Protective Boxes to Prevent Airborne Transmission of SARS-COV-2: Hospital-Based Experiences and a Narrative Literature Review.

OBJECTIVE: Occupational safety in healthcare settings is an integral part of treating COVID-19. A growing body of evidence suggests that the inhalation of both respiratory droplets (>5 µm) and tiny aerosols (<5 µm) is a possible route of virus transmission. Recently, innovative barrier enclosures (aerosol boxes) have been designed to cover patients' heads while allowing the implementation of airway management procedures through fitted holes. The initial design has undergone a series of modifications to improve staff safety, operators' ergonomics, and the efficacy of airway procedures. METHODS: We reviewed the literature concerning different box modifications and provided an insight into our experience of using the box. Aerosol boxes have garnered the attention of clinicians who are frequently exposed to aerosols while performing aerosol-generating medical procedures, particularly endotracheal intubation. Current evidence comes from simulation-based studies rather than real-life clinical investigations. RESULTS: The reports indicated that the box has significantly reduced the diffusion of aerosols into the room; however, the operators have experienced difficulties in the maneuverability of airway devices. CONCLUSION: Aerosol boxes should be used for patients necessitating simple elective intubations after healthcare providers are adequately trained. Customized designs can be further made based on clinicians' experiences.

A Push-to-Talk Application as an Inter-Professional Communication Tool in an Emergency Department During the COVID-19 Pandemic.

OBJECTIVE: To assess the effects of using a smartphone-based push-to-talk (PTT) application on communication, safety, and clinical performance of emergency department (ED) workers during the COVID-19 outbreak. DESIGN: An observational, cross-sectional study. SETTING: ED in an academic medical center. PARTICIPANTS: All ED staff members, including physicians (consultants, specialists, residents, and interns), nurses, emergency medical services staff, technicians (X-ray), and administration employees. INTERVENTIONS: Eligible participants (n=128) were invited to fill out an online questionnaire 30 days after using a PTT application for sharing instant voice messages during the COVID-19 outbreak. MAIN OUTCOME MEASURES: Self-reported data related to communication, implementation of personal protective measures, and clinical performance at the ED were collected and analyzed on a 5-item Likert scale (from 5 [strongly agree] to 1 [strongly disagree]). Also, the proportions of favorable responses (agree or strongly agree) were calculated. RESULTS: Responses of 119 participants (51.3% females, 58.8% nurses, and 34.5% physicians; 90.4% received at least one notification per day) were analyzed. The participants had favorable responses regarding all domains of communication (between 63.0% and 81.5%), taking precautionary infection control measures (between 49.6% and 79.0%), and performance (between 55.5% and 72.3%). Receiving fake and annoying alerts and application breakdowns were the lowest perceived limitations (between 12.5% and 21.0%). CONCLUSION: The assessed PTT application can be generalized to other departments and hospitals dealing with patients with COVID-19 to optimize staff safety and institutional preparedness.