COVID-19: Latest update

  • FAQs
  • Training material
  • International guidelines
  • Related articles
  • Documents
  • Press materials and contact

Last updated: 09 June 2020.
New resources
Video Tutorials: HAMILTON-G5 / S1

Dear customers,

Due to the rapid spread of the coronavirus, the demands on you are growing exponentially. Thank you for your commitment and acts of heroism in caring for patients in this battle against the coronavirus. Our thoughts are with you and we are doing everything possible to support you globally in intensive care. In this time of crisis, we are committed to helping you rise to this challenge.

In this regard, we have increased our production capacity by 50% compared to last year and are aiming to double our production capacity by the end of April. Our clinical experts are available by telephone for individual support. They can be reached via your respective Hamilton Medical direct contact.

On this page we are constantly compiling current information, helpful links and answers to frequently asked questions.

FAQs

Questions regarding ventilation of COVID-19 patients

  • In an emergency, could it be possible to connect several people to one ventilator? Using a Y-connector if necessary?

    • Hamilton Medical does not recommend the use of one mechanical ventilator for more than one patient. To ensure appropriate and lung-protective ventilation, monitoring and ventilator settings need to apply for one patient only. This is made possible by the proximal flow- and pressure-measurement technology in our devices. 
      If you use our ventilators on more than a 1:1 patient to ventilator ratio, be aware that:

      a) This will most probably result in distending (and damaging) the healthier lungs of the ventilated patients, while the lower compliant lungs will collapse further.
      b) The increase in artificial airways (breathing tubes) will reduce the ventilator's performance (pressures will be lost due to circuit/breathing tube compliance)
      c) There is no other recommendation than to put the proximal flow sensor at the Y-piece of the ventilated patient (which patient will you choose?).
      d) Recommendations for COVID-19 and ARDS include tidal-volume monitoring and limitations, and individual PEEP settings: How can you make sure this works for two patients on one ventilator?
      e) Weaning the patient from the ventilator is one of the most important way to ensure the availability of ventilators. How can you be sure you can wean your patient with the likelihood of total asynchrony between patient and ventilator?
      f) Running two patients on one ventilator will also involve serious hygiene problems. Patients may also have additional pathogens like multi-resistant bacteria or other viruses, etc.
      g) Important procedures like prone positioning will not be possible in such a setting.
      h) Click here to read the joint statement from the Anesthesia Patient Safety Foundation (ASPF), Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), American Association of Critical‐Care Nurses (AACN), and American College of Chest Physicians (CHEST), who have joined together to address the issue of placing multiple patients who have respiratory failure on a single ventilator.

      Should you run out of ventilator equipment, we recommend instead:

      a) Informing the local authorities and asking for help
      b) Informing the clinical directorate: all non-essential treatments (surgery, endoscopy, examinations…) should be postponed to free up all ventilators within the hospital
      c) Informing the operating-room department: ask for anesthesia devices, transport ventilators, old ventilators in the basements and whatever works within its intended use
      d) Asking hospitals in the region for help (ventilators): the local authorities may help
      e) Asking private operation centers for their anesthesia devices: once again, the local authorities may have to help
      f) Trying to use NIV devices (not on COVID-19 patients) wherever possible instead of invasive ventilators, and getting patients weaned and extubated as soon as possible
      g) Trying to reduce the number of COPD patients who have their own sleep apnoea devices, but are connected to an ICU ventilator in hospital. Try to bring these patients back to a state where they can be ventilated on their own equipment

  • Do you have any experience with ASV and INTELLiVENT-ASV for ventilating severe coronavirus patients?

    • We have information about COVID-19 patients ventilated with INTELLiVENT-ASV. So far these patients show stiff lungs (Cstat < 20 ml/cmH2O), ASV applies high rates and small tidal volumes (~6 ml/kg IBW) as is typical for ARDS lungs, and driving pressures of about 12 cmH2O. At the moment, we have no further information about settings or outcome as hospitals have to treat this information confidentially.

  • How can I use the ventilator safely on COVID-19 patients?
  • Is the Intellicuff pressure line with filter suitable for use with COVID-19 patients? Is there a risk of contamination?

    • According to current knowledge, the SARS-CoV-2 virus is transferred by droplets and aerosols containing the virus. As droplets and aerosols are filtered by the hydrophobic bacterial filter in the IntelliCuff pressure line (PN282016), the risk of contamination is essentially close to zero. This is not the case if you use a syringe or manual cuff controller, although the risk remains quite low even when using these tools.

      However, the clinical relevance of this issue during the pandemic should be questioned, because ventilators providing support to COVID-19 patients will only be used on those patients and NOT on non-COVID-19 patients. If there is any concern that the inside of the cuff pressure controller might be contaminated, the IntelliCuff or the ventilator can be decontaminated by putting it into quarantine in a dry room for 72 hours.

  • What significance does Driving Pressure have for ARDS patients?

Hygiene, disinfection, and use of filters

  • How do I disinfect Hamilton Medical ventilators used on patients infected with the corona virus?

    • The exterior of the ventilator can be disinfected according to the cleaning and disinfection protocol as described in the respective device’s operator’s manual. 
      The following disinfectants are effective against SARS-CoV-2 (synonym: new corona virus) and can be used on all Hamilton Medical ventilators’ housings and touch screens.  
      - Bacillol AF / Bacillol AF Tissues
      - Bacillol 30/ Bacillol Tissues
      - Microbac Tissues 
      - Microbac forte
      - Mikrozid AF
      - Mikrozid sensitive wipes
      - Ecolab Sani Cloth
      - Incidin Rapid 
      - Incidin Foam 
      - Incidin Pro

      It is important to follow the instructions for use provided by the respective manufacturer of each product. The operator’s manual for each ventilator model may list additional products (e.g., Ethanol 70%) to be used specifically for disinfection of that particular ventilator.

  • Can Hamilton Medical ventilators be operated safely in a SARS-CoV-2 contaminated environment?

    • Yes, Hamilton Medical ventilators can be operated safely on COVID-19 patients. Follow the instructions in the respective operator’s manual, as well as the recommendations for safe use of Hamilton Medical ventilators on infectious patients.

      a) The internal airway of the turbine-driven ventilators (HAMILTON-C1/C2/C3/C6/T1/MR1) is protected by a HEPA filter, which guards against contamination of the internal gas path from the environment. 
      The HEPA filter does not specifically require changing after the ventilator has been used on a COVID-19 patient. It is sufficient to change the HEPA filter according to the service plan. 
      Hamilton Medical ventilators which are connected to the hospital’s compressed-air supply (HAMILTON-G5/-S1, GALILEO, RAPHAEL) run no risk of being contaminated as the hospital’s air supply is filtered. 

      b) On the patient side, you need to install a filter on the inspiration port. This protects the interior gas path against SARS-CoV-2 contamination on the patient side. Please see our filter overview for more information.

      c) Survivability of SARS-CoV-2: Results from the latest research show that the corona virus remains viable for 72 h on plastic and steel surfaces. In the case of suspected contamination of the interior gas path of a ventilator, quarantining the ventilator for an appropriate duration may be a means of solving the issue.

      d) Contamination of the flow sensor tube connectors is avoided due to permanent rinse flow through the flow sensor tubing towards the patient.

  • How should I handle a ventilator with suspected SARS-CoV-2 contamination during service and maintenance?

    • Disinfect the surface of the ventilator with a virucidal disinfectant, which is at the very least effective against enveloped viruses. If you have to disassemble/change the interior gas path, always use gloves and a protective face mask  (class FFP 2, N95). If there is time, the ventilator should preferably be kept in quarantine for 3 days in a warm and dry place.

  • Are there any restrictions or special actions to be performed on a Hamilton Medical ventilator after use on a COVID-19 patient?

    • If the ventilator is equipped according to the instructions as described in the respective operator’s manual, there is no specific action to be performed on the ventilator. Carry out the regular cleaning and disinfection of the device as described in the hospital’s hygiene protocol. In this case, ensure that the disinfectant is at the very least effective against enveloped viruses.
      As SARS-CoV-2 is highly infectious, the patient should be treated in quarantine conditions and hospital staff should take extreme care with personal hygiene. Use of single-use consumables is highly recommended to avoid any cross-contamination within the hospital.

  • Is the HEPA filter effective in protecting against the virus? Need it be changed after each SARS-CoV-2 patient? What is the meaning of HEPA efficiency for a particle size of 0.3µm?

  • How long can SARS-CoV-2 survive on any surface without disinfection?

    • So far, there is no documentation on transfer of the infection via inanimate surfaces. However, research has shown that relevant quantities of virus have a survival time of  up to 72h  on plastic and steel surfaces.1 

  • How can a filter be used to protect the surroundings from infectious SARS-CoV-2 particles from a ventilated patient?

    • To prevent any bacterial and viral contamination being released by the expiratory limb of a Hamilton Medical ventilator, a highly efficient hydrophobic filter (e.g., PN 279204) should be placed in front of the expiratory valve. Humidity and nebulized drugs might affect the resistance of the expiratory filter: please monitor expiratory flows and exchange the filter on a regular base. 

      If you use a proximal bacterial and viral HMEF filter, please position it between the flow sensor and the flextube as described in the Instruction for Use of the ventilator – this filter suffices to protect the expiratory valve and environment, in this case an additional filter at the expiratory valve is not needed.  If you use active humidification, please use hydrophobic bacterial and viral filters on both the inspiratory outlet and the expiratory inlet of the ventilator.  Position the filters as displayed in the images here.

  • Can HEPA filters be gas sterilized when used on a COVID-19 patient? 

    • HEPA filters which are used on HAMILTON-C1/T1/MR1 or HAMILTON-C6/C3/C2 ventilators are not intended to be reprocessed (this includes any kind of sterilization)

  • Can a Hamilton Medical ventilator be disinfected using ozone treatment?

    • At present, Hamilton Medical is not able to confirm that Hamilton Medical ventilators and accessories are compatible with disinfection by means of ozone gas. Even though the majority of users perform wipe disinfection on their ventilators, there are hospitals around the world using ozone generators to decontaminate operating rooms and ambulances with devices in them between surgeries or transports. The locations are cleaned and then sealed airtight before being filled with ozone. Ozone is an odorless and toxic gas which effectively destroys the remaining microbes. However, some plastic materials are also known to be destroyed by the highly aggressive gas. These include polyurethane, which is used in electronic parts, or elastomers used in seals and gaskets.

Products and supply

  • Has Hamilton Medical increased production capacity?

    • Since the start of the year and the outbreak in China, we have massively increased our capacity for producing ventilators. Production has continued through the weekends and we have added a second shift to ensure the highest possible output of ventilators in a short space of time. We have already delivered thousands of ventilators to the countries most affected.
  • Is Hamilton Medical affected by supply shortages?

    • At the current time our supply of materials and components is secured, but it is possible that we may face shortages as we further ramp up production. However, we are fortunate in having several different ventilator product lines so not all products will be affected at the same time. 
  • Will the prices of ventilators or consumables increase because of COVID-19?

    • We denounce any opportunistic utilization of this humanitarian crisis, including a raise in prices. Our prices will remain the same as before the coronavirus outbreak. 
  • How long are the delivery times?

    • In a critical situation such as this, we are not able to operate on normal delivery times. Our primary goal is to make sure all our ventilators that are already supporting patients can be used continuously. This means ensuring they have all the consumables necessary for operation. Our secondary goal is to provide as many ventilators as fast as possible.
  • How long can flow sensors, expiratory valves and breathing circuit sets be used for a single patient?

    • All products mentioned below are tested for a use of up to 28 days and thus can be used for a single patient. A frequent routinely performed change of flow sensor, expiratory valve and breathing circuit set is generally not recommended.1-3 The regional supply situation should be considered when deciding on how often to change the sets for COVID-19 patients.

      Relevant products (REF nos.):
      -    Flow sensors, adult/ped, single-use (282049, 282051, 281637)
      -    Flow sensors, neo, single-use (155500, 260177, 260179)
      -    Expiratory valves (161186, 161189, 160176, 950158)
      -    Coaxial breathing circuit sets (260087, 260094, 260127, 260128, 260144, 260145, 260167,  260168, 260184, 260206, 260207, 260239, 260240, 260257) 
      -    Breathing circuit sets, dual limb unheated, neo, single-use (260241, 260244, 260180, 260182, 260169, 260170)
      -    Breathing circuit sets, HAMILTON-H900, adult/ped and neo, single-use (260161, 260186, 260185, 260187)

      References:
      1 Restrepo R. D., Walsh B. K. Humidification During Invasive and Noninvasive Mechanical Ventilation: 2012, Respir Care 2012;57(5):782–788, DOI: 10.4187/respcare.01766 
      2 Hess D. R. et al. Care of the Ventilator Circuit and Its Relation to Ventilator-Associated Pneumonia, Respir Care 2003;48(9):869 – 879 
      3 Prävention der nosokomialen beatmungsassoziierten Pneumonie, Bundesgesundheitsbl 2013 · 56:1578–1590 DOI 10.1007/s00103-013-1846-7)
  • Is Hamilton Medical working together with manufacturers in other industries to increase production capacity?

    • To have our ventilators built by other companies is an interesting idea, but one that is not likely to help in the short term. The materials and the components needed to build a ventilator are highly specific. Furthermore, if another manufacturer sourced parts from the same suppliers we are using, our whole supply chain would be placed under even greater pressure. This would mean re-inventing the whole supply chain as well. In the short-term, it is probably easier and more efficient to extend the production facilities that already exist. However, we are certainly evaluating options for cooperating with other companies in terms of producing and assembling specific components to increase our output.
  • How might governments help?

    • One of our most pressing requests would be that governments have some sort of centralized system to order and distribute ventilators at a national level. In Switzerland, such a system has been set up and is extremely helpful in providing ventilators where they are needed the most.

Training material

The current situation sometimes does not allow regular procedures for product training of new staff or for new devices. To make it easier for everyone to use our products on short notice, we have collected the basic training materials here:

Product Training

Training material for lung-protective technologies

Tech Support Training

International organizations

For the current experiences and recommendations on how to treat COVID-19 patients please refer to the following international guidelines. These organizations regularly update their information.

  1. WHO guidelines 
  2. ESICM information
  3. JAMA network – current evidence about COVID-19
  4. CDC – Centers for Disease Control and Prevention
  5. NIH – National Institute of Health
  6. RKI – Robert Koch Institut
  7. ECDC – European Centre for Disease Prevention and Control
  8. Society of Critical Care Medicine (SCCM)

Related documents

Safe use of Hamilton Medical ventilators for patients with highly infectious diseases

PDF / 70.8 KB

ELO20200306N

EN

Adapters & filters

Filter overview

PDF / 123.7 KB

ELO20200328N

EN

Press materials

Press contact

Kathrin Elsner
media.med.global@hamilton-medical.com
Note: Please provide your questions in written form.

Video footage
You may use stock footage from our production for your media release.
You can download the file by pressing the button on the bottom right on the vimeo page. 

Original PAL footage
Password:      Press_Pic_Enter

NTSC transcoded footage
Password:      Press_Pic_Enter

Photos
Pictures from the company and ventilator production

Other inquiries

Please click the button below for all other inquiries:

Contact us