VACuum INtubation (VACcIN) box restricts the exhaled air dispersion generated by simulated cough: description and simulation-based tests of an innovative aerosolization protective prototype

Abstract

The COVID-19 pandemic has caused personal protective equipment shortages worldwide and required healthcare workers to develop novel ways of protecting themselves. Anesthesiologists in particular are exposed to increased risks of contamination when performing interventions such as airway manipulations. We developed and tested an aerosolization protective device which contains aerosols around the patient’s airway and helps eliminate particles using negative pressure. This intubation box is a polymethyl methacrylate prism with openings for gloves, integrated suction and ventilation connectors. We conducted a randomised controlled series of tests to detect 0.5 µm particles after a simulated cough inside the intubation box, using a high-fidelity simulation mannequin. Setting and main outcome: We measured particle concentrations inside the box with and without suction turned on, in both negative and positive pressure operating rooms. We also obtained particle concentrations outside our box and compared them to non-airtight barrier devices. One minute following simulated cough, the mean number of particles per cubic foot in our box with suction on is around 45% that with the suction off (1,462,373 vs 3,272,080, P\u2009<\u20090.0001) in the negative pressure room, and four times lower than with the suction off (760,380 vs 3,088,700, P\u2009<\u20090.0001) in the positive pressure room. After a simulated cough inside the box, particles can be detected in front of the anesthesiologist’s face with a non-airtight device, while none are detected when our box is sealed and its suction turned on. The use of our negative pressure intubation box prevents contamination of surroundings and increases particle elimination, regardless of room pressure.