Preventing spread of aerosolized infectious particles during medical procedures: A lab-based analysis of an inexpensive plastic enclosure

Severe viral respiratory diseases, such as SARS-CoV-2, are transmitted through aerosol particles produced by coughing, talking, and breathing. Medical procedures including tracheal intubation, extubation, dental work, and any procedure involving close contact with a patient’s airways can increase exposure to infectious aerosol particles. This presents a significant risk for viral exposure of nearby healthcare workers during and following patient care. Previous studies have examined the effectiveness of plastic enclosures for trapping aerosol particles and protecting health-care workers. However, many of these enclosures are expensive or are burdensome for healthcare workers to work with. In this study, a low-cost plastic enclosure was designed to reduce aerosol spread and viral transmission during medical procedures, while also alleviating issues found in the design and use of other medical enclosures to contain aerosols. This enclosure is fabricated from clear polycarbonate for maximum visibility. A large single-side cutout provides health care providers with ease of access to the patient with a separate cutout for equipment access. A survey of medical providers in a local hospital network demonstrated their approval of the enclosure’s ease of use and design. The enclosure with appropriate plastic covers reduced total escaped particle number concentrations (diameter > 0.01 μm) by over 93% at 8 cm away from all openings. Concentration decay experiments indicated that the enclosure without active suction should be left on the patient for 15–20 minutes following a tracheal manipulation to allow sufficient time for >90% of aerosol particles to settle upon interior surfaces. This decreases to 5 minutes when 30 LPM suction is applied. This enclosure is an inexpensive, easily implemented additional layer of protection that can be used to help contain infectious or otherwise potentially hazardous aerosol particles while providing access into the enclosure.

623. Exploring ‘Slicer Dicer’, an Extraction Tool in EPIC, for Clinical and Epidemiological Analysis

Background

Electronic Health Record (EHR) implementation has created an unprecedented library of patient data. Data extraction tools provide an opportunity to retrieve clinico-epidemiological information on a wide scale. Slicer Dicer is a data exploration tool in the EPIC EHR that allows one to customize searches on large patient populations. This software contains a variety of models that present de-identified information from EPIC’s Caboodle database. We explored the applicability and potential utility of this tool utilizing the diagnosis of Lyme disease as an example.

Methods

The following steps outline an overview of data extraction utilizing ICD-10 codes around Lyme disease at our health system. Step 1-3: Denominator chosen as ‘All Patients’ over a 3-year period, ‘Slicing’ of the data by ‘Lyme disease, unspecified’ was applied to these results, and the ‘sliced’ data was categorized by year of diagnosis (Slide 1). Step 4: This data was further arranged by month of diagnosis for trend analysis (Slide 2). Step 5: Sub-diagnosis was applied for Lyme arthritis (Slide 3). Step 6: Further ‘slicing’ was/can be done by other variables, such as ‘Hospitalization,’ ‘Encounter Diagnosis,’ and ‘ED Diagnosis’ (Slide 4). Step 7-8: Output was ‘sliced’ by ‘Age’ (Slide 5) and ‘Postal Code’ (Slide 6).

Slide 1. EPIC EHR screen capture showing 3-year period data

Results

Macro-level data of period prevalence on Lyme disease over 3 years (Slide 1), seasonal trends (Slide 2), specific sub-diagnosis (Slide 3), output by setting of diagnosis (Slide 4), and demographic information of our patient population (Slides 5, 6) was revealed by application of these parameters.

Slide 3. EPIC EHR screen capture showing application of sub-diagnosis for Lyme arthritis

Conclusion

Slicer Dicer can provide a snapshot for preliminary data analysis prior to investing time and commitment to a project. The appeal of this tool is that it mines de-identified data and thus does not require initial IRB approval. This opens an avenue for potential full research projects based on the results obtained and helps generate preliminary hypotheses through analysis of healthcare.

Slide 6. EPIC EHR screen capture showing slicing of data by demographic information (Postal Code)

Disclosures

All Authors: No reported disclosures

Effects of metals and arsenic on riparian communities in southwest Montana

: Concentrations of metals and arsenic in floodplain soils of Silver Bow Creek and the upper Clark Fork River in southwest Montana were related to phytotoxic responses by individual plants in laboratory experiments, vegetative community structure and composition in the field and wildlife habitat. Samples collected from barren or very sparsely vegetated mixed mine tailings and alluvium deposits (slickens) in the floodplains along Silver Bow Creek and the Clark Fork River had concentrations of As, Cd, Cu, Pb and Zn that were significantly elevated relative to reference sites. Laboratory phytotoxicity tests demonstrated severe and rapid effects of the elevated concentrations of metals and As on hybrid poplar and standard test species (alfalfa, lettuce and wheat): growth inhibition of hybrid poplars was nearly 100% and of standard test species ≥75%. Vegetation community measurements revealed that slickens have replaced riparian forest, shrub, hay fields and pasture land; in doing so, the slickens have reduced both the compositional and structural heterogeneity of the riparian habitat. This reduction in habitat complexity has reduced the capacity of the area to provide a diversity of suitable wildlife habitat.