Summary

Executive Summary

In a crisis such as the COVID-19 pandemic, normal processes must often be modified to ensure that the best possible care is provided while ensuring the safety of patients and personnel despite limited resources. We have collected many ECRI publications that provide guidance to help healthcare organizations meet challenges such as equipment and supply shortages, management of devices with FDA Emergency Use Authorization, environmental cleaning and disinfection, and safe and efficient vaccine practices.

In keeping with its mission to advance effective, evidence-based healthcare globally, ECRI is making these resources freely available to the public—no membership or other payment is required to access them.

Who Should Read This

Full Text

COVID-19 OUTBREAK PREPAREDNESS AND RESPONSE

This section provides links to ECRI technology management resources—and a few outside sources—that healthcare organizations may find useful during the COVID-19 pandemic. No membership or other payment is required to access this content, or to view the wealth of additional content available through ECRI's COVID-19 Resource Center. (Members of certain ECRI programs can access an expanded array of technology management resources through the ECRI Essentials page devoted to this topic, as well as our Healthcare Recovery Center—COVID-19.)

COVID-19 and Medical Devices: A Lab Webcast Series
This live-streamed lab webcast series features guidance from ECRI experts and others on device-related issues that are arising as a result of the COVID-19 crisis. View recordings of previous webcasts and access supplementary materials:

Dry Ice for Storing Vaccines: How to Handle It Safely

Dry ice, which is solid carbon dioxide, may be required for storing vaccines for COVID-19. Read about the hazards associated with dry ice and our safe handling recommendations. Also check out our infographic.

From CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

The U.S. Centers for Disease Control and Prevention (CDC) has issued interim recommendations to address the COVID-19 coronavirus outbreak. Key concepts in CDC's guidance are (1) limit how germs can enter the facility, (2) isolate symptomatic patients as soon as possible, and (3) protect healthcare personnel.

  

New Technologies or Technology Applications

Emergency Preparedness: Planning and Mitigation

Emergency preparedness includes planning, preparation, mitigation, response, and recovery. This guidance article discusses planning and mitigation. Organizations should take an all-hazards approach to planning for facility- and community-based natural and human-made disasters. Participation in annual community-based drill exercises is mandatory.

Emergency Preparedness Device List

A list of relevant equipment organized according to ECRI's Universal Medical Device Nomenclature System (UMDNS) device terms.
 

Lessons from SARS

Though on a much smaller scale than the 2020 COVID-19 pandemic, the 2003 epidemic of severe acute respiratory syndrome (SARS) was a public health crisis worldwide. Dealing with that outbreak provided vital lessons in how hospitals should protect against, and cope with, disasters involving airborne pathogens.

Preparation Is the Best Protection

Learn what part the healthcare facility, its surrounding community, clinicians, and facilities and clinical engineering staff can play in preparing for an outbreak.
 

Lessons from Ebola

In 2014 and 2015, an outbreak of the Ebola virus spread from Guinea to seven more countries, killing over 10,000 people. ECRI's Ebola-related publications at that time placed a heavy emphasis on preparedness.

Ebola Preparedness Survey: Results and Commentary

Here are responses to our survey asking hospitals to assess the status of their Ebola preparedness planning. Find out what challenges facilities have encountered in selecting equipment that might be needed to treat an Ebola patient.

Webinar: Ebola: Medical Device and Personal Protective Equipment Preparedness

With so much for hospitals to manage related to Ebola preparedness, efforts to manage the details of technology may get lost in the shuffle. This 90-minute interactive webinar, which took place in December 2014, gave an overview of Ebola equipment preparedness.

Checklist: Equipment-Related Preparedness for Ebola

If your hospital has to treat patients with Ebola, there are a host of equipment-related issues to address to keep your staff and patients safe. Here's a look at the most important ones. 
 

SUPPLIES AND ACCESSORIES—PERSONAL PROTECTIVE EQUIPMENT (PPE)

ECRI's PPE Testing

N95 Mask Testing Program
By testing imported masks, as well as isolation gowns, ECRI is helping healthcare organizations validate products prior to purchase and verify the safety and quality of products already in inventory.

NIOSH/ECRI Respirator Testing Summary
This periodically updated spreadsheet lists the results of testing of N95-style respirators by ECRI and the National Institute for Occupational Safety and Health (NIOSH). Data includes model/product line, international standard, filtration efficiency percentage, N95 particle filtration efficiency (PFE) requirement assessment, test report, and, for the products ECRI tested, a product image.  

Gown Testing Summary
This periodically updated spreadsheet lists the results of ECRI's testing of each product's water repellency to determine its Association for the Advancement of Medical Instrumentation (AAMI) equivalent level. Other information includes manufacturer, model name, model number, lot number, country of origin, color, cuff type, thumb hole, seam locations, material, and a product photo. 
 

Considerations for Respirators

Note that some of the resources included in the "Addressing Shortages" and "Alternative Suppliers" sections, below, likewise apply to respirators.

ECRI's live-streamed lab webcasts:

Strategies for Addressing Expected or Known Shortages of Powered Air-Purifying Respirators and Accessories [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0609)
The COVID-19 patient surge has contributed to a worldwide shortage of powered air-purifying respirators (PAPRs) and PAPR accessories (e.g., filters, breathing tubes, facepieces/helmets/hoods). Guidance is offered for conserving and optimizing supplies, obtaining new supplies, and identifying alternatives.

Strategies for Addressing Expected or Known N95 Respirator Shortages [ECRI Exclusive Hazard Report] [Update] (ECRI Alerts Accession No. H0577 01)

This Hazard Report updates the recommendations found in H0577 (see next item below).

Strategies for Addressing Expected or Known N95 Respirator Shortages [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0577)
Increased N95 respirator use during a COVID-19 patient surge may exceed the available supply, resulting in shortages at the healthcare facility. Guidance is offered for calculating expected usage, modifying care practices, and identifying alternatives to help protect healthcare workers during the surge.

Decontamination of N95 Respirators: FDA Recommends Transition from Use of Decontaminated Disposable Respirators [ECRI Exclusive User Experience Network] [Update] (ECRI Alerts Accession No. S0394 02)

This update of Special Reports S0394 and S0394 01 (see next items below) provides new information regarding FDA's recommendations to transition away from crisis capacity conservation strategies for disposable respirators.

Decontamination of N95 Respirators: UV Light May Be Considered for Limited Reuse Situations [ECRI Exclusive User Experience Network] [Update] (ECRI Alerts Accession No. S0394 01)

This update of Special Report S0394 (see next item below) contains new UV dose recommendations to reflect guidance from the U.S. Centers for Disease Control and Prevention (CDC), FDA, and the National Institute for Occupational Safety and Health (NIOSH) regarding decontamination and reuse of N95 respirators.

Disinfection of N95 Respirators: UV Light May Be Considered For Limited Reuse Situations [ECRI Exclusive User Experience Network] (ECRI Alerts Accession No. S0394)
Extended use and reuse of single-use N95 respirators may increase healthcare worker exposure to pathogens, as compared to using new N95 respirators for each patient interaction. When faced with shortages, however, facilities may attempt to decontaminate single-use N95 respirators using various methods, including UV disinfection. Technical considerations and risks associated with the use of UV disinfection, along with ECRI's recommendations, are discussed.

MaxAir CAPR System (Syntech International) for Preventing Infectious Agent Transmission

The MaxAir CAPR (Controlled Air-Purifying Respirator) System is a loose-fit, powered air-purifying respirator (PAPR) intended to be worn (e.g., by healthcare workers) to prevent transmission of infectious agents (e.g., anthrax, bacterial meningitis, influenza, tuberculosis) to patients or medical staff. 
 

Addressing Shortages

Note that resources focusing specifically on respirators are listed in the preceding section.

Use of Novel Intubation Boxes Does Not Reduce the Need for Appropriate PPE and Intubation Precautions [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0598)
In the face of PPE shortages, healthcare workers have sometimes been compelled to improvise protective barrier enclosures (e.g., intubation boxes) for use during high-risk procedures such as intubation. ECRI recommends that such barrier enclosures be considered only as a means of additional protection, not as a substitute for wearing standard PPE.

Strategies to Conserve Existing Supplies of Personal Protective Equipment [ECRI Exclusive Special Report] (ECRI Alerts Accession No. S0400)
Inefficient use of existing PPE supplies can cause hospitals to burn through their current stockpiles at a faster rate and quicken shortages. Recommendations are offered for conserving existing PPE supplies so that protective equipment is available for the most essential patient care activities.

Strategies for the Use of Homemade Facemasks [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0597)
Increased facemask use by healthcare workers and the general public during the COVID-19 patient surge will likely exceed the available supply, resulting in shortages at many healthcare facilities. Recommendations are offered for conserving supplies, selecting appropriate designs for expected activities, ensuring a proper fit, and cleaning masks appropriately.

Strategies for Addressing Expected or Known Eye Protection Shortages [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0584)
Patient surges associated with COVID-19 have led to a worldwide shortage of eye protection. Increased usage of eye protection when treating such patients will likely result in shortages at many healthcare facilities. Guidance is offered for conserving and optimizing supplies, as well as for identifying alternatives.

Strategies for Addressing Expected or Known Facemask Shortages [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0591)
The COVID-19 patient surge has contributed to a worldwide shortage of facemasks, such as the surgical masks used to protect healthcare personnel from respiratory droplets. Guidance is offered for conserving and optimizing supplies, as well as for identifying alternatives.

Strategies for Addressing Expected Glove Shortages [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0586)
Patient surges associated with COVID-19 are expected to lead to a shortage of gloves used as a method of broad barrier protection for healthcare personnel. Guidance is offered for conserving and optimizing supplies, as well as for identifying alternatives.

Strategies to Combat Inadequate Supplies of Isolation Gowns [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0578)
Increased isolation gown utilization to treat suspected and confirmed COVID-19 patients may exceed the available supply of gowns, resulting in shortages at some healthcare organizations. Guidance is offered for conserving and optimizing isolation gown supplies, as well as for identifying alternatives.
 

Alternative Suppliers

Outbreaks like the COVID-19 pandemic can put a severe strain on healthcare supply chains, forcing hospitals to look for alternate suppliers of certain PPE, such as goggles, masks, and gowns.

Personal Protective Equipment Supply Equivalents

This periodically updated proprietary database provides the best matches for the three most popular brands of exam gloves, face shields, isolation gowns, air-purifying respirators (e.g., N95, PAPRs), safety eyewear, shoe covers, and surgical masks based on key performance indicators (KPIs) and functional equivalence.

Nontraditional PPE Suppliers (Domestic and International)

ECRI is collaborating with The Association for Health Care Resource & Materials Management (AHRMM) to provide lists of nontraditional suppliers offering PPE supplies. In the collaboration, AHRMM is tracking nontraditional domestic suppliers, and ECRI is tracking nontraditional international suppliers. The combined effort and solution will help providers vet non-traditional suppliers and provide assurance that they have been assessed by each organization. 

Alternate Supplier List: Personal Protective Equipment

This is a comprehensive directory of go-to sources to supplement the usual suppliers. It is organized by equipment type: respirators, shoe covers, masks, etc.
 

SUPPLIES AND ACCESSORIES—OTHER

Production Disruption of GE Healthcare Omnipaque (Iohexol) and Visipague (Idixonal) Could Impact Imaging Studies, Causing Delays or Cancellations (ECRI Alerts Accession No. H0774)

Because of the current outbreak of COVID-19 in Shanghai, the iodine contrast material manufacturing facility was temporarily closed, creating a halt on the production of Omnipaque products. The facility has now reopened at reduced capacity with production output continuing to increase. This situation is creating a very low stock of Omnipaque products, and some distributors are reporting it on backorder.

IR Temperature Screening Lacks Supportive Evidence for Preventing COVID-19 Transmission [ECRI Exclusive Special Report] (ECRI Alerts Accession No. S0412)

Hospitals are spending financial resources on infrared (IR) cameras, kiosks, and thermal imaging systems for COVID-19 screening. However, the high cost and low evidence for the use of this type of system can make it a poor purchasing choice. IR temperature screening, even when it includes questionnaires, produces a false sense of security and can use scarce resources that could be better used elsewhere. Read our recommendations.

3-D Printed Test Swabs Manufactured without Proper Validation Procedures Can Harm Health Care Providers and Patients [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0621)
Swabs that were 3D printed and manufactured without following proper validation procedures may not perform as intended. Defective or damaged swabs may result in inaccurate results, potentially causing errors in treatment plans and putting patients and staff at unnecessary risk. Recommendations are presented for identifying reliable sources for 3D printed products, as well as for designing or manufacturing such products.

SARS-CoV-2 Test Kits—Product Equivalents

This periodically updated proprietary database includes a list of identified SARS-CoV-2 tests on the market with confirmation of availability and whether a supplier is accepting new customers.

Coronavirus Support Product Equivalents

This periodically updated proprietary database provides the best matches for the three most popular airway clearance units, breathing circuits, dialysis catheters, disinfecting wipes, HME filters, IV extension sets, IV solutions, and universal transfer media based on key performance indicators (KPIs) and functional equivalence.

3-D Printed Objects Manufactured without Following Proper Validation Procedures Can Harm Healthcare Providers and Patients [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0603)
Healthcare facilities may be compelled during the COVID-19 pandemic to use 3D printed products that have not been validated to be safe and effective. The use of untested product designs or failure to adhere to current good manufacturing practices could lead to harm. Recommendations for reducing the risk are discussed.

COVID-19 Emergency Response: Oxygen Supply Considerations [ECRI Exclusive User Experience Network] (ECRI Alerts Accession No. S0396)
COVID-19 treatments are associated with high oxygen consumption. The increased demand for oxygen can lead to depleted oxygen supplies, reduced oxygen pressures, and other challenges. Guidance is offered for addressing oxygen shortages, minimizing waste, and locating alternate supplies.

FDA and FTC Warn of Fraudulent COVID-19 Products (ECRI Alerts Accession Nos. H0567 through H0567 02)
FDA and FTC have issued warning letters to multiple companies for selling fraudulent COVID-19 products, described as products claiming to prevent, mitigate, treat, diagnose, or cure COVID-19, which may cause consumers to delay or stop appropriate medical treatment, leading to serious and life-threatening harm. FDA's report is summarized and actions needed are outlined. 
 

PATIENT CARE EQUIPMENT—VENTILATORS

Following are a few resources to help organizations address challenges related to the use of mechanical ventilators. Also see the Equipment Support and Facilities Management section, below, for ventilator-related guidance.

Coping with Shortages

Ventilators Obtained from Storage, Unknown Sources, or Accelerated Manufacturing Require Inspection before Patient Use [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0624)
In responding to the COVID-19 pandemic, hospitals may require an influx of ventilators from multiple sources and in unknown conditions. In many instances, such equipment has failed incoming inspections, highlighting the importance of conducting acceptance checks on any incoming ventilators before placing them into service. Recommended steps are outlined.

Philips—Respironics E30 Ventilators: ECRI Assessment of Emergency Use Authorization Device [ECRI Exclusive Special Report] (ECRI Alerts Accession No. S0404)
Philips has received an Emergency Use Authorization (EUA) from FDA to temporarily sell the E30 ventilator to provide invasive and noninvasive ventilatory support for appropriate individuals with respiratory insufficiency during the COVID-19 pandemic. The limitations of the E30 compared to an ICU ventilator are described, along with ECRI's concerns.

Ventilators on FDA Emergency Use Authorization List: Hospitals Should Seek Clarity on Post-EUA Status Before Purchasing [ECRI Exclusive Special Report] (ECRI Alerts Accession No. S0399)
Healthcare facilities that are using ventilatory support devices that have been cleared by FDA for use only during the COVID-19 pandemic under an Emergency Use Authorization (EUA) need to be aware that continued use of the devices outside the special exemption provided by the EUA could expose the hospital to liability and/or action by accreditors or payers. Recommendations for navigating this issue are presented.

Shortages of Intensive Care Ventilators—Strategies for Mitigation [ECRI Exclusive Special Report] (ECRI Alerts Accession No. S0398)
Hospitals may experience shortages of intensive care ventilators during the COVID-19 pandemic. ECRI summarizes its recommendations for maximizing your supply and identifying and deploying alternatives.

Deploying Anesthesia Machines as ICU Ventilators

Ventilating Multiple Patients with a Single Ventilator

General Technology Guidance

Ventilators in Isolation Rooms May Fail to Alert Clinicians of Critical Alarm Conditions [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0625)

Unique conditions during the COVID-19 pandemic make it more likely that ventilator alarms won't be heard—for example, ventilator patients require isolation with room doors closed, staff are limiting the number of entries into the room, or staff may not be familiar with alarm sounds and indicators on models not typically used in their area. Respiratory administrative and clinical recommendations are provided.

Mechanical Ventilation of SARS Patients
ECRI recommends that breathing-circuit filters be incorporated in the exhalation limb of any ventilator used on a patient with SARS, since the virus can be carried by droplets that exit from the limb. In this article, we review the issues behind our recommendations and describe steps hospitals can take to prevent any adverse effects on ventilation.

Evaluation: Portable/Transport Ventilators
Portable ventilators often have advanced features rivaling full-size units. But sometimes a simpler design is better. This article will help you find a model that meets your needs.  
 

PATIENT CARE EQUIPMENT—GENERAL RESPIRATORY CARE

Use of Consumer-Grade Obstructive Sleep Apnea Devices May Supplement Ventilator Supply during Shortage [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0587)
Under appropriate conditions, devices intended for obstructive sleep apnea may be used as a temporary measure for low-acuity patients while respiratory care devices cleared for other preferred therapies are in a critical shortage. Device requirements and patient selection considerations are discussed.

Strategies for Addressing Known or Expected Single-Use Video Laryngoscope Blade Shortages [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0596)
Since many COVID-19 patients require intubation, hospitals that intubate with single-use video laryngoscopes are depleting their inventory of single-use video laryngoscope blades much faster than normal. Guidance is offered for optimizing supplies, as well as for identifying alternatives.

Automatic Gas-Powered Resuscitators: What Is Their Role in Mass Critical Care?

Although automatic gas-powered resuscitators may seem like a wise choice for ventilating patients in mass critical care scenarios, ECRI recommends against stockpiling the devices for this purpose. Find out why in our Evaluation.
 

PATIENT CARE EQUIPMENT—IMAGING TECHNOLOGIES

Magnetic Resonance Imaging Systems

N95 Respirator and Surgical Mask Precautions for COVID-19 Patients in the MRI Room [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0590)
The presence of metal nose clips on N95 respirators (and similar devices) can cause problems in the MR environment. Respirators worn by patients, for example, can become hot enough to injure the patient or could create image artifacts. Recommendations for patients and staff are provided.

Procedure Precautions When Using MRI Imaging [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0588)
Use of the MR suite for potentially infectious patients may lead to contamination of the scanner, coil, and/or room. Without proper precautions, the risk of cross-contamination affecting patients or staff is high. Recommendations for minimizing the risks are discussed.
 

Radiology Equipment

Procedure Recommendations for Use of Mobile X-Ray Devices [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0585)
Mobile x-ray units used on contagious patients, as may occur in makeshift emergency rooms or triage areas, can become contaminated, putting patients and staff at risk from cross-contamination and reducing the availability of the unit during decontamination procedures. Recommendations for minimizing contamination risks are discussed.

Failure to Routinely Clean CT Scanner or Fixed Radiology Equipment Surfaces between Patients Could Intensify Community Spread of COVID-19 [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0580)
Fixed radiology equipment like CT scanners may be used on contagious patients, creating the risk for cross-contamination (affecting patients or staff) if the equipment is not properly cleaned and disinfected between patients. Recommendations are detailed for minimizing the risks and managing the workflow impact of the decontamination requirements.  
 

Ultrasound Scanners

Following are a few resources to help organizations make effective use of ultrasound scanners, with a special focus on point-of-care ultrasound (POCUS).

ECRI's live-streamed lab webcast Ultrasound in the Age of COVID-19: Guidance through the Recovery and Future Planning (5/13/2020)

Disinfection Considerations

Point-of-Care Ultrasound Is Beneficial to Triage Patients for Suspected COVID-19; Safeguards Are Required [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0573)
Inappropriate use of point-of-care ultrasound (POCUS) to triage patients with suspected COVID-19 can lead to cross-contamination if devices are not properly cleaned and disinfected, or misdiagnoses if clinicians are not qualified to perform POCUS for lung applications. Technical considerations and ECRI's recommendations are discussed.
 

PATIENT CARE EQUIPMENT—OTHER

Dialysis Equipment

See ECRI's May 6, 2020, live-streamed lab webcast, Renal Replacement Therapy and COVID-19 Patients. 

Infusion Pumps

In addition to the resources below, also see ECRI's April 8, 2020, live-streamed lab webcast Infusion Therapy—Conserving Supplies in the Age of COVID-19.

Large-Volume Infusion Pump Administration Sets—Responding to Possible Availability Disruptions [ECRI Exclusive User Experience Network] (ECRI Alerts Accession No. S0393)
Shortages of some infusion pump administration set configurations can necessitate exploring alternatives. The use of non-standard methods to deliver drugs may be required in the case of limited administration set availability, but the practice can increase the risk of medication errors. Safety considerations and ECRI's recommendations are discussed.

Large-Volume Infusion Pumps—Considerations When Used with Long Extension Sets outside Patient Rooms to Help Reduce Staff PPE Use [ECRI Exclusive User Experience Network] (ECRI Alerts Accession No. S0392)
In some cases, infusion pumps can be used with extension sets that allow the pump to be placed outside the patient room as a temporary measure to protect the clinical personnel and conserve personal protective equipment (PPE) during the COVID-19 pandemic. Technical considerations and ECRI's recommendations are discussed.

Physiologic Monitoring 

Home-Use SpO2: Considerations before Prescribing or Using Consumer-Grade Pulse Oximeters in the Home Care Environment [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0619)
With limited resources to host patients during the COVID-19 pandemic, facilities may consider monitoring the oxygen levels of non-COVID patients at home using home-use SpO2. Additionally, consumers are showing interest in these devices. Without proper training, however, patients may receive misleading results or gain a false sense of security. Recommendations are presented to help determine when this technology can be useful, which models to select, and how to support proper use.

 

SURGICAL CONSIDERATIONS

Recommendations for Reprocessing Flexible Endoscopes Used on COVID-19 Patients [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0630)
As facilities return to their pre-pandemic endoscopic procedure loads, they may need to take steps to prepare their staff and equipment in order to avoid increased infection risk and equipment damage (e.g., due to extended periods of nonuse). We provide recommendations.

Considerations for Endoscopy Procedures [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0631)
Healthcare personnel may be exposed to SARS-CoV-2 while performing non-elective/emergent endoscopy procedures on confirmed and/or asymptomatic COVID-19 patients. Recommendations are provided for deciding whether procedures should be performed, for taking precautions before and during such procedures, and for completing proper cleaning afterward.

Strategies to Minimize Surgical Staff Exposure to COVID-19 [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0614)
The risk that healthcare personnel could be exposed to SARS-CoV-2 while performing surgery on a COVID-19 patient requires that additional precautions be taken before, during, and after surgery. Appropriate practices to protect the surgical team and others are discussed.

Considerations for Smoke Evacuation during Non-Deferrable Surgery [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0613)
While there are no relevant studies on transmission of the SARS-CoV-2 virus via surgical smoke, there is anecdotal evidence of similarly sized viral particles transmitting disease to surgical staff via smoke plume, causing concern. The lack of clinical evidence and concern for transmissivity of the virus warrants considering expanded use of surgical smoke evacuation. The recommendations in this report place an emphasis on diligence and best surgical practices in any situation, regardless of the current pandemic.
 

CLEANING AND DISINFECTION

Following are resources to help organizations effectively clean and disinfect spaces and equipment. Also see ECRI's April 29, 2020, live-streamed lab webcast, SARS-CoV-2 Disinfection—Killing the Spread.

Downloadable Cleaning and Disinfection Checklist

Complete this checklist for routine cleaning and disinfection (C&D) of specific items within suspected/confirmed COVID-19 patient rooms.

Use of Automatic Chemical Disinfection Systems May Lead to Chemical Exposure and Equipment Damage [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0635)

The COVID-19 pandemic has increased interest in automatic chemical room disinfection systems—hydrogen peroxide vapor (HPV) or chemical fog—that could be used in healthcare, industrial, and commercial settings. Misuse of these systems could result in personnel exposure, unknown system efficacy, and equipment degradation or damage. Recommendations are provided.

Systems for Disinfecting the General Public Are Ineffective and Hazardous [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0618)
In some areas of the world, the COVID-19 pandemic has prompted an ineffective and hazardous practice of spraying disinfectants on people who are not wearing appropriate personal protective equipment (PPE). ECRI outlines its objection to this practice.

Disinfectant Concentrations and Contact Times for EPA's List of Products Effective against Novel Coronavirus SARS-CoV-2, the Cause of COVID-19
This table lists disinfectant concentrations, contact times, and use settings for EPA's List N, which covers antimicrobial products effective against coronavirus SARS-CoV-2 but does not specify disinfectant concentrations. Our list will help you ensure you're using a suitable, effective disinfectant at a sufficient concentration and contact time to kill SARS-CoV-2. 

Routine and Terminal Cleaning of Suspected or Confirmed COVID-19 Patient Rooms [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0595)
Temporary changes to cleaning policies, procedures, and personnel during the COVID-19 pandemic (e.g., to conserve PPE) can increase the risk of improper or ineffective cleaning. Recommendations are provided for reducing both the risk of staff exposure to the SARS-CoV-2 virus and the potential for cross-contamination of patient care equipment.

Cleaning and Disinfection without Appropriate Training May Result in Damage to Equipment [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0627)
Use of improper techniques for cleaning medical equipment, including failure to follow cleaning product or equipment manufacturer instructions, using excessive amounts of cleaning solutions, and incorrect rinsing procedures while cleaning equipment, may cause problems such as harmful residues remaining on surfaces, wetting of areas susceptible to fluid damage, and equipment failures. Recommendations for ensuring proper cleaning are provided.   
   

EQUIPMENT SUPPORT AND FACILITIES MANAGEMENT

Guidance for Temporary Airborne Isolation of COVID-19 Patients Undergoing Aerosol-Generating Procedures [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0617)
Airborne infection isolation rooms (AIIRs) are recommended for isolating suspected or confirmed COVID-19 patients during aerosol-generating procedures, but facilities may not have enough AIIRs available to meet the needs of COVID-19 patient surges. Alternatives for establishing temporary airborne patient isolation are discussed as a way to protect healthcare personnel from airborne infectious diseases.

Recommendations for Emergency Power Outlet Management at Peak Resource Use [ECRI Exclusive Special Report] (ECRI Alerts Accession No. S0403)
Emergency measures implemented during the COVID-19 pandemic could lead to patient harm from power interruptions if emergency power is not managed carefully. Considerations include whether general care areas that are converted to function as intensive care units have a sufficient number of emergency power outlets, and how devices that are pressed into service for emergency life support will respond to power interruptions. Recommendations for nurses and for biomedical engineering/facilities staff are provided.

Medical Device Dust Filter Replacement Considerations during Pandemic [ECRI Exclusive User Experience Report] (ECRI Alerts Accession No. S0405)
During servicing of medical device dust filters, particles that had been captured by the filter are likely to be released into the air. This report outlines precautions to take during routine exchange/cleaning of medical device dust filters to reduce the risk of spreading COVID-19.

Protecting against Infectious Disease Transmission during Equipment Maintenance

This article provides guidance for clinical engineering, respiratory therapy, and other personnel involved in maintaining potentially SARS-exposed equipment.

Selecting Respiratory Protection for Equipment Servicers and Other Hospital Personnel

This article addresses the advantages and limitations of the N95 respirator for respiratory protection against infectious diseases and offers recommendations for further protection.

Inspection and Preventive Maintenance (IPM) Procedures

 

IT CONCERNS

The U.S. Department of Homeland Security and other organizations have warned healthcare organizations that malicious actors may seize on opportunities created by the COVID-19 pandemic to initiate cyberattacks, including phishing campaigns and attempts to exploit remote access capabilities. Following are a few resources to help organizations deal with these threats.

The Transfer of Loaned Equipment during the COVID-19 Response Could Lead to Breach of Sensitive Information [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0616)
Devices used in a healthcare setting can contain sensitive information, including electronic protected health information (e-PHI) or network configuration information or credentials. When receiving or returning such devices, measures must be taken to prevent disclosures of (1) e-PHI (which could constitute a HIPAA violation) or (2) protected data that could be used as intelligence in targeted hacking attacks.

The Use of Loaned or Warehoused Devices during the COVID-19 Response Could Pose Security Risk [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0615)
While responding to COVID-19-related surges, facilities may obtain devices from alternative sources, including loaned or warehoused devices. Such devices could have out-of-date firmware and may contain cybersecurity vulnerabilities (e.g., be infected with malware from a previous use). Recommendations are provided to reduce the risks of introducing potentially out-of-date or infected devices onto hospital networks.

Health Emergency Exploited by Phishing Campaigns [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0570)
Malicious actors are exploiting the COVID-19 health emergency with targeted phishing e-mails falsely claiming to contain COVID-19-related content. Recommendations are presented to help facilities thwart attempts to compromise credentials or spread malware.

Expanded Work from Home Policies May Pose Increased Security Risks [ECRI Exclusive Hazard Report] (ECRI Alerts Accession No. H0571)
The large number of employees working from home during the COVID-19 health emergency poses security risks, from employees being inexperienced with handling protected health information (PHI) from home to remote access systems being configured in a way that bypasses perimeter security controls. Steps to minimize the risks are discussed.

HHS Temporarily Allows Use of Consumer Audio or Video Chat Applications for Telemedicine Use [ECRI Exclusive User Experience Report] (ECRI Alerts Accession No. S0390)
The removal of prohibitions against the use of consumer audio or video chat applications for telemedicine will require that healthcare facilities draft temporary technology-usage policies to accommodate telemedicine use and that they have a plan for rolling back those policies post crisis.

EHR Screening for Wuhan Novel Coronavirus (2019-nCoV) [ECRI Exclusive User Experience Network] (ECRI Alerts Accession No. S0385)
If electronic health records (EHRs) are not configured to effectively screen patients for the 2019 novel coronavirus (SARS-CoV-2), staff may not be alerted to take the necessary isolation precautions. Recommendations for screening are outlined.

From the HSCC: Management Checklist for Teleworking Surge during COVID-19 Response (may not display properly in Internet Explorer)
A checklist and related resources from the Healthcare and Public Health Sector Coordinating Council intended to ensure that bandwidth and cybersecurity needs are met during a teleworking surge resulting from wide-scale public emergencies such as COVID-19.

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Topics

Emergency Preparedness; Equipment and Facility Planning; Physician Preference Items

Caresetting

Ambulatory Care Center; Emergency Department; Hospital Inpatient; Hospital Outpatient; Trauma Center

Clinical Specialty

Critical Care; Infectious Disease; Pulmonary Medicine

Roles

Allied Health Personnel; Biomedical/Clinical Engineer; Clinical Practitioner; Infection Preventionist; Materials Manager/Procurement Manager; Patient Safety Officer; Regulator/Policy Maker; Risk Manager

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