Intraoperative aerosol box use: does an educational visual aid reduce contamination?

Abstract

Background: The aerosol box was rapidly developed and disseminated to minimize viral exposure during aerosolizing procedures during the COVID-19 pandemic, yet users may not understand how to use and clean the device. This could potentially lead to increased viral exposure to subsequent patients and practitioners. We evaluated intraoperative contamination and aerosol box decontamination and the impact of a preoperative educational visual aid. Methods: Using a double-blinded randomized design, forty-four anesthesiology trainees and faculty completed a simulated anesthetic case using an aerosol box contaminated with a fluorescent marker; half of the subjects received a visual aid prior to the simulation. Intraoperative contamination was evaluated at 10 standardized locations using an ultraviolet (UV) light. Next, subjects were instructed to clean the aerosol box for use on the next patient. Following cleaning, the box was evaluated for decontamination using an UV light. Results: Median total contamination score was significantly reduced in the experimental group (5.0 vs. 10.0, P < 0.001). The aerosol box was completely cleaned by 36.4% of subjects in the experimental group compared to 4.5% in the control group (P = 0.009). Conclusions: The use of a visual aid significantly decreased intraoperative contamination and improved box cleaning. Despite these findings, a potentially clinically significant amount of viral exposure may exist. Thorough evaluation of the risks and benefits of the aerosol box should be completed prior to use. If an aerosol box is used, a visual aid should be considered to remind practitioners how to best use and clean the box.

Health Care Simulation as a Training Tool for Epidemic Management

“…The study characteristics are presented in the Table 1. Most of the studies on simulation-based training were developed in response to SARS-CoV-2 (n = 117, 79.1%) 6–8,16–128 . Eighteen were motivated by Ebola outbreaks (12.2%), 129–146 7 by influenza (4.7%), 147–153 3 by MERS (2%), 154–156 and 3 by pandemics in general (2%) 157–159 …”

Prevenção à exposição por aerossóis da COVID-19 durante a intubação orotraqueal

“…38 When dealing with preventive measures during OTI, studies mostly bring the use of protective barriers in association with the use of PPE: devices in box format, plastic and cover that cover the patients' headboard. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]32,33,35 The hypothesis raised is that only the use of PPE does not adequately protect, requiring the association of protective barriers to ensure safety. 36 Intubation boxes are acrylic boxes containing two where the allocates the arms for access to the airway, and an opening in its lower portion to attach the patients' head.…”

“…19,23 The two openings designed to accommodate the intubator's arms allow for the redirection of aerosols to the environment, with evidence of accommodation on professionals' arms, chest and head. 14,20,26,33 Some articles highlighted the need to associate airflows with negative suction systems inside the acrylic box, coupled in HEPA filters, showing less contamination of the intubator, as well as the almost minimal dispersion to the environment. 29,32,35 The post-procedure risk was also evidenced: at the end of intubation, the removal of the acrylic box allows the dispersion of aerosols concentrated inside it directly to the bedside, procedure materials, as well as the team involved.…”

“…26,28,30 If the association of barrier protectors with OTI is chosen, teams must be trained in the decontamination of boxes and plastic barriers, with additional risk of exposure during removal after completion of the procedure. 20,33 The use of protective acrylic boxes should be based on team familiarization and training of those involved in handling, in order to reduce exposure to aerosols. 20,24 The use of a video laryngoscope facilitates the visualization of the airway and avoids the increase in intubation time, providing greater safety for both professionals and patients.…”

“…20,33 The use of protective acrylic boxes should be based on team familiarization and training of those involved in handling, in order to reduce exposure to aerosols. 20,24 The use of a video laryngoscope facilitates the visualization of the airway and avoids the increase in intubation time, providing greater safety for both professionals and patients. 24 Thus, teams should analyze care routines on the benefit and risk of adding barrier protectors to intubation, and the possibility of increasing the videolaryngoscope in daily life.…”