In a step forward in the fight against COVID-19, SEHA, GE Healthcare and ADI have delivered the first ‘CT in a Container’ in the UAE. This innovative solution featuring advanced Computed Tomography (CT) equipment by GE Healthcare helps in diagnosing viral pneumonia attributable to COVID-19.

The fully-insulated, self-contained modular containers are sited in temporary tactical areas so that those who are suspected of COVID-19 are tested without them having to enter hospital facilities. This, in turn, ensures better infection control and an additional level of protection for frontline healthcare workers in hospitals.

Four ‘CT in a Container’ were specially built and fully assembled in the UAE. The first two at Sheikh Khalifa Medical City and Al Ain Hospital will be operational this week. Two additional units at the special COVID-19 screening centre in Al Dhafra and Emirates Humanitarian City are expected to be operational in the coming weeks.

The ‘CT in a Container’ allows physicians to complete patient lung screenings in under one minute and is expected to serve more than 100 visitors a day.

These modular CT 'containers' come with 90 per cent HVAC filtration to assure ongoing decontamination of air, lead-line and equipped with UV functional lighting. It takes approximately five minutes to decontaminate the room between patients.

News that a local health worker has contracted the coronavirus has just demonstrated the increased need for the provision of personal protective equipment for the individuals on the frontline combating the spread of the virus.

As essential health workers take care of patients with COVID-19, they require personal protective equipment (PPE) that include surgical masks, respirators (N95 masks), eye protection (goggles), latex gloves, boots, long-sleeve gowns and hazmat suits.

A study by the World Health Organization (WHO) indicates that the current global stockpile of PPE is insufficient, particularly for medical masks and respirators; and the supply of gowns and goggles is soon expected to be insufficient. Surging global demand − driven not only by the number of COVID-19 cases but also by misinformation, panic buying, and stockpiling − will result in further shortages of PPE globally. The capacity to expand PPE production is limited, and the current demand for respirators and masks cannot be met, especially if widespread, inappropriate use of PPE continues.

Health workers around the world have improvised PPEs as shortages hit, with nurses in New York using garbage bags as gowns, and doctors in Italy improvising snorkelling masks to be used as reusable respirator masks.

The situation in Kenya is no different. There has been increased demand for personal protective equipment especially surgical masks, N95 masks and disposable gloves. This accompanied by reduced supply from China, a major supplier of medical equipment, has resulted in hiked prices of the commodities by suppliers due to surge in demand.

Many private facilities are struggling to access the PPEs due to unavailability from suppliers and increased prices, which are up to 10 times the normal prices. Some private health facilities are even considering scaling down operations or closing their facilities to avoid exposing their healthcare workers to COVID-19 in the absence of PPEs.

Getting it right

The management of PPE should be coordinated through the essential national and international supply chain management mechanism to reduce the bottleneck in access. This would entail the Government of Kenya considering taking control of the PPE supply chain through direct importation, explore government to government deals with China, India, and other countries who are major exporters of medical supplies and centralising the ordering process of PPEs. The Government should also consider the reduction of importation taxes on essential medical supplies.

To encourage local manufacturing of PPEs, the government should subsidise production cost for local manufacturers and reduce the regulatory and licencing issues for local manufacturers that can produce PPEs for Kenya and the region to accelerate processes of manufacturing PPEs without compromising quality. Innovation aimed at designing PPEs from locally available materials should be encouraged by the government to reduce the bureaucracy associated with approval of new innovation.

The main pharmaceutical suppliers, KEMSA and MEDS, who are major distributors, should be allowed to supply PPEs to private facilities in addition to the public facilities and faith-based health institutions they currently supply.

Greater coordination by all stakeholders including the Ministry of Health, KEMSA, development agencies, KEPSA and KAM would ensure optimisation of the supply chain. This would enable price control of PPEs as opposed to allowing market forces to determine prices.

PPE use in hospitals should be based on the risk of exposure and health workers should be sensitised on the various PPE needed for the different setups as per WHO guidelines. Health administrators need to be aware of the concerns of health workers to allay their anxiety and reduce the insistence of use of full PPEs out of fear of their health.

Hospitals can minimise the use of PPEs by embracing telemedicine consultation, use of physical barriers such as glass windows for pharmacists dispensing medicine and restricting patient rooms to only health workers taking care of the patient.

The severity of the situation dictates that we need to protect our health workers, who day-in-day-out are doing all things possible to protect the rest of the country from a full-blown outbreak. If we leave the health workers to undertake this daunting task without the necessary equipment and they end up getting infected, where does that leave the country in the efforts to mitigate the surging spread of COVID-19?

As the COVID-19 pandemic intensifies, TrueProfile.io – a leading provider of primary source verification (PSV) solutions powered by the DataFlow Group – provides access to their database of job-seeking, verified healthcare staff in the GCC via TrueProfile.io Recruiting.

TrueProfile.io Recruiting enables healthcare hiring managers to access a digital pool of verified medical staff in the GCC who are actively seeking new opportunities. This pre-verified professional directory provides the means to stem the growing need for qualified healthcare talent throughout all regions in the GCC.

To respond to the growing need for healthcare professionals, TrueProfile.io will grant access to its database of over 30,000 healthcare professionals the majority of whom are already based in the GCC. Employers can view over 30,000 professional profiles, including their verified documents and can contact these individuals with relevant job opportunities. As the urgency for verified healthcare professionals escalates, TrueProfile.io Recruiting provides the same mandatory PSV of required credentials for medical staff, but with a 20-30-day time reduction in the hiring process – meaning that critical staff can be hired and on-boarded at speed.

Alejandro Coca, Head of Business at TrueProfile.io, says, “TrueProfile.io provides hospitals and healthcare recruiters in the GCC with the tools they need to efficiently and safely connect with verified healthcare professionals, whose professional documents have been screened and authenticated. This offers a means to bridge the staffing shortfall in the current crisis.

“With the recent launch of TrueProfile.io Recruiting, we have now significantly reduced the time-to-hire in the healthcare sector by creating a bank of pre-verified candidates, the majority of whom are seeking new roles in the GCC. This is transformational, as typically the sector can have a lengthy hiring process of up to six months for verifying the credentials of candidates, especially those from overseas. In a period where staffing shortages are hampering the efforts to contain COVID-19, removing this obstacle and supporting regulators and employers to quickly and securely hire staff is vital.

At Arab Health 2020 in January, Sonavi Labs pitched Feelix, a digital stethoscope and software to diagnose respiratory conditions, and won the Innov8 Talks Pitch Competition. In just four months, the world as we know it has transformed completely, and the company is working tirelessly to deliver this need-of-the-hour solution to physicians, researchers and frontline hospital staff.

Ellington West, CEO & Co-Founder, Sonavi Labs told Omnia Health Insights: “We are sending devices to researchers at the American Hospital in Dubai, UAE to build a reference library of clean audio files for the COVID-19 disease. We hope that by collecting and analysing this data, we will be able to identify the specific acoustic signature of COVID-19, in the same way, we have been able to validate the technology on pneumonia. If we are successful in validating our classification algorithm on the COVID-19 virus, then we will be able to train all of our devices to detect the disease, providing a dry digital diagnostic solution anyone can use that is rapid, accurate and sustainable.”

She explained that the Sonavi Labs classification algorithm has so far been trained to differentiate pneumonia from asthma. The company is currently working with FINDdx, a global non-profit organisation, to address Tuberculosis. So far, they have been able to validate the classification algorithm on over 10,000 patients and have the ability to distinguish healthy from unhealthy lung sounds with a 91 per cent accuracy.

Ellington West

 

Sounds of life

Sonavi is taken from the Latin word Sono, to make noise, and Vita, meaning life, and the company examines the sounds to detect and manage diseases, West shared. The company was founded in October 2017, when West teamed up with Ian McLane, a student in the West Lab of Johns Hopkins. Her father, Dr. James West, who leads the West Research Lab, and is a world-renowned acoustician and professor at Johns Hopkins, told her about the work that he and McLane were doing since taking on a Gates Foundation challenge to reduce paediatric mortality as a result of pneumonia, but lamented that once McLane graduated, the work would be relegated to the Hopkins archives.

She said: “At the time I was a Business Development Director for a national healthcare organisation, and realised that the work that McLane and my father were doing could have a major impact on global health and there were many millions of people around the world that could use a device capable of detecting respiratory diseases in seconds. We have made it our mission to support health systems, clinicians of all skill levels and patients everywhere with our advanced, AI-enabled technology, Feelix.”

How does Feelix work?

The Feelix and FeelixPro stethoscopes were developed to support the clinicians of all skill levels. From the original Gates Foundation challenge, researchers were able to develop algorithms that could be helpful in several settings, including traditional and untraditional clinical environments, in the field or even a patient’s home. With the ability to be used without Internet access, the company has a mission to increase access to healthcare around the world.

The devices use the company’s proprietary adaptive noise suppression algorithm to collect and store clean lung sounds. Another patented classification machine learning algorithm analyses the sounds in real-time, much like a clinician does and delivers a classification decision in about 10 to 15 seconds.

“We have validated the classification algorithm on thousands of patients and have thus far trained it to detect and differentiate pneumonia from asthma in paediatric patients. Through ongoing studies around the world, we hope to validate the platform on multiple conditions and body systems,” West highlighted.

Both these devices are currently pending U.S. Food and Drug Administration (FDA) approval and have qualified for the Quality in Review pilot programme, which reportedly expedites the 510(k)-approval process.

West shared that the Feelix@Home platform will soon follow the launch of the Feelix and FeelixPro devices, which will translate the clinical support offered by the FeelixPro to everyday users. “We hope this platform will help chronic asthma and Chronic obstructive pulmonary disease (COPD) patients better manage their condition and live healthier lives,” she added.

Saving Lives

The Feelix platform has received numerous awards for its potential impact on healthcare. The company attended Arab Health 2020 as a grant recipient from the Maryland Department of Commerce and were able to display their technology in the Maryland pavilion.

West highlighted: “Our experience at Arab Health was fantastic because it gave our team a great opportunity to review the competitive landscape and showcase our novel technology to a global audience. Participating at the Innov8 Talks had a significant impact. We were able to celebrate the win as a team and made great contacts that will help us to propel our technology forward. The ExportMD programme further provided us with a great opportunity to not only attend Arab Health, but we were also introduced to potential partners and clients.”

Sonavi Labs team at Arab Health 2020

Sonavi Labs has also won an MIT - SOLVE Challenge, multiple National Institute of Health (NIH) grants and other global competitions. The company is a Johnson and Johnson Innovation; JLABS portfolio firm and intends to continue building partnerships that connect healthcare institutions to its innovative solution. West’s vision is for AI to augment and increase the capacities of healthcare professionals and health systems, in addition to bridging some of the current gaps that exist between communities, resulting in greater access to quality care.

“The Sonavi Labs team is a diverse group of accomplished and resourceful individuals and we have made it our mission to ensure our technology reaches the communities that are most devastated by treatable and manageable conditions. We aim to help providers save time, save resources and save lives,” she concluded.

Omnia Health Live

West will be participating in the ‘Innov8 Talks - Start-up Panel Discussion’ at Omnia Health Live on Thursday, June 25 at 18:00 GST.  Register for free to learn from her and other leaders in healthcare.  

Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) has taken a leading role in informing global communities on methods of prevention and controlling the spread of COVID-19 with an innovative online course titled the MBRU Community Immunity Ambassador Programme.

The programme has drawn an incredible global response, with more than 647,000 people signing up to become MBRU Community Immunity Ambassadors on the University’s dedicated online learning platform: www.learn.mbru.ac.ae. More than 450,000 people have completed the course and received their certificates and ambassador status.

While the majority of MBRU’s Community Immunity Ambassadors are from within the UAE, the initiative has engaged online users based in the U.S., UK, India, Cuba, Pakistan and the Philippines eager to gain valuable knowledge in the fight against COVID-19. It is available in English and Arabic and will shortly also be available in French.

Omnia Health Insights spoke to Professor Nabil Zary, Director of the Institute for Excellence in Health Professions Education at MBRU, to find out more about how people can sign up for the course and the impact it will have on breaking the chain of infection.

Who is eligible to take the course?

Anyone can take the course as caters to all age groups. Users can take the course at their own pace, with an estimated completion time of one hour. After finishing the course, users will receive a certificate confirming that they are now an MBRU Community Immunity Ambassador. Participants are prompted to share their success on their social and professional networks, challenging three people to join the movement. 

Why should people take the course?

The MBRU Community Immunity Programme is a public health initiative composed of two main parts:

• A course that aligns with the World Health Organisation (WHO) and Federal and local authority measures implemented in the UAE, addresses the chain of infection and provides comprehensive details on how infectious diseases are transmitted. The course also clearly puts forward simply and easy-to-adopt solutions to break the chain of infection through concrete preventive actions.
• A community engagement movement through social media where the Ambassadors are asked to spread the gained awareness among the public in general and more specifically by recruiting more ambassadors to the programme.

What are the key takeaways from the course?

This course is an ideal opportunity to engage and empower the various sections of society to come together and play a part in making a difference in these extraordinary times. The course contains factual information aligned with advice from WHO. The course, through its innovative and interactive outlook, identifies the chain of infection, provides comprehensive details on how infectious diseases like COVID-19 are transmitted, and advocates effective solutions, implementable all over the world to break the chain of infection.

Supplied image

 

With global advice about COVID-19 changing almost daily, how do you ensure that the information on the MBRU course is up-to-date?

The course covers the foundational aspects of infection transmission and prevention. It is aligned with key advisories and directives put forward by the WHO and UAE's Federal and local governments.  The course team meets on a regular basis to review if changes are needed.

What are the key solutions put forward to break the chain of infection through concrete preventive actions?

The solutions put forward to break the chain of infection are simple, effective, and widely adoptable. They include practising basic hand hygiene (washing hands regularly with soap and water for 20 seconds, the regular use of alcohol-rich hand sanitisers, and avoid touching your face with unwashed hands), practising cough etiquette which includes coughing solely into a tissue and disposing it off immediately in a safe manner, sneezing into the crook of your arm (elbow) instead of covering your mouth with your hands, cleaning your everyday environment and common areas with a disinfectant regularly (door handles, kitchen surfaces, etc.), and maintaining effectively social distancing.

We are living in challenging times. The new decade has thrust upon us the biggest international crisis since the Second World War, with seemingly no end in sight.

Such is the extent of disruption happening, that ordinary pundits and experts alike are questioning what our post-COVID 19 future will look like beyond simply rebuilding economies. How we work, how we get about and how we live could all see profound transformation.

Related: Dr Maliha Hashmi, MENA healthcare leader, shares NEOM's vision of healthcare model of the future

It’s a lot to take in.

And yet, with crisis comes opportunity - a rare opportunity to build a better, fairer and more robust world.

We can start with the sector that is today firmly in the spotlight: healthcare.

While predicting the future is incredibly hard, we have envisioned a new approach to healthcare that we believe will work better for all. It’s an approach furthermore that is consistent with two rising developments we are currently witnessing in the pandemic - the importance of wellbeing and the rapid adoption of new person-centric technologies.

Wherever you go in the world, existing systems focus on healing and recovery and seem to have forgotten the basic premise that care begins at the cradle and ends at the grave. We need to move to a truly holistic integrated model that centers around a person’s needs and that of his loved ones. A move away from our archaic 'sick care' system to an actual 'health caring' system is an inevitable future where it is a system that is proactive than reactive.

NEOM is taking the revolutionary approach of empowering its citizens to take control of their health away from the hospitals and into their homes, workspaces and playgrounds. Health will become a new level of human consciousness, achieved by design and technology to build nudging devices and soft monitoring into the everyday environment.

This will include telemedicine; a Smart Mirror in the bathroom that gives you instant access to your vital signs and Dr NEOM: a virtually-enabled AI doctor you can consult anytime, anyplace and anywhere. At the same time, every citizen will have complete knowledge of and access to their genotypic and phenotypic data.

This advanced concept will remove the uncertainty many patients feel under current healthcare practice - except in NEOM, we won’t be patients. We’ll be individuals and families, and every one of us will have full knowledge of and control over our own health.

By lifting the veil of mystery from human wellness NEOM will empower us with the real-time knowledge of what is happening with our bodies and how we will overcome any issues. It’s a world-changing approach not just to physical health but to happiness: just imagine the joy and the peace you would feel when you get up, look in the mirror and it tells you that your vital signs are perfectly fine.

In order for NEOM to define this new era in health care we must remove the archaic barriers to the holistic approach. In traditional, outmoded systems we have public health in one silo; primary prevention in another; and mental health in yet another.  We’ll break through these silos to develop an ecosystem that treats mental, physical and emotional health in a unified manner, thus acknowledging the fundamental truth that a healthy body is dependent upon a healthy mind.

Within this system the hospital will be the last resort – its function replaced by local health centres staffed by specialists ranging from nutritionists physiotherapists and life coaches to psychologists offering fully integrated healthcare and, ideally, negating the need for clinical intervention.

Technology is a critical component. Human connections are as essential for mental health as they are for economic productivity, and tech will facilitate those. The current crisis has accelerated the use of such applications and we now need to explore this new normal to see how technology can be the catalyst for physical, mental and emotional wellbeing. Dr NEOM is one such innovation, but we’ll also have online counselling, therapy and mindfulness clinics as well as the by now familiar exercise classes.

Health (care) of the future is about mind, body and soul, and at NEOM we have an extraordinary, globally unprecedented opportunity to accelerate human progress by hitting the reset button and completely rethinking how the job should be done.

No health system is perfect, but we’ve travelled the world studying the way different nations approach the matter, identifying not only the elements of expertise from which NEOM can learn, but also those aspects which don’t work so well.

This insight has enabled us to model a revolutionary, end-to-end, integrated system built from best practice, high-performance, globally sourced components. It’s only when you have the opportunity to build a system from scratch that you can effect such radical change.

We’re going to be agile, adaptive innovative thinkers – a living laboratory built from the ground up and staffed the world’s finest talent to provide pre-eminent, data-driven health care.

This is the New Normal. This is the New Future. This is NEOM.

About the Author:

Dr. Maliha Hashmi is the Executive Director & Deputy Sector Head Health and Well-Being and Biotech at NEOM, where she also served as the Executive Director for all Strategic Partnerships. Dr. Hashmi also serves as a Leading Expert & Council Member for the Prestigious Global Future Council on Health & Healthcare at the World Economic Forum. Recently, Dr. Maliha Hashmi, was selected and recognized as one of the seven top most talented emerging Female Health Leaders of the MENA region. 

Dr. Maliha Hashmi has held Executive roles in various sectors and globally renowned organizations and is a well-known name in the region for health & wellbeing. Dr. Maliha Hashmi received her Doctorate and MastersDegrees from Harvard and MIT. Dr. Maliha Hashmi is listed as one of the top 20 women in the Nation in the United States of America for her achievements making it into the Who’s Who in America List.

Mucopolysaccharidosis Type 1 (MPS 1) is a rare genetic disorder that causes joint, heart and eye problems. A progressively debilitating disorder, it is a rare and lethal condition that had no treatment available till the 1990s and at that time, life expectancy for children with MPS 1 was less than 15 years.

Dr. Fatma Al Jasmi, Chair of Genetics & Genomics department, Associate Professor at College of Medicine and Health Science, UAE University, Metabolic Consultant at Tawam hospital and founding member of UAE Rare Disease Society told Omnia Health Magazine: “Mucopolysaccharidosis Type 1 is a rare inherited disease that affects parts of the body. It results from the missing enzyme called L-iduronidase. This enzyme breaks down large molecules into smaller particles. When the enzyme is missing or not working properly, this results in the build-up of this large molecule in the cell of different organs in the body.

This accumulation increases as the patient gets older and results in progressive deterioration of his/her condition and early death. If the patient has severe enzyme deficiency, this results in a severe form of the disease while mild deficiency of enzyme results in the attenuated form of the disease.”

She highlighted that MPS 1 is classified as a rare disease because it occurs in around 1 patient per 100,000. “In the UAE, we have diagnosed around 10 cases of MPS 1 from different ethnic backgrounds,” she added.

People who are diagnosed with it lack an enzyme in their body that helps break down food waste materials. Over time, this causes damages to organs such as heart, liver, brain. It also has other risks such as stiffening of joints, difficulty in breathing, stunted physical growth, headaches and vomits that often result in passing out, blindness, deafness, enlargement of the stomach and the head, and having an abnormally large liver and in certain cases mental retardation.

“Patients with MPS 1 present with a recurrent respiratory infection, hearing problems, distended abdomen because of the large liver and large spleen, umbilical and inguinal hernia, restriction of their joint movement, heart problem because of thickening of the heart valve as well as coarsening of their facial features such as thick lip, thick eyebrows, prominent forehead and they tend to have a large head,” explained Dr. Al Jasmi. “Patients with a severe form of the disease present with loss of developmental skills. It can be treated by replacing the missing enzyme by enzyme replacement therapy and stem cell transplantation for the severe form of the disease. “

Dr. Al Jasmi said that the UAE has taken a number of steps to create awareness around the disease. The country has carried out several educational awareness programmes for general physicians and paediatricians about the disease for early diagnosis and early treatment. Moreover, the country established the UAE Rare Disease Society in 2018 to increase awareness about rare diseases in the country.

Dr. Fatma Al Jasmi

 

Impact of personalised medicine on MPS 1

Commenting on some of the recent advancements such as the use of personalised medicine, Dr. Al Jasmi shared that the UAE has successfully adopted these practices.

She explained: “In the field of inborn errors of metabolism, we know that each patient presented to our clinic is unique. Therefore, we tailor the treatment based on the genetic makeup, biochemical and clinical evaluation for each individual. The treatment is different for the same disease between different families and even between the siblings with the same disease.

“For example, a patient with severe MPS 1 disease who is present with developmental delay, is treated with stem cell transplantation while patients with the attenuated disease are treated with enzyme replacement therapy.”

Furthermore, she shared that the UAE has been practising personalised medicine in the genetics field for many years. “SEHA and the Abu Dhabi Health Authority have been very supportive to provide innovative and personalised treatment for our patients in a timely manner and because of that, we have had a good outcome for our patients. These treatments have prevented death and severe complications in our patients,” she added.

There are also many ongoing clinical trials for rare diseases with great potential for success, she highlighted.

“I believe we will have more treatment available for our patients to improve the quality of their health and life. My advice to patients’ family, scientists and pharmaceutical companies is that we should work together to find cure for such rare diseases,” she concluded.

Fighting for life

Ryan Dant, son of Mark Dant, a police officer the in U.S. was diagnosed with MPS 1. To save his son, Mark began a global search for scientists and philanthropists who could aid in finding a treatment in time to help children and families living with MPS. A conversation with a research scientist at a symposium in Düsseldorf, Germany eventually led him to Dr. Emil Kakkis, a researcher at the University of California, Los Angeles (UCLA) who was working on a project to help treat MPS. With help from supporters and researchers like Dr. Kakkis, the family found a treatment and helped Ryan all the way to college graduation. Moreover, Mark founded The Ryan Foundation to create awareness about this rare disease.

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

Read the magazine online today >>

At the recently concluded Arab Health Exhibition and Congress, Dr. Simon Davies, consultant interventional cardiologist at the Royal Brompton & Harefield Hospitals Specialist Care, conducted a simulated transcatheter aortic valve implantation. This is an alternative approach to conventional open-heart surgery. However, it is not just for those who benefit from a minimally invasive approach but can show better results in patients who are suitable for open-heart surgery too.

Transcatheter aortic valve implantation (also known as TAVI) is mainly used to correct aortic stenosis, sometimes with aortic regurgitation – conditions that account for 75 per cent of all patients with valve disease. Royal Brompton and Harefield Hospitals runs the largest transcatheter aortic valve implantation programme in the UK, carrying out hundreds of TAVIs since its start in 2007.

The aortic valve and valve disease

Cardiovascular disease (CVD) remains one of the leading causes of fatality in the Middle East. Faulty heart valves are a common cause of CVD and can be a result of age-related changes to the heart.

The aortic valve is one of four valves in the heart and is the outlet valve from the main pumping chamber. It controls the blood flowing out of the heart and around the body with thin leaflets of tissue that open and close when the heart beats to regulate blood flow. Aortic stenosis is the most common and serious form of valve disease. The condition causes the leaflets to stiffen so that the valve does not open properly, and this narrowing of the valve makes it harder for the heart to pump blood to the body. This causes symptoms including shortness of breath, heart murmur, fainting and fatigue.

Aortic regurgitation occurs when the aortic valve doesn’t close tightly and allows some of the blood that was pumped out of the left ventricle (the heart’s main pumping chamber) to leak back in. TAVI cannot be used for aortic regurgitation alone but can be used for mixed aortic valve disease where the aortic regurgitation is accompanied by aortic stenosis.

Patients with aortic stenosis do not always need intervention, in moderate cases, there often are no specific symptoms and medications are sufficient. In severe cases, however, the only effective, long-term treatment is to replace the valve. Severe aortic stenosis tends to present in people in their 70s and 80s, due to wear and tear, although others may develop this younger, even in childhood on rare occasions.

Until very recently, open-heart surgery was the only option for replacing the aortic valve, but not all patients are suitable for this. Since the TAVI procedure was first developed in 2002 it has been refined and is now lifesaving, less invasive, non-surgical alternative for many patients worldwide.

How TAVI works

During the procedure, which can be performed under general or local anaesthetic, a catheter is guided through an artery to the patient’s heart using special scanning equipment. Access to the heart is via a small incision in the groin and the new valve is then advanced along the blood vessels leading to the heart. The new valve is then placed within the narrowed aortic valve and is then expanded to relieve the obstruction. This all takes places within the cardiac catheter laboratory.

Dr. Davies says: “Imaging is a very important part of the process. The combination of a very low dose X-ray and, where necessary, an echocardiogram, helps to guide the device into position and checks it is working properly. One week before the procedure high-quality computed tomography (CT) scans are taken to provide images of the patient’s aortic valve. This identifies the right size and type of replacement valve.”

He continues, “The same CT scan shows us the access routes, as with some patients we need to go in behind the collarbone or the carotid artery, located on each side of the neck, for example. Before being discharged from the hospital, patients have another echocardiogram.

“A patient requiring treatment is not just getting me as a consultant, they are getting a whole team. I work closely in a highly skilled multi-disciplinary team, so the procedure is backed up by surgeons, cardiologists, anaesthetists, imaging experts, specialist nurses and technicians.”

Royal Brompton and Harefield Hospitals is the only medical centre in the UK with transcatheter programmes for all four of the heart’s valves: mitral, pulmonary and tricuspid as well as aortic. With aortic valve implantation, there is also a choice of two types of valve – a self-expanding or balloon-expanding version.

Dr. Davies says: “We think that it’s important patients and doctors have a choice, based on the person’s anatomy and medical condition.”

Transcatheter aortic valve implantation is certainly less traumatic than open-heart surgery for many patients, especially if they have existing comorbidities. But Dr. Davies says Royal Brompton and Harefield Hospitals now offer TAVIs to patients who are good candidates for open-heart surgery too. 

He says: “Recent clinical trials showed TAVI is as good as conventional surgery in those people. We now offer more routinely to people in their late 60s and early 70s without other health problems.”

Patients with failing surgical valves made from tissue, which degenerate in 10 to 15 years, are also excellent candidates for TAVI, as younger people would otherwise need several open-heart surgeries in their lifetimes. 

Dr. Simon Davies

Benefits for patients

Most patients who have had TAVI find that their heart is almost immediately able to pump better as there is no longer any hindrance to blood leaving the organ.

However, Dr. Davies explains: “For many patients who have been deconditioned by their illness, their bodies take a little longer to recover. For example, an older person who has suffered serve heart failure for some time will need to build up condition again over a few weeks. However, their breathing will be better pretty much from the start.”

Dr. Davies sees many patients, male and female, from the Middle East for transcatheter aortic valve implantation to treat aortic stenosis. The multi-disciplinary team carefully review each individual patient to ensure they are on the best treatment as soon as possible.

Links with the Middle East

RB&HH Specialist Care has a strong and long-established relationship with the Gulf region. The organisation works closely with health authorities including the Dubai Health Authority, Hamad Medical Corporation and the Ministry of Health and Prevention.

Royal Brompton & Harefield Hospitals Specialist Care is known across the world over for its expertise, standard of care and research success. This is one of the reasons Royal Brompton and Harefield Hospitals operates a visiting doctor programme with key hospitals across the Middle East region. The programme helps to provide better clinical outcomes and strengthen relationships with the region’s healthcare providers.  

Dr. Davies practises at the Royal Brompton and Harefield Hospitals NHS Foundation Trust, as well as its private arm Royal Brompton & Harefield Hospitals Specialist Care. He is director of the TAVI programme there and has wide-ranging clinical interests including valve repair and replacement, coronary angioplasty, and cardio-oncology.

Procedure: Transcatheter aortic valve implantation (TAVI)                                                        

How does it work? A catheter is guided through an artery to the heart using imaging equipment, then a new valve placed within the narrowed aortic valve and expanded to relieve the obstruction there.

What problem does it solve? It corrects a narrowed valve which makes the heart’s work pumping blood around the body harder and which otherwise causes symptoms such as breathlessness, heart murmur, chest pain and fainting.

References available on request.

 

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

Read the magazine online today >>

Medical gloves, as described by the FDA, are examples of personal protective equipment (PPE) that are used to protect the wearer and/or the patient from the spread of infection or illness during medical procedures and examinations.  

Medical gloves are one part of an infection-control strategy.

Can medical gloves protect healthcare workers against the coronavirus?

Related: Omnia Health Live Blog: Updates from the virtual healthcare event

In its guidance for wearing and removing PPE in healthcare settings for the care of patients with suspected COVID-19, the European Centre for Disease Prevention and Control advised that gloves should be used when managing suspected or confirmed COVID-19 patients. 

The FDA has not cleared, approved, or authorised any medical gloves for specific protection against the virus that causes COVID-19 or prevention of COVID-19 infection.

However, in its factsheet on PPE the CDC explains that nonsterile disposable patient examination gloves, which are used for routine patient care in healthcare settings, are appropriate for the care of patients with suspected or confirmed COVID-19.

According to CDC Guidance, extended length gloves are not necessary when providing care to suspected or confirmed COVID-19 patients. Extended length gloves can be used, but CDC is not specifically recommending them at this time.

The CDC adds that the American Society for Testing and Materials (ASTM) has developed standards for patient examination gloves that include length requirements, which must be a minimum of 220-230mm, depending on glove size and material type.

Can you sanitise disposable gloves?

The WHO advises that gloves should be worn when providing direct care for a COVID-19 case and then removed, followed by hand hygiene (hand washing) between COVID-19 patients. Using the same gloves for a cohort of coronavirus cases (extended use) must not be done.

Changing gloves between dirty and clean tasks during care to a patient and when moving from a patient to another, accompanied by hand hygiene, is absolutely necessary. Double gloving is not recommended, except for surgical procedures that carry a high risk of rupture.

Can gloves protect against coronavirus for the general public?

When not providing direct care for a COVID-19 patient, the WHO cautions that handwashing with soap offers more protection against catching the coronavirus than wearing rubber gloves. It explains that the coronavirus can still be picked up on gloves and that this can be transferred to one's face.

Should you wear gloves while you grocery shop?

Patricia Dandache, MD, an infectious disease specialist at Cleveland Clinic, suggests going grocery shopping without gloves, and wearing a face mask among other steps.

However, whether you can or cannot differs by territory. Measures introduced in Dubai during the coronavirus outbreak, for example, require the general public to wear gloves and masks at all times when leaving the home for essential errands.

Why are there medical glove shortages? 

Major distributors in the US have reported shortages of PPE that include gloves. According to the WHO in its interim guidance, global demand for PPE is driven not only by the number of coronavirus cases but also by misinformation, panic buying and stockpiling. 

What is being done to address medical glove shortages?

Malaysia's Top Glove, a leading manufacturer of gloves worldwide, expects global demand for gloves to double in 2020. It has increased its utilisation to near 100 percent, while its lead time has increased from 30 days to 150 days.

In September 2020, Top Glove announced that its fiscal 2020 post-tax profit grew 417 percent from last year due to the global surge in demand for gloves amid the pandemic. The business also expects up to 30 percent additional growth for 2021.

Chinese factories are reportedly increasing glove production capacities:

However, there has also been a reported rise in counterfeit medical gloves, potentially posing a health risk:

The FDA identified a series of medical glove conservation strategies for healthcare providers aimed at augmenting, rather than replacing, specific controls and procedures developed by health authorities:

• Conventional Capacity Strategies (supply levels are adequate to provide patient care without any change in routine practice)
• Contingency Capacity Strategies (limited supply levels may change patient care, but may not have a significant impact on patient care and health care provider safety)
• Crisis or Alternate Strategies if Medical Gloves are Running Low or Not Available (may need to be considered if medical glove supplies are critically low and demand is high)

A 3D printing company has meanwhile developed a medical device named the Distancer allowing health care workers to pass through a hospital safely without directly touching surfaces or any door handle, thereby avoiding contamination. The Distancer simply hooks on to the handle to let the holder through. 

The structural features of the surgical suite can influence not only the efficacy of the treatment provided but also the overall patient and staff experience. Modular operating room construction (MOR) is a concept that aims at improving architectural and engineering design as well as ergonomics of the occupied space. Various marketed advantages of MORs include increased functionality, sterility and cleanliness, comfort, safety, flexibility, durability and aesthetics. Aspects such as ease of maintenance and renovation and the possibility of making swift modifications and upgrades to existing utilities are also emphasised.

The substructure is the skeleton of the MOR architecture to which the wall and ceiling elements are installed, connected and sealed. The profiled floor rails, vertical supports and ceiling rails form the framework, creating cavities for the passage of utilities (such as electricity, water and gases). It is because of this substructure that no walls or partitions are required for installing MORs. They may be installed in open-plan areas, alleviating the necessity for duplicated construction (reducing cost and space redundancy).

Wall elements come in different materials and finishes. This article will focus on two categories; powder coated stainless steel attached to plasterboard panels, and more recently, frameless glass elements, made of thermally tempered safety glass. The wall elements can be disassembled and reinstalled if required with minimal operating room downtime. Built-in elements can be integrated, including monitors, cabinets, control panels, central clocks, cameras, etc.

The surfaces of both stainless steel and glass panels are microscopically flat and free of pores, resistant to living organisms, chemical substances and most common hospital detergents and disinfectants. Fire, noise and x-ray protection can be integrated in accordance with project requirements. However, some characteristics can differ from Stainless Steel to glass. In fact, aesthetics and functionality are combined in the glass material, which improves the patient care coefficient. Glass elements can be backlit using high-performance LEDs, which generate friendly and appealing atmospheres in the room and lead to better working environments. Glass is a robust material with a lower number of joints and is fully resistant to acids and bases. On the other hand, stainless steel panels add future-proof flexibility for service, maintenance or modernisation, as individual wall elements can be dismantled without damage and can be designed to incorporate a service panel circulating the room’s perimeter, allowing for utility outlets addition with very minimal disruption.

Other integrated components common to both categories include:

• Operating room ceilings
• Operation room doors
• Laminar airflow systems
• Scrub sinks
• Integrated HIS screens
• Room lights
• Writing boards
• Pressure relief dampers
• Operating room flooring
• Operating room control panel
• Operating room storage systems
• Operating room isolation panels, etc.

Doors can be hinged or sliding, single or double-leaf, manual or motorised, fire and x-ray protected. There is a wide variety of available finishes for the panels (including printing of images and logos), which allows to create spaces that are more pleasant for the users.

Compared with conventional construction, a number of advantages have been claimed to be associated with MORs in medical facilities. The relevance of such advantages should be assessed in an unbiased scientific way, which takes into consideration information made available through evidence-based citations and unbiased institutional reports. While doing so, manufacturer claims ought to be disregarded unless they are backed by scientific and research-based evidence.

Ease and speed of installation of modular operating rooms

This is relative and varies from one project to another, however, depending on how a project is planned, procured and executed, both conventional construction and MOR construction can have bottlenecks and delays. For example, if a prefabricated component breaks during transport or installation, it cannot be replaced by off the shelf items. It would have to undergo the standard manufacturing process, which may be lengthy, especially when a special character is involved such as colour or style. Nevertheless, since MOR concept is a single entity, turn-key construction solution involving all building elements (walls, ceilings, floors, doors, windows and MEP associated services), coordination efforts become much easier and execution time and errors have proven to be reduced considerably in projects involving advanced engineering technologies.

Future modifications and expansion

Although wall panels are prefabricated, removed and re-installed relatively faster and cleaner than conventional works, it remains a fact that any modification to the room layout, shape or size will require serious workflow reconfiguration and ceiling modifications. For instance, the operating room table must remain in the centre of the suite. Ceiling elements must follow. This means that HVAC, room and surgical lights, pendants and associated embedded services like power and medical gases will require extensive work to be relocated. That’s why surgical suites are hardly reconfigured in normal working practices, and when they do, whether the affected room is constructed from conventional material or modular elements, the work site will have to be identified and designated as a “construction site” and sealed off from the rest of the surgical suite until completion of the works. What is marketed very frequently about converting two operating rooms to one in a matter of a few hours is true from a very limited perspective. Nevertheless, there is no doubt that renovations incorporating MOR elements will endure much less noise, dirt, dust and smell when compared with conventional construction (gypsum or other material, plaster, sanding, paint, etc.)

Infection control and prevention

According to the Center for Disease Control (CDC), surgical site infections (SSIs) occur after surgery in the part of the body where the surgery took place. SSIs can sometimes be superficial infections involving the skin only, but they can also be more serious involving tissues under the skin, organs, or implanted material.

According to a study published in Infection Control and Hospital Epidemiology Journal, Vol. 35, No. 6 (June 2014), pp. 605-627, and endorsed by the CDC, SSIs are common complications in acute care facilities. They occur in 2 – 5 per cent of patients undergoing inpatient surgery and are considered to be the most common (20 per cent) and most costly hospital-acquired infections (each SSI is associated with 7–11 additional postoperative hospital-days). SSIs are associated with substantial morbidity and mortality; patients with SSIs have a 2 –11 times higher risk of death compared with operative patients without an SSI (77 per cent of deaths in patients with SSI are directly attributable to SSI). Such factors place a considerable burden on healthcare systems and must be treated very seriously.

Up to 60 per cent of SSIs have been estimated to be preventable by using evidence-based guidelines. Several infrastructure elements have been proven to contribute positively in reducing SSIs. They include training and education of staff, patients and patients’ families on the proper implementation of processes, methods and tools related to the reduction of SSI risks.

Proper ventilation was listed among the most important factors affecting infection prevention and reduction in the operating room. Patient cleanliness, surgical site shaving, surgeon’s attire and scrubbing, antibiotics administration, etc. have all been proven to affect SSIs in one way or another. However, no evidence-based citations were found to link material performance and the ease of cleaning and disinfection of vertical surfaces (walls and doors) with reduced post-surgical infections.

Reduced downtime

The total cost of operations in hospitals can be separated into fixed and variable components. Fixed costs are ones that don’t change in proportion to the volume of operations or occupancy. They include overhead, facility and equipment upkeeping, maintenance and depreciation, services and indirect staff. Variable costs are ones that are linked directly to the work volume and they change in direct proportion to volume and occupancy. They include staff in direct connection with patients, the activity functional rooms, sterile supplies, disposables, medication, medical waste disposal, etc.

Operational costs of surgical suites vary from one place to another, but they generally range from US$16 to US$150 per minute depending on surgical speciality (staff, equipment, etc.) and type of facility, among many other factors. Downtime of the activity spaces is directly proportional to operational loss, which is made up of the full fixed cost and part of the variable cost. In surgical suites, where resources are limited (space, materials and equipment), any downtime due to maintenance, disinfection or other reasons will create a significant impact on the return on investment and overall cash flow. For instance, one day of inoperability of one operating room incurs losses in the range of US$30,000 or more (assuming a median of US$50 per minute for a combination of fixed and partial variable costs).

Maintenance-related incidents leading to operating room closure and consequently downtime may be divided into two general categories; namely, emergency corrective maintenance (unscheduled) and planned preventive maintenance (scheduled).

Emergency corrective maintenance is the response to sudden failures, which cannot be controlled or prevented, irrespective of construction method and materials. Such failures include fixed equipment (lights, pendants, fire elements, HVAC elements, etc.), wall outlets (PMG, power and network), as well as architectural elements (doors, motors, fixed cabinets, etc.).

Planned preventive maintenance is the scheduled type of maintenance where the facility engineering team of the hospital has the luxury of planning and scheduling the works ahead of time, with the surgical suite coordinator, and preparing the required parts to be replaced, as well as any tools, accessories or other materials necessary for job completion. When the facility maintenance team conducts the required scheduled preventive maintenance works, it should seldom affect the schedule of surgeries. Such works may be done on weekends or nights.

While corrective and preventive maintenance of engineering elements are somewhat the same for MOR and conventional methods, the MOR panels, whether made of glass or stainless steel, require no paint or maintenance and are easier to clean and disinfect when compared with conventional walls. Re-paint is totally alleviated throughout the life cycle of the glass or stainless-steel wall elements.

In summary, the advantages of the MOR concept may be divided into two categories:

General and long term

This is related to enhancing the working environment and staff comfort, through ambient aesthetics such as convivial lighting and colour attributes, resulting in a modern and lively working environment.

Additionally, ease of cleaning and disinfection, as well as reduction of downtime and disturbances related to scheduled preventive maintenance and renovation works.

Immediate and project-specific

This is related to streamlining the project coordination and execution process which, to a certain extent, can reduce the otherwise encountered errors and delays.

Other issues related to project-specific considerations such as budget and schedule attributes should be examined carefully to properly and adequately assess the suitability of the MOR concept.

Ahmad Jawhar

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

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