Patient Safety COVID-19

Patient Safety During COVID-19:

At Anacortes Dermatology patient safety is our number one concern. We have implemented numerous protocols to ensure patient protection:

 

1.) We perform high-dose UV-C light and ozone gas sanitization of exam rooms. See the details below for efficacy and testing.

2.) All contact surfaces are cleaned with hospital-grade sanitizers between every appointment.

3.) HEPA air purifiers are used throughout the clinic and exam rooms, rapidly exchanging the room air every 3-4 minutes. This far exceeds industry/hospital standards.  See below for a further discussion of HEPA air purifiers for COVID-19.

4.) Our exam rooms have negative air pressure and constantly exhaust and replace the room air. Between 300-500 cubic feet of air is replaced every minute.

5.) Our provider and staff use Positive Air Pressure Respirators (PAPR’s) and full isolation hoods. This is the highest level of protection other than using a self-contained breathing apparatus (SCBA). Our PAPR's use P100 filters, which block 100% of viral particles from entering breathing air.

6.) Our social distancing precautions include staggered appointments, with long intervals between patients, and car check-in (patients can wait in their vehicle until we are ready for them).

7.) Providers, staff, and their families practice extreme social distancing outside work. When rapid testing for COVID-19 is more widely available, we anticipate testing staff weekly. 

8.) Patients are asked to wear a mask for their appointment.

9.) We follow the regulations and guidelines of the Washington State Department of Health and our professional societies, such as the American Academy of Dermatology and the American College of Mohs Surgery.

 

UV-light and Ozone Sanitization at Anacortes Dermatology

Studies indicate that both UV-light and Ozone are able to inactivate Coronaviruses such as SARS 1, 2.  Our exam rooms are treated with high-dose UV-light and ozone gas (O3).  We have documented this system is highly effective at killing approximately 99.9% of respiratory pathogens in our clinic, even when performed BEFORE the cleaning of surfaces with chemical agents, HEPA air purifiers, and negative pressure air exchange.  

 

In April 2020, we tested our UV-light and ozone systems by placing microbial populations of respiratory bacteria on exam surfaces. Samples were cultured to assess the number of bacteria present before, and after, whole-room UV light and ozone treatment. This is the same method hospitals gauge the effectiveness of cleaning protocols and indicators for the potential presence of virus pathogens such as COVID-19.  The pictures below demonstrate its’ remarkable effectiveness at killing 99.9% of respiratory bacteria on exam surfaces. Each small dot represents a living bacterial colony. Note the absence of growth in UV-light/ozone treated samples. 

 

 

1.)    Darnell, M., et al. Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV. Journal of virologial methods, 2004. 121:p. 85-91

2.)    Zhang et al. Examination of the efficacy of ozone solution disinfectant in inactivating SARS virus. Journal of Disinfection (Chinese), 2004- 01. R187


HEPA air purifiers for COVID-19 at Anacortes Dermatology
COVID-19 is very small, around 80 to 120 nanometers (0.12-0.08 microns). It is believed that the main mode of infection from Coronavirus is via respiratory transmission, where the virus is emitted into the atmosphere on much larger droplets of moisture or saliva, around 12-21 microns. These droplets can dehydrate and shrink to some degree, and remain suspended in the air for eight to fourteen minutes. The micro-droplets can also adhere to much larger particles such as dust or pollen (15-200 microns).  These particle sizes are effectively captured by HEPA purifiers, which filter out particles greater than 0.3 microns.  

Current data suggests that COVID-19 is transmitted when a patient coughs, sneezes, talks, or even just breathes normally. Because COVID-19 is a new virus, the literature is very confusing regarding air purification with HEPA filters. Recent data suggests it's unlikely respiratory droplets less than 1 micron are infectious because nearly all emitted droplets are larger than that size, and the  probability that the original hydrated 3-micron drop (which would dehydrate to 1 micron) contains an infectious virus particle is less than 0.01%.3

Use of HEPA purifiers to filter infectious pathogens is well documented in Positive Pressure Powered Air Respirators, where the HEPA purifiers have been used to block a variety of viruses.4  Recently scientists have designed systems utilizing HEPA purifiers to protect physicians when intubating patients with COVID 19.5  During the initial SARS outbreak in 2003, HEPA air purifiers were widely used to control infection throughout hospitals in Taiwan.6  Further, HEPA filters can effectively block the particle transmission of Porcine Respiratory Virus (PP-RSV), which is approximately half the size of COVID-19.7 Finally, according to the Centers for Disease Control, HEPA filters capture 99.9% of particles (bacteria, fungi, and larger viruses or virus clumps) 0.1-0.3 micrometers in diameter. We feel the predominance of the evidence suggests that HEPA filters are an excellent addition to our clinic and will make it a much safer environment for our patients. During an average appointment, the air in our exam rooms will have been filtered and exchanged approximately 8 to 10 times!! 


3.) Valentyn et al., The airborne lifetime of small speech droblets and their potential importance in SARS-CoV-2 transmission. Proceedings of the National Academy of Sciences, 13 May 2020, htttps://doi.org/19.1973/pnas.2006874117

4.) The microenvironment of Positive Pressure Powered Air Purifying Medical Protective Equipment, Feng et al, Journal Emergency Medicine, May 2020: 37(5):256-257

5.) Lin et al, SWIVEL-HEPA-ETT (SHE)(HE) Methods for safe intubation while managing patients with COVID-19. Emergency Infectious Disease 2004 July:10(7):1187-94

6.) Esswein et al, Environmental and Occupational Health Response to SARS, Taiwan, 2003

7.) Dee et al. Evaluation of systems for reducing the transmission of porcine reproductive and respiratory syndrome virus by aerosol. Canadian Journal of Veterinary Research 2006 Jan 70(1):28-33.



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