Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, Florida.
Respir Care. 2020 Dec;65(12):1923-1932. doi: 10.4187/respcare.08568.
Exposure of respiratory therapists (RTs) during aerosol-generating procedures such as endotracheal intubation is an occupational hazard. Depending on the hospital, RTs may serve as laryngoscopist or in a role providing ventilation support and initiating mechanical ventilation. This study aimed to evaluate the potential exposure of RTs serving in either of these roles.
We set up a simulated patient with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in an ICU setting requiring endotracheal intubation involving a laryngoscopist, a nurse, and an RT supporting the laryngoscopist. All participants wore appropriate personal protective equipment (PPE). A fluorescent marker was sprayed by an atomizer during the procedure using 3 different methods for endotracheal intubation. The 3 techniques included PPE alone, a polycarbonate intubating box, or a coronavirus flexible enclosure, which consisted of a Mayo stand with plastic covering. The laryngoscopist and the supporting RT were assessed with a black light for contamination with the fluorescent marker. All simulations were recorded.
When using only PPE, both the laryngoscopist and the RT were grossly contaminated. When using the intubating box, the laryngoscopist's contamination was detectable only on the gloves: the gown and face shield remained uncontaminated; the RT was still grossly contaminated on the gloves, gown, neck, and face shield. When using the coronavirus flexible enclosure system, both the laryngoscopist and the RT were better protected, with contamination detected only on the gloves of the laryngoscopist and the RT.
Of the 3 techniques, the coronavirus flexible enclosure contained the fluorescent marker more effectively during endotracheal intubation than PPE alone or the intubating box based on exposure of the laryngoscopist and supporting RT. Optimizing containment during aerosol-generating procedures like endotracheal intubation is a critical component of minimizing occupational and nosocomial spread of SARS-CoV-2 to RTs who may serve as either the laryngoscopist or a support role.
呼吸治疗师（RT）在进行气管插管等产生气溶胶的程序时会暴露在其中，这是一种职业危害。根据医院的不同，RT 可能担任喉镜医师，或者提供通气支持和启动机械通气的角色。本研究旨在评估担任这两种角色之一的 RT 的潜在暴露风险。
我们在 ICU 环境中设置了一名患有严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）感染的模拟患者，需要进行气管插管，涉及喉镜医师、护士和支持喉镜医师的 RT。所有参与者均穿戴适当的个人防护设备（PPE）。在气管插管过程中，使用雾化器通过 3 种不同的方法喷洒荧光标记物。这 3 种技术包括仅 PPE、聚碳酸酯插管盒或冠状病毒柔性外壳，后者由带有塑料覆盖物的梅奥支架组成。使用黑光检查喉镜医师和支持 RT 是否有荧光标记物污染。所有模拟均被记录。
仅使用 PPE 时，喉镜医师和 RT 均受到严重污染。使用插管盒时，仅在手套上检测到喉镜医师的污染：手术服和面罩仍未被污染；RT 的手套、手术服、颈部和面罩仍受到严重污染。使用冠状病毒柔性外壳系统时，喉镜医师和 RT 都得到了更好的保护，仅在喉镜医师和 RT 的手套上检测到污染。
在这 3 种技术中，与单独使用 PPE 或插管盒相比，冠状病毒柔性外壳在气管插管过程中更有效地包含了荧光标记物，从而更好地保护了喉镜医师和支持 RT。优化气管插管等产生气溶胶的程序中的遏制措施是最大限度地减少 SARS-CoV-2 向可能担任喉镜医师或支持角色的 RT 职业和医院内传播的关键组成部分。
