Beyond the Front Line

Innovative contributions from SONHS in the fight against COVID-19


COVID-19 has led to life disruptions and fear, isolation and financial distress. In these turbulent times, the School of Nursing and Health Studies is focused on initiatives aimed at curbing the pandemic’s profound effects on global health and well-being.

With increased isolation raising the risk of domestic violence, for example, Nick Metheny, SONHS assistant professor, is an investigator on a Canadian-based project aimed at keeping women and children safe during COVID-19-related home confinement. Substance use, not to mention the heightened danger of smoking amid a pandemic that attacks the lungs, is another issue being targeted by Denise C. Vidot, assistant professor. Vidot designed a COVID-19 Cannabis Health Questionnaire and is principal investigator on related multi-institution studies to understand cannabis consumer behaviors during the pandemic. Preliminar y results from over 3,000 respondents in dozens of countries have demonstrated, she warns, “an alarming prevalence of anxiety and depressive symptoms associated with increased alcohol and non-medical cannabis use since the start of the pandemic, particularly among young adults.”

COVID-19 also has intensified an already high rate of health disparities among people with disabilities. To support equitable, objective treatment of this vulnerable population, Ashley Falcon, assistant professor of clinical, led the creation of a rapid response team training in collaboration with the Miller School of Medicine’s Mailman Center for Child Development. The free online course, “Preventing discrimination against people with disabilities during a public health emergency,” is available at https://bit.ly/2QcnD98.

Harnessing simulation to support their frontline colleagues from behind the scenes, SONHS faculty Juan E. Gonzalez, director of the B.S.N.-D.N.P. Nurse Anesthesia program, and Greta Mitzova-Vladinov, associate director, provided certified registered nurse anesthetists (CRNAs) from UHealth Tower with hands-on refresher courses at the Simulation Hospital for Advancing Research and Education (S.H.A.R.E.™). The sessions have focused on ultrasound-guided central line insertion, a highly specialized skill.“This gives us a chance to ser ve other nurse anesthetists in the UM community so they can better ser ve the community at large during the COVID-19 pandemic,” says Mitzova-Vladinov.Read on to learn other ways SONHS faculty and students are combatting this global health crisis.

 

Teaming Up for Healthcare Workers

 

Looking like something out of a horror movie, smoke billows from the patient simulator’s nose and mouth, filling the clear acr ylic chamber encircling its head. This dramatic scene played out during a series of prototype tests conducted recently at the Simulation Hospital for Advancing Research and Education (S.H.A.R.E.™).

The theatrical fog streaming from the retrofitted manikin is intended to replicate the aerosol and particle spray that occurs during intubation. This invasive ventilation procedure requires clinicians to be mere inches from their patient’s face, a concern for contagion even with the requisite personal protective equipment (PPE) in place.

“We’re trying to elucidate exactly how the particles spread and how they affect the intubator,” explains Nichole Crenshaw, the SONHS assistant professor of clinical performing the mock intubations to test the effectiveness of the chamber-like acrylic barrier.

Crenshaw and Professor of Clinical Jeffrey Groom, director of special projects for S.H.A.R.E.™, are members of the University of Miami’s COVID-19 Preparedness Committee, a team of engineers, architects, physicians, nurses, and other innovators recruited by vice provost for special projects, Jean Pierre Bardet.

“Our role is to weigh in on the clinical discussions and help facilitate any prototype testing that could be done in the setting of S.H.A.R.E.,” explains Groom.

He, Crenshaw, and Richard McNeer, a professor of anesthesiology at the Miller School of Medicine, are finalizing the prototype along with members of the College of Engineering and School of Architecture. The final product will be part of committee’s initiative to 3-D print and fabricate devices and PPE that will better safeguard medical personnel from COVID-19.

McNeer, the team’s lead, obser ved that the protective intubation box, or barrier, flawlessly shielded Crenshaw from smoke exposure. Something else he noticed led to an “aha” moment for all involved.

If Crenshaw positioned the Yankauer, a commonly used oral suctioning tool, strategically near the base of the manikin’s vocal cords, known as the periglottic region, she could evacuate most of the aerosol particles prior to intubation.

“It was a serendipitous discovery,” recalls McNeer. “Suction has been used to remove ever ything from stomach contents to blood. But this is perhaps the first time it’s been considered for use in suctioning out aerosols. This is something that can be done upstream of just about any of the other strategies and safety measures to prevent exposure to the virus during intubation.”

Groom, a nurse anesthetist and former paramedic, says the team’s work has implications beyond COVID-19 and recommends that both an intubation shield and periglottic suctioning be used by any health care worker facing infection risk from aerosol or particle exposure.

“Being a part of this project has been a way to make sure we’re all staying safe,” says Crenshaw, a nurse practitioner in the ICU at Jackson Memorial Hospital. “There’s been a heightened sense of taking care of each other during this crisis. That’s what has stood out to me more than anything.”