Beyond Clean and Dr. Ryan Lewis, Sr. Director of Medical Affairs at ASP, answer some of the questions for sterile processing professionals in this Beyond Clean podcast.

Ryan Lewis (00:00):

So there’s going to be pressure put on the system that may processes those to make them turn over faster, make them more readily available to that large number of patients. And so there’s going to be some time pressure. There’s going to be maybe the temptation to cut some corners perhaps or even leave out steps that might be critical to safely reprocessing. Those SPD folks are very well trained and they understand how critical their mission is to the safety of patients. But sometimes in a crisis things can put a lot of pressure on folks in their roles.

INTRO Speaker – Beyond Clean (00:35):

What if one conversation could save a live? What if one new process or new product could save a patient from surgical harm? Broadcasting from a hospital basement near you, you are listening to the beyond clean podcast, the global voice of sterile processing. Each week we spotlight the best practices products and people from around the world who are disrupting our profession and helping you fight dirty every instrument, every time. Join us as we have the kinds of conversation that matter and keep our industry the kind of voice that it deserves. [inaudible] and now it’s time to go beyond clean.

Justin Poulin – Beyond Clean (01:18):

This week beyond clean has a bonus episode for you on the topic of COVID-19 or Coronavirus and your role in sterile processing. We speak with Dr. Ryan Lewis, who is the senior director of medical affairs for Advanced Sterilization Products in Irvine, California. He is a licensed physician with a master’s in public health from Johns Hopkins university where his emphasis was in leadership, public health policy and medical devices. He was physician at large for the Coconino County board of health in Arizona, the second largest County in the U S and he has been in the medical device industry for 20 years. Mike, we were searching around for somebody to come onto the show and speak to us about Coronavirus, but nobody better than Dr. Ryan Lewis where we actually recently received a paper, not only on the Corona virus, but really around the role that sterile processing professionals play in this environment. And so, so great to take some of his insight and knowledge and bring it to the podcast and get it out to our listening audience.

Ryan Lewis (02:32):

Yeah, absolutely. So, I mean I think we kind of have in some cases an information overload and you know, we just, this is all anyone is talking about, but one piece that nobody else is talking about is how does this affect sterile processing or does it affect it at all? And so this is a really important topic for us to discuss on this podcast because I mean who else is going to talk about it, right?

Beyond Clean (02:57):

That’s right Mike. It’s beyond clean. So we’re going to get right into the interview after this.

Beyond Clean (03:04):

As a reminder, you can subscribe to Beyond Clean on iTunes, Stitcher, Google play and Spotify or search for beyond clean on your favorite podcast application. We can also be heard on the sterile education app available on iTunes and Android. Follow beyond clean on Twitter at beyond clean info, facebook.com/beyond clean podcast, linkedin.com/company/beyond clean. Our Instagram is beyond clean podcast and on YouTube, youtube.com/beyondclean for fighting dirty with Hank Balge and real talk with Bob Mars. All season eight episodes will be certified for CE credits in a single package with one quiz and certificate at the end of the season. Select beyond clean podcast episodes are worth points toward the CNOR or CSSM credentials through CCI. Beyond clean also offers clinical education, social media and podcast consulting for vendors along with survey preparation and remote consulting services to hospitals, surgery centers and clinics. Is your facility survey ready email [email protected] for more information. And finally we are excited to announce beyond the tour of compelling and gritty new film series that is shining a spotlight on innovators and disruptors in healthcare manufacturing. The premiere episode of beyond the tour will release late April, so tune in to beyond clean social media pages for details. We’ll be right back after a short break.

Justin Poulin – Beyond Clean (04:46):

You’re listening to Beyond Clean the global voice of Sterile processing. Joining us now is Dr. Ryan Lewis, senior director of medical affairs for Advanced Sterilization Products Incorporated. And Ryan, we’re really excited to have you on the show. Maybe not so excited for the reasons behind this bonus podcast. We’re in between season seven and season eight of beyond clean. But as anybody who is listening to this episode is fully aware, just about every focus in healthcare right now is on COVID 19 or the Coronavirus. And interestingly, we got a document from you and your organization, uh, maybe a month and a half ago, uh, talking about how this was going to be an impending concern for healthcare and yet an interesting take here on preventing contaminated medical devices in the context of Coronavirus. So nobody better to come and talk with us today about this topic. So thanks for coming on the show. Thank you. Thanks for having me on your podcast. Well, I think we should just start with what do we know about the Coronavirus because I know a lot of people or watching the news every single day and depending on what channel they’re watching, they’re getting different information and I just thought maybe we could anchor around, you know, some real solid facts as we kick this off.

Ryan Lewis (06:19):

Yes, Justin, there’s still a lot unknown about the coronavirus for sure. Fortunately, there have been a couple of coronaviruses prior to this that have been studied to provide a little bit of information on what coronaviruses can do. But this particular coronavirus is behaving fairly similar but a little bit different. You know, it’s on everybody’s minds right now. It’s a disease that probably started about December, mid December, 2019 and that’s where the name comes from, COVID 19 coronavirus disease 19 and that really started in this region Wuhan China. The scientists tell us that it started as zoonosis or in other words, a disease that normally is in animals that made a jump to humans.

Justin Poulin – Beyond Clean (07:03):

So Ryan, like you mentioned, there have been a number of coronaviruses prior and I think it’s important to note that you know, this isn’t COVID 1, this is COVID 19 and so I wondered if you could kind of describe for us what is so special about this virus, especially considering maybe previous coronaviruses like SARS or MERS.

Ryan Lewis (07:26):

So SARS stands for severe acute respiratory syndrome and MERS stands for middle East Acute respiratory syndrome are two very similar coronaviruses in that family, the same family of coronaviruses. And they also had the ability to cause epidemics and pandemic spread. So what’s really critical about these particular viruses, SARS, MERS and now COVID 19 are that they are capable of spreading rapidly in human population and causing sometimes severe disease. It seems like a COVID 19 is already parsed to pass both SARS and MERS and the number of patients affected and the number of deaths worldwide. And recently the world health organization declared it a pandemic. And so, uh, I think we’ll see more cases and more deaths from COVID 19 then we’re seeing with you either SARS or MERS.

Justin Poulin – Beyond Clean (08:25):

Yeah, there's certainly been a big impact on not just the healthcare industry, but the NBA is suspended their season. Lots of the conferences that are in healthcare, including AORN is a big one, was canceled as well, obviously to help prevent the rapid spread of the virus. But I also wanted to just talk about such a variation in symptoms. It seems like some people have really minor symptoms, but then it obviously all the way to severe symptoms and ultimately possibly leading to death. I think half the death toll coming from one longterm care facility just outside of Seattle. So are there a standard set of symptoms or do we see a wide range? We already kind of know that the severity of the symptoms has quite a wide range, but what about the types of symptoms that somebody might experience?

Ryan Lewis (09:20):

Yeah, so we're seeing a fairly wide range of symptoms. You know, as the name implies, it's a respiratory virus and so most of the symptoms we see our flu like right now, and they can range from mild and it tends to be more mild in younger populations. People below let's say 60 and a-all the way up to severe where patients might develop severe respiratory symptoms such as shortness of breath, inability to oxygenate their blood, the need for mechanical ventilation, that sort of thing. Fortunately, uh, most people don't go on to that advanced stage where they need ventilators. It's a small percentage and they tend to be over the age of 60 and also have maybe some other comorbidities or other health conditions like heart problems or preexisting respiratory problems or high blood pressure, diabetes, those sorts of things.

Justin Poulin – Beyond Clean (10:19):

So obviously a lot of our listeners work in the medical device reprocessing industry. And so I think there are many out there who were kind of wondering, you know, what role does sterile processing play in this current outbreak? Because there's so much strain, like you said, that's being placed on healthcare and potentially it could get worse. And so I think there's probably a lot of us who are saying, okay, what do we do?

Ryan Lewis (10:44):

Boy, I sure appreciate those people. And sterile processing department as a doctor, my training was an ear, nose and throat head, neck surgery, and much of what they do is behind the scenes, but so critical. I think as a patient and as a physician, I expect when I go to the hospital that I'll be safe. I'll be kept safe and free from any potential sources of infection. Well, especially during a crisis, I think that the processes and the systems within the hospital become even more critical in order to keep patients, in fact, staff safe from disease transmission.

Justin Poulin – Beyond Clean (11:20):

So Ryan, as an industry, and I don't just mean as healthcare providers, I mean hospital, staff and vendors and despite the fact that a lot of vendors are being restricted to only going into the facility at many hospitals if they're supporting a scheduled case that day. But what can we all do to help prevent the spread of COVID 19 in the healthcare setting?

Ryan Lewis (11:45):

Right. I think there are some very, very basic principles at work here that healthcare providers and people who work in the healthcare setting are fairly familiar with that sometimes we may forget and we talk about some of those basics such as washing your hands and doing that appropriately, making sure you cover all the surfaces, using hand sanitizer when needed, making sure that you cover your coughs and sneezes even in any healthcare setting, the appropriate use of personal protective equipment, PPE, it can sure that you're um, able to don and doff those without contaminating yourself or others. And again, masks need to be appropriately fitted and masking to also be used in according to manufacturer's specifications. But I think for all of us that are in health care and serving patients, I think we just need to be aware of those recommendations right now from public health, keep ourselves healthy and strong by engaging in self care, making sure we get enough sleep and proper nutrition and then be available to help.

Justin Poulin – Beyond Clean (12:52):

You know, we have such a tendency to dismiss sort of basic things and I know there's probably a lot of people out there who may not wear masks on there and when they're normally, you know, in decontamination or maybe they kind of skimp on the hand hygiene and their thinking is what's the big deal? It's such a simple thing to maintain hand hygiene. It's such a simple thing to cover your coughs and your sneezes and it's almost like we're looking for like some big amazing solutions to some of these problems when really what we need is just basic stuff, normal stuff, standard precautions. And so I'm grateful that we, you know, we have cooler heads who are available to be able to tell us these kinds of things. And I think one of the biggest issues with COVID 19 is the potential for that overwhelming demand that can be placed on hospitals. Can you describe the impact of that overwhelming demand that can be placed particularly on high volume reprocessing in a crisis situation.

Ryan Lewis (13:59):

So in a crisis situation there may be the need to use equipment more than what is standard during normal operations. For example, imagine that you have a number of patients coming to the hospital who potentially have Coronaviruses, COVID 19 and part of the workup is to do Bronco LBO or LVAD, which is a procedure done with a bronchoscope along flexible endoscope. It's put down the airway and down into the lung. Some saline is injected through the working channel and then suction backup through to take a sample to be sent off to the microbiology lab for diagnosis. Imagine a number of patients, a large number are needing bronchial or Loveis or lung washing. I guess we can call it in common terms and are only a fixed number of bronchoscopes at that facility and those bronchoscopes are going to be used more than normal. So there's going to be pressure put on the system that may reprocesses those to make them turn over faster, make them more readily available to that large number of patients. And so there's going to be some time pressure. There's going to be maybe the temptation to cut some corners perhaps or even leave out steps that might be critical to safely reprocessing. Those SPD folks are very well trained and they understand how critical their mission is to the safety of patients. But sometimes in a crisis things can put a lot of pressure on folks in their roles.

Justin Poulin – Beyond Clean (15:32):

Well, and I think you said the key phrase there and that is pressure because you know, as we look at sort of human performance metrics, and I know our chief medical officer, Dr. Peter Nichol has talked about this on the show before, that uh, when you have a well trained process in place, error rates tend to be relatively low. I think national standards are typically about one per 100 opportunities, but as soon as you add stress into the mix that jumps from one in a hundred to about one in 10 and so when we're talking about something as potentially dangerous as flexible endoscopy, just in general, one mistake per 10 opportunities when cleaning one of these things properly might have as many as a hundred steps. You're talking about potentially making 10 mistakes per reprocess. And so this becomes really critical for the process to be well understood, to be well trained and to have a sufficient amount of equipment available as well as the ability to turn it over very rapidly.

Ryan Lewis (16:39):

That is 100% accurate, especially these are complex pieces of equipment to clean and disinfect. Some of the equipment also needs to go through a sterilization process. But I would say that leaving out a step could make the difference between transmitting a disease from patient to patient versus having safe reprocessed medical device for the next patient to use.

Justin Poulin – Beyond Clean (17:03):

So Ryan, we had an interview, I think it was the second episode of season seven and it was really focused on a story from Las Vegas and really talking about emergency preparedness and how many people after one of our largest mass shootings, how everybody in the health care area had pulled together and gone to offer support and just the measures in place that hospitals have to be ready in the event of an emergency or a disaster. And this is one of those scenarios that really tests hospital preparedness. And I thought one of the biggest challenges is supplies. You mentioned masks and PPE and getting those supplies, especially since this hit in China to begin with, has proven to be a rather large logistical challenge. That's also what you said. We've got to keep the amount of people going into the hospital down so that we can keep the pace of play at a level where those supplies can be replenished. But do you have anything else that you might add just in terms of hospital preparedness and maybe even from a staffing standpoint because the demand may be going up?

Ryan Lewis (18:24):

Yeah. From a staffing standpoint, things can happen that people are people, they have lives outside the hospital. You know, some may have childcare issues. For example, in Washington, we're seeing a number of school closures happening right now, which will impact the workforce, including hospital workforces. And so, you know, people have lives and there's a level of personal prepared this that asked me to go through. But at the same time being prepared as a hospital system and really making sure that folks are well trained, they're knowledgeable in their roles, that they understand how the equipment that they're interacting with, whether it's terminal sterilization piece of equipment or a high level disinfection piece of equipment, they understand the intricacies of working, that they understand also how the disposables are used and monitor for those. And then there are sufficient supplies that those disposable or consumable items such as biocide detergents and filters and other things that are part of the processes of disinfection and sterilization. And so, you know, the preparation needs to go on at a broader level than just being personally prepared. They, you need to make sure that there's sufficient stock to take care of the equipment that is processing these vital medical devices. And then also you need to make sure that there's sufficient training and maybe training needs to be revisited during a crisis. It seems like that would be the last thing folks would want to do, but it's reinforcing some of those key steps, you know, making sure that people understand they can take the time to do it right. And remember that pre-cleaning and cleaning and disinfection, you know, there are key steps that we want to make sure that people have enough time to do in order to make sure it's done right so we don't compromise quality.

Justin Poulin – Beyond Clean (20:14):

All right, Ryan, last question as we wrap up this bonus interview in between season seven and season eight, but what else can be done at home and with our families and to protect them? I know there's a lot about, we kind of referenced quarantine earlier, but any additional thoughts of extra measures that can be taken maybe even outside of the healthcare environment?

Ryan Lewis (20:37):

So buy all the toilet paper you can find? No, just kidding.

Justin Poulin – Beyond Clean (20:42):

It's really like, it's funny because I literally joked earlier, I swear that's the only conversation happening on Facebook, this Corona virus and toilet paper these days.

Ryan Lewis (20:54):

Yeah, that's right. Um, no, I think making sure your family understands what hand-washing is all about. You know, your, your family is precious to you, your, your health is precious to you. It's part of your productivity and ability to do things on a daily basis. And we care about our loved ones. And um, hand washing is probably the most powerful thing we can do, uh, watching out for our vulnerable elderly family members. And I think our community, public health officials are doing a good job of closing down public venues where people might be at risk. And I just enjoy your family again, get the sleep you need, take care of your health, get a little exercise when you can do whatever you need to do to, to make sure you feel healthy and that your loved ones are well taken care of.

Justin Poulin – Beyond Clean (21:42):

All right, Ryan, you did a fantastic job and I appreciate you coming on. Really on short notice. I think we talked what, maybe eight hours ago and now we have the interview and we're going to have this out to the sterile processing community and appreciate your contribution, especially during a time where maybe a lot of people are feeling uncertain and so bringing some facts to the podcast and relating it to their day to day work in sterile processing. So key, thank you so much.

Ryan Lewis (22:10):

Thank you.

Justin Poulin – Beyond Clean (22:11):

That was Dr. Ryan Lewis, senior director of medical affairs for Advanced Sterilization Products and Mike, really a very obvious hot topic in the industry right now. But when we got this information, it just made so much sense because it's coming from the perspective of everybody has a role to play in healthcare on a day to day basis, but to be able to apply this specifically to the role that's being played by sterile processing professionals. I'm so glad we were able to provide that to our listeners, especially for such a timely subject.

Mike – Beyond Clean (22:47):

Yeah, absolutely. And I know you mentioned the episode that we did with Dwayne Taylor earlier where you know, it just seems like it's a problem within our industry to connect. What we do on a daily basis to what's going on in the hospital at large. And so when, you know, when we see something like this break out, like it's really easy to understand what role doctors play and it's really easy to understand what role nurses play. But very often when it comes to what role do we play in sterile processing, it's very easy to get lost and just kind of say, well, you know, we just process instruments. But the reality is is that we play a very important role to making sure that the devices that are needed to care for those patients are available and safe to use. And, uh, Ryan brought those up in a great way and I'm just really grateful for this interview.

Justin Poulin – Beyond Clean (23:41):

Yeah, you make a great point. It's all about maintaining that vision of healthcare because if you work in a hospital, you're contributing. So very important to be able to remember everybody that's involved. You know, really EVS has a huge role in this. So at some point there needs to be a podcast very specific to EVS and their role as well. Um, so many of the support services, I just hope they don't get overlooked because they're not providing direct patient care, but they're all very critical to the functioning in the hospital. That's going to do it for this week's show. As a reminder, you can help support us by subscribing to beyond clean on iTunes, Stitcher, Google play, and Spotify. We'd certainly appreciate a rating and a review because your feedback is important to the show, and if you have any topics that you'd like us to cover on a future episode, just send an email to [email protected] on behalf of Mike and myself, thank you for listening to this bonus episode of Beyond Clean.



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