Aerosol Retention Characteristics of Barrier Devices.

BACKGROUND: Disease severity in coronavirus disease 2019 (COVID-19) may be associated with inoculation dose. This has triggered interest in intubation barrier devices to block droplet exposure; however, aerosol protection with these devices is not known. This study hypothesized that barrier devices reduce aerosol outside of the barrier. METHODS: Aerosol containment in closed, semiclosed, semiopen, and open barrier devices was investigated: (1) "glove box" sealed with gloves and caudal drape, (2) "drape tent" with a drape placed over a frame, (3) "slit box" with armholes and caudal end covered by vinyl slit diaphragms, (4) original "aerosol box," (5) collapsible "interlocking box," (6) "simple drape" over the patient, and (7) "no barrier." Containment was investigated by (1) vapor instillation at manikin's right arm with video-assisted visual evaluation and (2) submicrometer ammonium sulfate aerosol particles ejected through the manikin's mouth with ventilation and coughs. Samples were taken from standardized locations inside and around the barriers using a particle counter and a mass spectrometer. Aerosol evacuation from the devices was measured using standard hospital suction, a surgical smoke evacuator, and a Shop-Vac. RESULTS: Vapor experiments demonstrated leakage via arm holes and edges. Only closed and semiclosed devices and the aerosol box reduced aerosol particle counts (median [25th, 75th percentile]) at the operator's mouth compared to no barrier (combined median 29 [-11, 56], n = 5 vs. 157 [151, 166], n = 5). The other barrier devices provided less reduction in particle counts (133 [128, 137], n = 5). Aerosol evacuation to baseline required 15 min with standard suction and the Shop-Vac and 5 min with a smoke evacuator. CONCLUSIONS: Barrier devices may reduce exposure to droplets and aerosol. With meticulous tucking, the glove box and drape tent can retain aerosol during airway management. Devices that are not fully enclosed may direct aerosol toward the laryngoscopist. Aerosol evacuation reduces aerosol content inside fully enclosed devices. Barrier devices must be used in conjunction with body-worn personal protective equipment.

Supporting COVID-19 Vaccine Rollout before Charter Class Arrives: The University of California, Irvine Experience.

Despite numerous challenges in relation to being a recently established school, the University of California, Irvine (UCI) School of Pharmacy and Pharmaceutical Sciences (SPPS), similar to many schools of pharmacy in the United States, was highly committed to supporting the rollout of COVID-19 vaccines. UCI SPPS and our affiliated UCI Medical Center (UCIMC) Pharmacy Department partnered to spearhead the pharmacy element of a large-scale COVID-19 vaccination clinic on campus for both employees and the community. Three key initiatives were established in order to overcome the obstacles we faced in the large-scale roll out of COVID-19 vaccines: (1) forging new collaborations within the pharmacy team, (2) leveraging interprofessional education and practice, and (3) raising awareness of the pharmacists' role. Our response to the COVID-19 vaccines at UCI was a tangible, visible model that demonstrated that, while we continue to embrace our role in team-based, patient-centered care, it is also important for us to step up and lead the profession. Additionally, this vaccine rollout experience is a teachable moment for our communities and our health professional partners as we continue to march forward as one voice to serve the American public.