COVID19 Re-Opening Strategies for Respiratory Diagnostic Services

The past two and half months have been anything but normal. In healthcare, we have seen a horrific drama play out before us; from working without necessary supplies, some being forced into overtime, watching our colleagues fall ill, and losing friends- to seeing others losing their jobs; being set aside from the patients we have taken an oath to serve. We are thankful for advances in telemedicine and other avenues to provide necessary care in these strange times. But many healthcare providers are left wondering what is next. What will the next phase of patient care in our system and offices look like? While I cannot say for certain (as none of us can), we are on the track to re-opening public life. This includes outpatient services and physician office face to face visits resuming. Fortunately, we have been given some guidelines for infection control in the office and pulmonary labs which is what I am writing to share with you today. The ERS published their recommendations for lung function testing during COVID and beyond while ATS has a similar document that is scheduled to be released later this month. I have included the links to read the documents as you wish but will do my best to break down the common recommendations below.

American Thoracic Society (ATS)             European Respiratory Society (ERS)

• COVID19 + patients should not be tested.
• COVID patients may be tested only after >30 days post infection (ERS); ATS has not provided a designated time frame
• Regional assessment of prevalence should be made for each office/ lab (i.e. follow your local health departments recommendations for contact and infection control guidelines)
• During high regional prevalence only urgent/essential testing for diagnostics of current illness
• Examples include surgical evaluations, transplant candidacy, complex dyspnea, medication toxicity  
• Testing should be done ONLY with a disposable bacterial viral filter (99.999%) in place. “Use of disposable combined mouthpieces/ sensors is not recommended at this time.” The only exception is when a filter is added. (ERS).  If you need these to fit your device, please call us, we can help 😉
• Weigh the risk/benefits of testing (ie. pathogen exposure vs clinical importance)
• Spirometry and DLCO may be deemed more essential than lung volume studies
• Exercise testing, bronchial challenge testing should be postponed during periods of high prevalence and limited to specific equipment and space afterwards
•  Nebulization or aerosol generating procedures should be held during periods of high prevalence
• MDI’s are preferred if post bronchodilator assessment is performed
• Nebulizer’s should be used with a filter in designated space in lower prevalence regions
• See document for additional recommendations such as negative pressure rooms, PPE, etc.
• Patients should wear a mask when not performing a testing maneuver
• Consider use of home spirometry devices for patients requiring higher surveillance
• Equipment should be disinfected per the manufacturer’s instructions.
•  Click here for Vitlagraph instructions  
• Contact your manufacturer or distributor to obtain instructions for your cleaning policy and procedure 

For more information on Vitalograph specific questions, this link is quite helpful. For additional questions, feel free to myself or the clinical team at CDS. Finally, to all, please stay safe.