Patient‐Worn Enhanced Protection Face Shield for Flexible Endoscopy

Abstract

Objectives The primary objective of this study was to compare the protection afforded by a standard face shield design with a new enhanced design in a controlled setting. Methods This study was exempted from review by institutional review board waiver. A flexible fiberoptic endoscopy was placed through stellate openings in the standard face shield and the enhanced face shield. A series of simulated coughs were created with bursts of fluorescein dye through an atomizer tip placed within the test participant’s mouth. Ultraviolet lighting illuminated the test area, and areas of dye splatter were noted. Results Fluorescein dye is easily aerosolized along the lateral inferior aspect of a standard shield with significant contamination of the surrounds. The enhanced face shield maintained a barrier to the aerosolized dye. Discussion Face shields, rather than face masks, should be considered a preferred alternative for the public and for health care professionals alike, as they address many of the personal protective equipment concerns especially during the COVID-19 pandemic. Otolaryngologists are at high risk from aerosol-generating procedures, such as flexible fiberoptic endoscopy, even when wearing personal protective equipment. Here we describe a uniquely designed face shield to be worn by the patient as another layer of protection for the environment and for medical personnel. Implications for Practice During the course of a flexible fiberoptic endoscopy, medical personnel are safely isolated from potential infectious particles with a newly designed face shield.

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

“…Nine studies (7%) discussed these devices for general AGMPs [ 22 , 25 , 32 , 46 , [56] , [57] , [58] , [59] , [60] ] and 9 (7%) for endoscopic procedures. [ 10 , 11 , 43 , 45 , [61] , [62] , [63] , [64] ]…”

Assessing the Physiological Relevance of Cough Simulators for Respiratory Droplet Dispersion

“…In this study, we characterized various properties of commonly utilized cough simulators that are used to study how respiratory droplets can spread in clinical encounters. These cough simulators have been used in a number of recent reports, in particular to model SARS-CoV-2 viral droplet dispersion [ 10 , 12 , 13 , 14 , 15 , 17 , 20 ]. Since these simulations are used to inform clinical guidelines for PPE, it is important to understand the physiological accuracy of these simulators.…”

“…In order to develop and inform best practices for personal protective equipment, various simulations of respiratory and aerosolized droplet dispersion have been conducted. However, it is unclear which of these methods of simulation, if any, approximate physiologic breathing or coughing [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. This is an important issue as data from these experiments are often used to inform guidelines for personal protective equipment (PPE) in the COVID-19 era.…”

“…Several studies have used complex setups that require the use of cell culture media, a micropump nebulizer, or optical particle counter [ 10 , 11 ]. However, given their complexity, low-cost setups with a UV-visible surrogate have been widely utilized [ 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. One procedure that was investigated was direct laryngoscopy intubation with and without an “intubation box” for protection against viral droplets and aerosol [ 12 ].…”

Objective Assessment of Aerosolization During Transnasal Endoscopy: A Systematic Review

“…Similarly, Tan et al 13 showed that coughing during nasoendoscopy was not a maneuver that yielded significant droplet formation. In contrast, Anon et al 14 and Davies et al 15 observed significant particle formation with simulated coughing during nasal endoscopic procedures.…”