Abstract
Background The current COVID-19 pandemic has resulted in over 54,800,000 SARS-CoV-2 infections worldwide with a mortality rate of around 2.5%. As observed in other airborne viral infections such as influenza and SARS-CoV-1, healthcare workers are at high risk for infection when performing aerosol-generating medical procedures (AGMP). Additionally, the threats of a global shortage of standard personal protective equipment (PPE) prompted many healthcare workers to explore alternative protective enclosures, such as the “aerosol box” invented by a Taiwanese anesthetist. Our study includes the design process of a protective barrier enclosure and its subsequent clinical implementation in the management of critically ill adults and children infected with SARS-CoV-2. Methods and Results The barrier enclosure was designed for use in our tertiary care facility and named “SplashGuard CG” (CG for Care Givers). The device has been adapted using a multi- and interdisciplinary approach, with collaboration between physicians, respiratory therapists, nurses, and biomechanical engineers. Computer-aided design and simulation sessions throughout the entire process facilitated the rapid and safe implementation of the SplashGuard CG in different settings (intensive care unit, emergency department, and the operating room) during AGMPs such as bag-valve-mask ventilation, nasopharyngeal suctioning, intubation and extubation, and noninvasive ventilation. Indications for use and anticipatory precautions were communicated to all healthcare workers using the SplashGuard CG. The entire process was completed within one month. Conclusion The rapid design, development, and clinical implementation of a new barrier enclosure, the “SplashGuard CG,” was feasible in this time of crisis thanks to close collaboration between medical and engineering teams and the use of recurring simulation sessions to test and improve the initial prototypes. Following this accelerated process, it is necessary to maintain team skills, monitor any undesirable effects, and evaluate and continuously improve this new device.
Highlights
Introduction e current COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in over 54,800,000 cases of infection since its first description in December 2019 in Wuhan, China, and has already led to over 1,300,000 deaths worldwide [1]
Certain clinical situations and procedures may Critical Care Research and Practice generate even more airborne aerosols [4, 5]. Invasive procedures such as endotracheal intubation or the use of noninvasive ventilation in COVID + patients represent particular risks while air is insufflated into the oropharynx under positive pressure with the possibility of air leaks. ese aerosol-generating medical procedures (AGMP) put healthcare workers at even greater risk for infection, especially in the critical care setting
Children are at higher risk of complications related to intubation, such as subglottic stenosis [8]. us, early intubation of COVID + pediatric patients without a prior trial of noninvasive support is not acceptable for pediatric critical care physicians
Summary
Simulation-Based Rapid Development and Implementation of a Novel Barrier Enclosure for Use in COVID-19 Patients: The SplashGuard CG. E rapid design, development, and clinical implementation of a new barrier enclosure, the “SplashGuard CG,” was feasible in this time of crisis thanks to close collaboration between medical and engineering teams and the use of recurring simulation sessions to test and improve the initial prototypes. Following this accelerated process, it is necessary to maintain team skills, monitor any undesirable effects, and evaluate and continuously improve this new device. Refining of this new technology required further collaboration with biomedical engineering, the infection prevention unit, and the ergonomic units at our institution (see SplashGuard CG Study Group)
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