Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC.
CMAJ Open. 2020 Aug 31;8(3):E554-E559. doi: 10.9778/cmajo.20200090. Print 2020 Jul-Sep.
The intubation of patients with coronavirus disease 2019 (COVID-19) puts health care workers at risk of infection through aerosol, droplet and contact contamination. We evaluated the risk of droplet and contact contamination for health care workers using 3 intubation barrier techniques as part of a quality assurance study at our institution.
This randomized quality assurance study was completed at a tertiary academic hospital in Vancouver, British Columbia, Canada, on Apr. 4, 2020. Participants in personal protective equipment performed simulated intubations on a manikin with (a) no barrier, (b) a clear plastic sheet covering the manikin and (c) a plexiglass intubation box over the manikin, in random order. Fluorescein was ejected from inside the manikin's mouth to simulate droplet and contact spread during a standard intubation sequence. Two blinded independent assessors evaluated the location and degree of contamination on the intubator and assistant using an ultraviolet light. Contamination severity was rated in a standard fashion (0 = none; 1 = minor; 2 = major). The primary outcome was total contamination score and secondary outcomes were scores between intubator and assistant, anatomic areas contaminated and qualitative feedback on ease of intubation.
Five participants completed this study. Total contamination score was different between the 3 groups for the intubator ( = 0.02) but not the assistant ( = 0.2). For the intubator, the total contamination score was higher when the sheet was used (median 29 [interquartile range (IQR) 25-34]) than when the box was used (median 17 [IQR 15-22]) or when no barrier was used (median 18 [IQR 13-21]). All 5 participants reported challenges during intubation using the sheet.
Use of a plastic sheet while intubating patients with COVID-19 may increase the risk of droplet and contact contamination during intubation and impede intubation. Further study should be undertaken before implementing barrier techniques in practice.
对 2019 年冠状病毒病（COVID-19）患者进行插管会使医护人员面临通过气溶胶、飞沫和接触污染感染的风险。我们在本机构进行了一项质量保证研究，使用 3 种插管屏障技术评估了医护人员发生飞沫和接触污染的风险。
这是一项在加拿大不列颠哥伦比亚省温哥华的一所三级学术医院进行的随机质量保证研究，于 2020 年 4 月 4 日完成。穿戴个人防护装备的参与者在一个模拟患者身上以随机顺序进行了 3 种模拟插管：（a）无屏障，（b）用透明塑料片覆盖模拟患者，（c）在模拟患者上方放置有机玻璃插管盒。荧光素从模拟患者的口中喷出，以模拟标准插管过程中的飞沫和接触传播。2 位独立的盲法评估者使用紫外线灯评估插管者和助手的污染位置和程度。污染严重程度按标准方式评分（0 = 无；1 = 轻微；2 = 严重）。主要结局是总污染评分，次要结局是插管者和助手之间的评分、污染的解剖区域和插管的难易程度的定性反馈。
5 名参与者完成了这项研究。对于插管者，3 组的总污染评分不同（ = 0.02），但助手之间的评分无差异（ = 0.2）。使用塑料片时，插管者的总污染评分（中位数 29 [四分位距 25-34]）高于使用插管盒（中位数 17 [15-22]）或无屏障（中位数 18 [13-21]）。所有 5 名参与者都报告了使用塑料片时插管的困难。
对 COVID-19 患者进行插管时使用塑料片可能会增加插管过程中飞沫和接触污染的风险，并阻碍插管。在实践中实施屏障技术之前，应进行进一步研究。
