The tools and best practices for handling infection control during pulmonary function testing have evolved and changed for the better during the pandemic. 

By Lisa Spear


In all clinical settings, the safety of the patients and staff are of primary concern, but pulmonary function testing (PFT) comes with a unique set of risks that clinicians must contend with.

During PFT testing, patients are rapidly exhaling in close proximity to clinicians, which makes infection control more difficult than during other common procedures. While infection control practices were stringent before the global pandemic took hold, the rise of the novel coronavirus has forced medical administrators to rethink their policies and revamp how they deliver care safely. 


“Labs had become very complacent prior to COVID, not really thinking about the potential for any patient having a communicable disease and breathing on their system.  Now we look at every patient as possibly being infectious and take precautions before, during, and after each study to ensure the safety of all,” explained Ralph Cook RRT, RPFT, vice president of market & product management at MGC Diagnostics.

“I feel the pandemic has made us rethink all of the policy and procedures we had in place.”

The Rise of Filters

The first line of defense against the spread of infection is the pulmonary function filter, a filter that, if working properly, can capture viral and bacterial particles and prevent the spread of infectious diseases. This is of the utmost importance to protect both clinicians and other patients.  

“If there is an in-line filter solution available for your spirometer, use it,” said Jaimee Burgess, RRT/RCP, director of strategic market sales and clinical support at NDD Medical Technologies, a company that produces pulmonary function testing instruments.

At the start of the pandemic, some companies saw a need to create new in-line filters for their PFT devices. For instance, NDD Medical Technologies worked to test about two dozen available filters with the company’s spirometers to offer protection to clinicians. 

“We did take the time to rigorously test like every filter on the market to see if we could get a good filter that would work with our device, but still keep it accurate,” said Burgess. The new NDD Medical Technologies filter was launched to providers last summer.

“Right now, it is important to have something like that in place during pulmonary function testing,” she said. 

It is important that the filters have been validated, not just by the manufacturer, but by independent studies, said Janson Lanier, a formers respiratory therapist and the national sales and business development manager for healthcare at Vitalograph.

Vitalograph filters are independently tested through Nelson Labs to ensure that the filters are capturing 99.99% effective at blocking bacteria or viruses.  

Burgess said to ensure that the PFT device is providing an accurate reading while the filter is in place, she recommends referring to the manufacturer for guidance. Aside from the use of filters, common sense approaches to cleaning equipment still apply.

“The biggest things that I encourage as an RT and educator for PFTs is making sure that your providers are protected first and foremost, making sure that they are in adequate PPE for an aerosol generating procedure, making sure that an appropriate COVID screen has been done on these patients,” Burgess said. 

Flexible PFT Systems

Even if PFT filters are doing their job, the thought of patients breathing through the system for days or weeks may be an unsettling thought for staff members. The ability to change the patient breathing circuit/block without losing time is an effective way to deal with this situation.

“When looking at replacement equipment, verify that the entire breathing circuit/block can be removed and easily cleaned, or possibly economically discarded, without having to wait for warm-up time and recalibration,” said Cook. 

Cook explains that all of the MGC Diagnostics’ PFT products, including Platinum Elite Plethysmograph & Ultima Series, have a removable patient circuit and allows for quick replacement of the entire breathing circuit. 

The flow sensor and breathing circuit can also be exchanged to help with infection control without having to wait for the system to warm up or having to recalibrate.

By being able to break down the system, and easily clean and replace parts, clinicians can ensure that each patient has a clean breathing circuit. 

Consider the Air

During the pandemic, some medical facilities had to get creative to keep their staff safe. Some sites, Burgess said, were taking patients outside when conducting spirometry just to reduce the possibility for contamination inside. 

Another popular infection control tool that has gained a more robust foothold during the pandemic is air exchange systems. HEPA air filters and negative pressure rooms have also gained attention as ways to stop the spread of the disease. Some HEPA filters even have added UV light exposure to further disinfect the air. 

A formers respiratory therapist, Lanier suggested that providers might consider adding extra time in between appointments to allow the air in the room to settle or be filtered. 

To decrease wait times between patients, but still ensure clean air, Cook recommends a fast HEPA filter from Airpura. The air filter has a high rate of air exchanges per minute. It also comes with a UV light and a pre-filter for several layers of protection in removing 99.99% of airborne contaminants from the air. 

All these new infection control measures have taken a toll on providers. The increase in cleaning time has cut down on the number of patients clinicians can see in a set period of time, but there are several tools that can decrease this burden. 

Cook anticipates that demand for pulmonary testing will continue to rise due to the coronavirus and administrators need to be prepared. 

“Labs that used to be able to handle same day appointments are now having patients wait weeks or even a month before getting them in for testing,” he said. “And when we look at monitoring many of the patients who have recovered from COVID, the demand for diagnostics services will probably remain high for quite some time.”


RT

Lisa Spear is associate editor of RT. For more information, contact [email protected]