Blog
About

1
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Use of Disposable Clear Plastic Elastic Band-Rimmed Bag to Limit Infectious Aerosol during Airway Instrumentation

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for appropriate protective measures for health care providers, particularly for those involved in aerosol-generating procedures. We report the use of the banded bag for extubation to contain infectious aerosols. The banded bag is a clear and disposable shower-cap style image intensifier cover which is commonly used as a sterile cover for mobile X-ray systems. With the addition of a filtered suction, safe air exchange rates can be obtained. We anticipate that the banded bag, which is economical, convenient, and highly practical, can be used as a safety-enhancing device for COVID-19 extubations.

          Related collections

          Most cited references 16

          • Record: found
          • Abstract: found
          • Article: not found

          Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

          To the Editor: A novel human coronavirus that is now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formerly called HCoV-19) emerged in Wuhan, China, in late 2019 and is now causing a pandemic. 1 We analyzed the aerosol and surface stability of SARS-CoV-2 and compared it with SARS-CoV-1, the most closely related human coronavirus. 2 We evaluated the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces and estimated their decay rates using a Bayesian regression model (see the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). SARS-CoV-2 nCoV-WA1-2020 (MN985325.1) and SARS-CoV-1 Tor2 (AY274119.3) were the strains used. Aerosols (<5 μm) containing SARS-CoV-2 (105.25 50% tissue-culture infectious dose [TCID50] per milliliter) or SARS-CoV-1 (106.75-7.00 TCID50 per milliliter) were generated with the use of a three-jet Collison nebulizer and fed into a Goldberg drum to create an aerosolized environment. The inoculum resulted in cycle-threshold values between 20 and 22, similar to those observed in samples obtained from the upper and lower respiratory tract in humans. Our data consisted of 10 experimental conditions involving two viruses (SARS-CoV-2 and SARS-CoV-1) in five environmental conditions (aerosols, plastic, stainless steel, copper, and cardboard). All experimental measurements are reported as means across three replicates. SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A). SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A). Both viruses had an exponential decay in virus titer across all experimental conditions, as indicated by a linear decrease in the log10TCID50 per liter of air or milliliter of medium over time (Figure 1B). The half-lives of SARS-CoV-2 and SARS-CoV-1 were similar in aerosols, with median estimates of approximately 1.1 to 1.2 hours and 95% credible intervals of 0.64 to 2.64 for SARS-CoV-2 and 0.78 to 2.43 for SARS-CoV-1 (Figure 1C, and Table S1 in the Supplementary Appendix). The half-lives of the two viruses were also similar on copper. On cardboard, the half-life of SARS-CoV-2 was longer than that of SARS-CoV-1. The longest viability of both viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic (Figure 1C). Estimated differences in the half-lives of the two viruses were small except for those on cardboard (Figure 1C). Individual replicate data were noticeably “noisier” (i.e., there was more variation in the experiment, resulting in a larger standard error) for cardboard than for other surfaces (Fig. S1 through S5), so we advise caution in interpreting this result. We found that the stability of SARS-CoV-2 was similar to that of SARS-CoV-1 under the experimental circumstances tested. This indicates that differences in the epidemiologic characteristics of these viruses probably arise from other factors, including high viral loads in the upper respiratory tract and the potential for persons infected with SARS-CoV-2 to shed and transmit the virus while asymptomatic. 3,4 Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, 5 and they provide information for pandemic mitigation efforts.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Consensus guidelines for managing the airway in patients with COVID ‐19

            Summary Severe acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious. Airway management of patients with COVID‐19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID‐19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID‐19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID‐19. The advice in this document is designed to be adapted in line with local workplace policies.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Barrier Enclosure during Endotracheal Intubation

              To the Editor: Clinicians with inadequate access to standard personal protective equipment (PPE) have been compelled to improvise protective barrier enclosures for use during endotracheal intubation. We describe one such barrier that is easily fabricated and may help protect clinicians during this procedure. The barrier studied was an “aerosol box,” 1 which consists of a transparent plastic cube designed to cover a patient’s head and that incorporates two circular ports through which the clinician’s hands are passed to perform the airway procedure. The dimensions of the box are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org. In our simulation (see video), a laryngoscopist, attired in standard PPE, took position at the head of an airway mannequin. To approximate a forceful cough and generate a spread of droplets and aerosols, a small latex balloon containing 10 ml of fluorescent dye was placed in the hypopharynx of the mannequin. The balloon was inflated with compressed oxygen that was run through tubing inside the mannequin until the balloon burst; the explosion of the balloon represented a crude simulation of a cough. We repeated the experiment without and with the aerosol box, and after each simulation, we illuminated the scene with ultraviolet light to visualize the spreading of the dye. With the use of PPE only, dye was found on the laryngoscopist’s gown, gloves, face mask, eye shield, hair, neck, ears, and shoes (Figure 1). Contamination of the floor occurred within approximately 1 m from the head of the bed and also on a monitor located more than 2 m away. When we repeated the experiment with the aerosol box, the simulated cough resulted in contamination of only the inner surface of the box and the laryngoscopist’s gloves and gowned forearms. Examination of the laryngoscopist and the room with ultraviolet light showed no macroscopic contamination outside the box. Our simulation method, although pragmatic, was not validated for the projectile direction, speed, or turbulence of a true cough, nor did it match the particle-size distribution. Droplets were overproduced as compared with aerosols. Our method of detection could not identify very small quantities of material that could be infectious. Nevertheless, we suggest that our ad hoc barrier enclosure provided a modicum of additional protection and could be considered to be an adjunct to standard PPE. A caveat: we found that the box restricted hand movement and would require training before use in the treatment of patients. Operators should be ready to abandon use of the box should airway management prove difficult.
                Bookmark

                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                11 October 2020
                October 2020
                : 12
                : 10
                Affiliations
                [1 ] Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, USA
                Author notes
                Article
                10.7759/cureus.10896
                7654979
                Copyright © 2020, Wong et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Categories
                Anesthesiology
                Infectious Disease
                Quality Improvement

                Comments

                Comment on this article