Trisha L.

Matula
BSN-3G

Preventing transmission among operating room staff during COVID-19 pandemic:

the role of the Aerosol Box and other personal protective equipment

The COVID-19 pandemic presents significant challenges for the medical staff in
emergency rooms and operating rooms. The most typical symptoms of SARS-CoV-2, a
positive-sense single-stranded RNA beta-coronavirus that primarily affects the human
respiratory system, include fever, cough, myalgia, and pneumonia. But since SARS-CoV-
2 RNA was found in stool samples, much more focus has been placed on digestive
symptoms like nausea, diarrhea, and loss of appetite. Additionally, the presence of ACE-
2 receptors in absorptive enterocytes from the ileum and colon raises the possibility of a
high risk of SARS-CoV-2 infection in these organs. The production of both airborne
particles and droplets during aerosol-generating medical procedures (AGMP; for
example, intubating and extubating patients or any surgical procedures) may increase the
risk of infection. It is strongly advised that the surgical staff wear personal protective
equipment in this circumstance (PPE). Recently, a transparent plastic cube known as the
"Aerosol Box" (AB) was created to provide additional defense against droplet and
aerosol exposure during the AGMP. The World Health Organization (WHO) and the
Centers for Disease Control and Prevention (CDC) established a list of AGMP that all
involved theater staff should be advised to use personal protective equipment (PPE). PPE
consists of long-sleeved gowns, a N95 mask, gloves, and a head covering. The total viral
load in the secretions to which the healthcare workers are exposed is the main factor in
determining the risk of contagion. It is therefore strongly advised to keep the amount of
time spent in close proximity to patients to a minimum. In this regard, the "Aerosol Box"
(AB) has been asserted as a valuable protective resource during endotracheal intubation
or extubation and open suctioning of airways. This system appears to be a low-cost,
room-efficient, and simple to set up solution to limit the area of contact against expelled
aerosol particles. It was originally designed by a Taiwanese doctor on a basic cuboid with
two access ports for arms. In this study, we concentrate on the role of PPE and AB in
preventing transmission among operating room staff. AB consists of a disposable
polycarbonate sheet box, which can be re-used after careful decontamination with an
appropriate cleansing agent. According to a recent report, COVID-19 infection poses a
serious risk of complicating surgical patients' recoveries. The chance of surgical team
members infecting patients and other staff members is also very high. Even though there
is little evidence of PPE's effectiveness during the COVID-19 pandemic, respiratory
protection is required. Even though there is little evidence of PPE's effectiveness during
the COVID-19 pandemic, respiratory protection is required. In fact, two randomized
controlled trials found no differences between N95 and surgical masks in terms of
infection rates. The use of local protocols for PPE in the operating room, including
scrubbing, donning, and doffing techniques, is advised by a recent global guidance for
surgical care. We support the use of both PPE and AB to protect surgical staff during the
current COVID-19 outbreak due to the high risk of disease transmission during AGMP.

Reference:
F. Bianco, P. Incollingo, U. Grossi & G. Gallo (2020), Preventing transmission among
operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other
personal protective equipment. Updates in Surgery volume 72, pages907–910 (2020).
Retrieved September 01, 2022 at https://link.springer.com/article/10.1007/s13304-020-
00818-2