Aerosol and surface contamination assessment of a novel ventilated infectious aerosol containment device

Healthcare personnels (HCPs) are at risk of respiratory infectious diseases during patient care activities. HCPs rely primarily on personal protective equipment to prevent pathogen exposures, but there is a need to develop alternative, or complementary control strategies, including engineering controls. The objective of this study was to evaluate the ability of the 3 designs (denoted D1A, D1B, and D2) of the University of Utah Containment Ventilation for Exposure Reduction (U-COVER), a protective barrier enclosure device to contain respirable aerosols when placed over a simulated patient. The 2 primary performance metrics were the percent reduction in: (i) the concentration of respirable aerosols in the simulated breathing zone of an HCP, and (ii) surface contamination outside the device, which were tested using salt aerosols and fluorescein aerosols, respectively. Briefly, salt or fluorescein aerosols were generated as though expelled by a prone patient under 3 conditions: (i) no device (control), (ii) with the device but without exhaust ventilation, and (iii) with the device with exhaust ventilation. Device D2 was also tested under simulated use conditions, in which cardboard "arms" were placed inside the device ports. All 3 device designs showed the ability to reduce particle concentrations in the simulated HCP breathing zone and on surfaces by >99% with exhaust ventilation compared to the control condition. Without exhaust ventilation, device performance was lower and highly variable. Under simulated use conditions, device D2 reduced particle concentrations in the simulated HCP breathing zone by ≥91% and on surfaces by >99% relative to control for all combinations of "arms" tested. The U-COVER device demonstrates excellent aerosol containment and warrants further testing with dynamic simulated or actual use conditions.

Aerosol containment device design considerations and performance evaluation metrics

BACKGROUND

Spurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated?

METHODS

A scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation.

RESULTS

Fifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance.

CONCLUSION

With respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience.