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Acrylic window as physical barrier for Personal Protective Equipment (PPE) conservation

Published:April 17, 2020DOI:https://doi.org/10.1016/j.ajem.2020.04.044
      As COVID-19 cases increase, the global supply of Personal Protective Equipment (PPE) is becoming insufficient, particularly for medical masks and respirators followed closely by gowns and googles. The World Health Organization (WHO) released in February 2020 an interim guidance [
      ‘Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)’, World Health Organization, Interim Guidance.
      ] on the rational use of PPE for coronavirus disease 2019 (COVID-19). The guidance state that to minimize the need for PPE, WHO recommends the “use of physical barriers to reduce exposure to the COVID-19 virus such as glass or plastic windows.”
      We, therefore, would like to present the one set-up barrier which can be transformed in a hospital area where patients will present first such as triage areas the registration desk at the emergency department or at the pharmacy window where medication is collected. The construction of this barrier ensures that the hospital will be able to conserve their supply of PPEs The constructed barrier, is made of an “acrylic window” designed to separate the clinician and the patient, it also features two fixed gloves through which the clinician can place both hands and be able to collect throat or nasopharyngeal swabs. The full diagram of the barrier is provided in Fig. 1.
      Fig. 1
      Fig. 1Full diagram of the constructed barrier.
      According to the WHO guideline on infection prevention and control [
      • World Health Organization
      Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care.
      ], the clinicians should perform standard, contact, and airborne precautions during the collection of respiratory specimens from patients with severe symptoms suggestive of pneumonia. This also includes placement of patient in a single room with negative pressure air handling, if available, and clinicians' use of PPE including respirator N95 or FFP2 standard, long-sleeved fluid-resistant gown, gloves and eye protection. If a negative pressure room is not accessible, we need to place the patient in a single confined room.
      The isolation device is the design of Tseng Yu-Chi and Tseng Kai-Chen. The design shows that a negative pressure room is not required, but it needs to ensure that air does not circulate to other areas. The whole specimen collection process involves two persons: (1) clinician A performs the swabbing (Fig. 2); and (2) Clinician B donned in standard PPE is located outside the exam room to check on the fixed gloves regularly and delivers the specimen to a designated location for further examination. All surfaces that are possibly contaminated, especially the examination area, including the fixed gloves, will then be wiped with disinfectant.
      Fig. 2
      Fig. 2Clinician standing inside the room while communicating with the patient outside using wireless walkie-talkie.
      With the use of this barrier, the use of PPE for clinician A will be significantly reduced. A standard PPE for Clinician A includes a long-sleeved fluid-resistant gown, gloves, disposal face shield, N95 respirator, hair caps, and shoe covers; the barrier ensures that PPEs are preserved and can be used several times. As PPE supplies might not be able to keep up with the surge of COVID-19 patients [
      • Mason D.J.
      • Friese C.R.
      Protecting health care workers against COVID-19—and being prepared for future pandemics.
      ], and witnessing hospitals around the world struggle with the use of their daily allotments with some even rationing their PPE to units or departments. Implementing and constructing this cost-effective approach can assist healthcare facilities in reducing their use of PPEs and not be burdened with a possible shortage in the future.

      Acknowledgments

      We thank Gan Zuo Meng Albie (University of Queensland) for providing us with Fig . 1; colleagues and volunteers at Taichung Tzu Chi Hospital for their kind assistance in this project.

      References

      1. ‘Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19)’, World Health Organization, Interim Guidance.
        ([Online]. Available:)
        • World Health Organization
        Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care.
        World Health Organization, 2014
        • Mason D.J.
        • Friese C.R.
        Protecting health care workers against COVID-19—and being prepared for future pandemics.
        JAMA Health Forum. Mar. 2020; 1: e200353https://doi.org/10.1001/jamahealthforum.2020.0353