EH 6/2014

www.totoku.eu The new CCL650i2 When size matters - 6 Megapixel - 30inch - 800cd/m² brightness LEDBACKLIGHT C M Y CM MY CY CMY K EH@ECR Currently there is a truly enormous hole in the ground in the city of Wiener Neustadt, Austria, but by summer 2012 MedAustron, one of the most modern centres for ion therapy and research in Europe, is to be built here. After two treatment centres in Germany failed, gaining from the experience and failure in others, this €200 million MedAustron project will be one of four ion therapy centres worldwide to offer treatment with protons as well as carbon ions Ion therapy is considered a great beacon of hope in cancer care – especially for tumours with no hope for a around 70,000 have received ions. This inclu protons as we ‘This therapy is ferent from c radiotherapy a by increased, effectiveness,’ Ramona Maye MedAustron. ‘T of the ray allow geted applicati certain tumour slow-growing, tumours, or tum imity to radiati will particularl procedure whic plement to che gery in these ca The ions hav to up to 70% o with the help o tor. Financed by Austria, the sta and the City o the MedAustro on 50 years of by the Euro for Nuclear R Geneva, Switz Institute for Pa wide, for the its own accel ‘The accelerat will basically world’s larges tor, the LHC, big bang exp explained Dr Managing Direc ‘The design wh the so-called Machine Study on a synchrotr erator with a around 80m, w particles to hig 40 MedAust spent several CERN on the Belg Ever grow cancer th Around half a d gigantic cyclotro therapy, yet ove technology. The of the working p has also installe Prague, Paris (O East, three of its Korea and one i In late Novem showing a signi same period in 2 performance in systems sold in financial quarte an ultra-compac This first insta solution will be In January 20 diagnosis and Applications Olivier Legrai became Chief succession to CEO Pierre M Board – prior Such neat pla typify the int 2,100 profess diagnostics a specialist firm EUROPEAN HOSPITAL Publisher, Theodor-Althoff-Str. 45, 45133 Essen, Germany Phone: +49 (0)201 87 126 850 Fax: +49 (0)201 87 126 864 E-mail: info@european-hospital.com Editor-in-Chief Brenda Marsh Art Director Mary Pargeter Managing Editor Brigitte Dinkloh Editor Karoline Laarmann Production & Distribution Janka Hoppe Russian Supplement Sergey Bezrukov, Fibrotex GmbH, Fischerstr. 1, 40477 Düsseldorf Phone: +49 211 550 49 70, E-mail: ﬁbrotex@gmx.net Executive Director Daniela Zimmermann Founded by Heinz-Jürgen Witzke Correspondents Austria: Michael Kraßnitzer, Christian Pruszinsky. France: Annick Chapoy, Jane MacDougall. Germany: Anja Behringer, Annette Bus, Bettina Döbereiner, Karl Eberius, Guido Gebhardt, Walter Schäfer, Susanne Werner, Holger Zorn. Great Britain: Brenda Marsh, Mark Nicholls. Malta: Moira Mizzi. Poland: Pjotr Szoblik. Russia: Olga Ostrovskaya, Alla Astachova. Spain: Eduardo de la Sota. Switzerland: Barbara Steinberg, Dr. André Weissen. USA: Kerry Heacox, i.t. Communications. UK editorial address 55 Wey Meadows, Weybridge, Surrey KT13 8XY Subscriptions Janka Hoppe, European Hospital, Theodor-Althoff-Str. 45, 45133 Essen, Germany Subscription rate 6 issues: 42 Euro, Single copy: 7 Euro. Send order and cheque to: European Hospital Subscription Dept Printed by Frotscher Druck Darmstadt, Germany Publication frequency bi-monthly European Hospital ISSN 0942-9085 Representatives China & Hongkong: Gavin Hua, Sun China Media Co., Ltd, Room 802, 15th Building, BinJiang Residential Quarter, Dongyuan Road, Futian District, Shenzhen, Guangdong, China, Code: 518031 Phone: +86-0755-81 324 036 E-mail: gh@european-hospital.com Germany, Austria, Switzerland: Ralf Mateblowski Hintergasse 1, 55234 Hangen-Weisheim, Germany Phone: +49 6735 912 993 E-mail: rm@european-hospital.com France, Italy, Spain: Eric Jund, 2264 Chemin de Sainte Colombe, 06140 Vence, France Phone: +33 493 58 77 43 E-mail: ej@european-hospital.com GB, Scandinavia, BeNeLux: Simon Kramer, Willem Alexander Plantsoen 25, 2991 NA Barendrecht Phone:/Fax +31 180 6200 20 E-mail: sk@european-hospital.com Israel: Hannah Wizer, International Media Dep. of El-Ron Adv. & PR Co., Ltd., 7, Leteris street, Tel-Aviv 64166, Israel Phone: +972-3-6 955 367 E-mail: hw@european-hospital.com South Korea: CH Park, Far East Marketing Inc, Room 103-1011, Brown Stone, 1330, Baekseok-dong, Ilsan-ku, Goyang-si, Gyunggi-do, Korea 410-360 Phone: +82 2 730 1234 E-mail: ch@european-hospital.com USA & Canada: Hanna Politis, Media International, 8508 Plum Creek Drive, Gaitherburg, MD 20882, USA Phone: +1 301 86 96 610 E-mail: hp@european-hospital.com EUROPEAN HOSPITAL www.european-hospital.com EUROPEAN HOSPITAL Vol 23 Issue 6/14 2 NEWS & MANAGEMENT On 29 July, Dr James Ritchie was attending the American Association of Clinical Chemistry’s annual conference in Chicago when he received the call that a physician and missionary worker, who had been in West Africa, were headed to Atlanta’s Emory University Hospital. Nearly four months later, Ritchie, an associate director of the core and toxicology laboratories at the hospi- tal, shared some of the lessons he and his staff learned in eventually treating four ebola patients. During a webinar hosted in November by the American Association of Clinical Chemistry (AACC), he explained: ‘Laboratory testing … was what really made the difference between the treatment they would received in the U.S. compared to the treat- ment they would have received in West Africa, where they were sta- tioned.’ Emory University certainly had a leg up in handling the virus. The facility’s Serious Communicable Disease unit was established in 2003, after the facility was approached by the U.S. Centers for Disease Control, also based in Atlanta, about provid- ing a place where workers could come if they contracted a virus in the field, or had an accident at one of their laboratories. Lab staff was comprised of four different medical technologists, all point-of-care (POC) coordina- tors who trained every six months. Ritchie said they used a completely isolated facility instead of the main lab for testing, out of an ‘abundance of caution’, and because it was available, though he notes that a dedicated lab is not required when working with ebola. Protective clothing and an observer’s surveillance Of course, caution was also taken when interacting with the patients. Lab workers, as well as nurses and doctors, would first go into a clean anteroom, put on paper scrubs and plastic shoes in a locker room and then don protective gear before going into the patient’s room. There was always a safety person, who was nearly suited up, looking on in case there was an accident. After leaving, the visitor would remove their gloves, wash their hands and doff their PPE in a special ‘hot area,’ before going into the locker room to shower. Even with so much already in place, the facility needed to be flexible. In the lab, with doctors requesting more and more tests, they had to expand from one particular chemistry rotor to a whole family of chemistry rotors. Something Emory lab workers also found useful was a fully automat- ed PCR instrument from BioFire Diagnostics, which was used a lot to monitor respiratory, GI and blood culture infections to rule out other diseases the patient may have had. Communication was the key in coordinating testing, Ritchie said. At Emory, the lab technicians started out taking verbal orders from the physicians, but after a lot of mis- communication, with things getting done that weren’t ordered and vice versa, they switched to a paper requisition that the nurse or doctor filled out. There was a team meeting every morning to review plans and protocol and there were many open forums and town hall meetings. ‘It’s very important that every member of the team knows what’s expected of them and what’s going to be happening during the day,’ Ritchie pointed out. Staff in the area also had their tempera- ture taken twice daily and had to answer questions about symp- toms, which continued for 21 days after their last shift in the unit via the web. As the first commu- nity hospital in the United States to admit an ebola patient, staff at Texas Health Presbyterian Hospital, Dallas, also found that communica- tion was important in handling the virus. Beverly Dixon, medical direc- tor in the hospital’s department of pathology and laboratory medicine, offered a list: ‘Communication to the nurses to control times of testing and draws and allowable testing; communication to the doctors who would like to order everything in the EMR lab catalogue, which can’t really be done and turns out it isn’t necessary anyway; communication to staff in a manner that allows you to post lab menus so that they could know exactly what can be done.’ When the patient first came to the hospital, she said, they didn’t know he had ebola and the facility han- dled the specimens in the standard way, with ‘no negative outcomes.’ More stringent decontami- nation of instruments The second time, to rule out other illnesses, they ran the specimens using standard universal precau- tions, but with more stringent decontamination of instruments. There were two workers furloughed for 21 days, who were found to not have used standard precautions properly. Ultimately, 38 people were monitored. The facility did switch from standard universal precautions to using much more stringent PPE, which made staff feel much safer in handling the specimens, she said. Dixon advises labs to perform a risk assessment to figure out appropriate protocol and equip- ment for that facility. She recom- mends a template for public health risk assessment for the ebola virus that is available on the Association of Public Health Laboratories web- site. Dixon also recommended tak- ing a mock specimen and run- ning through the handling process. ‘During that observation, you’ll see things you would never have thought of while you were sit- ting there at a desk versus walk- ing through the actual procedure on an instrument with a mock specimen.’ Handling waste and shipping specimens Something Emory wasn’t prepared for was the amount of medical waste the patients generated. Ritchie said two patients generated a total of 350 bags, or about 3,000 pounds, of medical waste. Shipping specimens is also a big issue. While Emory University Hospital was lucky enough to have the CDC down the street, laborato- ries do need to plan a shipping strat- egy. Peter Iwen of the University of Nebraska Medical Center, noted that the facility found it challenging to arrange shipment of ebola sam- ples with a courier, and ultimately ended up spending $1,900 per sam- ple. ‘This was not an easy thing to do,’ he explained. Samples are required to be shipped as Category A infectious substances, which meant the per- son packaging the sample and the courier had to be certified. Once you have an ebola positive patient, the CDC will provide guidance, but the shipping issue will likely be a challenge. ‘You need to have this relationship with your public health laboratory,’ Iwen said. ‘You need to work out details of how you’re going to get samples from a patient that might be in your emergency department, who you are trying to screen or rule out ebola virus infec- tion.’ Seeking best practice EU: Mo Lisa Chamoff reports on a US lab that rapidly formed anti-ebola skills Dr James Ritchie, associate director of the core and toxicology laboratories at Atlanta’s Emory University Hospital Jane McDougall reports on pre- liminary findings from the EU funded initiative striving for greater equality in healthcare sys- tems across Europe. The European Commission has an ambition to create more equitable, cost-effective and available health- care throughout its member states. Dr François Meyer, International Advisor to the French Haut Autorité de Santé (HAS) presented results from one EU initiative, collaboration between HTA agencies (EUnetHTA), set up to help achieve these aims at a recent meeting organised by MAPI, a service provider to the global healthcare industry. Health technology assessment is a multi-disciplinary field of policy analysis that studies the medical, social, ethical and economic impli- cations of development, diffusion and use of health technology. It bridges the gap between the world of research and the world of deci- sion-making. In terms of Europe today, health- care systems are financed and organ- ised at the national level with inter- Editor-in-Chief: Brenda Marsh Art Director: Olaf Skrober Managing Editor: Chrissanthi Nikolakudi Editor: Brigitte Dinkloh Editorial Assistant: Sascha Keutel Senior Writer: John Brosky Executive Director: Daniela Zimmermann Founded by Heinz-Jürgen Witzke Correspondents Austria: Michael Kraßnitzer, Christian Pruszinsky. France: Annick Chapoy, Jane MacDougall.Germany: Anja Behringer, Annette Bus, Walter Depner, Bettina Döbereiner, Matthias Simon, Axel Viola, Cornelia Wels- Maug, Susanne Werner, Holger Zorn. Great Britain: Brenda Marsh, Mark Nicholls. Malta: Moira Mizzi. Poland: Pjotr Szoblik. Russia: Olga Ostrovskaya, Alla Astachova. Spain: Eduardo de la Sota. Switzerland: Dr. André Weissen. USA: Cynthia E. Keen, i.t. Communications, Jacquie Michels Subscriptions Janka Hoppe, European Hospital, Theodor-Althoff-Str. 45, 45133 Essen, Germany Subscription rate 6 issues: 42 Euro, Single copy: 7 Euro. Send order and cheque to: European Hospital Subscription Dept Printed by: WVD, Mörfelden-Walldorf, Germany Publication frequency: bi-monthly European Hospital ISSN 0942-9085 Representatives China & Hongkong: Gavin Hua, Sun China Media Co, Ltd. Phone: +86-0755-81 324 036 E-Mail: gh@european-hospital.com Germany, Austria, Switzerland: Ralf Mateblowski Phone: +49 6735 912 993 E-Mail: rm@european-hospital.com France, Italy, Spain: Eric Jund Phone: +33 493 58 77 43 E-Mail: ej@european-hospital.com GB, Scandinavia, BeNeLux: Simon Kramer Phone/Fax: +31 180 6200 20 E-Mail: sk@european-hospital.com Israel: Hannah Wizer, International Media Dep. of El-Ron Adv. & PR Co., Ltd. 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EH 6/2014

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