St George’s COVID shield for use by ENT surgeons performing tracheostomies

  1. Sabrina Brar
  2. Jahan Daya
  3. James Schuster-Bruce
  4. Sanjeev Krishna
  5. Hamid Daya

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Abstract

Healthcare workers are at increased risk of exposure to COVID-19. The majority of cases are acquired through inhalation of infected respiratory particles, contamination with infected surfaces or whilst performing aerosol-generating procedures. Basic infection prevention measures are essential to protect healthcare workers from contracting the disease when managing patients; consequently global demand for personal protective equipment (PPE) has exceeded supply in many regions. We present a novel, innovative polycarbonate shield designed for ENT clinicians performing tracheostomies. Clinical investigations using the shield demonstrated a sixteen-fold decrease in the number of particles detected at the position of the operating surgeon when the shield was used (particle size 0.3μm; with shield 27,000 versus 439,000 without shield). The shield, used with appropriate PPE, could therefore help to minimise exposure to aerosol generated particles such as during tracheostomies on patients with COVID-19.

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    SciScore for 10.1101/2020.05.04.20087072: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Study limitations: There are limitations to recognise when interpreting the data presented in this study. Firstly, the particle counter detected fixed particle diameters and the smallest particle detected during our experiment was 0.3μm. The aerosol particle size of SARS-CoV-2 has been demonstrated to have a diameter of 0.25μm - 0.5μm.4, 5 We are therefore unable to account for viral particles smaller than this size for both our primary and secondary outcome measure; however we are confident that we can extrapolate our data for particles of a similar size to those of SARS-CoV-2. Additionally, the experiment illustrated that over time, the level of particles (0.3μm, 2.5μm and 10μm) decreased to ambient environment levels or below. It is therefore likely that particles smaller than specifically tested during the experiment would follow the same pattern. A second unknown is how the density of these aerosol particles will vary in different temperatures. We used the particle detector to measure the ward temperature (23.5°C) – this was consistent throughout the experiment. Whilst we do not anticipate that a different temperature in theatre would impact the distribution of aerosol particles, it is possible that the rate of particle dissipation may increase in higher ambient temperatures. Finally, the accuracy of a cough to mimic the expulsion of SARS-CoV-2 aerosol particles during a tracheostomy is uncertain and may have case-by-case variation depending on a variety of factors, incl...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.04.20087072v1 on medRxiv