Safety Is a Must when Repairing or Replacing Equipment in an Isolation or COVID-19 Room
By: Becky Crossley, CBET
September 9, 2021
Categories: AAMI News
What safety measures should HTM professionals follow when repairing or replacing equipment in an isolation room or COVID-19 room?
Although this is an excellent question, typically it isn’t discussed as a healthcare technology management (HTM) issue. HTM professionals tend to receive little training on proper isolation room practices compared with nursing staff, but our practices also are important in limiting the spread of disease.
Let’s start with the basics. The first thing that HTM professionals should do is work with their infection control (IC) department when changing out or working on equipment in an isolation room or COVID-19 room. This is something that helped our department get early buy-in from nursing.
The next step is for everyone to get a “fit test” for a face mask. According to the Occupational Safety and Health Administration, a fit test “tests the seal between the N95 mask's, or respirator's, facepiece and your face.” This test takes 15 to 20 minutes and should be done prior to the person’s initial exposure to an isolation room or a COVID-19 room and at least annually thereafter. There are a few versions of this test, but mostly the test seeks to determine whether you can smell a sour odor coming through the mask. If the odor cannot be smelled, then the seal is considered tight enough to ensure safety from air-borne disease.
If you “fail” a fit test, you will need to use a device like a power air-purifying respirator (PAPR). Basically, it is a hood with a fan that blows air away from the wearer to keep air-borne infections away from the wearer.
Next, ask your IC department to give an in-service training to your department. Usually, they are more than willing to provide a training session. At this point, I would imagine that most HTM departments have done this training or developed an IC-related process for working in a patient room during isolation.
Proper donning of personal protective equipment (PPE), such as facemasks and gowns, is vital for HTM professionals who will be working in an isolation room or COVID-19 room. Caution also must be exercised when leaving the room with contaminated equipment.
The next piece of vital personal protective equipment (PPE) is a gown. The gown should fully cover your body (torso) from the neck to knees and from shoulders to ends of wrists. The gown should go around your back. It should be tied at the neck and waist.
Next, you will don a mask or respirator (PAPR). Take extra care to ensure the elastic bands are secure, the bridge of the nosepiece is tight to your nose, and the mask goes below your chin. Ensure the mask is properly fit by inhaling deeply. The mask should suck into your face—this is a good seal.
Next, you will don goggles or a face shield, which should be placed over your eyes or face. If you wear glasses, ensure that they are not fogging. If fogging occurs, you don’t have a good mask seal. Next, you will don your gloves. Take extra care to ensure the gloves go over the wrist of the isolation gown. I like to wear two pairs of gloves because, as luck would have it, I always seem to puncture one with a screwdriver or other instrument while doing the repair.
You are now ready to go into the isolation room and perform the repair. If you are taking equipment into the room, it can placed on a cart or table outside the room while you don your PPE. Be sure to grab it after your PPE is ready, then go into the room.
When you are bringing equipment out of a room, place it on a table or cart near the door. Clean the equipment, then hand it to someone outside of the room without setting it down or holding it against your body (and thereby contaminating it). Each hospital likely has specific policies for handling this process, and it’s another area where IC’s input is highly valued. In our facility, as an added precaution, we decided to hand the equipment to someone outside the room who was wearing gloves. This person would clean the equipment again, then remove their gloves.
After the repair is complete and the equipment has been cleaned and is outside the room, you are ready to remove your PPE. Make sure you are near the door and begin by removing your gloves. Remember that everything on the outside or exposed area is considered contaminated! This means that you should grasp the palm area of one gloved hand and peel that glove off first. Now, hold the glove that is removed in the hand of the contaminated glove. Use the fingers of your ungloved hand to slide under the glove on your contaminated hand. Slide this glove inside out and off and dispose of both gloves in a waste can.
Goggle removal is next. Remember that the outside of your goggles or face shield are contaminated! Remove the goggles by grasping the back of the headband and pulling it over your head or by taking it off your head. Place the goggles in the designated container for processing.
We are now ready to remove the gown. Remember that the front of the gown and sleeves are contaminated! Unfasten the ties in the back. Be very careful that your sleeves do not come in contact with any exposed skin while undoing the ties. Now, pull the gown away from your neck and shoulder, being careful to touch the inside of the gown only. Turn the gown inside out and discard it in the waste or processing container.
Mask removal is next. Remember that the front of the mask is contaminated! Grab hold of the ties or elastic bands and remove the mast without touching the front. Then, place the mask in a processing container, dispose of it, or place it in the proper storage container.
Finally, you are ready to wash your hands using hot soapy water followed by alcohol-based hand sanitizer. Remember not to touch your face or any other part of your body before you wash your hands.
If you have followed these steps, you have played a major role in limiting the spread of air-borne contaminates.It is easy to see why nursing receives training and is evaluated on the process of entering isolation or COVID-19 rooms. As I emphasized earlier, involving your IC department is paramount. I would advocate that HTM departments should practice the steps described here at least annually. It isn’t often that we are called to an isolation room to repair or replace equipment, but it only takes one time of not following proper procedures for you or other staff to get very sick.
Becky Crossley, CBET, is a BMET specialist in the Biomedical Engineering Department at the University of Pittsburgh Medical Center Susquehanna-Williamsport in Williamsport, PA. Email: email@example.com