An Inexpensive, Portable Shield to Improve Healthcare Worker Safety During Intubation Procedures*

Healthcare workers (HCW) are exposed to risk of infection during intubation procedures, in particular, in the prehospital setting. Here, we demonstrate a novel shield that can be used during intubation to block aerosols and droplets from reaching the HCW. The device is mounted on the patient’s head and provides a barrier between patient and HCW. It incorporates a self-sealing port through which an endotracheal tube can be inserted. The port "floats" in the plane of the shield to facilitate maneuvering of the endotracheal tube. The shield is fabricated from transparent materials to enable the HCW to visualize the procedure. Using two complementary imaging methods, background oriented Schlieren imaging and laser sheet droplet imaging, we show that the device prevents detectable transmission of gas flow and droplets through the shield both before and after endotracheal tube insertion.Clinical Relevance— This device has the potential to protect HCWs from infections during intubation procedures, especially in the prehospital setting.

I. Introduction

The COVID-19 pandemic has magnified the disease exposure risk faced by frontline health care workers (HCWs) on a day-to-day basis. In September 2021, the World Health Organization released a report estimating 110,000 HCWs had died worldwide due to COVID-19 complications between January 1, 2020 and May 16, 2021 [1]. HCW viral exposure is not new, though, particularly for emergency care workers on the front lines of infectious respiratory diseases. In one study of the SARS outbreak in 2003, 9% of HCWs who intubated patients contracted the disease [2]. Several groups have sought to improve personal protective equipment (PPE) during intubation, including piloting the use of plastic boxes placed over a patient’s face and the use of curtains between the patient and the HCW [3]–[7]. While these studies have shown a significant reduction in HCW aerosol droplet exposure during intubation, few have considered intubation in non-hospital settings, where a patient is possibly not in a supine position and space is limited [8]. Yet prehospital intubation, particularly for SARS-COV-2 infections is common. In a retrospective study of the care provided to COVID-19 patients in the prehospital setting by the Paris Fire Brigade advanced life support team, 6% of COVID-19 patients were intubated in a prehospital setting [9]. Here we propose and assess the performance of a novel, portable, protective shield that can be used for prehospital intubation.