VACuum INtubation (VACcIN) box restricts the exhaled air dispersion generated by simulated cough: description and simulation-based tests of an innovative aerosolization protective prototype.

The COVID-19 pandemic has caused personal protective equipment shortages worldwide and required healthcare workers to develop novel ways of protecting themselves. Anesthesiologists in particular are exposed to increased risks of contamination when performing interventions such as airway manipulations. We developed and tested an aerosolization protective device which contains aerosols around the patient's airway and helps eliminate particles using negative pressure. This intubation box is a polymethyl methacrylate prism with openings for gloves, integrated suction and ventilation connectors. We conducted a randomised controlled series of tests to detect 0.5 µm particles after a simulated cough inside the intubation box, using a high-fidelity simulation mannequin. Setting and main outcome: We measured particle concentrations inside the box with and without suction turned on, in both negative and positive pressure operating rooms. We also obtained particle concentrations outside our box and compared them to non-airtight barrier devices. One minute following simulated cough, the mean number of particles per cubic foot in our box with suction on is around 45% that with the suction off (1,462,373 vs 3,272,080, P < 0.0001) in the negative pressure room, and four times lower than with the suction off (760,380 vs 3,088,700, P < 0.0001) in the positive pressure room. After a simulated cough inside the box, particles can be detected in front of the anesthesiologist's face with a non-airtight device, while none are detected when our box is sealed and its suction turned on. The use of our negative pressure intubation box prevents contamination of surroundings and increases particle elimination, regardless of room pressure.

An Integrative Review of the Structures and Processes Related to Nurse Supervisory Performance in Long-Term Care.

BACKGROUND: Understanding the structures and processes related to the supervisor performance of regulated nurses (registered nurses [RN] and registered practical nurses [RPN]) is critical in order to discern how administrators of long-term care (LTC) homes can facilitate and better support nurses given their important contribution to nurse assistants' job satisfaction and resident outcomes. AIMS: The aim of this integrative review is to identify the structures and processes related to supervisory performance of regulated nurses in LTC. METHODS: An electronic search of six databases for studies published in English between 2000 and September 2015 was conducted by a librarian. The inclusion criteria were studies focused on RN or RPN supervisory performance in LTC, which included a structure or process related to supervisory performance of the nurse. Screening, quality assessment using the Mixed Methods Assessment Tool, and data extraction for the included studies were conducted independently by two reviewers. RESULTS: A total of 22 studies were included in the review. Six nurse structures (e.g., nurses' "perceptions of their supervisory role and authority" as well as their "personal qualities"), and eight organizational structures (e.g., "organizational support (culture) for supervisory and management practices" and "staffing levels") were identified. Six processes of effective supervisory performance were identified, such as "being flexible, understanding, considerate listeners and encourage staff input" as well as "respect, value, recognize, acknowledge and motivate" nursing assistants they supervise. LINKING EVIDENCE TO ACTION: The results highlight the nuanced and complex nature of nurses' supervisory performance and the multifaceted approach required to support effective nurse supervisors in LTC. Future research should examine how resident-related structures, as well as other moderators and mediators, may influence supervisory performance. Developing detailed models of effective supervision can inform future interventions targeting modifiable processes related to supervisory performance to thereby change practice and optimize supervisory performance in LTC.