When inside-the-box thinking doesn’t cut it, you need to get out of it.
Staff at the University of Virginia Medical Center threw away convention to find a way to extend the life of personal protective equipment in the face of the highly communicable and deadly virus, SARS-CoV-2.
With a pandemic raging, staff across the center’s departments worked to find ways of extending the life of protective gear as shortages of N-95 masks and other equipment used when treating patients grew critical in other parts of the country struck by COVID-19, the disease caused by the virus.
Staff wound up playing McGyver with a robot designed to clean hospital rooms of virulent organisms, turning it into a virus-killing, gear-cleaning, ultraviolet ray gun called Tru-D.
There was a need for speed. Dr. Carlene Muto, assistant professor of infectious diseases and international health, had been on a trip to Italy with her daughter when the pandemic began to ravage that country.
“We got out in the nick of time and I started thinking, ‘What’s going to happen when it gets here?’” Muto recalled.
“For us, the problem was not the protective gloves or gowns but the masks. There are different types and people who fit in one type can’t necessarily fit into another,” she said. “Normally, we don’t reuse them but when there’s a shortage of them around the world and the [Centers for Disease Control and Prevention] is putting out advice on reusing them, we knew we had to address it.”
With advance warning, Muto said medical center management was willing to get behind anything that could make supplies last longer.
There were options. Some hospitals use a hydrogen peroxide electrostatic misting device to kill resistant bacteria and pathogens in patients’ rooms and have modified that to kill the new coronavirus.
But, according to industry research, proper use of the equipment takes time, training and calibration.
“Then there was ultraviolet light,” Muto said. “It’s been used in health care for decades. We were already using it to disinfect equipment.”
In her previous stint at the University of Pittsburgh Medical Center, Muto had seen equipment like the robot used to disinfect patient rooms. The robot’s name, Tru-D, is short for Total Room Ultraviolet Disinfection.
The robot is effective at killing various organisms including Clostridioides difficile, typically known as C. diff., an antibiotic-resistant bug that can cause severe illness and even death and often is caught while in a hospital.
Tru-D’s operation seems simple. It stands in the room’s center, using sensors to calibrate the exact dose of energy necessary to disinfect the entire room. It turns on its light. The light is reflected back so all surfaces receive the right amount of power.
You can’t see it happen, but the high-energy light is absorbed in the cellular RNA and DNA of microorganisms, damaging nucleic acids to prevent them from reproducing. Pretty much neutered, the organisms no longer can infect humans and die without replicating.
Muto met with others and discussed the options. If Tru-D could kill the coronavirus in a room, could it kill the virus on protective gear within a room?
“We were using it in Pittsburgh to disinfect patients’ rooms,” Muto said. “Some of those gizmos can be set to a high level of energy and kill C. diff spores, which are hard to do. We had some UV machines here, but they didn’t have the 360-degree sensors needed to clean a whole room. It seemed like it would be the easiest to just drop into place.”
What normally would have taken a while to propose, study, arrange, purchase, deliver and set up was accomplished in a very short time.
“Our leadership was on it and they understood the issue and how little time we had to act,” Muto said. “We have been pushed to a place where merely purchasing the best products is no longer an option because there are none to purchase. There is a worldwide shortage and hospitals and states and countries are trying to purchase gear. There has never been a more crucial time, or a need so great to become a thinker out of the box. We need to think, plan and do. “
And so they did.
Epidemiology, clinical engineering, procurement, clinical staff, environmental services, supply chain staff, central sterile processing teams and senior leadership teams went to work.
A classroom was repurposed for a sterilization chamber. Its surfaces were painted with reflective paint to increase Tru-D’s efficiency.
With a chamber in hand, engineers designed racks to go into the room that could hang gear at the right distance and angles to make sure no piece of virus would miss its dose of radiation. Special collection boxes were designed so that the masks could be brought to the sterilization chamber without shedding any virus along the way.
Management then approved purchase of the 5-foot, 6-inch tall device.
The problem was that it could take several weeks, like a dozen, to deliver. Channeling Radar O’Reilly from the television show MASH, Muto reached out to a friend that could make it happen much quicker.
“In Pittsburgh we had about 30 of those things in different hospitals and clinics so I knew someone at the company,” she admitted. “I talked to him and we were able to find one. Management quickly got us a purchase order and it was going to be shipped. Except that it would take three weeks.”
That, everyone agreed, was too long.
“They said ‘if you come and get it, you can have it now.’ So we did,” Muto mused.
Michael Friesen, director of clinical engineering, and Patrick Headley, manager of clinical engineering professional services, grabbed the keys to the company plane and traveled to Tennessee to get training, get the machine and get home.
“The robot is large, fragile and incredibly valuable, yet we needed to get it operational as quickly as possible,” said Friesen.
“This is truly an all-hands-on-deck situation, and every hour and day is important,” Headley said. “We were on our way Monday morning, returned home that afternoon with Tru-D in hand and had the robot’s UV light up and running by Tuesday afternoon.”
Set at maximum power, Tru-D can disinfect hundreds of masks with each 20-minute cycle. Total cycle time from prepping the prep masks to disinfection, recovery and repackaging for the frontline healthcare providers is a little less than an hour for about 6,000 masks a day.
“By utilizing Tru-D, we can extend our current supply of personal protective equipment to meet the essential needs of our frontline faculty and staff,” said Dr. K. Craig Kent, executive vice president for health affairs. “UVa Health will continue to do all we can, from supply chain management to clinical innovations, to ensure every person in our facilities is safe and protected.”
Muto said she is proud to have played a role in the innovative, off-the-cuff and out-of-the-box thinking that put the medical center ahead of a potentially life-threatening problem.
“It’s the kind of thinking we need right now. We have never in our lives been faced with anything like this and drastic times require drastic measures,” she said. “It’s really forced people to be innovative thinkers. There has never been a time where the need was so great. I’m proud of the people here. We don’t wait. We get it done. I’m proud to be part of that.”