When it became apparent COVID-19 infections would spread the UK, I like the majority of my colleagues, started to look at ways we could mitigate risk to our patients, staff and of course, ourselves and families.
Having been a relatively early adopter of telehealth, working several sessions a week online, I was able to share this experience with my colleagues to enable us to continue providing a secure and safe patient experience, while limiting the risks to the practice.
However, the reality remained that some people will always need to attend, and we wanted to be able to protect these patients, especially as they are more likely to be more vulnerable.
PPE requirements for CPR
As the focus on PPE increased, it was interesting to note that CPR was not deemed an AGP (aerosol generating procedure). Yet the recommendation remained that 'level 3 PPE was required' when attending a patient with confirmed or suspected COVID-19, and that, even with level 3, 'attending staff must be limited to a minimum'.
Despite the UK classing CPR as a non AGP, further advice was then sent out stating that CPR cannot be administered without 'full PPE'.
In reality, this meant that CPR or other similar emergency support cannot be provided in a timely fashion, and almost certainly not within a community setting. Every surgery and hospice I have worked in relies on a stock of basic PPE – the standard gloves, paper mask and tear off plastic 'dinner lady' apron.
At the same time as this, my husband Mat (a medical technology specialist and senior fellow at the University of Birmingham College of Medical and Dental Sciences) had been approached by Dr Egidio da Silva, an anaesthesia consultant at the Royal Orthopaedic Hospital in Birmingham, about finding a way to protect teams during intubation and extubation.
In April, a perspex box nicknamed 'the Taiwanese box' had been discussed. A solid, four-sided structure, this 'box' provided some protection to staff, but was clumsy and difficult to use and clean.
Coming up with a new design
Following this conversation, Mat and I sat down to further discuss and improve a new design for preventing aerosol spread during close interaction with infected patients.
Key was to have a cheap, lightweight, easy-to-use, fast-to-deploy solution that could be used in more than just the anaesthetics room. We wanted a way to contain infected aerosol throughout the patient journey, and this led to the creation of the AerosolShield.
Launched within six days of starting working on it, the AerosolShield, manufactured by Airquee Ltd, a current NHS supplier and Europe's largest manufacturer of medical isolation tents, is produced to the specifications required of a medical isolation tent.
The work we have done has been covered internationally and we have multiple papers being written, as well as some publications already out.
Of utmost importance to us all was the need to provide a product that was already up to specifications expected of Western healthcare, and we engaged renowned specialists in medical technology from the outset.
So far, the team have been working for free and providing the AerosolShields at cost, as well as fundraising to provide a certain amount for free to NHS via GoFundMe.
How it could work in GP practices
Our patient journey leaflet shows how one individual AerosolShield can provide significantly increased protection for hundreds of staff and their environments, without hindering the interactions.
We are very much hoping to increase awareness so that more NHS practices and care homes can obtain them.
In my local practice group have a supply of six, which we have on standby on the resus trolley and in the boot of the car (they collapse to about 60cm x 60cm x 10cm). They take approximately 20 seconds to set up from scratch, but as we have a resus trolley we leave one set up on top ready for use.
In the case of an emergency, we now don our level 1 PPE, and then one person approaches the patient with the AerosolShield and places it over their head and shoulders, before tucking it under them. We are then able to work on the patient providing CPR/bivalve and any other support as per normal, whilst securing the potential expulsion of any contaminant from the patient.
When the ambulance arrives, the AerosolShield stays in place on the patient and travels with them to the hospital, again protecting the paramedics and their ambulance. It remains in place throughout A&E and onwards.
If we consider that at least three people would attend a patient in distress in a surgery, then two paramedics, and then that patient would easily come within 6 feet of at least 20 NHS staff within the first 30 minutes of arrival at A&E, it is very easy to see the importance of each AerosolShield. The video below shows how it could work in a GP surgery.
The AerosolShield can remain in place for extended periods and through multiple interventions, or until it is soiled or damaged. This allows patients to receive nebulising treatments and/or CPAP/biPAP on a ward whilst significantly reducing the risk of spread to staff. It also enables next of kin to be closer to patients, and for patients themselves to feel secure - we have also not had any reports of issues with patient compliance.
Staff report vastly improved confidence when treating or working with patients who are within a shield, which we believe will reduce the risks of stress-related illnesses in the coming months.
Even when COVID-19 is no longer a threat, the reality is that aerosol-borne contagion is now a heightened risk and concern about this is an increasing stressor for all healthcare staff.? Finding a way to minimise this risk without impacting on care will be an ongoing issue, and the AerosolShield is a great way of doing this easily, quickly and cheaply.
- Dr Campbell-Hill is a GP in Wiltshire