Surgery suites at Allegheny Health Network have a new piece of equipment to protect against the novel coronavirus.
Before intubation, a clear plastic cube is now placed over a patient’s head and shoulders. It's meant to reduce airborne secretions from spreading during surgery. The covering includes an “access port,” which allows physicians to insert breathing tubes.
“Working in and around the operating room is an area where aerosols and oxygen flow and airflow is very high. There is a potential of the spread of aerosols and vapors,” said Dr. JP Lawrence, one of the cube's designers.
By some estimates, as many as 45 percent of people infected with the coronavirus are asymptomatic. This concerns anesthesiologists, who insert breathing tubes when putting people to sleep for surgery. The process causes secretions to aerosolize, potentially exposing operating room staff to the virus.
“[The cube] really protects the providers as well as the surrounding environment … equipment and operating rooms, emergency rooms and intensive care unit rooms ... the equipment and the tables and everything from gross levels of contamination,” said Lawrence, who is AHN’s chief of anesthesiology.
Lawrence said the idea evolved from conversations with staff who had learned of a physician from Taiwain named Dr. Hsien Yung Lai, who designed an "aerosol block" back in March. Lawrence made contact with Warrendale-based Magee Plastics Company, which is producing the cubes. The manufacturer specializes in thermoplastic and composite products, like the interior paneling of airplanes.
Doctors in Pittsburgh probably aren’t the only ones inspired by Lai. According to the head of the American Society of Anesthesiology, providers from across the county have come up with various methods to contain droplets and aerosols during surgery, but it's unclear if any of them are effective.
“We just don't have really the studies to decide whether they're good or they're bad. It sort of makes logical sense, but we know a lot of things that make logical sense,” said Dr. Mary Dale Peterson, the society’s president.
While the anesthesiology organization doesn’t have a position on cubes, Peterson said that appropriate personal protective equipment will prevent exposure to the virus.
Allegheny Health Network will receive 200 cubes; 150 cubes will go to other area medical networks, including Butler Health, Heritage Valley and Excela. The endeavor was partly funded with a $150,000 grant from the Richard King Mellon Foundation.
One medical system that will not be using the cube is UPMC. A spokesperson for the AHN rival said UPMC doctors have created a "negative pressure box," that, like Lawrence's cube, is also designed to contain aerosols during surgery. The device is currently under review by the Food and Drug Administration.
In the meantime, AHN is working to improve its cube by partnering with Carnegie Mellon University. Aerosol researchers are experimenting with materials like cling wrap and surgical draping to find ways to better contain aersols and droplets.