A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber

Abstract The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient’s body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.

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Airway Management (DRAFT)

10.1093/med/9780190612474.003.0024 ◽

2018 ◽

Author(s):

James M. Dargin ◽

Lillian L. Emlet

Keyword(s):

Airway Management ◽

Severe Respiratory Failure ◽

Rapid Response Teams ◽

Clinical Context ◽

Careful Planning ◽

Respiratory Status ◽

Management Interventions ◽

Hospital Environments ◽

Advanced Airway ◽

Increased Risk

Deterioration in respiratory status is the most common reason for activation of rapid response teams (RRT). Severe respiratory failure may necessitate advanced airway management interventions including endotracheal intubation (ETI) in hospital environments that may be especially challenging in clinical context, space, equipment, and personnel. Furthermore, patients undergoing ETI during the course of an RRT event are critically ill, identifying them as patients who are at increased risk for adverse events during the procedure. Many of the challenges of airway management during RRT events can be overcome with appropriate staffing, proper equipment, and careful planning prior to attempts at ETI. In this chapter, we discuss the evaluation and management of patients requiring ETI during the RRT event including recommendations on pharmacology and intubation techniques.

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RESEARCH: Dry Heat Processing of Single-Use Respirators and Surgical Masks

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-54.6.410 ◽

2020 ◽

Vol 54 (6) ◽

pp. 410-416

Author(s):

Joyce M. Hansen ◽

Scott Weiss ◽

Terra A. Kremer ◽

Myrelis Aguilar ◽

Gerald McDonnell

Keyword(s):

Microbial Contamination ◽

Healthcare Providers ◽

High Volume ◽

Airborne Particles ◽

Heat Processing ◽

Protective Equipment ◽

Healthcare Facilities ◽

Dry Heat ◽

Surgical Masks ◽

Single Use

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged healthcare providers in maintaining the supply of critical personal protective equipment, including single-use respirators and surgical masks. Single-use respirators and surgical masks can reduce risks from the inhalation of airborne particles and microbial contamination. The recent high-volume demand for single-use respirators and surgical masks has resulted in many healthcare facilities considering processing to address critical shortages. The dry heat process of 80°C (176°F) for two hours (120 min) has been confirmed to be an appropriate method for single-use respirator and surgical mask processing.

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A novel box for aerosol and droplet guarding and evacuation in respiratory infection (BADGER) for COVID-19 and future outbreaks

Scientific Reports ◽

10.1038/s41598-021-82675-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hau D. Le ◽

Gordon A. Novak ◽

Kevin C. Janek ◽

Jesse Wang ◽

Khang N. Huynh ◽

...

Keyword(s):

Respiratory Infection ◽

Healthcare Providers ◽

Airborne Particles ◽

Risk Of Infection ◽

Indirect Contact ◽

Vacuum Suction ◽

Qualitative And Quantitative ◽

Additional Layer ◽

Increased Risk ◽

Design Construction

AbstractThe coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions and killed more than 1.7 million people worldwide as of December 2020. Healthcare providers are at increased risk of infection when caring for patients with COVID-19. The mechanism of transmission of SARS-CoV-2 is beginning to emerge as airborne spread in addition to direct droplet and indirect contact as main routes of transmission. Here, we report on the design, construction, and testing of the BADGER (Box for Aerosol and Droplet Guarding and Evacuation in Respiratory Infection), an affordable, scalable device that contains droplets and aerosol particles, thus minimizing the risk of infection to healthcare providers. A semi-sealed environment is created inside the BADGER, which is placed over the head of the patient and maintains at least 12-air changes per hour using in-wall vacuum suction. Multiple hand-ports enable healthcare providers to perform essential tasks on a patient’s airway and head. Overall, the BADGER has the potential to contain large droplets and small airborne particles as demonstrated by simulated qualitative and quantitative assessments to provide an additional layer of protection for healthcare providers treating COVID-19 and future respiratory contagions.

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Novel repurposing of a Laerdal Airway trainer to simulate aerosolisation

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2020-000802 ◽

2021 ◽

pp. bmjstel-2020-000802

Author(s):

Sven Peter Oman ◽

Scott Helgeson ◽

Philip Lowman ◽

Pablo Moreno Franco ◽

Jonathan Tomshine ◽

...

Keyword(s):

Airway Management ◽

Ultraviolet Light ◽

Healthcare Workers ◽

Saline Solution ◽

Size Range ◽

Ambient Air ◽

Airborne Particles ◽

Exposure Risk ◽

Aerosol Model ◽

The Usa

COVID-19 has claimed over 200 000 lives in the USA and put healthcare workers at risk. Healthcare workers have an increased exposure risk from aerosol-generating procedures such as endotracheal intubation. New barrier designs such as the acrylic box and horizontal plastic drape have emerged to reduce exposure to airborne particles. Particle generating models are needed to test aerosol generating procedure (AGP) barrier designs. To achieve this, an aerosol model that generates a visible and measurable increase in particles which SARS-CoV-2 could travel on and that can also be intubated was created. The model was created using a Laerdal Airway Management Trainer (Laerdal Medical, Stavanger, Norway) combined with a nebuliser and Ambu bag-valve resuscitator (Ambu, Columbia, Maryland, USA). Nebulised Glo Germ (Glo Germ, Moab, Utah, USA) dissolved in saline solution was moved through the tubing and out of the mannequin’s mouth with compression of the Ambu bag. This nebulisation was visualised under ultraviolet light and the quantity of particles between 0.3 and 10.0 μm was measured with a particle counter. Nebulisation was visible exiting the mouth of the mannequin. Nebulised Glo Germ was visualised under ultraviolet light moving in the ambient air. Particles in the size range of 0.3–0.5 µm increased by 20-fold and 1–10 µm increased by 10 252%. SARS-CoV-2 can travel on aerosol and droplet particles and particle generating models are needed to visualise and measure exposure areas and the path particles take during AGPs. We used existing medical and simulation supplies to create a particle simulator.

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Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

Health Policy and Planning ◽

10.1093/heapol/czaa172 ◽

2020 ◽

Author(s):

Joshua P Murphy ◽

Aneesa Moolla ◽

Sharon Kgowedi ◽

Constance Mongwenyana ◽

Sithabile Mngadi ◽

...

Keyword(s):

South Africa ◽

Qualitative Study ◽

Policy Implementation ◽

Community Health ◽

Resource Constraints ◽

Health Workers ◽

Healthcare Providers ◽

Successful Implementation ◽

Programme Implementation ◽

Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

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Theoretical and contextual considerations for self-management strategies of children and adolescents with chronic diseases: An integrative review

Journal of Child Health Care ◽

10.1177/13674935211013697 ◽

2021 ◽

pp. 136749352110136

Author(s):

Logan J Camp-Spivey ◽

Ayaba Logan ◽

Michelle Nichols

Keyword(s):

Children And Adolescents ◽

Chronic Diseases ◽

Management Strategies ◽

Healthcare Providers ◽

Integrative Review ◽

Self Management ◽

Intervention Delivery ◽

Management Interventions ◽

Technological Platforms ◽

Management Behaviors

The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl’s methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.

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The role of a remote knowledge broker from an academic setting using an adaptive approach to implement evidence-based practice in primary care settings: A case study of integrating mood management interventions for treatment seeking tobacco users.

10.21203/rs.2.21301/v1 ◽

2020 ◽

Author(s):

Nadia Minian ◽

Sheleza Ahad ◽

Laurie Zawertailo ◽

Arun Ravindran ◽

Claire de Oliveira ◽

...

Keyword(s):

Primary Care ◽

Healthcare Providers ◽

Family Health ◽

Practice Change ◽

Knowledge Broker ◽

Local Context ◽

Knowledge Brokering ◽

Mood Management ◽

Management Interventions

Abstract Background: Knowledge brokering is an emerging knowledge translation strategy used within healthcare to bridge the gap between evidence and practice. Reported studies indicate that the day-to-day role of a knowledge broker often involves in-person communication with frontline workers and decision makers. However, travelling to primary care sites can be cost- and resource-intensive and thus not feasible. In this paper, we describe the role and experience of a remote knowledge broker (rKB) working in an academic health sciences centre, delivering tailored one-on-one support to end-users using phone and email communications. Methods: A rKB was hired to support (n = 62) English-speaking Family Health Teams (FHTs) across Ontario with implementing mood management interventions as part of an existing smoking cessation program, the Smoking Treatment for Ontario Patients (STOP) program. We describe the eight categories of tasks performed by the rKB over a 12-month period, as well as their experience communicating via technology to develop relationships with healthcare providers (HCPs). Results: Sixty-one of the 62 FHTs (n = 73 HCPs) were provided rKB services. The total number of successful phone and email communications with the rKB ranged from 3-98 interactions over 12 months. Common barriers to implementation reported by FHTs were associated with the Inner and Outer Setting domains of the Consolidated Framework for Implementation Research (CFIR) and included lack of time, resources, and patient engagement. Conclusions: The role of the rKB involved building relationships with HCPs, identifying and helping to problem solve barriers, and building capacity in the field. Similar to traditional knowledge brokering, this analysis shows that developing a meaningful relationship between a remotely situated KB and HCPs could take anywhere between 1-6 months. Using implementation frameworks such as CFIR can help the rKB identify barriers and be ready to address them. In addition, hiring a rKB with previous engagements and knowledge of the local context may facilitate clinical practice change. Our future work will evaluate the cost-effectiveness of rKBs to inform its potential to be scaled up.

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Emergent airway management outside of the operating room – a retrospective review of patient characteristics, complications and ICU stay

BMC Anesthesiology ◽

10.1186/s12871-019-0894-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Uzung Yoon ◽

Jeffrey Mojica ◽

Matthew Wiltshire ◽

Kara Segna ◽

Michael Block ◽

...

Keyword(s):

High Risk ◽

Hospital Mortality ◽

Airway Management ◽

Hospital Stay ◽

Operating Room ◽

X Rays ◽

Icu Stay ◽

Management Interventions ◽

The Mean ◽

Emergent Airway Management

Abstract Background Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward. Methods We retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained. Results 336 intubations were performed in 275 patients during the six-month period. The majority of intubations (n = 196, 58%) occurred in an ICU setting, and the rest 140 (42%) occurred on a normal floor or in a remote location. The mean admission ASA status was 3.6 ± 0.5, age 60 ± 16 years, and BMI 30 ± 9 kg/m2. Chest X-rays performed immediately after intubation showed main stem intubation in 3.3% (n = 9). Two immediate (within 20 min after intubation) intubation related cardiac arrest/mortality events were identified. The 30-day in-hospital mortality was 31.6% (n = 87), the overall in-hospital mortality was 37.1% (n = 102), the mean hospital stay was 22 ± 20 days, and the mean ICU-stay was 14 days (13.9 ± 0.9, CI 12.1–15.8) with a 7.3% ICU-readmission rate. Conclusion Patients requiring emergent airway management are a high-risk patient population with multiple comorbidities and high ASA scores on admission. Only a small number of intubation-related complications were reported but ICU length of stay was high.

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Issues and Challenges in Implementing Care Coordinator in Primary Healthcare in Malaysia: A Qualitative Study

Journal of Primary Care & Community Health ◽

10.1177/2150132720956478 ◽

2020 ◽

Vol 11 ◽

pp. 215013272095647

Author(s):

Zalilah Abdullah ◽

Siti Hajar Abdul Aziz ◽

Nur Aliyah Sodri ◽

Ainul Nadziha Mohd Hanafiah ◽

Nor Idawaty Ibrahim ◽

...

Keyword(s):

Primary Healthcare ◽

Resource Constraints ◽

Clinical Skill ◽

Healthcare Providers ◽

Healthcare Setting ◽

Care Coordinator ◽

Good Communication ◽

Increasing Demand ◽

The Individual ◽

Inner Setting

Background: Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics. Methods: This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains. Results: A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years’ experience in the primary healthcare setting. Conclusion: The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

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(P1-62) The Risk Factors for Difficult or Failed Airway: A Prosepctive Cohor Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11003943 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s118-s118

Author(s):

C. Hsu

Keyword(s):

Risk Factors ◽

Airway Management ◽

Difficult Airway ◽

Healthcare Providers ◽

Positive Association ◽

Daily Practice ◽

Trauma Patients ◽

Airway Trauma ◽

Failed Airway ◽

Airway Devices

The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper managementof difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.

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