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Research ArticleSpecial Article

A Flexible Enclosure to Protect Respiratory Therapists During Aerosol-Generating Procedures

Cameron R Smith, Nikolaus Gravenstein, Thomas E LeMaster, Ceri M Borde and Brenda G Fahy
Respiratory Care December 2020, 65 (12) 1923-1932; DOI: https://doi.org/10.4187/respcare.08568
Cameron R Smith
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
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Nikolaus Gravenstein
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
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Thomas E LeMaster
Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, Florida.
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Ceri M Borde
Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, Florida.
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Brenda G Fahy
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Exposure of respiratory therapists (RTs) during aerosol-generating procedures such as endotracheal intubation is an occupational hazard. Depending on the hospital, RTs may serve as laryngoscopist or in a role providing ventilation support and initiating mechanical ventilation. This study aimed to evaluate the potential exposure of RTs serving in either of these roles.

METHODS: We set up a simulated patient with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in an ICU setting requiring endotracheal intubation involving a laryngoscopist, a nurse, and an RT supporting the laryngoscopist. All participants wore appropriate personal protective equipment (PPE). A fluorescent marker was sprayed by an atomizer during the procedure using 3 different methods for endotracheal intubation. The 3 techniques included PPE alone, a polycarbonate intubating box, or a coronavirus flexible enclosure, which consisted of a Mayo stand with plastic covering. The laryngoscopist and the supporting RT were assessed with a black light for contamination with the fluorescent marker. All simulations were recorded.

RESULTS: When using only PPE, both the laryngoscopist and the RT were grossly contaminated. When using the intubating box, the laryngoscopist’s contamination was detectable only on the gloves: the gown and face shield remained uncontaminated; the RT was still grossly contaminated on the gloves, gown, neck, and face shield. When using the coronavirus flexible enclosure system, both the laryngoscopist and the RT were better protected, with contamination detected only on the gloves of the laryngoscopist and the RT.

CONCLUSIONS: Of the 3 techniques, the coronavirus flexible enclosure contained the fluorescent marker more effectively during endotracheal intubation than PPE alone or the intubating box based on exposure of the laryngoscopist and supporting RT. Optimizing containment during aerosol-generating procedures like endotracheal intubation is a critical component of minimizing occupational and nosocomial spread of SARS-CoV-2 to RTs who may serve as either the laryngoscopist or a support role.

  • COVID-19
  • coronavirus
  • SARS-CoV-2
  • intubation
  • viral exposure
  • aerosol-generating procedure
  • respiratory therapists
  • endotracheal intubation
  • occupational exposure

Footnotes

  • Correspondence: Brenda G Fahy MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, M509, PO Box 100254, Gainesville, FL 32608. E-mail: bfahy{at}anest.ufl.edu
  • The authors have disclosed no conflicts of interests.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (12)
Respiratory Care
Vol. 65, Issue 12
1 Dec 2020
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A Flexible Enclosure to Protect Respiratory Therapists During Aerosol-Generating Procedures
Cameron R Smith, Nikolaus Gravenstein, Thomas E LeMaster, Ceri M Borde, Brenda G Fahy
Respiratory Care Dec 2020, 65 (12) 1923-1932; DOI: 10.4187/respcare.08568

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A Flexible Enclosure to Protect Respiratory Therapists During Aerosol-Generating Procedures
Cameron R Smith, Nikolaus Gravenstein, Thomas E LeMaster, Ceri M Borde, Brenda G Fahy
Respiratory Care Dec 2020, 65 (12) 1923-1932; DOI: 10.4187/respcare.08568
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Keywords

  • COVID-19
  • coronavirus
  • SARS-CoV-2
  • intubation
  • viral exposure
  • aerosol-generating procedure
  • respiratory therapists
  • endotracheal intubation
  • occupational exposure

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