31 minute read
and into the future
from REP Dec 21
Data Integration Success
Novant Health’s process-driven approach and integration leads its supply chain team solutions through the pandemic and into the future.
By Daniel Beaird
Supply chain costs can account
for nearly one-third of total operating expenses for health systems. Clarity within those supply chains is a must and the COVID-19 pandemic highlighted that in new ways. Lack of data visibility and transparency left patients and frontline workers vulnerable as healthcare supply chains were thrown into the spotlight.
Kim Haynes
Mike Bianchin
As many health systems sought ways to improve their data analytics and integration, Winston-Salem, N.C.-based Novant Health was already prepared. It had implemented a methodical, process-driven supply chain approach seven years ago to its clinical decisions. One that incorporates clinicians, manufacturers and suppliers. Novant Health’s clean data within its supply chain provides the necessary transparency and trust to its healthcare partners.
“It’s foundational to our relationships with physicians, clinicians, manufacturers and suppliers,” said Mike Bianchin, vice president of supply chain operations and distribution logistics for Novant Health. “Good data on the front end lessens the clean-ups and fire drills on the back end. We’re a collaborative partner with our vendors and clinical leaders, and we must be able to give them information that helps make informed and fact-based decisions.”
A foundation built to meet the pandemic
This data-accommodated supply chain laid the foundation for Novant Health’s response to the pandemic. Accurate data prevented wasted time and abetted the 15-hospital health system in changing tasks quickly.
“Good data equals efficiency and speed,” said Martha Bergstedt, vice president of sourcing and contract/vendor management for Novant Health.
“We weren’t worried about misinformed data and that allowed us to focus on having the correct product on hand – and enough of it – for our clinical teams,” said Kim Haynes, senior director of supply chain finance, procurement and analytics for Novant Health. “Our foundation helped us handle it as best we could. It provided us confidence in understanding what was really happening.”
Hourly changes, including which PPE should be used and how much of it should be used, were controlled through Novant Health’s data integration.
“It allowed us to work quickly with third-party vendors that wanted to help during the pandemic,” Haynes said. “Our data was clean, and we had dedicated sourcing managers with knowledge of products that could be worked into our enterprises during the pandemic.”
The supply chain team partnered with respiratory leadership to input data on all new fit-tested N95 masks for team members within the health system. A database was quickly built of team members who
– Martha Bergstedt, vice president of sourcing and contract/vendor management for Novant Health.
were fit tested to different brands of N95 masks and who chose a primary brand and a backup brand from seven distinct options.
“We didn’t get to the point of mass switching N95 masks, but we were building toward it based on our data inputs and our system approach,” Bianchin said. “We kept locations stocked based on individual clinical needs.”
– Kim Haynes, senior director of supply chain finance, procurement and analytics for Novant Health
Data is a regular topic of discussion
Data is always a part of the weekly conversation between the supply chain team, clinical leadership and vendors. “Working backwards on data issues is much harder than keeping it in mind from the start,” Bianchin said.
Whether it’s supply or implant cost per case or spend metric levels being met for rebate purposes, data builds trust that Novant Health’s supply chain team is focusing on the right things to better serve its patients and bring value to the health system.
Novant Health’s supply chain dashboards track cost to the physician level across all service lines. The sourcing teams use data daily to identify opportunities at the system, market, facility, service line, procedure level and physician level, according to Bergstedt.
“We’ve built numerous Microsoft Power BI dashboards to incorporate data into a live interactive dashboard for supply chain team members and non-supply team
members and they can access data as needed,” Haynes said. “It also supports executive and department level meetings, presenting opportunities through data management.”
Product contracts are associated with sourcing categories and tied to transactional level items like spend, savings and utilization. Novant Health’s categorization management system captures its spend based on how it sources its contracts for medical and surgical supplies.
“Spend data is enriched with clinical outcome and revenue information, making it easier to make decisions,” Bergstedt said. It allows spend to be seen in real time and automates data for monthly calculations of savings tied to specific item codes.
“We can quickly analyze how we are performing, and report monthly realized savings,” Haynes said. “It’s a robust savings reporting, validation and tracking process.”
Novant Health’s data and processes allow the supply chain team to tell the story of what’s happening in its system, including expanding on the purchased services side where it has leveraged third parties like Modulini, a provider of clinical and financial insight to hospitals.
“Our transactional data isn’t currently connected to our contracts for purchased services like our product data,” Bergstedt said. “But it’s an area of improvement and advancement for us and the goal is to move our processes to purchased services too.”
“On the purchased services side, we’ve developed dashboards of total spend by vendor and by a facility/ cost center perspective,” Haynes added. “We’re moving to a single point of entry for all requisitions and that will help us tie in spend at the time of requisition to specific contracts and also enable OCR to collect data on those invoices.”
AI and machine learning on the system level
Novant Health is also branching into artificial intelligence (AI) and machine learning through some RPA and machine learning potential use cases.
“AI is being used at the system level to help identify patterns and trends for better informed decision making,” Haynes explained. “It will be a significant part of our supply chain strategic plan for many years to come as the value it presents to efficiencies gained is evident.”
Bianchin added that a cleaner process will come as AI evolves in healthcare. “Inventory accuracy will improve, and we’ll be able to look ahead several weeks on surgery schedules and match the demand to the schedule,” he said. “Predictive ordering that’s based on patient type and patient volume will also progress.”
Bergstedt concluded that while Novant Health’s supply chain isn’t doing it yet, it’s the best path forward to harvest and optimize the immense amount of data being produced. “In the future, it will ensure our teams are able to minimize their time spent on low value activities,” she said.
Clinicians desire data integration
Supply chain shortages impact patient care, particularly in the operating room (OR). A survey of more than 300 clinicians from Cardinal Health reported that almost threequarters of those clinicians have experienced not having a product needed for a procedure. Manual supply chain management processes emerged as a challenge as over 80% of those clinicians said they still rely on manual inventory management for some parts of the supply chain.
Clinicians answered that some advantages to automating the OR supply chain were decreasing costs, automating and advancing accurate documentation of case costs, improving charge capture, enhancing data for analytics and ordering, advancing clinical workflow, giving clinicians more time to focus on patients, reducing expired and recalled products, and improving patient outcomes.
Employing the power of data analytics is the top supply chain outcome for provider organizations. Business processes and the standardization of those processes are also highly ranked outcomes, according to a Global Healthcare Exchange survey.
Data visibility and data management help reduce operational costs and improve service levels through optimizing processes like procurement, forecasting demand and managing inventory. It also helps the contract life cycle as it gets handed off to each team from negotiation to final price to tracking of metrics.
– Mike Bianchin, vice president of supply chain operations and distribution logistics for Novant Health
People and processes
“We have dedicated teams within our supply chain that handle each function of the contract life cycle,” Bianchin said. “It’s built into our supply chain process and within our health system culture. We are constantly seeking the best terms for quality, outcomes and cost.”
Haynes added that multiple viewpoints and thought leaders across Novant Health’s supply chain team is the driver to their success. “It brings different approaches to the table for discussion to vet how our processes can be supported and utilized,” she said.
“The people component is key,” Bergstedt said. “The best decisions are made with data, people and processes. Have all the voices at the table being heard and engaged. That gets us to a better outcome and gets supply chain buy-in and alignment.” Diversity in roles, backgrounds and perspectives at Novant Health helps for well-rounded decisions and minimizes the unintended consequences to decisions.
“Our team – in partnership with supply chain analytics – creates, reviews and takes concrete actions throughout the life of our key agreements and categories,” Bergstedt emphasized. “Targets are set, monitored and shared with supply chain leaders, physicians and clinicians.”
Novant Health’s data integration success has resulted in significant contributions to cost savings, improved patient value, physician engagement and understanding of the need for continuous cost reduction. Its data, people and processes drive the approach to clinical immersion.
The medical supply and product manufacturer is developing results that solve unmet clinical needs
With the national healthcare expenditure (NHE) estimated to reach $6.2 trillion by 2028, there are mounting concerns about the country’s ability to provide financially responsible care while attaining acceptable quality, effectiveness, and equity levels.
As a leader in the development and manufacturing of medical products, Dukal recognizes the tremendous need to play a significant role in using innovation to improve care while lowering the overall costs to our partners.
Creating on-the-job processbased solutions for clinicians
Dukal is working to foster innovation and improve care through a jobs-based
approach. Working in partnership with leaders in the field of innovation, medicine, and universities – we’re creating a deeper understanding of healthcare professionals’ objectives and underlying processes to identify needs and foster successful innovation.
“We’re leveraging our 30 years of product expertise and manufacturing processes to develop exciting patent-protected solutions to current pain points in the market,” said Michael Bielski, Director of Innovation for Dukal.
With a new vision of Better Health. Better Future. – We’re leveraging our R&D, manufacturing, and regulatory expertise to bring innovative solutions to market.
Healthcare innovation to reduce costs and improve care
Working collaboratively with healthcare professionals, we’re turning innovative ideas into practical patented solutions. By listening to clinicians and understanding the underserved portions of the market, we’re developing solutions that solve unmet clinical needs while enhancing family and community health.
We’re going beyond healthcare manufacturing and putting the well-being of patients and all who serve them at the heart of what we do.
From invention and patent applications to prototype development and design – from supply chain to branding, marketing and sales, we offer our innovation partners a full range of capabilities.
Capseus bone dust collector
Dukal launched its first innovative surgical solution in September 2019, the Capseus bone dust collector (Capseus BDC-15). Designed to easily provide cost-effective local autograft generated at the surgical site during spinal fusion surgery, the Capseus BDC-15 reduces hospital costs, time, and infection risk, while providing higher-quality bone.
Improving the healthcare supply chain through innovation
Dukal’s innovation goes beyond product development. Through technology investments and supply chain strategy, we’re continuing to improve the resiliency of our suppliers. We’re developing collaborative forecasts and safety stock programs and using automation and IT investments to obtain real-time information to improve transparency and proactive decision-making. We are committed to getting inventory to the vital health systems throughout the U.S. when they need it.
Trusted partnerships
A strength of Dukal has always been our ability to act as a trusted partner and advisor for our channel partners.
Dukal’s industry-leading knowledge of quality and regulatory compliance requirements continue to differentiate us as the complexity of our product solutions increase. Dukal continues to look at our supply chain and innovation opportunities to ensure that we stand ready to provide our customers with the absolute highest level of service and care.
Celebrating 30 Years of Enhancing Family and Community Health
For the past three decades, Dukal has evolved with the ever-changing healthcare industry. We’ve transformed from a single product company operating from founder Gerry LoDuca’s basement, to a leader in the development and manufacturing of medical products.
Working collaboratively with healthcare professionals, Dukal aims to create a resilient and innovative healthcare industry. Our 30th anniversary is a celebration of our journey and a tribute to our employees and partners.
As a leader in the development and manufacturing of medical products we partner with healthcare professionals to launch innovative solutions to unmet clinical needs. Learn more about our capabilites and products by visiting our website dukal.com
Long COVID: The Pandemic’s Sequel
Patients with Long COVID may share symptoms and receive similar treatment, but the disease remains an enigma.
For more than a decade after the 1918 influenza
pandemic, “a mysterious Parkinson-like syndrome with sleep disturbance, hypomimia, and a high mortality rate developed in thousands of people across the globe,” write the authors of a recent editorial in the Annals of Internal Medicine. In 1920 the U.S. Surgeon General declared that the syndrome, popularly termed “encephalitis lethargica,” was caused by influenza. However, opinions varied, and even today, questions remain regarding its cause, transmission and treatment.
And here we are, a hundred years later, short on answers to another ill-defined post-pandemic illness, which some call “Long COVID.”
Long COVID: The Pandemic’s Sequel
An enigma
It wasn’t until October 2021 that the World Health Organization published a clinical case definition: “Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of COVID-19 with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.” Common symptoms include fatigue, shortness of breath, cognitive dysfunction, and other symptoms that affect everyday functioning.
Complicating matters, some presentations of Long COVID resemble those of other post-viral syndromes, such as chronic fatigue syndrome, dysautonomia (e.g., postural orthostatic tachycardia syndrome [POTS]), or mast cell activation syndrome (MCAS). The CDC reports that some of these conditions have been reported in patients who recovered from severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), two other life-threatening illnesses resulting from coronavirus infections.
Given the difficulty defining Long COVID, it’s not surprising that statistics about its incidence vary widely. The World Health Organization, for example, believes that approximately 10% to 20% of COVID-19 patients experience lingering symptoms for weeks to months following acute SARS-CoV-2 infection.
The authors in the Annals editorial note that studies of SARS-CoV-2 infections indicate that up to 61% of patients have experienced symptoms that persist for months, occurring in hospitalized and nonhospitalized adults, adolescents and children. “However, the absence of well-defined control groups or reliance on serologic
testing or self-reporting will limit improving our current understanding,” they write. “Even if only 10% of patients experience persistent symptoms after COVID-19, the number afflicted will easily be tens of millions.”
Meanwhile, a report in the Journal of the American College of Cardiology estimates that 33% to 98% of patients who have recovered from initial COVID-19 illness experience long-term manifestation of PASC, or post-acute sequelae of COVID-19 – a more formal name for Long COVID. The most-often reported symptoms are fatigue (28.3%-98%), headache (91.2%), dyspnea (13.5%-88%), cough (10%-13%), chest pain (5%-42.7%), anxiety/ depression (14.6%-23%), and olfactory/gustatory deficits (13.1%-67.5%). Less frequent symptoms include palpitations/tachycardia (11.2%), concentration or memory deficits (23%), tinnitus or earache (3.6%), and sensory neuropathy (2.0%). Most symptoms are more frequently reported by women and older individuals.
Hard to believe
“Long COVID is a brewing public health crisis, yet there is no consistent system for how to manage people affected in the UK,” writes Professor Brendan Delaney from Imperial College London. “[W]hen patients go to their GP they often find themselves being bounced back and forth with different referrals and no clear answers.” Some providers fail to take complaints from their patients seriously. It’s a pattern set with other postinfectious disorders, such as mononucleosis and Lyme disease.
“Frustration frequently arises in these often marginalized patients with symptoms that some clinicians dismiss as only nonphysiologic or related to mental health,” according to Delaney. “On another angle, some alternative practitioners offer false hope with antibiotic treatments, using Lyme disease as a stand-in for chronic, medically unexplained symptoms without a basis in demonstrable infection. Moreover, desperate patients seek information through social media and take non-evidence-based treatments for chronic Lyme disease, partly due to modern mainstream medicine’s lack of effective approaches.”
CDC suggests that healthcare professionals choose a conservative diagnostic approach in the first four to 12 weeks following SARS-CoV-2 infection. Laboratory and imaging studies can often be normal or nondiagnostic in patients experiencing post-COVID conditions, and symptoms may improve or resolve during the first few months after acute infection in some patients.
Long COVID: The Pandemic’s Sequel
“However, workup and testing should not be delayed when there are signs and symptoms of urgent and potentially life-threatening clinical conditions (e.g., pulmonary embolism, myocardial infarction, pericarditis with effusion, stroke, renal failure). Symptoms that persist beyond three months should prompt further evaluation.
“Overall, it is important for healthcare professionals to listen to and validate patients’ experiences, recognizing that diagnostic testing results may be within normal ranges even for patients whose symptoms and conditions negatively impact their quality of life, functioning (e.g., with activities of daily living), and ability to return to school or work.”
According to the CDC, holistic support for the patient throughout their illness course can be beneficial. Many post-COVID conditions can be improved through already established symptom management approaches (e.g., breathing exercises to improve symptoms of dyspnea). A comprehensive rehabilitation plan may be helpful for some patients and might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms.
Gradual return to exercise as tolerated could be helpful for most patients. Optimizing management of underlying medical conditions might include lifestyle counseling such as nutrition, sleep and stress reduction.
Long COVID clinics
Some health systems have created clinics specifically for people with Long COVID.
Norton Children’s in Louisville, Kentucky, for example, launched its Long COVID clinic in October
Factory-Direct Quick Shipments
MANY ITEMS SHIP SAME-DAY
Despite the current chaos of global supply chain disruptions and container chokepoints, DETECTO continues to provide quick lead times on freight for most products from the company’s centralized US factory. Proudly employing 280 American production and professional staff, DETECTO’s Webb City, MO factory and headquarters is centrally located in our nation’s heartland for freight distribution. As a company ethos, DETECTO cares greatly about boosting our domestic economy, providing quick lead times, manufacturing quality products, and creating more American job opportunities. The US factory in a central location means that you get your products quicker when you need them, whether they are scales, medical carts, waste receptacles, glove box holders, or stadiometers. Many items ship the same day.
Don’t get caught short. Buy DETECTO.
Long COVID: The Pandemic’s Sequel
2020. “As infectious disease doctors, we’re always looking for up-to-date information about evolving diseases, as most infectious diseases do evolve,” infectious disease specialist Daniel Blatt, M.D., told Repertoire. “Long COVID was an emerging syndrome for a new disease. There wasn’t a lot of information out there, and we wanted to set up an all-encompassing clinic for people experiencing it. It isn’t only a resource for families and pediatricians, but also an exercise in learning about the disease and gathering data so we can help clinics all over the country.
“We provide a medical home for these patients, with the time and expertise in infectious disease to not only track their progress, but make sure we deal with compounding developments if necessary,” he says. The clinic has a sophisticated data-gathering system, which allows clinicians to track even subtle changes over time, and if necessary, refer the child to a specialist. “That’s the medical perspective. From the patient point of view, we offer a lot of reassurance and time, and someone to just listen to them. Most kids get better.”
WMCHealth in Valhalla, New York, launched its Post-COVID-19 Recovery Program in October 2020. The major symptoms with which patients present include fatigue, mental “fogginess” and shortness of breath, according to Carol Karmen, M.D. and Garry Rogg, M.D., internal medicine specialists with Westchester Medical Center and the clinical leaders of the program. “These symptoms can be moderate to severe and very persistent. We have patients presenting now who have been sick since the start of the pandemic in the spring of 2020.
Given Westchester Medical Center’s wide variety of clinical specialties, “we are having success treating many of the symptoms,” they say. That said, “the neurocognitive effects of COVID-19, namely mental ‘fogginess’ and fatigue, are the most difficult problems to treat.”
Common diagnostic tests may turn up normal, “but after caring for so many patients with these symptoms, sometimes over many, many months, we are certain these
Smell retraining therapy
Smell retraining therapy (SRT) is a treatment for loss of smell, also referred to as hyposmia or anosmia. It is believed to work as a combination of the unique ability for smell nerves to regrow while encouraging improved brain connectivity.
Most studies on SRT have been done on patients with post-viral smell loss (i.e., following a cold or upper respiratory infection). Research findings on SRT for COVID-19-related smell loss are not yet available.
The process of SRT involves the repeated presentation of different smells through the nose to stimulate the olfactory system and establish memory of that smell. It is best to start with at least four different scents, especially smells you remember. The most recommended fragrances are rose (floral), lemon (fruity), cloves (spicy), and eucalyptus (resinous). Many people use essential oils, which can be purchased online or from local
Source: American Academy of Otolaryngology–Head and Neck Surgery health food, aromatherapy or craft stores.
Take sniffs of each scent for 10 to 20 seconds at least once or twice a day. While sniffing, it is important to be focused on the task. Try to concentrate on your memory of that smell. After each scent, take a few breaths and then move on to the next fragrance. It is recommended that you do this for at least 12 weeks, but you can do it longer, alternating the scents if you like.
Is it COVID-19 or the Flu?
Quickly detect and differentiate between Influenza and COVID-19* with a single test this flu season, with clear, trusted, digital results in 15 minutes.
See what’s new at BDVeritor.com/COVID-Flu
*Emergency Use Authorization Information for the SARS-CoV-2 and SARS-CoV-2 & Flu A+B assays: • These products have not been FDA cleared or approved; but have been authorized by FDA under EUA for use by authorized laboratories • The BD Veritor™ System for Rapid Detection of SARS-CoV-2 has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, • These products are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.
BD Life Sciences, 7 Loveton Circle, Sparks, MD 21152-0999 USA 800-638-8663
Long COVID: The Pandemic’s Sequel
symptoms are real. Program patients have shared stories telling how other physicians dismissed them. Because of this, they are so grateful WMCHealth established this program at Westchester Medical Center.”
The University of Texas Medical Branch in Galveston launched its Post-COVID Recovery Clinic in July 2020, says Tammy McCrumb, RN, clinic manager. “Our original mission was to support post-hospitalized patients, some of whom were going home oxygendependent and with limited physical mobility and overall status. Gradually, we shifted to treating more patients who had not been hospitalized. Now we have a combination of both.”
The hospital has a robust pulmonary rehabilitation program and is a COPD Center of Excellence, says McCrumb. “We treat [Long COVID] patients with chronic shortness of breath similarly as we do patients with COPD.” Most undergo pulmonary function testing and a comprehensive assessment of mobility, nutrition, sleep and mental health. Oxygen-dependent patients with complex medical histories receive one-on-one rehabilitation, while others receive group therapy and exercises to perform at home. Patients reporting dizziness or palpitations are often treated with an initial Holter monitor and are referred to cardiology for further evaluation if necessary.
“Early on, we referred many patients to neuropsychology, because we didn’t understand brain fog,” says McCrumb. “Now we evaluate all our patients using the Pittsburgh Sleep Quality Index, and we’re finding that some have undiagnosed sleep apnea and probably had it prior to COVID.”
Patients with Long COVID may share symptoms and receive similar treatment, but the disease remains an enigma. “Some of our elderly patients who were very sick recover amazingly well after a couple of sessions of pulmonary rehab,” says McCrumb. “On the other hand, some younger patients – even those who weren’t hospitalized – may struggle for months to recover. Everyone recovers differently.”
The physician practice
Physicians in solo or small-group practices should refer patients with dyspnea or fatigue to a regional pulmonary rehabilitation program, if one is available, advises McCrumb. Lacking such a program, however, they can point to online resources for breathing exercises for the home. “Above all, encourage your patients to increase their activity level. Encourage them to take two laps around the neighborhood instead of one. The more they increase their endurance, the quicker their recovery tends to be, even if it is little by little each day.”
Says Dr. Blatt, “If the private practitioner can tap into a local health system with infectious disease or multidisciplinary support, I would recommend doing that. We have the time to help these patients, and we’re available. Not every infectious disease practice focuses on Long COVID, but a primary care physician can always refer to the proper specialist based on the patient’s presentation.”
The independent practitioner can reassure patients that almost universally, patients with Long COVID get better, he says. “But in order to keep those patients safe during the process and to decrease the duration of the disease, refer for a specialist intervention when necessary.”
Drs. Karmen and Rogg at the WMCHealth’s PostCOVID-19 Recovery Program encourage physicians to keep in mind that the symptoms patients with Long COVID are complaining of are, in fact, real. “So many of our patients were told by a medical professional they have psychosomatic illness, PTSD, depression, or that they’re just ‘tired’ from the pandemic in general. After seeing close to 400 patients since we started this program, we are sure these symptoms are real, and we are doing everything we can do to help.”
Knowledge of post-COVID conditions is likely to change rapidly with ongoing research, says the CDC. Healthcare professionals and patients should continue to check for updates on evolving guidance for post-COVID conditions.
Long COVID and the lab
Before ordering laboratory testing for post-COVID conditions, the healthcare professional should be clear about the goals of testing, advises the Centers for Disease Control and Prevention. Laboratory testing should be guided by the patient history, physical examination and clinical findings.
A basic panel of laboratory tests should be considered for patients with ongoing symptoms (including testing for non-COVID conditions that may be contributing to illness). Expanded testing should be considered if symptoms persist for 12 weeks or longer.
Basic diagnostic lab testing
ʯBlood count, electrolytes, and renal function. ʯ Complete blood count with possible iron studies to follow, basic metabolic panel, urinalysis. ʯ Liver function. ʯ Liver function tests or complete metabolic panel. ʯ Inflammatory markers. ʯ C-reactive protein, erythrocyte sedimentation rate, ferritin. ʯ Thyroid function. ʯ TSH and free T4. ʯ Vitamin deficiencies.
Source: U.S. Centers for Disease Control and Prevention
More specialized testing
Specialized diagnostic tests for Long COVID should be ordered in the context of suggestive findings on history and physical examination. They include testing for: ʯ Rheumatological conditions. ʯ Antinuclear antibody, rheumatoid factor, anti-cyclic citrullinated peptide, anti-cardiolipin, and creatine phosphokinase. ʯ Coagulation disorders. ʯ D-dimer, fibrinogen. ʯ Myocardial injury. ʯ Troponin. ʯ Differentiate symptoms of cardiac versus pulmonary origin. ʯ B-type natriuretic peptide.
Healthy Skin is the First Line of Defense in Healthcare
Hand hygiene is a critical aspect of patient safety1 and a task that is performed more than almost any other
activity in healthcare settings. In fact, frontline healthcare workers (HCW) may have the opportunity clean their hands up to 100 times per shift, however not all of those opportunities are realized and skin irritation is often cited as the reason why.2 To maintain healthy skin and ensure proper hand hygiene compliance, it is essential that HCW take care of their hands.
The skin is the largest organ of the human body and is essential to providing a first line of defense from pathogens. HCW hands are one of the most important tools they have and can be negatively affected by dry or damaged skin. Lack of awareness of the true causes of skin damage is a significant contributing factor to improper hand hygiene. It is important for HCW to understand the behaviors that actually lead to skin damage and the steps they can take for prevention.
The first key step for HCW is knowing when to use soap and water. A soap and water handwash should be used: ʯ When hands are visibly dirty or contaminated ʯ If hands are soiled with blood or other body fluids ʯ Before eating and after using the restroom ʯ After caring for patients with C. diff if facility policy requires it
Second, both national and international hand hygiene guidelines recommend using an alcohol-based hand rub (ABHR) as the preferred method of cleaning hands in healthcare
settings.3 The reason for this is that well-formulated ABHR products have superior efficacy over soap and water (even antimicrobial soaps) and offer other benefits, such as convenience and speed of use. Additionally, overexposure to hand washing with soap and water removes oils and lipids naturally present in the skin and disrupts the natural skin barrier. This can start the cycle of skin damage. Once the skin’s natural barrier has been disrupted it allows channels of exposure to nerves and tissues in the deeper layer of the skin. HCW then apply ABHR and get an immediate stinging sensation which is only a sign of skin damage that has already occurred. The stinging sensation often drives HCW to return to the use of soap and water as their primary means for hand hygiene, not knowing this is the source of the problem. The skin damage progresses with the continued overuse of soap and water making it extremely difficult for a HCW return to ABHR as their primary hand hygiene practice.
Skin irritation is often cited as a barrier to hand hygiene compliance.4 Therefore it is important for HCWs to be on the lookout for skin damage. Early warning signs of skin damage include dryness, tightness, flaking or itching of the knuckles, back of hands, and between fingers. To help prevent the cycle of skin damage it is essential for HCW to minimize handwashing with soap and water, except as required. Using lukewarm or cooler water (never hot) when washing hands, rinsing well and gently patting hands dry with a paper towel is another best practice. HCW should also be careful not to don gloves when hands are still wet. This can trap moisture underneath the gloves and irritate the skin.
Lotion is also essential for maintaining skin health. HCWs should use a facility-approved lotion frequently during their shift. Ideally this would be after every soap and water use, but at a minimum, applied twice per shift. HCW should never bring lotions from home into the clinical environment without approval. Non-approved lotions may not be compatible with other hand hygiene products, sterile gloves or may have levels of fragrance that are not appropriate.
Incorporating lotion into HCW routine is a good practice all of the time and especially during cold, dry weather or changes in climate. If a healthcare facility is switching from one hand hygiene product to another it is important to ensure lotion is used to support skin health during the transition period, or when hands feel dry for any reason.
HCW can continue to take care of their skin when they are
not working, too. Wearing gloves in cold, dry weather, using a mild soap at home, and applying lotion as frequently as possible are all elements to keeping skin healthy. Thicker lotions and creams have a higher oil content and can be very beneficial outside of work when more greasiness can be tolerated. Look for a thicker lotion or cream that is fragrance-free for use at home. Applying this type of a lotion or cream on hands before going to sleep allows it to remain on the skin for an extend period of time and is another beneficial step that HCW can take to help keep hands healthy.
1 Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/ APIC/IDSA hand hygiene task force. MMWR 2002;51:RR-16. 2 The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009. Available from: http://www.jointcommission.org/ assets/1/18/hh_monograph.pdf. Accessed February 7, 2019. 3 World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenge: clean care is safer care. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Published 2009. Accessed February 7, 2019 4 The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009.
Happy Holidays & Happy New Year
Surprise for you in 2022
