A comparison of droplet and contact contamination using 3 simulated barrier techniques for COVID-19 intubation: a quality assurance study.

ABSTRACT

BACKGROUND: 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. METHODS: 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. RESULTS: Five participants completed this study. Total contamination score was different between the 3 groups for the intubator (p = 0.02) but not the assistant (p = 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. INTERPRETATION: 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.