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

As the novel coronavirus (2019-nCoV) continues to spread and has now been declared an international emergency by the WHO, questions regarding the safe use of Hamilton Medical ventilators on patients with highly infectious diseases are becoming more frequent.

We therefore recommend implementing the following measures to avoid contamination:

• Follow the instructions for use of the ventilator and consider the WHO guidelines. (1, 2)
• Use an inspiratory bacterial and viral filter to assure non-contamination of the internal ventilator gas path.
• Protect the expiratory valve with a hydrophobic bacterial and viral filter.
• For active humidification, as with a HAMILTON-H900 humidifier, use a bacterial and viral filter on the inspiratory and expiratory port of the ventilator (hydrophobic version). 
• For passive humidification, use a bacterial and viral HME/HMEF filter between the proximal flow sensor and the patient to protect the airway against contamination. Be aware of changes in anatomical dead space and airway resistance, and exchange the filters regularly. 
• Contamination of the flow sensor tube connectors is avoided due to permanent rinse flow through the flow sensor tubing towards the patient.
• The Stand-by function can be used prior to disconnecting the ventilator from the patient to avoid mucus dispersion from the circuit. This decision should be made by the responsible clinician based on the situation of the individual patient.
• Use single-use consumables such as breathing circuits, flow sensor, airway adapters, expiratory valves, and filters to minimize the risk of cross-contamination when the ventilator has been cleaned and set up for a new patient. 
• Disinfect the outer surfaces of the ventilators during ventilation or after treatment of a patient with a registered hospital disinfectant. Consult the hygiene specialist in your facility regarding the appropriate disinfectant and follow the instructions for use of the manufacturer, particularly with respect to contact time.
• For suctioning, use a closed inline suction system only.
• Reduce the need for user interaction with the ventilator by using Hamilton Medical’s INTELLiVENT-ASV mode for intubated patients. INTELLiVENT-ASV continuously adapts ventilation to the patient condition and requires fewer interactions by clinicians. (3, 4)
• All turbine-driven Hamilton Medical ventilators (HAMILTON-C6*/C3/C2/C1/T1/MR1) are equipped with high-grade HEPA filters to keep the interior airway free of contamination. There is no need to change the HEPA filters more frequently than indicated in your regular maintenance plan.

Make sure that all clinical staff involved in the handling of the ventilator are informed about the above-mentioned measures. 

This information is available for download  below.

* Not available in all markets

References

1. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. World Health Organization, Geneva, 2014. 
2. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected Interim guidance. World Health Organization, Geneva, 2020. Licence: CC BY-NC-SA 3.0 IGO
3. Beijers AJR, Intensive Care Med. 2014 May;40(5):752-3.
4. Arnal, J.M.,Minerva Anestesiol, 2018. 84(1): p. 58-67.