Skip to main content
Download PDF

Universal mobile protection system for aerosol-generating medical interventions in COVID-19 patients

Critical Care volume 24, Article number: 264 (2020) Cite this article

Refers to:

Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses’ protection during the COVID-19 epidemic. Crit Care. 2020;24(1):120.

SARS-CoV-2 can actively replicate in the upper respiratory tract and is shed for a prolonged time after symptoms end [1]. The prolonged viral shedding in sputum is relevant for hospital infection control [1]. Hospital-related transmission of the virus is a large threat to healthcare workers [2] especially if COVID-19 patients are treated by non-invasive ventilation or high-flow nasal oxygen [3].

Leonard et al. have recently proposed to use a surgical mask for the patient treated by high-flow nasal oxygen. At 40 L × min−1, the surgical mask captured 83.2% of particles [3]. It remains unclear if this is effective with increased flow velocities, and it does not apply to many aerosol-generating medical interventions.

For healthcare workers performing aerosol-generating procedures on patients with COVID-19, using fitted respirator masks (e.g., N95 respirators) in addition to other personal protective equipment (i.e., gloves, gown, eye protection, such as a face shield or goggles) has been recommended [4]. This equipment is mainly based on disposable materials, and the supply is limited in the context of the pandemic [5].

A new mobile and reusable protection system has been established. Medical staff might use it in addition to the personal protection measures already in operation.

The construction (Fig. 1) is made of a commercially available and easy to process opaque aluminum composite panel (bottom) on swivel castors and a transparent acrylic glass (top). A detailed description is available (DOI https://doi.org/10.31219/osf.io/2s93d; https://osf.io/2s93d/).

Fig. 1
figure 1

The universal mobile protection system. Schematic outline from a the user’s side, b the lateral view, and c the bottom view. d Picture of the top of the system, view is towards the patient’s side, and two openings are in the middle of shield. e Protection shield used during transesophageal echocardiography. f Picture taken in the theater just after extubation of a patient. h The prototype was used in a test track: videolaryngoscopically guided rapid sequence intubation was trained with a dummy in combination with the protection system

Full size image

Unique features of the system are as follows: protective equipment neither worn by staff nor patients, but is placed on the ground and can be moved around on castors; flexible system for confined spaces, in operating rooms or functional areas; the transparent protective screen with an angled field of vision; and side shields deflect and prevent aerosols to be inhaled by the user. Openings allow personnel to treat patients without significantly reducing the shielding effect. The shielding has been visualized by steam tests (videos are provided online https://osf.io/7u2tv).

It might be used in addition to established protection measures for aerosol-generating procedures, e.g., for patient care during high-flow or non-invasive ventilation therapy, in-/extubation, upper GI endoscopy, bronchoscopy, transesophageal echocardiography, or drainage.

In those times, disposable protection gear is scarce, and the robust, easy-to-disinfect, reusable, mobile protection system might be helpful for medical personnel to work more safely in vulnerable situations. The universal, mobile protection system was evaluated in a test track and is considered useful by the main medical disciplines involved in the treatment of COVID-19 patients.

Availability of data and materials

1. Detailed description of the construction of the protection system: DOI https://doi.org/10.31219/osf.io/2s93d; https://osf.io/2s93d

2. Steam test videos: protection system with and without side shields

DOI https://doi.org/10.17605/OSF.IO/7U2TV, Open Access Download: https://osf.io/7u2tv

 1 Protectionsystem no side shields _ lat view

 2 Protectionsystem with side shields _ lat view

 3 Protectionsystem no side shields _ frontal view

 4 Protectionsystem with side shields _ frontal view

3. Information sheet in English and German language

DOI https://doi.org/10.17605/OSF.IO/7U2TV

Open Access Download: https://osf.io/7u2tv

Abbreviations

COVID-19:

Corona virus disease 2019

N95:

A medical mask meeting the N95 National Institute for Occupational Safety and Health air filtration rating (USA)

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

References

  1. Woelfel RC, Corman VM, Guggemos W, Seilmaier M, Zange S, Mueller MA, Niemeyer D, Jones Kelly TC, Vollmar P, Rothe C, Hoelscher M, Bleicker T, Bruenick S, Schneider J, Ehmann R, Zwirglmaier K, Drosten C, Wendtner C. Virological assessment of hospitalized cases of coronavirus disease 2019. Nature. 2020. https://doi.org/10.1038/s41586-020-2196-x.

  2. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses’ protection during the COVID-19 epidemic. Crit Care. 2020;24(1):120.

    Article  Google Scholar 

  3. Leonard S, Atwood CW Jr, Walsh BK, et al. Preliminary findings of control of dispersion of aerosols and droplets during high velocity nasal insufflation therapy using a simple surgical mask: implications for high flow nasal cannula. Chest. 2020. https://doi.org/10.1016/j.chest.2020.03.043.

  4. Alhazzani W, Moller MH, Arabi YM, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Crit Care Med. 2020. https://doi.org/10.1007/s00134-020-06022-5.

    Article  Google Scholar 

  5. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of covid-19. N Engl J Med. 2020. https://doi.org/10.1056/NEJMsb2005114.

    Article  Google Scholar 

Download references

Acknowledgements

This project was set up in a collaboration with the team of the Munich Clinic Bogenhausen and Schwabing. The following collaborators contributed to this project: Munich Clinic Collaboration Group: Volz S.1, Dorwarth U.1, Engel M.1, Schneider N.2, Lärmer J.2, Nagel B.2, Friederich P.4, Fisch R.4, Riess A.4, Benedikter J.5, Meyer F.J.5,6, Lewerenz B.7, Schepp W.7, Schmid M.8, Dodt C.8, Schmidt W.1, Weidenbach K.1, Rogowski S.1, Kossmann H.1, Berger M.1, Gatos C.1, Wuerstl B.9, and Deichstetter M.1

Special thanks go to Kevin Thuma und Halil Sayar, and the team of Matthias Wenzel (Wenzel GmbH, Munich, Germany) who advanced the project with great enthusiasm and precision in the phase of technical implementation and development of the prototype.

Dipl.-Ing. Rene Gross (Munich, Germany) gave technical advice in the area of material science. Many thanks to the cath lab personnel who helped with the gradual disinfection exposure tests.

1Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital, Technical University of Munich (TUM), Munich, Germany

2Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

3Department of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Academic Teaching Hospital (LMU), Kölner Platz 1, 80804 Munich, Germany

4Department of Anaesthesiology, Munich Clinic Bogenhausen, Academic Teaching Hospital (TUM), Munich, Germany

5Department of Pulmonology and Pneumological Oncology, Munich Clinic Bogenhausen, Academic Teaching Hospital (TUM), Munich, Germany

6Department of Pulmonology, Gastroenterology and Internal Intensive Care Medicine, Munich Clinic Harlaching, Academic Teaching Hospital (LMU), Munich, Germany

7Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Munich Clinic Bogenhausen, Academic Teaching Hospital (TUM), Munich, Germany

8Department of Emergency Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital (TUM), Munich, Germany

9Department of Hygiene and Prevention of Infectious Diseases, Munich Clinic Schwabing, Academic Teaching Hospital (LMU), Munich Germany

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital, Technical University of Munich (TUM), Englschalkinger Str. 77, 81925, Munich, Germany

    Florian Straube & Ellen Hoffmann

  2. Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany

    Florian Straube & Ellen Hoffmann

  3. Department of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich Clinic Schwabing, Academic Teaching Hospital (LMU), Kölner Platz 1, 80804, Munich, Germany

    Clemens Wendtner

Authors
  1. Florian Straube
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clemens Wendtner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ellen Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Munich Clinic Collaboration Group

  • S. Volz
  • , U. Dorwarth
  • , M. Engel
  • , N. Schneider
  • , J. Lärmer
  • , B. Nagel
  • , P. Friederich
  • , R. Fisch
  • , A. Riess
  • , J. Benedikter
  • , F. J. Meyer
  • , B. Lewerenz
  • , W. Schepp
  • , M. Schmid
  • , C. Dodt
  • , W. Schmidt
  • , K. Weidenbach
  • , S. Rogowski
  • , H. Kossmann
  • , M. Berger
  • , C. Gatos
  • , B. Wuerstl
  •  & M. Deichstetter

Contributions

F.S., S.V., and M.D. had the idea. F.S. developed the prototype, drafted and revised the manuscript, and made the figure. On 27 March 2020, the employer informed F.S. that the decision to publish is up to him. The co-authors C.W. and E.H. gave medical advice, and revised and approved the manuscript. The collaborators S.V., M.D., and M.E. gave substantial medical advice. S.V., M.D., N.S., J.L., B.N., P.F., R.F., A.R., J.B., B.L., W.S., M.S., W.S., K.W., S.R., H.K., and E.H. assessed the prototype in a test track to simulate representative clinical scenarios. In addition, they were test models for the size dimensions, especially for the positioning of the passage openings. All of them gave practical and medical advice. All collaborators read and approved the manuscript.

Authors’ information

Not applicable.

Corresponding author

Correspondence to Florian Straube.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

All individuals in the pictures of Fig. 1 gave written consent for publication. All the contributors and all person named in the “Acknowledgements” section gave written consent to have their name mentioned in this publication.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Straube, F., Wendtner, C., Hoffmann, E. et al. Universal mobile protection system for aerosol-generating medical interventions in COVID-19 patients. Crit Care 24, 264 (2020). https://doi.org/10.1186/s13054-020-02969-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13054-020-02969-5

Keywords

  • Aerosol-generation medical interventions
  • Healthcare personnel
  • High-flow nasal cannula oxygen
  • Non-invasive ventilation
  • COVID-19
  • SARS-CoV-2
  • Virus transmission
  • Protection gear
  • Shield

Critical Care

ISSN: 1364-8535