public spaces re-open, increasing the effectiveness of masks and antimicrobial surfaces could be a positive preventive public health intervention. For more information, read the Health Technology Update newsletter at cadth.ca/health-technology-update-issue-27-0. If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your region: cadth.ca/Liaison-Officers. To suggest a new or emerging health technology for CADTH to review, email us at H HorizonScanning@cadth.ca. ■

Deba Hafizi is a knowledge mobilization officer at CADTH. www.hospitalnews.com

INFECTION CONTROL 2020 SPONSORED CONTENT

Mitigating the impact of hospital-acquired infections By Greg Miziolek, President, BD–Canada ospital-acquired infections, sometimes referred to as healthcare-associated infections (in both cases, HAIs) are the most frequent adverse events affecting patients in hospitals around the world.1 In Canada, more than 200,000 patients contract HAIs per year.2 Common types of HAIs can include urinary tract infections (UTI), blood stream infections (BSI) including central line-associated bloodstream infections (CLABSI), and can be caused by organisms such as Clostridioides difficile (C. diff) and methicillin-resistant Staphylococcus aureus (MRSA).2 In a time when our hospitals are already battling the COVID-19 pandemic, measures to limit the risk of these infections, along with preserving the associated resources to manage them, is especially vital. While any HAI may be detrimental for a patient, infections by antimicrobial-resistant organisms, like MRSA, can be particularly concerning, especially as patients face existing infections, injuries or chronic conditions.3 While the rate of HAIs in Canadian hospitals is fortunately declining, the number of infections caused by organisms with antimicrobial resistance (AMR) is increasing and over 50 per cent of HAIs are resistant to at least one antibiotic.4,3 In the most dire cases, HAIs can be fatal.3 In other cases, they can result in prolonged hospital stays, long-term disability and additional costs for families and patients.1 Healthcare workers are also impacted by HAIs, as special

WHILE THE RATE OF HAIS IN CANADIAN HOSPITALS IS FORTUNATELY DECLINING, THE NUMBER OF INFECTIONS CAUSED BY ORGANISMS WITH ANTIMICROBIAL RESISTANCE (AMR) IS INCREASING control measures must be taken when treating an individual with a resistant infection, requiring time and resources. On a broader scale, HAIs also take a financial toll on our public health system: in 2012, costs to manage the estimated 37,900 C. diff episodes in Canada amounted to approximately $281 million.2 With the use of sophisticated surveillance tools, hospital teams can identify, track and report resistant infections when and where they occur. Policies such as mandatory reporting can support more frequent data collection and insight generation. Consistent and comprehensive reporting through normalization of data can

also support extensive benchmarking, allowing hospital administrators and governments to observe the impacts of strategies to combat HAIs. Canadian institutions may also find they spend considerable time manually engaging in these requisite reporting obligations. Adoption of automated surveillance tools has been helpful across numerous health systems, including Hackensack Meridian Health–JFK Medical Center, an example of a hospital that has seen great success in their efforts to combat HAIs. After identifying an increase in the number of C. diff infections in December 2016, a steering committee of key stakeholders was tasked with

developing a strategy to reduce the rates of this resistant infection. Their plan involved utilizing the BD HealthSight™ Clinical Advisor and Infection Advisor with MedMined™ Insights (formerly MedMined™ Surveillance Advisor) technology, as well as a review of current protocols and practices for infection prevention. The BD software aggregates and standardizes patient data to empower clinicians to intervene with at-risk patients, determine trends on infection types and facilitates benchmarking within a hospital or region. With use of the surveillance tool and guidance from the BD team, Hackensack Meridian Health– JFK Medical Center implemented daily huddles using mobile tablets to increase collaboration and information sharing, trained all front-line staff on new infection-prevention protocols and ensured appropriate testing allocation based on where symptoms suggested such tests were most needed. Within a year, Hackensack Meridian Health–JFK Medical Center saw a reduction of C. diff cases by 48%.5 By re-evaluating current practices and finding opportunities to improve current protocols, hospital teams can drastically reduce the rate of HAIs, benefitting patients, healthcare workers and entire hospital systems. With adequate infection prevention and control programs and strategies, hospital teams can better protect patients by reducing infections and supporting better outcomes. To collaborate with us and learn more about AMR, visit: go.bd.com/ H learnmoreAMR Q

1. World Health Organization. “The burden of health care-associated infection worldwide.” 2020. https://www.who.int/infection-prevention/publications/burden_hcai/en/. Accessed July 2020. 2.Government of Canada. “Evaluation of Healthcare-Associated Infection Activities at the Public Health Agency of Canada 2012-13 to 2016-17.” 2018. https://www.canada.ca/en/public-health/ corporate/transparency/corporate-management-reporting/evaluation/healthcare-associated-infection-activities-2012-2017.html#es. Accessed July 2020. *RYHUQPHQW RI &DQDGD ´7KH &KLHI 3XEOLF +HDOWK 2IÀFHU·V 5HSRUW RQ WKH 6WDWH RI 3XEOLF +HDOWK LQ &DQDGD ² +HDOWKFDUH DVVRFLDWHG LQIHFWLRQV ² 'XH GLOLJHQFH µ KWWSV ZZZ FDQDGD FD HQ SXEOLF KHDOWK FRUSRUDWH SXEOLFDWLRQV FKLHI SXEOLF KHDOWK RIÀFHU UHSRUWV VWDWH SXEOLF KHDOWK FDQDGD FKLHI SXEOLF KHDOWK RIÀFHU UHSRUW RQ VWDWH SXEOLF KHDOWK FDQDGD LQIHFWLRXV GLVHDVH never-ending-threat/healthcare-associated-infections-due-diligence.html. Accessed July 2020. 4.Jennie Johnstone, Gary Garber and Matthew Muller. “Health care-associated infections in Canadian hospitals: still a major problem.” 2019. https://www.cmaj.ca/content/191/36/E977. Accessed July 2020. %' ´%' 0HG0LQHG 6XUYHLOODQFH $GYLVRU FDVH VWXG\ µ

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OCTOBER 2020 HOSPITAL NEWS 31

INFECTION CONTROL 2020 Continued from page 30

Using social media to treat COVID-19 To address this dilemma, seven medical workers at Tongji Medical School Hospital, including two doctors and three nurses, set up a group chat on WeChat, a popular social media app in China. They invited patients at their clinic who were experiencing mild symptoms of COVID-19 but could not be diagnosed or treated to join the group. Upon sign-up, individuals were required to fill in a quarantine assessment questionnaire, and then to fill in a monitoring form on WeChat every day to self-assess their conditions. The form updated the medical team on a number of symptoms including fever, dyspnea, lack of strength and muscle soreness. Based on the update, the medical workers analyzed the symptom changes and used the individual chat function to provide instructions and suggestions to pa-

tients. A telemedicine system was thus established. In total, 188 home-quarantined individuals joined the telemedicine system, including 74 patients who were eventually diagnosed with COVID-19. For the 114 individuals who may have just been experiencing cold or flu symptoms, the telemedicine system prevented possible cross-infection by reducing their unnecessary clinic visits. Out of the 74 positive COVID-19 patients, six progressed to severe or critical conditions during home quarantine. Thanks to the telemedicine system, which enabled the medical team to take note of their deteriorating conditions, all six patients were admitted to the hospital in a timely fashion. One patient was on ECMO support for 17 days, but all 74 patients eventually recovered.

The telemedicine system has done much more than save six patientsâ&#x20AC;&#x2122; lives or prevent 114 people from infection. According to the study, several patterns of symptom changes were identified through vigorous statistical analysis as predictors for disease progression, which shed light on further understanding of the virus. In addition, the WeChat group worked as a support group that facilitated social interactions among those isolated and infected individuals. Patients shared songs, photos and recovery news to cheer each other on, largely alleviating their psychological stress. The medical team included a rehabilitation physician and a psychologist who provided formal consultation on recovery exercises and mental health issues. The telemedicine system also benefited the Chinese health-care system at

large, as this model can enlist the help of infected but recovered medical staff who are self-quarantining at home. Indeed, one nurse on the original medical team in the study was infected with COVID-19, and she worked from home to support the telemedicine system. Thus, in the case that COVID-19 surges again in Canada, this model could be used to ease shortages in the medical workforce and free up workers to fight on the frontline. With the wide availability of social media apps, this model can be easily adopted around the world. It does not matter which app is used. As long as home-quarantined patients can use the same platform to form a virtual support group and have timely access to medical professionals, the detrimental impacts of COVID-19 on physical and mental health can be H greatly contained. â&#x2013;

Martin Qiu, associate professor of Business at Wilfrid Laurier Universityâ&#x20AC;&#x2122;s Lazaridis School of Business and Economics, helped develop the telemedicine system and analyze the data.

INFECTION CONTROL 2020 SPONSORED CONTENT

Revolutionizing human waste management and infection control in hospitals n todayâ&#x20AC;&#x2122;s hospital environment, the patient experience, their health outcomes and the support of their professional care-givers has never been more important. One of the key areas within the hospital and health care setting that has, and remains a challenge, is the safe and efficient method of dealing with human waste. With mounting pressure on cost reduction, demands for increased efficiency and the need for improved infection control, the process of effectively dealing with human waste can put additional stress on nursing and care staff. Within the last century, a simple, yet effective way to combat these pressures, while delivering optimum care results has been achieved through the development of environmentally friendly, moulded pulp products and maceration disposal units. The pioneer and current leader in this field is Vernacare, who first introduced moulded pulp products and maceration units to the healthcare system. Vernacare brought the new biodegradable pulp product line made from 100% recycled post-consumer newsprint to the market in 1959 to replace the traditional method of human waste disposal via plastic or metal reusable bedpans, urinals, bowls and basins.

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SINGLE USE PULP PRODUCTS DRAMATICALLY REDUCE THE SPREAD OF INFECTION AND SAVE PRECIOUS NURSING TIME PREVIOUSLY SPENT ON UNPRODUCTIVE AND OFTEN UNSAFE MANUAL WASHING AND DISINFECTING OF REUSABLE BEDPANS, URINALS AND BASINS. This new product line revolutionized human waste methods by introducing single use, maceratable waste containers to the bedside. Single use pulp products dramatically reduce the spread of infection and save precious nursing time previously spent on unproductive and often unsafe manual washing and disinfecting of reusable bedpans, urinals and basins. To complement the advent of moulded pulp products and further enhance the human waste disposal system, environmentally friendly, compact and hands-free maceration units were added to complete the system. The maceration unit allows for the ultra-hygienic and efficient disposal of single use pulp products through the existing sewer system with minimal and in some cases no disruption to the existing plumbing configuration within

the health care facility or hospital. Not all maceration units can provide the assurance of minimization of particle size to ensure no dry or bulky material can pass into the pipework and causing disruptive clogs. Only Vernacareâ&#x20AC;&#x2122;s SmartFlow Technology can deliver this type of efficiency. Single-use containers and maceration units are now common place in hospitals around the world, thanks to the dedicated product development innovation focus of Vernacare. Other critical factors to consider and ensure successful implementation of this type of human waste disposal system are the ongoing training, support and supply chain effectiveness of your supplier. Selecting a supplier who has singular control from product manufacturing through to distribution and servicing of the products and system ensures the highest quality and reliability of this crit-

ical function. Again, Vernacare has the only moulded pulp factory in the world that is exclusively dedicated to the manufacture of medical grade products and their comprehensive training and service support is unparalleled. Downtime in human waste management is simply unacceptable. By working with the only end to end supplier in human waste systems, health care facilities can enjoy the benefits of improved infection control, assured excellence in material quality, better use of nursing resources, and improved efficiencies all resulting in enhanced patient experiences and cost control. The industry has been well served by Vernacare in their dedication to this vision, as the originator and leader in the field of human waste systems. The healthcare and patient care sectors are experiencing rapid evolution and change. Vernacare is an organization that is a trust partner known for delivering uncompromised quality and service support. Excellence in patient outcomes and staff morale depend on the quality of care often contingent on products that facilitate wellbeing and positive, reliable results. This objective is well served and understood by Vernacare, the global leader and innovator in human waste H management systems. Q OCTOBER 2020 HOSPITAL NEWS 33

FROM THE CEO’S DESK

Importance of partnerships for mental health care in a pandemic By Carol Lambie he alarming mental health and addiction statistics we are seeing with the COVID-19 pandemic heightens the importance of September as national Recovery Month, and Mental Illness Awareness Week from October 4 to 10. Unfortunately, one description of the stages of a pandemic indicates mental health challenges as the fourth wave unfortunately giving the impression it follows previous waves. In truth, we started to see alarming mental health needs months ago. Provincially, hospitals, community organizations, and associations are supportive of Ontario’s Roadmap to Wellness strategy and are ready to partner with government to meet the increased demand for access to treatment and care in the pandemic’s wake. Waypoint Centre for Mental Health Care and our partners across the system have worked hard to maintain services while keeping patients and clients, and the staff we need to care for them, safe during the pandemic. Virtual services were rapidly implemented and adjustments with a focus on infection control were made to ensure patient and staff safety. Six months later we are now focused on how to increase supports not only for those already in hospital and receiving community services, but to meet emerging needs of all ages for mental health and addiction services. As a specialty mental health hospital serving the Simcoe County, Muskoka and Parry Sound areas, and the entire province for high-secure forensic mental health programs, our patients’ recovery journeys can vary in length and require multiple services from in-hospital, to community and supportive housing. When the pandemic forced us to change the way we work, it not only put a strain on our patients, but also on staff. With this new reality, partnerships at all levels have become more important than ever. Working with

ENHANCEMENTS TO WELLNESS PROGRAMMING, DEVELOPING RESILIENCY WORKSHOPS AND AT-HOME WELLNESS ACTIVITIES, OFFERING MINDFULNESS SESSIONS, AND SHARING RESOURCES ON HOW TO STAY ACTIVE WHILE PRACTICING PHYSICAL DISTANCING ARE JUST SOME OF THE SUPPORTS AVAILABLE. other hospitals and organizations allows us to advocate with one voice, enhance programs, and build on each of our strengths. Waypoint’s membership in the Central Ontario Regional Ontario Health Team for Specialized Populations is one of those partnerships. The ten members are a network of agencies in Central Ontario providing person-centered care for vulnerable people and their families and caregivers with highly complex needs who

require specialized intensive services throughout their lifespan with a focus on mental health and addictions. This specialized Ontario Health Team provides the opportunity to collaborate with hospitals, primary care physicians, community and acute care partners through other local Ontario Health Teams. With so much shifting in the way healthcare workers are caring for patients, it’s also a priority to help them through this pandemic, ensuring sup-

ports are available through these unprecedented times. Enhancements to wellness programming, developing resiliency workshops and at-home wellness activities, offering mindfulness sessions, and sharing resources on how to stay active while practicing physical distancing are just some of the supports available. Rapid access to free mental health care support for healthcare and frontline workers became a focus for Waypoint in partnership with four other hospitals across Ontario and supported by the Mental Health and Addiction Centre of Excellence at Ontario Health. This service for healthcare and frontline workers provides free, confidential wellness and coping support during COVID-19. I urge you to make sure your staff know about this and other provincial services for healthcare workers by sharing the provincial website: COVID-19: Get support if you are a health care worker. With an eye toward future supports for mental healthcare professionals, a research study is also underway in partnership with Georgian College to benefit today’s and future healthcare workers. ECHOES, or Effects of COVID-19 on Healthcare Providers: Opportunities for Education and Support, is a joint study with Waypoint designed to learn more about healthcare providers’ experiences with the pandemic and the impact on their professional practice. As we move into the fall, we don’t know when this pandemic will end, but we do know that people have an increased need to access mental health and addiction treatment and care. We will continue to keep our focus on advocating for this with our partners, being innovative and finding new ways to support patients and clients to enhance their quality of life, and ensuring we are supporting our staff so they can continue to provide essential mental health care. Stay safe H and be well. ■

Carol Lambie is President and CEO, Waypoint Centre for Mental Health Care. 34 HOSPITAL NEWS OCTOBER 2020

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SAFE MEDICATION

Moving towards safer and better self-care By Crystal Zhang, Yifan Zhou, and Certina Ho y headache is killing me. I’ll take whatever medication is available in that gas station to help with the pain.” Self-medication is becoming increasingly common for management of minor illnesses due to the ease of access of non-prescription medications. However, patients may risk misdiagnosing their condition(s) and/or misusing self-selected medications, resulting in inappropriate or delayed healthcare management. As the most accessible healthcare professionals, pharmacists are uniquely positioned to bridge this gap and facilitate safe medication use.

What to consider?

SELF-SELECTED MEDICATIONS

“

According to the National Association of Pharmacy Regulatory Authorities (NAPRA) National Drug Schedules, there are medications that can be purchased without a prescription or without professional intervention from the pharmacist at the point of sale in Canada: Schedule III medications are generally known as over-the-counter (OTC) medications. They must be sold in an accredited pharmacy but can be displayed in the self-selection area. Some examples include fluconazole (when sold in a particular dosage form and pack size for vaginal yeast infection) and lactulose (for constipation). Schedule U or unscheduled medications can be sold from any retail outlets without professional supervision. Some examples include acetaminophen (when sold in particular dosage forms and pack sizes for fever, headache, or pain) and loperamide (for diarrhea when marketed for adult use (i.e. 12 years and older)). Despite the relatively lower risk associated with OTC and unscheduled medications, their indication, efficacy, safety as well as cost and convenience should be thoroughly assessed prior to self-medication. The self-selection process and considerations when choosing OTC and unscheduled medications may seem

What does this mean?

A Case Scenario

Indication Can this medication be used to treat the condition or its symptoms?

Assessing the signs and symptoms of a presenting illness is essential prior to selecting proper therapies. Since many conditions may have similar clinical presentations, appropriate screening can help identify differentiating symptoms and narrowing down the possible conditions. Additionally, red-flag symptoms may surface during the screening process. They are indicative of a more serious underlying condition, requiring referrals for further investigation. Screening questions may include, but not limited to, precipitating/palliating factors, characteristics/description of the symptoms, affected areas, severity of the symptoms, duration of the symptoms, and frequency of symptoms occurrence, etc.

A patient with a runny nose and sneezing says that spring and outdoors make the symptoms worse. Patient does not have a fever nor sore throat; the symptoms can last for hours and days. It is highly likely that patient may have seasonal allergies.

Efficacy Is this medication effective in treating the condition or alleviating its symptoms?

Oftentimes, there may be more than one treatment option available for a condition or symptom. In this case, efficacy is likely the first differentiating factor. Things to consider include the patient's relevant medical and medication history, as well as the selected medication's mechanism of action and route of administration, etc.

An antihistamine ophthalmic drop would be ineffective and inappropriate in this case, as the patient does not have any eye related symptoms.

Safety Is this medication safe for the patient?

The safety consideration should include not only the potential adverse effects of a medication, but also patient-specific factors that may preclude certain treatment options, such as patient’s drug allergies, age, pregnancy/breastfeeding status, etc. A thorough medical and medication history of a patient can help identify and prevent potentially harmful contraindications as well as drug-disease and/or drug-drug interactions.

If the patient is an older adult, then first-generation antihistamines (e.g. diphenhydramine) should be avoided. A second-generation antihistamine (e.g. cetirizine oral tablets) may be considered for alleviating the symptoms of runny nose and sneezing instead.

Cost/ Convenience Is this medication a good fit to the patient’s budget and personal preferences?

The affordability and dosing schedule of the selected If the patient needs to drive to work medication will also play a role, as they may contribute to every day, a second-generation (nonpatient’s medication adherence. drowsy) antihistamine with oncedaily dosing may be more practical, as compared to a first-generation antihistamine that would require more frequent dosing and may cause more drowsiness.

to be complicated. However, for safe and effective management of self-care medical conditions, patients are encouraged to reach out to their pharmacists and/or healthcare providers. It is also important for healthcare professionals to recognize the potential risks associated with self-medication and actively engage patients in their self-selection process.

MOVING TOWARDS SAFER AND EFFECTIVE SELF-CARE

There are many medications that can be sold in the market without health professional supervision. Patients considering or have been self-medicating are encouraged to talk to their pharmacists and healthcare professionals in order to minimize the

potential risk of harm from misdiagnosis and/or medication misuse. Pharmacists are well-positioned to utilize their clinical expertise to promote safe and effective medication use. Partnering with patients, improving patient education, and understanding the benefits and risks of self-medication are crucial to moving towards safer and better H self-care. ■

Crystal Zhang and Yifan Zhou are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. www.hospitalnews.com

OCTOBER 2020 HOSPITAL NEWS 35

LONG-TERM CARE NEWS

The Best Visit Possible:

New guide focuses on the needs of families during COVID-19 s the COVID-19 crisis continues to raise the risks for the seniors living and care sector, BC Care Providers Association (BCCPA) and EngAge BC are releasing a new guide to enhance in-person and online visits that support the best quality of life possible for residents of long-term care and assisted living homes. The association – which represents the majority of the province’s long-term care and assisted living operators – is showcasing best practices for the sector during a critical time. The Best Visit Possible: A guide for supporting family visits during COVID 19 was informed by wide ranging consultations with sector stakeholders – including care providers and family council representatives – and asked residents and family members to comment on what a good visit means to them. “Since the beginning of the novel coronavirus pandemic, no issue has

SINCE THE BEGINNING OF THE NOVEL CORONAVIRUS PANDEMIC, NO ISSUE HAS BEEN MORE VEXING AND HEART WRENCHING THAN THE ISSUE OF RESTRICTING FAMILY VISITS been more vexing and heart wrenching than the issue of restricting family visits,” says Terry Lake, CEO, BCCPA and EngAge BC. “So much so, that the sector was in many ways unprepared for the loss of comfort and support that family members provide as integral members of the care team. “While there is no substitute for the level of access family members had pre-COVID, the Best Visit Possible guide does provide many helpful ways to improve the visitation experience while keeping staff, residents and their loved ones safe.” The guide builds upon the association’s earlier publication titled The

Best Day Possible: A Quality of Life Framework for Seniors’ Care in B.C., a tool for promoting a culture of person-centered care. BCCPA and EngAge BC thanks the many individuals and organizations who contributed to this guide, including the members of the project’s advisory group, the Alzheimer Society of B.C., CanAge, the Vancouver Island Association of Family Councils, SafeCare BC, BCCPA’s Board of Directors, the EngAge BC Member Council and the many family members who took time to provide their feedback. To learn more and to download a copy of the guide, visit www.bccare.ca.

“There is much more work to be done by our organization when it comes to supporting our families during and after the pandemic ends,” adds Lake. “We will continue to work alongside our partners at the Ministry of Health and at the health authorities to establish a balance between keeping residents and staff safe and ensuring that residents have access to the family support they rely on to live well.” BCCPA and EngAge BC thanks the many individuals and organizations who contributed to this guide, including the members of the project’s advisory group, the Alzheimer Society of B.C., CanAge, the Vancouver Island Association of Family Councils, SafeCare BC, BCCPA’s Board of Directors, the EngAge BC Member Council and the many family members who took time to provide their feedback. To learn more and to download a H copy of the guide, visit www.bccare.ca. ■

Care after hospitalization

about where to turn, how to cope and where to get help. can be an overwhelming process. Our goal is to ensure that feel most comfortable – home.

Support is just a phone call away.

1.877.289.3997 clientservice@bayshore.ca

bayshore.ca 36 HOSPITAL NEWS OCTOBER 2020

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LONG-TERM CARE NEWS

Your Wi-Fi connection is their human connection. TELUS Business understands the difference great Wi-Fi can make to your residents â&#x20AC;&#x201C; and your business. telus.com/seniorsliving www.hospitalnews.com

OCTOBER 2020 HOSPITAL NEWS 37

LONG-TERM CARE NEWS

A gamified approach to exercise for older adults By Arielle Townsend tuart Embleton knows the value of a consistent exercise routine. It was the first thing his doctors prescribed when they found a blocked artery in his heart. â&#x20AC;&#x153;I havenâ&#x20AC;&#x2122;t had major heart surgery,â&#x20AC;? Embleton notes gratefully, but adds that this incident with his health motivated him to lead a more active lifestyle. His quest led him to the Cardiac Athletic Society of Edmonton (CASE), where he was offered the opportunity to join a trial for a gamified exercise platform called Virtual Gym. Thanks to Virtual Gym, Embleton and older adults like him will soon have access to personalized exercise routines

that they can do at home, while being supervised by their physiotherapists. â&#x20AC;&#x153;The original question we had when developing Virtual Gym, was how we could use technology to create personalized exercises that would be interesting and accessible to seniors,â&#x20AC;? says Eleni Stroulia, Project Lead. Stroulia and her research partner, Victor Fernandez, created the platform with support

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from the Centre for Aging + Brain Health Innovationâ&#x20AC;&#x2122;s (CABHI) Spark Program. Spark aides the development of early-stage innovations in the field of aging and brain health.

and Fernandez merged therapist-guided routines with interactive activities powered by virtual reality (VR). â&#x20AC;&#x153;Wrapping the activities in a game motivates people to do them,â&#x20AC;? says Stroulia. â&#x20AC;&#x153;With the gamified system, you get people to exercise and enjoy it.â&#x20AC;? This is true for Stuart, who says the VR component is a significant draw for him. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s fun for me. Instead of sitting on a couch lifting weights, Iâ&#x20AC;&#x2122;m slashing cubes with light sabers,â&#x20AC;? he says of one of the virtual games.

AN EXERCISE REGIMEN WITH A TWIST

CO-DESIGNING WITH OLDER ADULTS

THANKS TO VIRTUAL GYM OLDER ADULTS WILL SOON HAVE ACCESS TO PERSONALIZED EXERCISE ROUTINES THAT THEY CAN DO AT HOME, WHILE BEING SUPERVISED BY THEIR PHYSIOTHERAPISTS

To make the exercises in Virtual Gym appealing to older adults, Stroulia

With CABHIâ&#x20AC;&#x2122;s support, Stroulia and Fernandez were able to test and

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LONG-TERM CARE NEWS validate the project in a real-world setting at CASE. They received valuable feedback from older adults on ways to make the platform more user-friendly. “One of the things we learned was that people don’t want an activity they are being corrected on all the time,” says Fernandez. “The important part is that they like it so much that they forget they’re exercising.” Yet meeting the demand to create rehabilitative program that was engaging, but not overly prescriptive, presented a challenge for the pair. To address this issue, Fernandez amended the game to repeat levels or combos the user did not complete or completed incorrectly. This way, users could still receive the rehabilitative benefits of the exercise without feeling pressured to get it right on the first try.

CABHI’S SPARK-U INITIATIVE HELPS INNOVATORS PLAN FOR NEXT STAGE OF

THE VIRTUAL GYM

Since being accepted into the Spark Program, Fernandez and Stroulia have received additional support from CABHI’s Spark-U initiative. Spark-U is a learning collaborative for innovators, designed to support their journey from innovation development to planning for sustainability. For Fernandez, Spark-U has already played a significant role in the development of Virtual Gym. It will continue to do so as the platform is refined and prepared for use by a broader group of older adults. “The Spark-U lectures tell you how to protect your copyright, when to protect your copyright, and what things you should be careful of when you deploy these devices to the public.” Thanks to the knowledge gained from Spark-U, Fernandez and Stroulia feel confident about taking their innovation to the next level. “The vision is to have a catalogue of exercises. We’ll also be collecting feedback to share with the physi-

cians who prescribed the exercise, so that they can see what improvements are being made,” Fernandez adds. Stuart has no doubt the platform will accomplish this vision and more. “I’m convinced Virtual Gym will en-

hance my physical activities. I’m enthusiastic about its potential, and confident that Victor and Eleni will get the job done.” Visit cabhi.com to learn more about how technology is improving the lives H of older adults. ■

Arielle Townsend is the Marketing and Communications Content Specialist, Centre for Aging + Brain Health Innovation.

Are you caring for someone with dementia? VHA Home HealthCare has a FREE online toolkit to help you care for your loved one VHA’s Heart In Mind Activation Therapy toolkit was created with families, personal support workers, therapists and other health care providers in mind. The toolkit provides easy access to feelings-based communication and activity ideas for loved ones and clients living with dementia.

Visit www.vha.ca/HeartInMind for your copy of the Heart In Mind Activation Therapy toolkit.

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