How a box is safeguarding doctors treating COVID-19 patients.
Houston Methodist builds plexiglass shields to protect clinicians from COVID-19
Dr. Faisal Masud hovers inches from a patient’s face when he guides a tube into their mouth and windpipe, allowing a ventilator to then move air in and out of the lungs. But with COVID-19, this distance felt suddenly too intimate. Too close.
“That is one of the most dangerous parts because the patient is actively breathing on you,” Masud said. “No matter what protection you have, you are much more vulnerable.”
COVID-19, the disease caused by the new coronavirus, is transmitted by coughing, sneezing or simply speaking, releasing infected droplets into the air. And since seriously ill COVID-19 patients often require ventilators, Masud, director of the Critical Care Center at Houston Methodist, wanted to protect his colleagues during this intubation procedure. So he helped create a clear plexiglass box that covers the patient’s head and shoulders.
This box is just one of the many ways hospitals are seeking to safeguard their employees who many say are doing heroic work trying to save other people’s lives. According to the Centers for Disease Control and Prevention, at least 9,282 U.S. health care personnel were confirmed to have COVID-19 as of April 9. The true number is likely higher as only 16 percent of COVID-19 cases reported to the CDC through a standardized form included data on if
the infected individual was a health care provider.
Houston Methodist’s intubation box, called the Houston Methodist Aerosol Container, is based off a prototype created by a physician in Taiwan. Many hospitals have created some sort of intubation box, including CHI St. Luke’s Health, with 18 hospitals across Texas and seven in Greater Houston; Memorial Hermann, with 14 hospitals, all in the Houston area; and HCA Houston Healthcare, with 13 area hospitals.
The boxes created in-house at Houston Methodist have two holes where a gloved physician can insert his or her arms, and plexiglass covers the top and three of the box’s sides. One side is left open for the patient’s head and shoulders, though a disposable surgical drape is attached to that open end and placed over the patient’s body.
Masud, Dr. Steven Hsu and Firas Zabaneh, director of System Infection Prevention and Control at Houston Methodist, altered the Taiwanese design, adding a vacuum device that removes air (and thus, the virus) out of the box and then filters it before releasing the air back into the room.
The device was tested with smoke, which the vacuum effectively cleared from the box, and by popping a liquid-filled balloon that simulated a patient throwing up. None of the liquid escaped the box.
Houston Methodist is on the third iteration of its version of this box and has delivered at least nine of them across its eight hospitals, all in the Houston area. It continues to build nine or 10 of these devices each week.
“I don’t see how we could go back to just doing intubations routinely without having safety devices like this,” Zabaneh said. “I can imagine this will be utilized over and over and over again in the future.”
‘Extreme measures’
Other Houston hospitals are developing similar devices to protect their staff. Memorial Hermann, for instance, is using clear, roughly 7-foot-tall plexiglass walls to protect registration and triage nurses from a patient’s respiratory droplets while assessing his or her condition. It’s also using vaporized hydrogen peroxide to sterilize N95 masks so that they can be reused.
“We have taken extreme measures to ensure the safety of our staff and our physicians and our patients,” Greg Haralson, CEO of Memorial Hermann-Texas Medical Center, said in a video interview provided by Memorial Hermann.
At Houston Methodist, two other plexiglass boxes are designed to conserve its use of personal protective equipment.
One box looks like a clear phone booth on wheels. Health care providers get inside this box, called the personal protective pod, and push it around a patient’s room to perform tasks that don’t require close patient contact, such as checking monitors or hanging IV bags. It’s light and easy to move, but the occupant will need help opening doors.
The booth has two oval openings (to accommodate people of various heights) with black sleeves that protect the health care provider’s arms. Cuffs cinch the sleeves at the wrists, and the health care provider wears gloves that he or she will change from one patient to the next. There is hand sanitizer inside the booth, and the occupant wears a surgical mask though this does not have to be changed with each patient.
That’s dramatically less personal protective equipment than normal when treating a patient with COVID-19, where a gown, mask, face shield and gloves are donned and then duffed each time the health care provider enters and then exits that patient’s room. All but the face shield are used only once.
“What spurred this innovation is need,” Zabaneh said. “To make sure our health care providers are safe even if we get short on supply. And also to conserve supplies so we are ready to respond and take care of our community in the long run.”
This phone booth-looking device has a sibling, called the collection pod, with a similar design. It’s used when testing noncritical patients who might have COVID-19. This pod is stationary and allows its occupants to sit when collecting a nasopharyngeal swab for the back of a person’s nose.
A new staple?
Houston Methodist has built and delivered 14 personal protective pods, with plans to make at least 25 of them, and 11 collection pods. The organization is making its designs for all three boxes available to other health systems.
And both Zabaneh and Masud expect these boxes will become hospital staples, for a variety of procedures, even after this pandemic passes.
“I would not have thought of these things two months ago,” Masud said, “and they will help us fight the next unknown disease that comes our way.”
“I would not have thought of these things two months ago, and they will help us fight the next unknown disease that comes our way.”
Dr. Faisal Masud