Innovators and researchers across Northeast Ohio have come together to rapidly find and implement solutions to help protect patients, caregivers and the community during the global pandemic.
Developing a new vaccine or treatment for COVID-19 will take time as new medications wind their way down a regulatory path to be tested and proven safe and effective. Scientists around the globe are racing to find these answers.
Meanwhile, many others are working toward fixes that can be implemented more rapidly to mitigate and track spread of the virus, protect caregivers and address shortages of personal protective equipment (PPE).
“Where I think innovation has been able to be so thoughtful and, quote unquote, rapid-to-market in response to the pandemic is in looking at ways to better protect patients and protect health care practitioners and capitalizing on opportunities that already existed in the marketplace, but looking at creative solutions to deal with raw material shortages, to deal with a lack of access for traditional manufacturing practices,” said Dr. Brian Rothstein, assistant professor of pediatric neurosurgery and clinical ventures fellow for University Hospitals‘ innovation arm, UH Ventures.
“And at the end of the day, really just outside the box thinking on how we can make health care as safe as possible in a very challenging and unpredictable time,” Rothstein said.
The work has not only offered practical solutions but also prompted new partnerships that may not have otherwise existed. For instance, UH worked with MAGNET, the Manufacturing Advocacy and Growth Network in Cleveland, to quickly develop testing booths — structures that allow a practitioner to directly interact with a patient through a Plexigas wall and long laboratory-quality testing gloves. After providing nasal swab testing for a patient, the front can be wiped clean, helping to preserve PPE.
MAGNET created a design for this booth less than two days after UH brought them the idea, Rothstein said. UH now has four of them in use throughout the system. Though people in the two organizations work together here and there, that collaboration may have never happened outside of COVID-19.
“I think that’s one of the most exciting aspects of this is that there’s been a level of trust that and engagement forged,” said Brandon Cornuke, MAGNET vice president. “It’s created a ton of respect and trust and knowledge that I believe is going to pay dividends in our region in terms of innovation and collaboration for a long time.”
Dr. Lara Jehi — chief research information officer for Cleveland Clinic, whose research background includes data research and predictive modeling — helped develop a risk prediction model for health care providers to forecast an individual’s likelihood of testing positive for COVID-19 and their outcomes.
Jehi also noted a new nursing practice implemented in response to the pandemic: IV lines were extended to allow providers to access IV and other pumps from outside a patient’s isolation room, preserving PPE. But the resulting lines of tubing laying on the floor presented potential safety issues, like tripping or line dislodgement.
Prior to COVID-19, an advanced practice pediatric nurse at the Clinic had developed the High-Line — a system that can keep tubing off the floor — and was in the process of initiating a research study to assess its value. It’s in place today to help lower the average of 66 pieces of PPE that caregivers typically use each day when caring for patients requiring isolation in intensive care units.
Innovations put in place during COVID-19, including a survey integrated into patients’ medical records to monitor symptoms, and other advances in research have the potential to help patients well into the future. The pandemic also has shown what can be achieved when innovators, researchers, industry, government and others set aside excuses (collaboration is too complicated, or there are insurmountable hurdles) and all work together, Jehi said. Now that COVID has helped show rapid, broad collaboration is possible and effective, she is hopeful that will help accelerate innovations in the future.
“It took having a common enemy, really. We all knew that COVID is what we need to fix,” Jehi said. “It’s a pandemic. It’s a life-threatening virus. It’s either it or us, and we have to figure it out.”
With PPE shortage concerns top of mind, many organizations shifted gears to begin production of needed supplies while some researchers worked to find ways to maximize safe use of existing products.
MAGNET assembled a supply chain of more than 20 partners across Ohio to help make face shields. Plus, the organization has helped create 3D-printed swabs locally, started down the path of creating a new type of ventilator and supported local production of more isolation gowns.
At Case Western Reserve University, work at the Sears think[box] innovation center led to an invention that rapidly disinfects N95 respirators. Ian Charnas, director of innovation and technology at Sears think[box], put together a small engineering team that worked with medical researchers at CWRU to develop a decontamination chamber that uses UV-C light to effectively decontaminate the N95 masks.
The Synchronous UV Decontamination System (SUDS) can decontaminate an N95 mask in just 60 seconds.
Charnas thinks this is much more practical for many systems than other options like a hydrogen peroxide vapor chamber that can sterilize tens of thousands of N95 masks. That process requires a lot more staffing, as well as tracking systems to ensure that masks are returned to the same clinician who used it before.
With SUDS, a clinician can exit an ICU room, place their N95 mask in the chamber to be decontaminated as they remove other PPE (cap, gown, booties, glove) and wash up. By the time they’re done, the door on the chamber pops open with a decontaminated mask.
“I think every innovation team that’s worth their salt right now is working on COVID-related projects,” Charnas said.
At University Hospitals, critical care physicians Drs. Amrita John and Shine Raju are exploring another way to decontaminate PPE: peracetic acid, a chemical disinfectant commonly used in the health care, food and water treatment industries.
The husband-wife duo, who have been caring for a lot of really sick COVID-19 patients in intensive care, had a lot of discussions around the dinner table about the challenges they and other health care providers were facing, Raju said.
“We both knew that when and if this does hit Ohio, we’re going to be in the thick of it,” John said. “We could already see how badly it was affecting our colleagues in New York. For me, I said this is our time. This is our time to prepare because we see what lies ahead. And to waste this time would be very foolish.”
John and Raju began looking for ways to help and ultimately found the peracetic acid application.
Because Ohio didn’t experience the surge that was first projected, UH hasn’t had to use this process on masks, but is currently using it to help decontaminate ventilators. The system currently has a dedicated room for this decontamination process, in which the peracetic acid is aerosolized and acts like a gas to reach difficult-to-clean areas of the ventilators.
The peer review process for their research is ongoing, and the U.S. Food and Drug Administration is reviewing the peracetic acid method, which has been proven to work for five cycles of decontamination, for an emergency use authorization.
UH collaborated with NASA’s Glenn Research Center to develop the peracetic acid method as well as an atomic oxygen method to decontaminate PPE for applications in aerospace and medicine.
In the past few months, University Hospitals has developed relationships with industries “far beyond what we’d ever imagined would be considered a part of the health care environment,” Rothstein said.
“And I think that that really will contribute to our ability to remain nimble, to remain really at the top of our innovation game, to be able to rely on these brilliant people who have different backgrounds than those of us who work in health care, to continue to solve the problems of how we deliver safe, effective and compassionate care to our patients.”
