Aerosol box usage has limited benefits in reducing contamination during airway procedures: JAMA

For reducing healthcare practitioner (HCP) exposure during aerosol-generating medical procedures (AGMPs), aerosol box has been used to manage COVID-19 patients.

The data in this context remains limited, and more research is required effect of aerosol box use on HCP contamination and AGMP procedure time.

Considering this background, researchers did RCT of 61 teams involving 122 participants performing aerosol-generating medical procedures, including 64.8% female and 69.7% physicians.

Participant teams performed three simulated patient scenarios: bag-valve-mask ventilation, ETI, and LMA insertion. Glo Germ generated aerosol during the procedure.

Teams of 2 HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box).

Interventions included an aerosol box or SplashGuard CG, a clear plastic barrier that covers the patient's head and shoulders. It has access ports that enable healthcare professionals to manage the airway.

The surface area of contamination (AOC) on participants was the primary outcome measured.

Here are the summarized results of the study:

• Using an aerosol box decreased AOC to the torso by 77.5%.
• Aerosol box usage decreased AOC to the facial area in airway HCPs by 60.7 %.
• Following doffing personal protective equipment between groups, no statistically significant difference was reported in surface contamination.
• In the aerosol box, the Time to complete ETI was longer compared to a control group, with a mean difference of 10.2 seconds.
• The mean difference for LMA insertion between groups was 2.4 seconds and was insignificant.

When considering aerosol boxes, it's crucial to balance the advantages of reduced surface contamination with the potential negative impact of longer intubation times on patient outcomes.

They said, based on the results of our study, the use of aerosol may be protective against surface contamination before doffing. Still, this effect is insignificant or not maintained after doffing personal protective equipment.

The study has limitations like the impossibility of exactly replicating aerosolization and potential bias.

Further reading:

Cheng A, Pirie J, Lin Y, et al. Aerosol Box Use Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study): A Simulation-Based Randomized Clinical Trial. JAMA Netw Open. 2023;6(4):e237894. doi:10.1001/jamanetworkopen.2023.7894