Introduction
In the month of December there were cluster of patients found in Wuhan, China who had similar respiratory illness like SARS, later it was notified as an epidemic due to novel Corona virus on 31st December by the world health organisation. It then continued to become a pandemic leading to mortality in the patients which was primarily due to sever acute respiratory illnes who needed ventilatory support. There is increased risk to healthcare workers during the pandemic.1 Aerosolisation leads to exposure of massive loads of virus and contamination of self and equipment the doffing of which may at time lead to infection of healthcare workers. Procedure like intubation, extubation, bronchoscopy, tracheostomy are noted to generate aerosols. On 3rd April an article published in the NEJM described the effect of aerosisation during a cough inducing procedure.2 The use of transparent aerosol box served as a barrier enclosure which will be an added protection during procedures in addition to donning standard personal protective equipment. However India is presently under a lockdown and there is no availability of any resources and raw material to build the box. Hence the author’s came out with a unique way of converting an incubator into what they have named their “super protect box” for aerosol generating procedures.
An incubator (made of hard and heavy acrylic) was found in a condemned section of the hospital (Figure 1). The weight of the incubator was 22 kilos. Two openings already present on one side was left open for handling the airway as show in Figure 2, Figure 3. The sides and the front section was cut open to accommodate the patients body and help in reduction of the weight as shown in Figure 2, Figure 3.
The super protect box is presently in use by the critical care physicians during all aerosol generating procedures like intubation, extubation, nebulisation, suctioning etc and till date have developed great confidence and literally ”feel safe” during any procedure involving generation of aerosols like intubation.
The merits of the “super protect box” is
Indigenously developed from waste and condemned material
Light weight (3 kilos)
Very stable on the bed
Enough space to manoeuvre as compared to the aerosol box mentioned in the NEJM article by Canelli et al.2
Markedly reduces the chances of contamination
Gives a great sense of security for health care workers.
Such indigeniously developed equipment may be warranted in hospitals dealing with Covid- 19 patients especially when countries are literally under a lock down in-order to ensure safety of their healthcare workers.