Abstract
The COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. One strategy to reduce risk of infection and preserve existing equipment is the implementation of secondary barrier devices placed directly over patients or providers. The authors describe an inexpensive, disposable, positive-pressure head isolation unit that can be rapidly constructed from materials readily available in nearly all health care settings for under five US dollars. The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.
Highlights
In May 2003, two resident physicians in a Taiwanese hospital were infected and subsequently died after contracting Severe Acute Respiratory Syndrome (SARS) while intubating a patient who was not known to be infectious
While the need for protective equipment (PPE) to protect against droplet versus aerosol transmission may initially be unclear for a novel virus,[3] health care workers (HCWs) performing Aerosol-generating procedures (AGP) must don aerosol protective PPE to ensure adequate protection in either case
There is an absence of published data related to the clinical efficacy of COVID-19 improvised PPE (iPPE) for protection of HCWs and prevention of nosocomial spread
Summary
In May 2003, two resident physicians in a Taiwanese hospital were infected and subsequently died after contracting Severe Acute Respiratory Syndrome (SARS) while intubating a patient who was not known to be infectious. Wearing a properly sized N-95 respirator will make the head isolation unit fit testing less necessary since the respirator will already provide sufficient protection for aerosolized droplets should the positive-pressure environment become compromised. In this case, the head isolation unit may be used to primarily reduce risk of N-95 or surgical mask contamination if supplies must be reused due to shortages. If the wearer reports no smell or a bitter taste upon direct exposure before fit-testing, use a different solution.[5] Once a detectable challenge agent has been selected, assemble and generate the positive-pressure environment (Figure 2D). If the provider elects to use a mobile air source, the unit should be properly disinfected before patient contact
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