Aerosol containment device design considerations and performance evaluation metrics

• Published in: The American journal of emergency medicine 2023-02, Vol.64, p.12-20
• Main Authors: Jones, Rachael M., Andrus, Niles, Dominguez, Thomas, Biggs, Jeremy, Hansen, Brian, Drews, Frank A.
• Format: Article
• Language: English
• Subjects: Aerosol box; Aerosols; Biomechanics; Containment; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID−19; Design criteria; Disease control; Disease prevention; Emergency medical care; Engineering controls; Equipment Design; Humans; Infectious diseases; Intubation; Intubation, Intratracheal - methods; Masks; Pandemics; Patients; Performance evaluation; Personal Protective Equipment; Protective equipment; Public health; Respirators; Respiratory aerosols; Respiratory Aerosols and Droplets
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2022.11.007

Spurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated? A scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation. Fifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance. With respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience.