Universal mobile protection system for aerosol-generating medical interventions in COVID-19 patients.

Refers to:

Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses’ protection during the COVID-19 epidemic. Crit Care. 2020;24(1):120.

SARS-CoV-2 can actively replicate in the upper respiratory tract and is shed for a prolonged time after symptoms end [1]. The prolonged viral shedding in sputum is relevant for hospital infection control [1]. Hospital-related transmission of the virus is a large threat to healthcare workers [2] especially if COVID-19 patients are treated by non-invasive ventilation or high-flow nasal oxygen [3].

Leonard et al. have recently proposed to use a surgical mask for the patient treated by high-flow nasal oxygen. At 40 L × min−1, the surgical mask captured 83.2% of particles [3]. It remains unclear if this is effective with increased flow velocities, and it does not apply to many aerosol-generating medical interventions.

For healthcare workers performing aerosol-generating procedures on patients with COVID-19, using fitted respirator masks (e.g., N95 respirators) in addition to other personal protective equipment (i.e., gloves, gown, eye protection, such as a face shield or goggles) has been recommended [4]. This equipment is mainly based on disposable materials, and the supply is limited in the context of the pandemic [5].

A new mobile and reusable protection system has been established. Medical staff might use it in addition to the personal protection measures already in operation.

The construction (Fig. 1) is made of a commercially available and easy to process opaque aluminum composite panel (bottom) on swivel castors and a transparent acrylic glass (top). A detailed description is available (DOI 10.31219/osf.io/2s93d; https://osf.io/2s93d/).

Fig. 1

The universal mobile protection system. Schematic outline from a the user’s side, b the lateral view, and c the bottom view. d Picture of the top of the system, view is towards the patient’s side, and two openings are in the middle of shield. e Protection shield used during transesophageal echocardiography. f Picture taken in the theater just after extubation of a patient. h The prototype was used in a test track: videolaryngoscopically guided rapid sequence intubation was trained with a dummy in combination with the protection system

Unique features of the system are as follows: protective equipment neither worn by staff nor patients, but is placed on the ground and can be moved around on castors; flexible system for confined spaces, in operating rooms or functional areas; the transparent protective screen with an angled field of vision; and side shields deflect and prevent aerosols to be inhaled by the user. Openings allow personnel to treat patients without significantly reducing the shielding effect. The shielding has been visualized by steam tests (videos are provided online https://osf.io/7u2tv).

It might be used in addition to established protection measures for aerosol-generating procedures, e.g., for patient care during high-flow or non-invasive ventilation therapy, in-/extubation, upper GI endoscopy, bronchoscopy, transesophageal echocardiography, or drainage.

In those times, disposable protection gear is scarce, and the robust, easy-to-disinfect, reusable, mobile protection system might be helpful for medical personnel to work more safely in vulnerable situations. The universal, mobile protection system was evaluated in a test track and is considered useful by the main medical disciplines involved in the treatment of COVID-19 patients.