2020年4月8日水曜日

Just my opinion. Infection Control in Home Ventilatory Therapy

 Just my opinion. Infection Control in Home Ventilatory Therapy
Home health care in Japan is described here.

There is a lot of information out there about the new coronavirus. It is my impression that there is a lot of information about infection control in medical institutions and general gargling and hand washing. There are many people in Japan who are undergoing home ventilatory therapy, and we feel that there is a lack of information on "home health care" related to the new coronavirus.

In the future, it is expected that "guides" and "countermeasures against infection" will be published by related organizations and academic societies regarding infection control in home health care. We will introduce you as soon as we answer.
At the same time, I will remove it as necessary so that my blog doesn't become confusing information.
The individual circumstances of home health care are too complex for me to write detailed advice.
What follows is a "personal opinion". (Please take it easy on me with your comments and requests.)

Guidelines and other references are listed below.


 1. Home Ventilatory Therapy

(1) Estimated number of patients in the country (2018 statistics by social and medical practice)
TPPV (ventilator used through a tracheotomy): 6285
NPPV (masked ventilator) 19959
CPAP (respirator used by people with sleep apnea) 446514


2) It is difficult to avoid 3 densities in home health care
There have already been outbreaks of new coronavirus infections among staff and users at several medical and nursing care facilities. In home health care, it is difficult to avoid the so-called "three densities" of sealed, dense, and close. Staff who visit patients' homes take great care to ensure that they do not become a source of infection themselves. Even so, both sides could be the source of the infection.

(3) The problem with home ventilatory therapy is aerosols
According to the Japan Aerosol Society, "Any system (state) that exists in the air as minute liquid or solid particles with some degree of stability is an aerosol.

Japan Aerosol Society's view on wearing masks for new coronaviruses and hay fever


Aerosols are produced when a patient on home ventilatory therapy is himself infected with a new coronavirus. Therefore, even if the person is asymptomatic, a family member who is caring for him or her may become infected and have to be hospitalized.


4) Basic approach to infection control in home health care at present
As many of the patients on TPPV (ventilator with tracheotomy) and 24-hour NPPV (masked ventilator) are expected to be out of the house infrequently
It's from the Japan Society for Environmental Infectious Diseases.
Infection Control in Elderly Care Facilities, 1st Edition (April 3, 2020)

This is very helpful.

Many people who take CPAP (respirators used by people with sleep apnea syndrome) are probably working during the day. We suggest separating the bedroom from your family as a normal infection control and aerosol control.


2. home ventilatory therapy and new coronavirus

(1) Home ventilatory therapy generates aerosols.
Here, home ventilatory therapy includes NPPV (masked ventilator), TPV (ventilator with tracheotomy), ASV (respirator for heart failure), and CPAP (respirator for sleep apnea syndrome).
Home ventilatory therapy is a situation where aerosols are generated. If the individual is infected with a new type of coronavirus, it is presumed that the aerosol will cause a large amount of virus to become airborne in the room where the individual is recuperating. We don't know how long this floating new coronavirus will be "alive". It is unknown how much effect can be obtained with commercially available air purifiers. Please note that although there is data on virus removal in many air purifiers, the experimental data does not show a new coronavirus.

(2) How to deal with people who are using ventilators in hospitals
For your reference, here are some excerpts of the measures currently in place in the hospital

from the Japanese Society of Respiratory Therapy Medicine and the Japanese Society of Clinical Engineering Technologists.
Handling of Ventilators for Patients with New Coronavirus Pneumonia
From the perspective of preventing infection through medical devices - Ver. 1.0 March 27, 2020

This is a summary of precautions for the handling of related medical devices from the perspective of preventing infection via ventilators.



(3) What measures can be taken at home?
It is difficult to adapt all of the "Handling of ventilators for use in patients with new coronavirus pneumonia" to home ventilatory therapy.

Why it's hard to adapt
The people are different. The home is centered on the person and his or her family.
 There is a helper (family doctor, visiting nurse, etc.).

The environment is different. The environment is different in the hospital and at home.

The equipment is different. Ventilators used in the hospital and for home use
 Ventilators are different.
 Ventilators with gas pipes used in intensive care units are not available at home. On the other hand, respirators used at home cannot be used for people with pneumonia who need to be treated in the intensive care unit. (Not that it can't be done, but it lacks performance. In overseas intensive care units, there is a shortage of ventilators, so they also use ventilators for home use.

The materials are different.
 Currently, medical institutions are implementing standard preventive measures. For confirmed or suspected cases of this new type of coronavirus infection, additional droplet prevention and contact prevention measures should be taken. For protection against droplets and contact, personal protective equipment covering the eyes, nose and mouth is usually a surge mask with eye shield or a combination of a surge mask and goggles/eye shield/face guard, cap, gown and gloves. In situations where a large amount of aerosol is generated, add an N95 mask. When putting on and taking off personal protective equipment, take care not to touch the mucous membranes of the eyes, nose and mouth, and perform hand hygiene at the appropriate time.

 It is difficult to deploy such medical materials in home health care.


In light of the above.


4) What we can think about now (2020/4/5)

(a) Actively ventilate the living room.
Proactive "ventilation" is suggested as a response to the aerosols that occur.
How do you ventilate when you're sleeping at night?
Is air conditioning ventilation not enough? I can't open a window in the summer!
I think this is where the various opinions come in.

As stated earlier, "Home health care is too complex of an individual situation to write detailed advice.

We believe it is a good idea to use a circulator or fan to allow the air to flow through the room and out of the room.

(b) Those who sleep together should be kept away from leak ports and exhalation valves.
If you have an NPPV (masked ventilator), TPV (ventilator with a tracheotomy) or ASV (respirator for heart failure), you are likely to sleep in the bedroom with your family.
The leak port on the mask and the exhalation valve in the respiratory circuit produce the air that was in the person's lungs.
If you sleep together, it is recommended that you keep a distance from the leak ports and expiratory valves in the ventilator circuit.

I don't know how much of a "preventative measure" it would be for a family member to wear a mask to bedtime.
I would like to wait for "guides" and "measures" from future conferences.

(c) Artificial nose with a bacterial filter.
In the case of TPPV (ventilator with tracheotomy) and without a humidifier, an artificial nose with a vague light filter is an option.
Unlike a normal artificial nose, the artificial nose is larger with a bacterial filter. A bacterial filter may be able to remove the new coronaviruses in the exhaled breath.
That said, the artificial nose addition is only 1500 points, and replacing one bacterial-filtered artificial nose a day doesn't fit within the "addition". Medical institutions are forced to take out (deficit) or pay out-of-pocket (actual cost).

(d) Closed suction tube.
In the case of TPPV (ventilator with tracheotomy), there is a way to change the suction tube to a special one. There are "methods," but how do we implement the mastery of the procedure and what do we do with the cost of goods? We believe that this is a problem and that it is difficult to use in home health care settings.

(e) Disinfection of ventilators, etc.
Cleaning and disinfecting with a cloth containing alcohol and antiviral disinfectants.

(f) The nebulizer is ventilated while
Nebulizers, like ventilators, produce aerosols. If a nebulizer is required, it should be carried out with ventilation.

At this time, we are unable to propose a universal solution to the aerosols that occur.
There is no universal method.
If you have a solution, we'd love to hear from you!

If the person's physical condition is infected with a new coronavirus, there is a possibility that a family member may be infected with the new coronavirus by an aerosol until a definitive diagnosis is made. Or, if a family member is infected with the new coronavirus, they may infect themselves.


Above.


It is expected that "guides" and "measures for the ○○" will be issued by the organizations and societies.
We will introduce you as soon as we answer.
At the same time, I will remove it as necessary so that my blog doesn't become confusing information.

If it needs to be added at a later date, it will be added with the date.
Hopefully, a guide or a countermeasure will come out and get the word out!

Translated with www.DeepL.com/Translator (free version)

2020年4月6日月曜日

私見です。在宅人工呼吸療法における「感染対策」について


新型コロナウイルスに関する多くの情報が出ています。医療機関内での感染対策や一般的なうがい・手洗いの情報が多い印象です。国内には、在宅人工呼吸療法をされている方が多くおり、新型コロナウイルスに関連した「在宅医療」の情報が不足していると感じています。

今後、在宅医療での感染対策について関連団体や学会等から「ガイド」や「〇〇対策」がでると予想されます。出たら直ぐにご紹介します。
と同時に、私のブログが紛らわしい情報にならないように必要に応じて削除します。
在宅医療は個々の事情が複雑過ぎて細かなアドバイスを書くことができません。
以下に記載することは「私見」です。(ご意見・ご要望はお手柔らかに。)

参考にしたガイドライン等は引用先を示します。

2020年1月5日日曜日

2019年を振り返り、2020年もよろしくお願いします

2020年が始まり5日が経過。
みなさま 今年もよろしくお願いします。

2019年を振り返ります。
まず昨年のブログ記事数21記事。過去ワースト(-_-;)

もはや、通信販売業界のロングテール戦略に近い状況です。

末永く・・・ そんなKeywordが聞こえてきそうです





2019年10月5日土曜日

私は転職3回しています

独り言です。

時代は変わりました。
医療ライセンスを持っている人で、
一つの施設に長く勤務される方は多くいます。
昔は、それが「普通」だったのかもしれません。
私は、どちらかと言うと「異常」な方だと思います。

時代が変わり、積極的に転職を検討する臨床工学技士も
増えてきた印象です。

あまり、参考にならないかもしれませんが・・・
私のケースを「差支えない範囲」でオブラートに包んで書きます。

2019年9月15日日曜日

なぜ在宅医療の道へ?への解答

今年度、特に何も考えもなく「Peing-質問箱-」にエントリーしました。
bot的な質問が多い中、たまにリアルな質問が来ます。

今回「なぜ在宅医療の道へ?」という質問を頂きました。
これがbotだったら、凄い!!
ふと、自分の過去ブログを検索したのですが・・・
検索にそれらしきものが出ない!?