With up to two-thirds of patients with chronic pain conditions also experiencing sleep disorders, two experts from a top U.S. hospital, Cleveland Clinic, suggest cognitive behavioural therapy for insomnia as a potential solution.

For people with chronic pain – whether from back pain, fibromyalgia or the pain of cancer treatment – sleep issues are especially common, and pain is one of the most common causes of insomnia.

“Pain worsens sleep patterns and sleep disturbances worsen the pain. It’s a vicious cycle,” said pain specialist Robert Bolash, MD. These problems can range from difficulty falling asleep to difficulty staying asleep, and lack of good sleep can lead to heightened pain and worsening sleep.

His colleague, behavioural sleep medicine specialist Michelle Drerup, PsyD., added that treating insomnia can help chronic pain subside, but before treating insomnia, it is important to rule out other issues that could be causing sleep problems.

“Sometimes, after receiving a new diagnosis, it is common for people to struggle with other disorders that can affect sleep, like depression or post-traumatic stress disorder,” she said.

If people struggle with insomnia, it can also be caused by a sleep-related medical condition, such as sleep apnea. When sleep quality is poor, pain levels are exacerbated. “At times, we see patients with pain diagnoses who really have a medical condition such as sleep apnea. When their sleep apnea is treated, their pain diminishes as well,” Dr Bolash explained.

A three-pronged approach to address insomnia

The two experts recommend the following three-pronged approach that could help people to address their insomnia: Understanding insomnia, understanding good sleep habits and understanding the therapy.

When it comes to therapies, cognitive behavioural therapy for insomnia (CBT-I) includes a number of strategies designed to improve sleep quality and help change thoughts and behaviours that interfere with sleep. This type of therapy is often preferred over medications because it has no side effects and is a more effective long-term solution.

Another strategy to help with insomnia is relaxation training, which reduces or eliminates muscle tension and distracts from racing thoughts. Techniques include specific muscle group relaxation, guided imagery and meditation.

Dr Drerup explained: “Relaxation is a process that decreases the effects of stress on your body and mind by activating your body’s natural relaxation response – the parasympathetic nervous system. Relaxation strategies help by slowing down your breathing and heart rate and can reduce the release of stress hormones.

“In general, relaxation techniques involve refocusing your attention onto something calming and increasing awareness of your body. Guided imagery or visualisation is one type of relaxation technique in which one focuses on mental images of a peaceful, calming place or situation. Incorporating as many of the senses as possible, including smell, sound, touch and sight is encouraged.” 

For example, if you enjoy relaxing at the ocean, you can picture yourself on your favourite beach, thinking about the sound of the crashing waves, the feeling of the sand under your toes and the warmth of the sun on your skin.  

“Learning basic relaxation techniques takes practise, but anybody can do it. Numerous apps and resources are available to help guide someone who is interested in developing these skills,” she added.

Due to the effects of COVID-19, the demand for antibacterial products continues to rise with increased concern over the hospital and community-acquired infections. An antibacterial installation can reduce the risk of HAIs and improve public confidence. Therefore, the importance of specifying antibacterial electrical devices has never been greater.

However, not all products are the same, which is why consultants need to be careful when specifying switches, sockets, and trunking systems, especially in healthcare, given they’re among the most frequently touched devices.

In an interview with Omnia Health Insights, Umar Khan, General Manager, Electrical Products at Honeywell Building Technologies, Middle East, Turkey and Africa, sheds light on what the need of the hour is for healthcare and solutions that are enabling better care across hospitals in the region.

How can an antibacterial installation reduce the risk of hospital-acquired infections (HAIs)?

Healthcare-associated infections occur in patients during the process of care within a healthcare facility. In the new normal, hospitals are presented with significant challenges including an influx of patients. Such outbreaks are characterised by intra and inter-hospital spread and are exacerbated specifically by overcrowding, delayed diagnosis and appropriate use of personal protective equipment among other reasons. According to WHO, hundreds of millions of patients are affected by HAIs around the world per year with the prevalence of the infections in developed countries varying between 3.5 per cent and 12 per cent.

To help combat the risk of HAIs, different materials and applications can be deployed that provide lasting protection due to their ability to minimise the colonisation of micro-organisms. An independent laboratory test demonstrated that MK Electric’s Logic Plus sockets and switches range have a kill rate of 99.9 per cent against MRSA, E. coli and salmonella. Honeywell’s MK solutions include the Prestige 3D Antibac Blue, which provides an antibacterial cable management solution with a unique fluorescence under UV light. It uses an additive inherent within the Poly Vinyl Chloride (PVCu) which acts as an effective weapon in fighting bacteria. The additive is a bactericide and kills bacteria instead of just restricting their growth.

Other solutions include the Logic Plus wiring devices, which complements the antibacterial offering and is effective at killing dangerous bacteria. The range is produced using Urea Formaldehyde, a high-grade thermoset material, which has similar inherent properties to antimicrobial additives, which inhibit the growth of infectious diseases. In addition, Logic Plus products are scratch-free thanks to high-quality mold tools, which means there are no dirt traps for bacteria to breed. The antibacterial additive used in the range is registered with the Environmental Protection Agency (EPA) and compliant with the European Biocidal Products Directive (BPD).

What are some of the challenge’s healthcare organisations are facing today and how can they operate more efficiently in the new normal?

During this period, hospitals are coping with greater numbers of patients, while exercising additional measures to keep frontline workers safe. This has led to an increased need to ensure sustainable modifications to healthcare operations for a smooth and safe flow of patients within facilities while ensuring the safety and compliance of patients and hospital staff. Such requirements have urged facilities management to implement technologies that aim to comply with social distancing practices and new hygiene requirements while taking into consideration the existing building infrastructure.

From a building owner perspective, new standards that require real-time, transparent insight into the actions that a building owner is taking to monitor and manage hygiene, improve air quality and implement social distancing are necessary. By adopting these standards, operators can ensure business continuity with efficient solutions that minimise resource usage along with defence-in-depth capabilities in the presence of changing needs.

How are Honeywell’s solutions enabling better care across hospitals in the region?

Honeywell is a pioneer in the evolution of digital operations helping organisations in the region embrace the shift to digitalisation. With more than 60 years’ experience in hospital environments, we understand the complex, challenging, and highly regulated world of healthcare. To support the changing requirements and the continued delivery of safe patient care, we have launched several innovative technology-led solutions that improve the health of their building environments for occupant re-assurance.

For hospitals and healthcare facilities, Honeywell’s Healthy Building solutions help building owners and managers support social distancing and help reassure patients and staff within the hospital’s perimeters. By integrating air quality, safety and security technologies along with advanced analytics, the solutions are designed to help minimise potential risks of contamination and ensure business continuity by monitoring both the building environment and building occupants' behaviours.

Other available solutions supporting the new normal include our mobile computers, which are specifically created for healthcare and can read person ID while maintaining safe distance during hospital check-in or ambulance pick-up. Portable printers that are used for taking labelling blood samples or printing patient wristbands are also among our offerings, to ensure operational hospital processes are carried out efficiently and effectively.

Directional airflow can also be crucial within healthcare spaces. Our Phoenix Controls Venturi Valves allow for precise airflow control for critical zones and for managing air quality when used in collaboration with other solutions such as High-Efficiency Particulate Air (HEPA) filters. The stable, directional flow of the solution enables the flexible transformation of isolated spaces, allowing hospitals to scale up or down to match the pace of their requirements.

At a facility level, the Honeywell Forge for Buildings platform improves operational efficiencies and security in buildings. Through data analytics, hospitals and healthcare facilities can map, control and monitor systems that include building management, energy optimisation, access controls and security enabling better care across hospitals.

What types of technological developments will have an impact on hospital design in the near future?

In the coming period, the adoption of technology-enabled care will become increasingly prevalent as organisations look to embrace digital transformation, leverage secure, reliable data to reinforce the resilience of their healthcare infrastructure, ensure business continuity, and prepare for future occupancy levels.

Hospitals and healthcare facilities are increasingly becoming reliant on technology as a fundamental enabler of their organisational strategy and a key driver into building resilience as well as overcoming future incidents and downturns that may arise.

References available on request

Dassault Systèmes and Aden Group, one of Asia’s largest integrated facility management companies, recently introduced a turnkey, ready-to-use infectious disease hospital solution, Akila Care, that could be quickly deployed and easily maintained in Arab countries severely impacted by COVID-19 and urgently in need of high-quality medical facilities. This new initiative comes in light of the successful world premiere of the hospital experience set up in a few days in Wuhan, China as well as in other countries.

The two companies have worked together to develop new hospital engineering, construction and operations processes by leveraging Dassault Systèmes’ 3DEXPERIENCE platform and Aden Group’s Akila Care smart and connected hospital concept. The solution relies on a virtual collaborative environment for the design, simulation and development of hospitals that can be built and operational within 150 days and remain operational for many years, as well as for optimizing their operations and maintenance throughout their entire lifecycle. As part of the collaboration, the two companies have assembled a consortium of companies specialized in medical equipment, engineering and construction to offer the solution to countries needing it most.

“In a global context where decisiveness and rapid action are essential to help in the fight against COVID-19, combining quickly buildable modular architecture with a digital platform can accelerate the construction of a cutting-edge medical facility and ensure it is fully operational in record time,” said Francois Amman and Joachim Poylo, co-founders, Aden Group. “By using the 3DEXPERIENCE platform, we have a solution that enables us to reduce engineering changes, maintain a rapid development schedule, and meet delivery commitments quickly and effectively, as well as ensure long-term hospital maintenance and safety in anticipation of further pandemics.”

The hospital solution provides a virtual collaborative environment in which employees and suppliers are invited to use a virtual twin of a hospital to optimize space planning, module design, negative pressure isolation rooms and other features, simulate manufacturing and equipment, and train for its construction. After the hospital is built, the solution will be used for digital asset management by connecting the facility with state-of-the-art medical equipment to monitor digitalized hygiene procedures and hospital floor robots.

“Aden’s Akila Care novel and proven approach to outcome-based facility management call for modular, smart and connected facilities engineered and built with an advanced manufacturing approach. The modularity and operation-centred facilities can only be made possible with a holistic, integrated, end-to-end virtual twin experience of the outcome. The 3DEXPERIENCE platform is the catalyst and enabler of such radical transformation, making our alliance a showcase for the future delivery of mission-critical infrastructure,” said Olivier Ribet, Executive Vice President, Europe, Middle East, Africa, Russia (EMEAR), Dassault Systèmes.

Dassault Systèmes’ 3DEXPERIENCE platform is used throughout the Middle East and North Africa by customers of all sizes including a large number of academic institutions that have recognized its business value and its capability to enable the workforce of the future.

Speaking during the three-day Patient Safety Virtual Edition, members of the global healthcare community from Singapore to the Middle East addressed the impact of the COVID-19 pandemic on patient safety, along with any new strategies deployed.

They revealed changes made in areas that included workflow enhancements, training, and technology in the form of new platforms. 

How caregivers are the heroes of the pandemic

Dr Samer Ellahham, Regional Chair, Middle East Patient Safety Movement Foundation; Director, Accreditation; Cardiology Consultant, Cleveland Clinic Care Giver, Cleveland Clinic Abu Dhabi was keen to stress that, at the end of it all, to err is human.

Healthcare, he conceded, is advanced but not reliable. When a medical error emerges it affects the entire team, medical organisation/hospital and community, rather than just patient and doctor alone.  

With the COVID-19 pandemic, new issues emerged. It challenged the entire healthcare system, including quality and safety, and undermined progress in ways that included:

• Staff reductions;
• ongoing distraction;
• lack of coordinated messaging between leaders;
• staff redeployment to new roles responsibilities and locations;
• new treatments for a new diseases resulting in new errors.

Measures introduced in response included telemedicine, PPE strategies, approaches to protecting healthcare worker safety, wellness resources, and communication with patients and healthcare workers.

Above all, he acknowledged the importance of frontline workers. “The healthcare community remains dedicated, resilient, and adaptable.” Caregivers are the true heroes, he added, with each and every one touching the lives of patients. “No offence to musicians or sportspeople. No offence to Hollywood.” 

He remains optimistic that “we can continue to provide our patients with effective and compassionate care without sacrificing the health and safety of our teams, colleagues and families.” 

The speaker noneltheless called for new ways of thinking beyond what he called "linear reductionism”, and underlined the need to be open and creative. Quality is a journey not a destination, he concluded.

AI enhances patient safety

In a separate session during the Patient Safety virtual event, Dr Samer Ellahham elaborated on the impact of AI on patient safety, in that it helps in reducing the burden of healthcare professionals by managing patient flow. It supports an early response to the pandemic by enabling efficient patient monitoring, screening and decision-making for the prevention of large-scale community spread.

Its practicable algorithms provide updated information to all individuals about positive cases in their vicinity as well as probable sites of infection and virux influx around. Clear description of cases helps in local awareness, health education and information allowing individuals to take necessary precautionary methods. 

He added that well-trained AI models are also useful in providing insights into the disease and drug treatment, which are not yet understood by practitioners. A useful discovery made with the help of deep learning algorithms is that patients may continue to spread the disease even after their efficient recovery because diagnostic tests were found to be positive 5-13 days after treatment.

The use of AI overall helps in enhancing patient safety due to early identification of complications and their logical management.

He cautioned that a limitation includes the lack of clinical trials demonstrating the safety of the use of AI in COVID-19 positive cases. This limits its use in diagnostic and treatment-related roles. 

Also, in vulnerable cases/patients with comorbid conditions, there is a lack of consensus-based guidelines devised by experts, which ascertains that sole dependence on AI in these cases may cause harm to the patient. 

New data dashboard improves the patient experience

Claire Jones-Manning, Decontamination Lead of University Hospitals of Leicester NHS Trust, revealed challenges during and post-COVID from an operating room perspective.

She told how the pandemic put on a pause on activities, enabling Leicester healthcare professionals to focus on how they conducted these and make changes. 

The teamwork they had internally was "outstanding", from clinicians to management to nurses and matrons, and communication with outside bodies was effective - there was support providing equipment during the darkest days. In addition there were no external pressures - companies were not trying to sell new products for example.

The pause also allowed an opportunity to review equipment to see whether it was fit for purpose and what was needed. Staff were additionally reployed to different roles, which was a real positive reflecting the positivity of doctors and nurses in those areas.

IT was fixed, allowing the team to use solutions in ways not possible previously. An example of this was the development of a Theatre Productivity Dashboard (Qliksense) to view key metrics of intensive care, theatre, anaesthetics, pain and sleep, and other data such as turnaround time. 

The dashboard also informs management where the team can improve in on-day non-clinical cancellations, for example, which can be an "awful patient experience". 

However, there were challenges that included decision-making, insufficient equipment and storage space for equipment, a rapidly changing situation, and staff exhaustion. 

Mindspace platform launched to provide emotional support to caregivers

Dr Allison Herbert, Staff Physician - Department of Preventive Medicine and Executive Health, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi

Dr Herbert revealed five areas of improvement with overlapping themes under Clinical Risk Assessment, that included workflow, specimen handling, caregiver safety, caregiver training and environmental. 

In workflow terms the clinical space was divided so that symptomatic and asymptomatic sides were developed. For example in the case of the former, caregivers were swabbed by the nurse, who then determined whether a phone consultation with the physician was appropriate or a an in-person home visit instead. 

Other workflow changes included introducing dividers and signage, eliminating outside seating areas, separating waiting areas, establishing that visits were appointment only (through online scheduling), defining traffic control through health unit coordinators, and mandating universal COVID-19 precautions such as social distancing and hand-washing.

Specimen handling measures were introduced that included communication of results, assigning a "clean" and "dirty" nurse to every room to handle samples, and defining a workflow on where samples were handed off. 

To safeguard caregiver safety, changes were brought in such as moving non-clinical staff out of symptomatic areas, assigning "clean" and "dirty" tasks to separate nurses, ensuring that nearly all doctor visits became telephonic, and changing the flow of suspected caregivers to create "clean" and "dirty" areas/corridors.

Many training actions were also identified for caregivers, for instance training for donning and doffing, and standardised nurse training for swabbing.

There were environmental measures - for example placing air purifiers and exchangers in swabbing rooms, and creating an area for donning and doffing PPE outside the swabbing area. 

Caregiver anxiety was also addressed to address challenges such as working from home (demotivation and isolation), working in different hospital environments and adapting to constantly changing rules/guidelines. Solutions included the launch of a mindspace platform, online workout sesions and weekly leadership virtual updates. 

Mindspace was a platform launched as a safe environment to share experiences. Facilitated by a professional mindspace coach, there are 1 on 1 coaching conversations, curated content, tips for leaders on how to best navigate with their teams, and tailored team coaching initatives.

Holistic approach works best

Dr Wai Khuan Ng, Principal Consultant, Infection Prevention & Control, Joint Commission International (JCI), based in Singapore, revealed the six areas most affected by the pandemic, as shown by JCI field team feedback. She was speaking during the session COVID-19 pandemic - What have we learned?

The areas named were utilities, staffing, safety and securiy, communications, patient management, and resources and assets. Patient management and resources and assets were seen as the most challenging areas, while utilities and staffing were least challenging. 

She shared an Emergency Management framework, explaining that it helps develop practical and actionable operations and policies. The consultant also advocated a "holistic approach" that included working with the community, working with other healthcare organisations, strengthening relationships with suppliers, and preparing for evacuations. 

Astronauts’ bodies are affected by space exploration in numerous ways. It can cause demineralisation of bones and create muscular atrophy. In fact, the heart actually changes size, shape and function in space! Also, astronauts get exposed to some ionizing radiation as well as galactic cosmic radiation, for which there isn’t an effective countermeasure yet. In addition, there are neurologic changes, variations in sleep cycles, loss of appetite, and limited hands on deck when it comes to medical care.

All these issues were put in the spotlight at the ‘Space health as an analog for Earth’ keynote featuring Aenor Sawyer, Chief Health Innovation Officer, Translational Research Institute for Space Health (TRISH) Director, UCSF Skeletal Health Service, on day three of Omnia Health Live Americas.

Sawyer explained that in human space exploration astronauts are exposed to environments different than terrestrial life. “Some environmental changes include microgravity in spacecraft as its orbiting. We have to understand how people will function not just in microgravity but also in partial gravity especially after they have travelled months to get there. Some other worrying factors include the distance from Earth, confined spaces, limited and altered movement patterns as well as the behavioural aspects of isolation and environmental hazards. And the constant exposure to baseline danger with the awareness that at any moment there could be episodic crises that could be life-threatening.”

Some of the principles, Sawyer said, that were learnt from the space environment have been applied to people being shut in during the COVID-19 era, with the added stress and limited resources, confinement and isolation. Several astronauts have shared how they coped with these factors in space.

She highlighted that space health goals have to be looked at just like those of patients, employees, and athlete’s, to maintain optimal health and function. The aim is to predict and prevent illness and injury. The goal of TRISH, Sawyer stressed, is to empower astronauts and crew as well as Mission Control and flight surgeons to maintain their physical and behavioural health.

“For medical management at the International Space Station (ISS), it’s pretty much telemedicine,” she shared. “We have synchronous communication and if a medical condition continues to escalate there is always the option to de-orbit and bring the astronaut back to Earth quickly. But that may not be the option as we move hundreds and millions of miles further out.”

For missions to Mars, for instance, there will only be asynchronous communication, so real-time telemedicine support will not be an option neither will sending information to the cloud and having it interpreted and computed and then returned. When it comes to deep space exploration, close loop processes will be required.

“The Moon will serve as an analog for Mars just as the ISS is going to serve as an analog to our Moon missions, which we are now ramping up. By 2024, we expect to be placing a woman on the Moon on the mission called Artemis,” she added.

Continuum of care in space

Sawyer said that there has been a shift from augmented to autonomous (A2A) health and medical management. Since each astronaut has a different gene pool and has had different exposures in life, they carry with them very different risks. That’s why there is a need for a personalised or precision medicine model. Such a model will require more understanding of an astronaut before they go to space and create predictive models of who is at higher risk. Also, there is very limited space so an entire pharmacy can’t be taken. Moreover, radiation can affect the shelf life of medication.

“The goal is to create a continuum. If we start from a state of wellness and optimal function, we are trying to find ways that we can pick up on early deflections and then give a signal back to that individual that says, for instance, “you need to drink more water”, if you don’t you are going to slide down into renal insufficiency and get them back to an optimal state whether it is hydration, fatigue or nutrition or stress,” she concluded.

Preventing diabetes

There seems to be a common link between patients who are at a risk for more severe illness from COVID-19. Anyone at any age is at the risk of contracting the virus but patients battling cancer, chronic diseases, obesity, and type 2 diabetes, among others, are at risk of severe illness.

According to a Lancet Diabetes & Endocrinology study mining 61 million medical records in the UK, 30 per cent of COVID-19 deaths occurred in people with diabetes. This was highlighted during the ‘Prime Movement Healthcare: Diabetes Care in a Post-COVID World’ session.

Prime Movement has partnered with the U.S. Centers for Disease Control and Prevention (CDC) for the National Diabetes Prevention Program (NDPP), a data-driven cost-effective lifestyle programme that focuses on healthy eating and physical activity to decrease the risk of developing diabetes. Reportedly, patients who successfully complete the programme have been shown to decrease their risk of developing diabetes by 58 to 71 per cent.

“This customised approach helps patients with chronic diseases manage their condition in real-time,” a company spokesperson said.

Standardising sterile processing practices

Another engaging session at the event was ‘When IFU’s and the real world do not align with your sterile processing practices/policies’, where panellists explained the process of how Instructions for Use (IFU) are developed.

Damien Berg, Regional Manager Sterile Processing – UCHealth. Said: “The life of an IFU starts when a manufacturer comes up with a concept but then they have to prove how that product is used and cleaned, inspected, assembled/disassembled, sterilised, how it is wrapped and containerised and how it is stored. The manufacturer has to think about all this and prove to the regulatory agency that this can be reproduced in the field.”

Berg stressed that in the past this has been challenging because IFU’s were validated based off of manufacturers proving this can be done but not in a hospital setting but, in a laboratory setting or a simulated environment. “Sometimes end-users can struggle with that. That’s one of the things manufacturers around the globe are working on, to develop IFU’s in a real-world hospital or clinic settings,” he added.

While Arthur Henderson, Senior Clinical Education Specialist, South Eastern Zone, STERIS Corporation, emphasised that there are different criteria for reprocessing. These include labelling, which reflects the intended use of the device. It should also feature reprocessing instructions, which advise users to thoroughly clean the device. These should be technically feasible and include devices and accessories that are legally marketed and be comprehensive.

Henderson said: “With the microbial process, there is sometimes a confusion such as what kind of lubrication agents need to be used, is visual inspection needed? What type of method of sterilisation needs to be carried out? What about the reuse life? One of the trends we have seen is that manufacturers are writing work instructions, which is based on IFU. When work instructions are written it is a much easier way for the end-user to understand what is being asked of them. “

“As an infection preventionist, we are trying to do the right thing but sometimes the IFU’s give too much information, which makes it almost impossible to follow,” added Jill Holdsworth, Manager, Infection Prevention - Emory University Hospital Midtown. “But sometimes the IFU’s don’t give enough information. That’s why IFU’s are a hot topic right now to make sure we are doing things safely and correctly and in the right way.”

Another challenge, Berg said, is that manufacturer’s need to make products for a global audience. Therefore, there has to be a consensus to develop standardised IFU’s.

The first day of Omnia Health Live Americas was packed with quality content. Closing the evening of 2 November, the debate How to establish new clinical protocols: learnings from COVID-19, moderated by Felipe Reis, from Hospital Beneficencia Portuguesa de Sao Paulo (BP), addressed the work of hospitals since the beginning of COVID-19, when it was still an unknown disease.

The session was moderated by Miguel Cendoroglo, Superintendent of Hospital Albert Einstein, and counted on the participation of Emerson Gasparetto, CMO of Rede Impar; Felipe Reis, executive manager of Innovation, Technology and Medical Solutions at BP; and Pedro Batista, executive director Prevent Senior. 

Cendoroglo recalled that there was a real "obsession" with the quality of processes and prepardeness since January, when Albert Einstein Hospital had been following the disease through research. "This overkill brought us greater peace of mind when dealing with the problem," said the superintendent. "One issue for example was beds, that had reached 85% occupancy, but we managed to avoid the problem of running out of them," he recalled. 

Albert Einstein was the first hospital to have received the first confirmed coronavirus patient with coronavirus in Brazil. Regarding negative aspects, all agreed with the inadequate way in which the information was passed on to both patients and clinical staff.

“Our scientific validation system is very flawed. At DASA [medical diagnostics company], a crisis committee was made where decisions were made and nothing was done without the approval of the scientific committee ”, highlighted Gasparetto. "An example was the failure to launch the rapid test, which did not meet the group's technical criteria," explained the executive.

Argentina’s healthcare system is one of the most fragmented and segmented in the Americas. This kind of system has the challenge of coordination, access and equality, explained Viviana E Rodriguez, MD, PhD, CPPS, Coordinator of Quality, Patient Safety and Clinical Management Department, IECS, Argentina, a panellist at the 'Quality and patient Security – International systems', on day two of Omnia Health Live Americas.

However, she said that the country has one of the highest investments in healthcare in the Americas. The country has spent more than 8 per cent of its GDP on healthcare and has the highest number of ICU’s in Latin America. But there are still problems in processes and outcomes.

Rodriguez said that COVID-19 showed the region the importance of needing more collaboration. “Quality and safety are the foundation of healthcare and healthcare is a human right. So, we should be thinking about collaboration to build standards among the countries to improve healthcare services,” she highlighted.

Argentina has quality and safety regulations in place and each province can select which guidelines they can follow and that can prove to be challenging.

“We have a National Quality Direction that regulates a national programme and is more related to policies, clinical guidelines and patient safety goals. Some of these were written 10 years ago. This programme was started in 1992 and was validated only three years ago, which highlights the long-time taken to comply with regulation,” she stressed.

Importance of patient safety regulations

While the country has been working very well in some respects, such as having good outcomes in mother and child health, in some other parts of the system and in dealing with the other diseases, the results vary.

According to reports, in 2016, 39,000 deaths could have been prevented by the health system, about three-quarters of which were due to poor quality. Currently, Argentina has 80 accredited hospitals, of which only three have been accredited by the Joint Commission International (JCI).

“Regulations, users voice and leadership all need to be present in order to foster quality and safety. Argentina invests a lot of money to give people access to healthcare. Despite this effort, people don’t get access and, therefore, the outcomes are not as good as it could be. The country needs to develop more regulations and reinforce user engagement and education to improve the results of the system,” Rodriguez concluded.

Experts at Omnia Health Live Americas discussed the increased focus on new cleaning and disinfection methods and technologies because of the pandemic. They were speaking during the panel talk Protocols and New Technologies for Hospital Disinfection.

The pandemic has put cleaning protocols and their weaknesses in the spotlight, resulting in a need for more innovative and effective products while not forgetting that cleaning personnel must continue to be trained. 

Roxana Trejo, Epidemiology Manager at Hospital ABC pointed out that they were able to identify areas of opportunity, and what could be improved in training and product handling processes. In addition, the epidemiologist explained the importance of having a defined protocol on paper, clarifying which materials are to be used, along with disinfectant and detergent.

This protocol must take into account cleaning standards put forward by the Mexican government. To identify cleaning and disinfection products, it's also necessary to review any scientific evidence that exists which validates their effectiveness against microorganisms. 

Similarly, Edgar Guadalupe González, industrial chemical engineer and marketing leader of the North Cluster of Diversey, affirmed that there is now greater attention on cleaning products, since they need to be effective for all areas of ​​the hospital. However, he stressed that cleaning procedures are key to ensuring that spaces are free of microorganisms.

Alejandro Sassoé González, head of the Epidemiological Intelligence unit of the Hospital Regional de Alta Especialidad de Ixtapaluca, assured that through the pandemic significant changes have been made in cleaning protocols, such as in the training of cleaning personnel in aspects of PPE.

New disinfectant technologies

While quaternary ammonium and sodium hydochlorite are effective against organisms such as SARS-CoV-2, they also have the disadvantage of requiring a long contact time. Instead new products exist that disinfect effectively in under two minutes.

In addition, it's possible to move away from traditional systems that involve the three steps of cleaning, rinsing and disinfection. According to Edgar Guadalupe González, there are currently technologies that combine cleaning and disinfection in a single step, such is the case of accelerated hydrogen peroxide, which is "very different from what is conventionally known or purchased in pharmacies."

This product furthermore does not pose a risk to whoever applies it, unlike sodium hypochlorite. It also has a broad spectrum of disinfection, acting against viruses, bacteria, fungi, tubers and removes mould.

Accelerated hydrogen peroxide is on the US Environmental Protection Agency (EPA) List N of products effective against COVID-19. The chemical engineer also explained the importance of a complementary disinfection with UVC, as it provides high coverage and penetration.

Finally, there are analyses that demonstrate low levels of hygiene compliance in hospital beds and operating rooms. This is because "although they depend a lot on manual cleaning of personnel, sometimes, due to lack of effective training, the surfaces are not cleaned as they should," said the expert.

Early October, in conjunction with the 2020 Medical Innovation Summit, Cleveland Clinic announced the Top 10 Medical Innovations for 2021. The 18th annual summit, which was virtual this year, brought together influential investors, entrepreneurs, clinicians and industry professionals to share their best practices and visions for affordable, sustainable widespread care.

Innovation is a cornerstone at Cleveland Clinic. As such, experts from across the organization always have their finger on the pulse of new technologies and the latest advancements. From novel gene therapy for blood disorders to increased access to telemedicine, these Top 10 Medical Innovations for 2021 are poised to have a great impact in the coming year.

Gene Therapy for Hemoglobinopathies

The latest research in the hemoglobinopathy space has brought an experimental gene therapy, giving those who have the condition the potential ability to make functional hemoglobin molecules – reducing the presence of sickled blood cells or ineffective red blood cells in thalassemia to prevent associated complications.

Novel Drug for Primary-Progressive Multiple Sclerosis

A new, FDA-approved therapeutic monoclonal antibody with a novel target is the only MS treatment for the primary-progressive population.

Smartphone-Connected Pacemaker Devices

Bluetooth-enabled pacemaker devices can remedy issues of disconnection between patients and their cardiac treatment. Used in conjunction with a mobile app, these connected devices allow patients greater insight into the health data from the pacemakers and transmit the health information to their physicians.

New Medication for Cystic Fibrosis

A new combination drug, FDA approved in October 2019, provides relief for patients with the most common CF gene mutation (F508 del) – estimated to represent 90 percent of individuals living with the disease.

Universal Hepatitis C Treatment

A new, approved fixed-dose combination medication has vastly improved hepatitis C treatment. More than 90 percent effective for hepatitis C genotypes one through six, the therapy represents an effective option for a wider scope of patients.

Bubble CPAP for Increased Lung Function in Premature Babies

Unlike mechanical ventilation, b-CPAP is a non-invasive ventilation strategy – delivering continuous positive airway pressure to newborns to maintain lung volumes during exhalation.

Increased Access to Telemedicine through Novel Practice and Policy Changes

COVID-19 saw increased adoption of telemedical practices. An increasingly virtual care model and increased consumer adoption came by way of fundamental shifts in policy at both the government and provider level.

Vacuum-Induced Uterine Tamponade Device for Postpartum Hemorrhage 

The newest advancement in treating excessive bleeding after childbirth and related complications is that of vacuum-induced uterine tamponade – a method that uses negative pressure created inside the uterus to collapse the bleeding cavity causing the muscle to close off the vessels. The device is a minimally invasive tool for clinicians and provides a low-tech solution that is potentially translatable to developing countries.

PARP Inhibitors for Prostate Cancer

Known for their success in women’s cancers, two PARP inhibitors have been demonstrated to delay the progression of prostate cancer in men with refractory cancer and DNA repair pathway mutations. Both were approved for prostate cancer in May 2020.

Immunologics for Migraine Prophylaxis

In 2018, new medications were developed to help head off migraine pain. The class of drugs works by blocking the activity of a molecule called calcitonin gene-related peptide (CGRP), which spikes during a migraine. Actively prescribed in 2020, this new FDA-approved class of medication is the first to be specifically designed for the preventive treatment of migraine, marking a new era of migraine therapeutics. 

For more information on the annual Top 10 Medical Innovations list please visit: ClevelandClinic.org/top10innovations2021