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Endotracheal intubation with barrier protection
  1. Farah Jazuli1,
  2. Monika Bilic2,
  3. Erich Hanel3,4,
  4. Michael Ha1,4,
  5. Kelly Hassall4,
  6. Brendon Gordon Trotter1,4
  1. 1 Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada
  2. 2 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
  3. 3 Department of Family Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada
  4. 4 St. Joseph’s Healthcare Hamilton, Hamilton, Canada
  1. Correspondence to Dr Brendon Gordon Trotter, Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada; brendon.trotter{at}


Given the high risk of healthcare worker (HCW) infection with COVID-19 during aerosol-generating medical procedures, the use of a box barrier during intubation for protection of HCWs has been examined. Previous simulation work has demonstrated its efficacy in protecting HCWs from cough-expelled droplets. Our objective was to assess its ability to protect HCWs against aerosols generated during aerosol-generating medical procedures. We used a battery-powered vapouriser to assess movement of vapour with: (1) no barrier; (2) a box barrier; and (3) a box barrier and a plastic sheet covering the box and patient’s body. We visualised the trajectory of vapour and saw that the vapour remained within the barrier space when the box barrier and plastic sheet were used. This is in contrast to the box barrier alone, where vapour diffused towards the feet of the patient and throughout the room, and to no barrier where the vapour immediately diffused to the laryngoscopist. This demonstrates that the box with the plastic sheet has the potential to limit the spread of aerosols towards the laryngoscopist, and thus may play a role in protecting HCWs during aerosol-generating medical procedures. This is of particular importance in the care of patients with suspected COVID-19.

  • infectious diseases, viral
  • resuscitation
  • acute care

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  • Handling editor Lara Nicole Goldstein

  • Contributors All six authors contributed to the development of ideas that culminated in this work. All six authors have seen and approved of the manuscript in its final form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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