Barrier enclosure use during aerosol-generating medical procedures: A scoping review

Price, Courtney; Ben-Yakov, Maxim; Choi, Joseph; Orchanian‐Cheff, Ani; Tawadrous, Davy

doi:10.1016/j.ajem.2020.10.071

Cited by 18 publications

(35 citation statements)

References 94 publications

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“…Different barrier enclosure devices were reported, from plastic boxes to just plastic sheets [13]. Plastic boxes usually lack portability and the ability to accommodate an airway assistant, while plastic sheets do not block aerosols generated by the patient.…”

Section: Discussionmentioning

confidence: 99%

“…A possible solution for such procedures would be the use of a protective box. The idea of a protective box first appeared in 2020 [9] and soon, multiple improvements were published [10][11][12][13][14]. The primary idea is to assemble a box-like object around the patient's head and upper torso, which would contain any droplets and aerosols generated by the patient.…”

Section: Introductionmentioning

confidence: 99%

“…Although, from the onset of the COVID-19 pandemic, there has been a substantial number of publications regarding barrier enclosure devices [13], there are only a few studies where the particle concentration was measured [11,[15][16][17][18]. In all cases where a negative airflow was established, the number of detected particles inside the protective box dropped over time.…”

Section: Introductionmentioning

confidence: 99%

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Size- and Time-Dependent Aerosol Removal from a Protective Box during Simulated Intubation and Extubation Procedures

Pirker

Čebašek²,

Serdinšek

et al. 2021

COVID

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Because the SARS-CoV-2 virus primarily spreads through droplets and aerosols, a protective box could provide adequate protection by shielding medical professionals during the intubation and extubation procedures from generated droplets and aerosols. In this study, size- and time-dependent aerosol concentrations were measured inside and outside the protective box in the particle size ranging from 14 nm to 20 μm during simulated intubation and extubation procedures. An improved protective box with active ventilation was designed based on a plastic bag with armholes covered with latex sheets that utilizes a supportive frame. Coughing during the intubation and extubation procedure was simulated using an aerosol generator which dispersed the aerosol powder into the protective box. During the intubation and extubation procedure, the concentration of particles increased inside the protective box but, due to the high negative airflow, quickly dropped to background levels. The particle concentration of all measured particle sizes decreased within the same time frame. No leakage of particles was observed through the armhole openings. The presented protective box design provides excellent protection against generated droplets and aerosols. The decrease in concentration does not depend on the particle size. Outside the box, particle concentration did not change with time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Size- and Time-Dependent Aerosol Removal from a Protective Box during Simulated Intubation and Extubation Procedures

Pirker

Čebašek²,

Serdinšek

et al. 2021

COVID

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show abstract

“…The majority of the barrier devices invented are plastic drape type (59%) and the rest are box type (42%). [ 33 ] Due to time constraints, to date, no large-scale randomized control trial has been conducted to provide solid evidence in support of these devices. The majority of the recommendations are based primarily on the visual assessment of aerosol and droplet spread.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, the plastic sheet system apart from being simplistic has demonstrated better efficacy and usability so far. [ 33 ]…”

Section: Introductionmentioning

confidence: 99%

The barrier techniques for airway management in covid-19 patients - review of literature

Yadav

Garg

2021

Journal of Anaesthesiology Clinical Pharmacology

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The coronavirus disease 2019 (COVID-19) has emerged as a pandemic and shall prevail for some time around the globe. The disease can manifest from asymptomatic to severe respiratory compromise requiring airway intervention. Transmission of COVID-19 has been reported to be by droplets, fomites, and aerosols, and airway management is an aerosol-generating procedure. The high viral load in the patient's airway puts the clinician performing intubation at a very high risk of viral load exposure. So, the need for barrier devices was considered and led to reporting of various such devices. All these devices have been reported individually and have not been compared. We present a review of all the information on these devices based on the reported literature.

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Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

et al. 2023

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ImportanceThe aerosol box has been used during the management of patients with COVID-19 to reduce health care practitioner (HCP) exposure during aerosol-generating medical procedures (AGMPs). Little is known about the effect of aerosol box use on HCP contamination and AGMP procedure time.ObjectiveTo investigate whether use of an aerosol box during AGMPs reduces HCP contamination or influences the time to successful completion and first-pass success rate for endotracheal intubation (ETI) and laryngeal mask airway (LMA) insertion.Design, Setting, and ParticipantsThis multicenter, simulation-based, randomized clinical trial was conducted from May to December 2021 at tertiary care pediatric hospitals. Participant teams performed 3 simulated patient scenarios: bag-valve-mask ventilation, ETI, and LMA insertion. During the scenarios, aerosols were generated using Glo Germ. Teams of 2 HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Statistical analysis was performed from July 2022 to February 2023.InterventionsThe aerosol box (or SplashGuard CG) is a transparent, plastic barrier covering the patient’s head and shoulders with access ports allowing HCPs to manage the airway.Main Outcomes and MeasuresThe primary outcome was surface area of contamination (AOC) on participants. Secondary outcomes were time to successful completion and first-pass success rates for ETI and LMA insertion.ResultsA total of 64 teams (128 participants) were enrolled, with data from 61 teams (122 participants) analyzed. Among the 122 participants analyzed, 79 (64.8%) were female and 85 (69.7%) were physicians. Use of an aerosol box was associated with a 77.5% overall decreased AOC to the torso (95% CI, −86.3% to −62.9%; P &lt; .001) and a 60.7% overall decreased AOC to the facial area (95% CI, −75.2% to −37.8%; P &lt; .001) in airway HCPs. There was no statistically significant difference in surface contamination after doffing personal protective equipment between groups. Time to completing ETI was longer in the aerosol box group compared with the control group (mean difference: 10.2 seconds; 95% CI, 0.2 to 20.2 seconds; P = .04), but there was no difference between groups for LMA insertion (mean difference: 2.4 seconds; 95% CI, −8.7 to 13.5 seconds; P = .67).Conclusions and RelevanceIn this randomized clinical trial of aerosol box use in AGMPs, use of an aerosol box reduced contamination deposition on HCPs’ torso and face predoffing; the use of an aerosol box delayed time to successful intubation. These results suggest that the incremental benefits of reduced surface contamination from aerosol box use should be weighed against delayed time to complete intubation, which may negatively affect patient outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT04880668

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Barrier enclosure use during aerosol-generating medical procedures: A scoping review

Cited by 18 publications

References 94 publications

Size- and Time-Dependent Aerosol Removal from a Protective Box during Simulated Intubation and Extubation Procedures

Size- and Time-Dependent Aerosol Removal from a Protective Box during Simulated Intubation and Extubation Procedures

The barrier techniques for airway management in covid-19 patients - review of literature

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

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