A variable dimensional aerosol shield provides for perioperative COVID‐19 patients

Coronavirus disease (COVID‐19) transmissions are mainly through direct exposure to droplets from an infected patient, as a result of coughing, sneezing or other direct contact. ¹ Some “devices” have been proposed to protect health care provides by limiting exposure during airway manipulation. Canelli et al. suggested a preformed “aerosol box” to protect clinicians from droplets spreading. But the major limitation of this device is the restricted hand movement during intubation. As a result, this approach has not been as effective during difficult airway management. ²

Utilizing equipment readily available in the operating room, we created a pliable, plastic, transparent, and disposable intubation shield to isolate the airway while allowing manipulation during intubation or at other times during the surgical procedure. The shield was accomplished using the following set‐up:

• Two L‐shaped stainless anesthesia arms used to secure the “ether screen” (length and height 59 cm) were fixed on each side of the operating room table.

• A transparent plastic bag (PAHSCO sterile cover 1040 mm × 1500 mm, Pacific Hospital Supply Co., Ltd, Taiwan) is placed over the arms and fixed to it with four metal clips to make a 45 × 65 × 50 cm³ space (Figure 1(A)). The plastic bag is placed under anesthesia screens and metal clips fixed the plastic bag on the stainless arms (Figure 1(B)). The plastic bag is tucked under the operating table mattress. Two X‐shaped holes (diameter: circumference of proximal forearm) are cut in the shield near the anesthetist at about the midclavicular line and a height of about the thoracic sixth to eighth levels (Figure 1(C)).

• To restrict the infected droplets in the shield following intubation, the contacted gloves and sleeves are sterilized thoroughly with 75% alcohol twice from above the level of the elbow to the gloves. Then, the “hand holes” in the intubation shield are sealed using OPSITE (45 cm × 55 cm, Smith & Nephew Medical Limited, England) (Figure 1(D)). The size is easily adjusted to optimize exposure for the surgical procedure by repositioning the arm and reclipping the plastic bag (Figure 1(E)).

• The screen size is resumed back by adjusting the clips to safely extubate the patient's trachea from the same hand holes while minimizing risk of exposure to aerosols.

This technique provides a safe method of protecting provider during airway management and other periods during surgery. The supplies are inexpensive and the technique for setting up the barrier is straightforward. The anesthetist can reposition the intubation equipment and view without confronting a large plastic or other barrier that restricts movement. If necessary, the anesthetist with full personal protective equipment (PPE) is able to press close to the patient with decreased risk of contamination. The technique can also be used during transport of the patient to the intensive care unit, if needed.

FIGURE 1.

Pliable and disposable intubation shield for perioperative protection. (A) Structure of the shield. (B) Plastic bag underneath the anesthesia ether screen, metal clip to fix it. (C) The anesthetist with face shield bends forward to press close to patient during intubation. (D) An OPSITE adherence on head side plastic bag and complete covering the cut holes. (E) Two anesthesia screens cross over and the sterilized surgical drape on the screens to secure environment sterility during operation. arrow, cut hand hole; m, metal clip; o, opsite; p, transparent plastic bag with rectangular frame; s, an adjustable L‐shaped anesthesia screen

Standard PPE is still required, because the possibility of tear or leakage of the shield exists. Further study to evaluate the efficacy and safety of this shield is required. We believe this approach could decrease aerosol transmission and add personal safety when confronted with the need to manage the airway of patients infected with COVID‐19.

CONFLICT OF INTEREST

The authors declare no potential conflict of interest.

Supporting information

Video S1 A variable dimensional aerosol shield video