We recommend you clean equipment often. Surfaces with direct exposure to patients (e.g., procedural area, isolation area) should be cleaned between patients.¹

• We have a summary list of cleaning solutions that have been tested to be compatible with BD Pyxis^™ equipment.
• BD Pyxis^™ Cleaning Guidelines are available here.
• The current CDC guidance states that “routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.”2
• The Environmental Protection Agency List “N” includes all commercial products that meet EPA’s criteria for use against COVID-19.²
• Regarding the issue of cleanability of BD Pyxis^™ matrix bins and cubies, we also invite Pyxis users to review the use of disposable bin liners (example available here). A 2005 study entitled “An Evaluation of Medication Drug Bins as a Potential Source of Nosocomial Pathogens” (supported by HealthCare Logistics Company) advocated that “regular cleaning of bins or use of bin liners should be considered as a strategy to reduce nosocomial infections” and that bin liners may be a “convenient, quick to use, and low cost in comparison to a bin cleaning program” (reference).

The Centers for Disease Control and Prevention has released guidelines on both topics:

• Frequently Asked Questions About Hand Hygiene For Healthcare Personnel Responding To COVID-2019
• Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations
• Morbidity and Mortality Weekly Report. 2002. Guideline for Hand Hygiene in Health-Care Settings

A “clean hands” approach involving “wash in before” and “wash out after” is advised for accessing medications from dispensing devices.

Medications should be replenished with a “clean hands” approach beginning in central pharmacy, covered/protected during transport, and hand washing before touching BD Pyxis^™ and the medications that will be loaded/stocked. In areas with high potential for exposure, it may also be advisable that pharmacy staff wear gloves (in addition to any other personal protective equipment that is deemed warranted) and discarding it before leaving that area (helping to prevent spread). Gloves should not be considered a substitute for proper hand hygiene.

With a significant proportion of inpatients being treated as COVID+ or presumptive positive, we are seeing hospitals leaving used medications in the patient room. This is especially the case for multi-use, bulk, or patient-specific items (e.g., creams, ointments, eye drops, inhalers, spacers) regardless of COVID+ status. We can appreciate the challenge (especially those setting up temporary isolation rooms) in meeting this requirement during these difficult times. The TJC website reminds us that their definition of secure does “not prescriptively require medications to be locked (unless required by law and regulation),” and their intent is that medications are “protected from unauthorized access, tampering, theft or diversion”³.

Unused sealed items (e.g., medications, supplies, RSI kits, code trays, etc.) simply may not be feasible to clean in a meaningful manner (e.g., alcohol sometimes causes the labels to bleed and become unreadable, vials have uneven surfaces and crevices). In today’s environment of medication shortages (expected to get worse), strategies to avoid throwing these items away are needed. Considering the recent evidence that suggests the coronavirus can remain viable and infectious in aerosols for hours and on surfaces up to days⁴ (van Doremalen, 2020), many are looking at alternative strategies like sequestering these items for a period of time. At NYU Langone, Arash Dabestani (Sr. Director of Pharmacy) recommends having a plan for the process of cleaning and replacing crash carts from isolation areas. “It’s best to have a dedicated space to process and quarantine returned meds and med trays from isolation areas for a few days⁵.” Others are sequestering items in rigid storage containers for up to ten days⁶. Because the duration of coronavirus viability varies by surface type and the initial viral load, duration recommendations are still not clearly defined⁵. We recommend the “SFAIRP” approach (so far as is reasonably practicable) and sequester drugs as long as feasibly possible during these difficult times.

References:
³ Jointcommission.org. 2018. FAQ: Medication Security - Bedside Medications / Self Administration: Do Medications Kept At The Bedside Need To Be Locked?. [online] Available at: https://www.jointcommission.org/standards/standard-faqs/critical-access-hospital/medication-management-mm/000002190/ [Accessed 2 April 2020].

⁴ van Doremalen, N., Bushmaker, T., Morris, D., Holbrook, M., Gamble, A., Williamson, B., Tamin, A., Harcourt, J., Thornburg, N., Gerber, S., Lloyd-Smith, J., de Wit, E. and Munster, V., 2020. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine.

⁵ connect.ashp.org. 2020. American Society Of Health-System Pharmacists (ASHP), COVID-19 Connect Community. [online]. “ASHP Pulse on Managing COVID-19: Lessons Learned From NYU Langone Health”. Available at: https://connect.ashp.org/communities/community-home/digestviewer/viewthread?MessageKey=a1238126-c4a6-4b34-8229-7e272b825e42&CommunityKey=ef9cb3a4-f25b-4959-87bd-c87f60738bca&tab=digestviewer#bma1238126-c4a6-4b34-8229-7e272b825e42 [Accessed 31 March 2020].

⁶ connect.ashp.org. 2020. American Society Of Health-System Pharmacists (ASHP), COVID-19 Connect Community. [online]. “ASHP Pulse on Managing Code Carts and RSI Kits” Available at: https://connect.ashp.org/communities/community-home/digestviewer/viewthread?MessageKey=a1238126-c4a6-4b34-8229-7e272b825e42&CommunityKey=ef9cb3a4-f25b-4959-87bd-c87f60738bca&tab=digestviewer#bma1238126-c4a6-4b34-8229-7e272b825e42 [Accessed 31 March 2020].

1. Can BD Pyxis^™ Systems generate a utilization report to support the re-allocation of existing devices to use in improvised emergency response clinical areas?

Customers with BD Pyxis^™ systems can utilize the below reports to help identify the prioritization of device re-allocation:



MedStation 4000 customers:	Analyze the Service Message report for select devices (can be found within the System Activity reports menu) for daily statistics, and system activities for each station requested.
MedStation ES customers with Med Knowledge Portal (KP):	Compare the 1) device report from ES and 2) device utilization Report from Med Knowledge Portal (KP) to get a full list of devices with and without activity.
MedStation ES customers without Med Knowledge Portal:	Compare the 1) device report from ES to obtain a list of all devices in a facility and 2) Login Activities report from ES to determine which ones devices have low activity.


To move a BD Pyxis^™ system to a different location within the hospital, the customer will need to contact your local BD representative so a Field Service Technician can assist with the move.

To move a BD Pyxis^™ system to a different site ID, the customer will also need to contact your local BD representative so a Field Service Technician can assist with the move.

2. How does the BD Pyxis^™ Medication Label Module (MLM) help support a patient isolation workflow (like with COVID-19)?

MLM is an optional label printer (Zebra™ LP 2824 Plus USB printer, using a 2-inch continuous adhesive label strip) that allows the Pyxis MedStation^™ ES system (v1.4 and later) to print a patient (dose) specific medication label during the medication remove process. In addition to the medication details, the label denotes the patient identifiers and many other details including a scannable barcode. The label can be applied to any dispensed item and may be especially helpful for multi-use, bulk, or patient specific items (e.g., creams, ointments, eye drops, inhalers, spacers) that will likely stay inside the isolation room. This label also provides a method to avoid the need to take an entire multi-patient item (e.g., insulin, nitro ointment) into the isolation room for bedside barcode scanning. To help support the five rights of medication administration, you may wish to consider enabling the “scan on remove” functionality for high-risk items.



For more information	Document
MLM User Guide	Access via Customer Portal
MLM User Guide (short)	Access via Customer Portal
“Scans on Remove”, located on page 27 of the “How it Works Guide” of the BD Pyxis ES System (v1.6.1)	Access via Customer Portal

3. What can you tell us about some of the zone decontamination systems on the market like the peroxide aeration system from BioQuell, NanoVapor Biotechs Microbial Suppression System, or ultraviolet light Robot from Xenex¹?

We do not have any information on these systems. Please contact the manufacturer for more details.

Reference:¹  Manganello, K., 2020. Xenex Disinfection Services (COVID-19 A New Emerging Threat). [online] Xenex. Available at: http://www.xenex.com/resources/blog/wuhan-coronavirus/ & http://www.xenex.com/our-solution/ [Accessed 2 April 2020].

4. What recommendations are there if the cleaning agent I’m interested in is not listed on the Pyxis Cleaning Document or the Summary Table?

BD does not recommend using products not listed on BD documentation on BD products. You may wish to consult with the manufacturer of that product or with your own internal environmental services department for additional information.

5. For hospitals that have an urgent need for additional BD Pyxis^™ Equipment, is it possible to accelerate the process to obtain new BD Pyxis^™ equipment?

For accelerated access to BD Pyxis^™ equipment, BD invites you to reach out to your sales representative to discuss BD’s new BD Pyxis^™ Emergency Response – Rapid Field Hospital Deployment Program.

6. As it relates to accessing BD Pyxis^™ machines (e.g., vending, supplying), what are some concerns with wearing gloves?

First, gloves are not a substitute for hand hygiene, and the improper use of gloves can make problems worse by spreading disease.To prevent this, when leaving the high-risk area, remember to remove gloves in a manner to avoid further contamination and wash your hands after doing so. Second, individual users and/or the entire device may need to be enabled to allow login via password (as opposed to fingerprint, which is impossible through a gloved hand). Your local hospital BD Pyxis^™ administrator can enable this setting. Reminder: on older systems that do not have Active Directory (AD) connected to your hospital's IT system, realize that some users may not have a password (or at least not one they remember). We recommend ample communication to inform your users of this change and your process to set their initial password.

7. What device settings should we be thinking about for BD Pyxis^™ in COVID-19 positive or presumptive positive areas?

We recommend you consider the following device settings:

• Login Mode - consider disabling fingerprint and switching to password login in those limited* situations when you expect gloves to be worn while accessing the BD Pyxis^™ machine. This can be set at the Device level (affects all users at that device) or at the User level (affects only those users).
• For more information about concerns with gloves and hand hygiene considerations with BD Pyxis^™, see questions number 6 within the “Looking for more FAQs?” section.
• Return to Stock (RTS) – recommend disabling this feature and only allow return of administered drugs via a common one-way return bin to reduce the possibility of cross contamination.
• Outdate Tracking – consider disabling this feature to help streamline refill/load workflows. This may be particularly advantageous in areas that you expect to be short-term or temporary (e.g., field hospitals).
• Print Transaction Slips – consider disabling paper transaction receipts to help streamline workflows.
• Profile Mode – consider leveraging the safety benefits of profile mode. When doing so, ensure Auto-Enable Critical Override is set in case of network related issues.
For assistance on these and any other device settings, contact Technical Support.

Additional Resources:

BD Pyxis™ ES Server User Guide (v1.6.1)	LINK
BD Pyxis™ ES: How it Works Guide (v1.6.1)	LINK
BD Pyxis™ Enterprise Server training series, Configuring critical override settings	LINK

8. Is there anything we can do with BD Pyxis^™ devices to address limited medication availability particularly that of certain dose sizes?

With all the medication shortages happening right now, the “equivalencies” functionality (profiled BD Pyxis^™ MedStations^™ only) is a way to allow medication access regardless of product size loaded. For example, you can allow removal of two of the 20 mg tablets instead of one of the 40mg tablet (e.g., the 40mg is unavailable, stocked out, not loaded).

Because there are some nuances that some might find complex, we encourage you to reach out to our special BD advisors who are experts on this feature via email at MedManagementCOVID-19@bd.com.

Additional Resources:

BD Pyxis™ ES Server User Guide (v1.6.1)	LINK
BD Pyxis™ ES: How it Works Guide (v1.6.1)	LINK
BD Pyxis™ Enterprise Server training series, Configuring equivalencies	LINK