Minimize Contact and Disinfect
Many clinics who are able are leaving the door to the clinic open, so the doorknob is one less surface to touch. They are not having individuals sign-in so community pens are not being touched. Reducing the number of surfaces that need to be touched is a good goal. It is reasonable to encourage patients to use hand sanitizer when they enter the clinic space for everyone’s safety.
Do not shake hands in greeting and minimize physical contact in general. You will want to wash your hands frequently which is already an expected practice in a health care setting, but you will want to be even more vigilant. Do not touch your face; this is a primary way to avoid exposing yourself to anything that is on your hands (this is always a good practice but one we want to be especially aware of in the current situation).
You will want to disinfect all surfaces including chairs, tables, counters, and door handles between patient visits. Throughout the day, wipe down community spaces with disinfectant (e.g., door handles to the restroom, keyboards, etc.). Make sure you wear gloves when disinfecting, these agents should not touch your skin.
Keep in mind, the current recommendation is to limit human contact as much as possible. Therefore, all non-essential appointments should be postponed. Each of you will need to work within your own clinic environments to determine who these individuals are and how they should be managed—just keep in mind that the overarching goal is to limit contact.
Please note that the following cleaning and maintenance instructions should be followed at all times, and not just during the COVID-19 outbreak
KUDUwave Cleaning and Maintenance
The KUDUwave is a highly sensitive, state of the art device that must be treated with care. It must be cleaned and disinfected regularly and care should be taken not to damage any of the sensitive microphones or speakers when cleaning or handling the device.
The KUDUwave must be thoroughly cleaned and disinfected after each and every use (i.e. before each new patient is tested) with a cleaning and disinfection wipes complying with EN1276 that are intended for use on plastic items.
When Cleaning the KUDUwave:
- Disconnect all USB cables and use an antibacterial wipe to clean the KUDUwave headset, ear cups, sound tubes, response button and the bone vibrator (if it was used).
- It is important to ensure that during cleaning no liquid enters any holes in the ear cups.
- Used foam eartips must be disposed of after each test as medical waste.
- When cleaning the device, avoid bending or twisting any of the cables or sound tubes.
- If any permanent sharp bends, cracks or holes in the sound tubes are visible, replace them with spares provided. Calibration can be verified using the standard daily biological calibration check routine.
- Check that the sound tube or stainless steel ear-tip coupler has not become blocked or obstructed over time.
- Check that no disinfectant liquid is blocking the couplers that insertinto the ear tips. Liquid occlusion of the couplers can cause up to a 20dB shift in calibration.
Warning: Never use acetone based cleaning products when cleaning the KUDUwave.
Note: Ear wax and debris can collect in the ear probe. Make sure that there is no debris on the ear probe or inside the disposable ear tip before placing an ear tip. Once debris or any foreign material has lodged into the little holes of the ear probe, it may be possible to remove the debris from the holes. If debris enters the holes, then the debris must be removed, cleaned and disinfected and the calibration should be verified using the standard biological calibration verification routines.
Warning: Make sure that there is no debris or cleaning liquid on the ear probe or inside the disposable ear tip before placing the ear tip onto the ear probe.
Note: The recommended daily biological calibration routine is as follows: Put the KUDUwave on your head and do an automatic KUDUwave pure tone threshold test of all the octave frequencies. Save the test results. Remove the KUDUwave, turn it around so that the left side is on the right ear and the right side is on the left ear and redo the automatic KUDUwave pure tone threshold test. Compare the left and right thresholds of the two tests with each other. None of the thresholds of the compared sides may differ with more than 10 dB.
Should you have the X-check on your KUDUwave the recommended daily biological calibration routine is as follows: Click on the X-Check button in the system menu on the left hand side or top right side. Plug the left sound tube into the bottom of the left cup of the KUDUwave where the grey X-check port t is visible, do the same with the right sound tube on the right cup, and when you are ready then click start. The KUDUwave will then automatically start the daily biological calibration check for you, once finished, save the report and continue with your testing.
Note: The X-Check verifies the calibration of the KUDUwave. This does not replace the need for calibration as per your local standards
Note: Disposable ear tips of different sizes act as a barrier between the ear probe and the patient. Never reuse disposable ear tips because old ear wax and cleaning solutions can damage the ear probe permanently. Cleaning solutions also damage the foam of the eartips and can lead to incorrect readings. It is an irresponsible risk to clean eartips for re-use, as cleaning solution or wax can end up inside the ear probe and give incorrect results.
Warning: Never reuse disposable eartips. Eartips are cheap and any perceived cost saving will not outweigh the risks to the device and more importantly, the patient.
Note: Disposable ear tips are classified as waste which is subject to special requirements for disposal and should be disposed of in accordance to the applicable regulations.
Orca Cleaning and Maintenance
The Orca Spirometer™ is a highly sensitive, state of the art device that must be treated with care. It must be cleaned and disinfected regularly and care should be taken not to damage any of the sensitive parts or areas where any moisture can penetrate the device when cleaning or handling the device.
The Orca Spirometer™ must be thoroughly cleaned and disinfected after each and every use (i.e. before each new patient is tested) with cleaning and disinfection wipes complying with EN1276 that are intended for use on plastic items.
When Cleaning the Orca Spirometer:
- Use an antibacterial wipe to clean the outside of the main body, handle and flow tube.
- It is important to ensure that during cleaning no liquid enters any holes in the device.
- Used disposable mouthpieces must be disposed of after each test as medical waste, in accordance with the applicable regulations of the specific country where the Orca Spirometer™ is used.
- When cleaning the device, avoid bending or twisting the cable.
- If any permanent sharp bends, cracks or holes in the cable are visible, contact eMoyo immediately before continuing testing.
- Once daily remove the spirometer flow tube and soak in boiling water for 10 minutes. Remove from the hot water and spray thoroughly with running water to remove any debris. Soak the head in a Milton, or similar bleach solution, as per manufacturer's instructions. Shake the solution out, dry and spray or wipe with EN1276 compliant wipe or solution.
- Make sure no liquid is blocking any of the small tubes inside the flow tube.
Warning: Never use acetone based cleaning products when cleaning the Orca Spirometer.
Warning: Never reuse disposable mouthpieces. Mouthpieces are cheap and any perceived cost-savings will not outweigh the risks to the device and more importantly, the patient.
Note: Disposable mouthpieces should be checked for any obstruction or blockages or loose material inside the tube before fitting them onto the Orca Spirometer.
Note: The disposable mouthpieces are classified as waste which is subject to special requirements for disposal and should be disposed of in accordance to the applicable regulations.
Note: If cross-contamination is a high risk between test subjects then if clinically acceptable, only expiratory spirometry testing is recommended.
Products to clean and disinfect your KUDUwave and Orca
D-Germ or similar product can be used. It contains 70% Propyl Alcohol and emollients and 0.5% Chlorhexadine Gluconate. Chlorhexidine gluconate is a water-soluble, cationic biguanide that binds to the negatively charged bacterial cell wall, altering the bacterial cell osmotic equilibrium.
The solution can be sprayed directly onto clean fabric swabs and then used to wipe down the KUDUwave or Orca. Pay particular attention to cables and areas in contact with the patient directly, as well as in contact with the healthcare practitioner.
Please be aware that there are severe shortages of these products in South Africa, and in fact worldwide, due to the demands as a result of the COVID-19 pandemic.
If there is a shortage of this product then the second-best option will be any other solution that contains 70% alcohol.