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LONDON, ON – Led by Lawson Health Research Institute, London Health Sciences Centre (LHSC), University Health Network (UHN) and General Dynamics Land Systems-Canada (GDLS-Canada), researchers have designed a non-invasive ventilation mask that could significantly reduce aerosolization – the production of airborne respiratory droplets that may contain viruses or bacteria – when treating patients with COVID-19. The new device aims to reduce infection risks associated with non-invasive ventilation and lessen the demand for invasive ventilators. It is currently being tested through a clinical trial with patients at LHSC.

“Since the beginning of this pandemic, there have been global concerns about a shortage of ventilators,” says Dr. Tarek Loubani, Lawson Associate Scientist and Emergency Department Physician at LHSC. “Non-invasive ventilators like CPAP (continuous positive airway pressure) and BiPAP (bi-level positive airway pressure) machines are associated with an increased risk of COVID-19 transmission and so many hospitals have moved directly to invasive ventilation.”

COVID-19 is primarily spread through inhalation of respiratory droplets and the most severely ill patients require a ventilator to help them breathe. Unlike invasive ventilators, which require intubation, non-invasive ventilators help patients breathe through a mask that provides positive pressure to keep the lungs open and functioning. While non-invasive ventilators may be effective for some COVID-19 patients, their use comes with a much higher risk of spreading infection through aerosolization of respiratory droplets.

The team’s non-invasive ventilation mask aims to eliminate this risk. The novel device is customized from a standard firefighter’s mask using 3D printing and can be attached to any CPAP or BiPAP machine. Unlike traditional masks, it creates two tight seals – one around the patient’s nose and mouth and another around the face. Patients breathe in and out of a filter that captures any viral particles before they are released to the air.

“There are countless CPAP and BiPAP machines idling around the world while all resources go towards invasive ventilation,” explains Dr. Azad Mashari, Anesthesiologist at UHN’s Peter Munk Cardiac Centre. “Our mask aims to put these machines back into the clinician’s toolkit. By eliminating air leaks, we can improve patient safety and significantly reduce the risk of contracting COVID-19 for health-care workers and other patients.”

Drs. Loubani, Mashari and Benjamin Thomson, Nephrologist at Mackenzie Health, were part of a clinical research team that worked with engineers from GDLS-Canada to develop the device within six days.

“GDLS-Canada responded quickly to the urgent need to support those on the COVID-19 healthcare frontlines during this global health emergency,” says Doug Wilson-Hodge, GDLS-Canada’s Manager of Communications, Community and Government Relations. “The innovative design was very much a collaborative effort between all parties to contribute solutions to the COVID-19 pandemic.”

The initial clinical trial will test the device with up to 50 patients at LHSC’s Victoria Hospital and University Hospital with plans to expand to UHN. In addition to patients with COVID-19, participants will include those with asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF).

The research team anticipates other hospitals in Ontario and across Canada will join the study to create a multi-centre clinical trial. The device will be used in emergency departments and has potential to be used in intensive care units, remote nursing stations and during pre-hospital transport. It has also been designed for easy production in resource-strained locations. 

“This problem affects everyone and it’s critical that we all do what we can to help,” adds Dr. Loubani. “We hope it will help not only those in urban centres like Toronto and London, but people in remote communities around the world.”

The trial is being supported with funding from Glia, an organization internationally recognized for producing medical supplies that are easily accessible and can be manufactured in low-resource settings.

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LONDON, ON – At a virtual event today, a research team from Lawson Health Research Institute is announcing details of the Methamphetamine Harm Reduction Project that will test the integration of harm reduction strategies into hospital settings for people who use methamphetamine. 

Evidence-based harm reduction strategies for methamphetamine use, for example needle/syringe services, supervised injection sites and safe supplies, have been used in the community to reduce health risks such as infection and overdose. “Harm reduction strategies are rarely used within hospitals in Canada. The current standard of care does not allow the use of illicit substances in hospitals as the safe consumption of substances requires an exemption under section 56.1 of the Controlled Drugs and Substances Act from Health Canada,” explains Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson and study co-principal investigator.

Recent studies from London, Ontario found that substance use in hospital is happening and poses a greater risk of infection than in the community. 

“There is an assumption that people in hospital aren’t using, but in fact we’ve found that almost 50 per cent of patients admitted to hospital with an infection related to substance use are continuing to inject during their stay. That is clearly an underestimate because many patients are worried about being stigmatized or other consequences of using in hospital and so may not be willing to report it to researchers or tell their health care providers,” explains Dr. Michael Silverman, Associate Scientist at Lawson, city-wide Chair/Chief of Infectious Diseases for London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London, and study co-principal investigator.  

Findings have shown that patients are more likely to get an infection related to substance use when being treated in the hospital as opposed to other settings and many people who are using leave hospital against medical advice, putting their health and safety at risk. “People aren’t able to access safe ways to use substances and they are doing it in secret, so it’s not the best way to do it to prevent infection. There are also gaps in support for withdrawal and other addiction services,” says Dr. Silverman.  

The research team will lead a four-year project with recruitment of up to 360 adults aged 16-85 years with past experience or current use of methamphetamine, including inpatients, outpatients and those in community outreach programs. Up to 180 health care and service providers will be recruited to share their perspectives on harm reduction strategies. After the consultation phase in the first year, with approval from Health Canada, the identified set of strategies based on the perspectives of people with lived experience will be implemented within LHSC and St. Joseph’s hospital sites. 

“To our knowledge, there are only five supervised consumption services based in acute care hospitals in the world. Three of these sites are in Europe and there are two locations in Canada that have implemented a similar approach. London will be the second place in North America to implement harm reduction strategies for substance users within hospital walls,” adds Dr. Forchuk. “We are leading the way towards a groundbreaking shift to greatly improve health care for Canadians who use substances.”  

Potential harm reduction strategies are safe injection sites or safe places to use substances, new needles and syringes, available Sharp boxes, support for detox and withdrawal, medication, resources at discharge, and enhanced addiction services and counseling.  

Sonja Burke, the Director of Harm Reduction Services at the Regional HIV/AIDS Connection, notes there has been a marked increase in more complex health care needs and a high rate of deaths in the community for people who are experiencing homelessness and addiction. 

“Harm reduction is about meeting people where they are without stigma or assumptions, accepting that substance use is a part of their life,” says Burke. “Our experience in the supervised consumption services proves that once a person is able to use their pre-obtained substances, they will engage in further supports for their health care. We have to change how the supports are being provided within the system to ensure we are reducing health risks and death.”  

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