To the Editor:
We read with great interest an article by Lee et al. on effective use of plastic bags as personal protective equipment during airway management for patients with coronavirus disease 2019 (COVID-19) (1). Safe airway management that minimizes exposure to aerosol from patients with COVID-19 has become a pressing issue for all emergency physicians. Several strategies have been proposed to this end, one of which involves the use of a transparent acrylic “aerosol box” designed to create a barrier to aerosol transmission during intubation, while allowing ample room for medical procedures to be carried out (1, 2, 3, 4). However, although this box can be highly effective in preventing aerosol exposure, the cost of building it on a large scale and the burden of decontaminating it after use are likely to limit its utility. In addition, the workers tasked with decontaminating the box would also require personal protective equipment to avoid exposure to the virus, increasing the need for further resources.
However, an inexpensive, easily constructed, do-it-yourself (DIY) disposable box using materials that are readily available can provide a more practical alternative to the acrylic aerosol box (Figure 1 ). To construct this DIY box, a square window is created on each side of a large cardboard box, leaving a margin of approximately 5 cm. Then, a transparent plastic bag large enough to cover the box is stretched snugly over the structure and affixed to the sides with a stapler. Finally, slits are created in the plastic bag to allow arm insertion. Should the physician require assistance, new slits can be created on either side of the box for assistants to insert their arms. This feature allows more flexibility during intubation procedures than the acrylic box. After completing a procedure, the bag need only to be detached carefully, the cardboard box folded, and both discarded in the medical waste bin.
Figure 1.
Intubation procedure using a do-it-yourself disposable aerosol box. (A) Top angle view. (B). Operator's view.
Acknowledgments
The authors thank Ms. Akiko Okita, Sachiko Imanishi, and Ayaka Takayama for their assistance with conceptualizing this manuscript.
References
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