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HYGIEA SHIELD – the Beauty of Simplicity

BARRIER ENCLOSURE FOR INTUBATION / EXTUBATION IN PATIENTS SUSPECT OR AFFECTED BY SARS-COVID-19

General Description

Hygiea Shield is a transparent barrier enclosure that acts as an extra protective barrier against contamination by healthcare personnel during intubation / extubation processes.

This project was conceived and developed by a multidisciplinary team of volunteer engineers and physicians, and is licensed with a Creative Commons License – Atribution – Non Commercial 4.0 Internacional.

Technical Description

Hygiea Shield aims to improve the level of protection of the entire healthcare personnel during the execution of the intubation and extubation procedures, and to minimize aerosol spray in the environment and on the materials and fabrics in the adjacent area.

The product was conceived to guarantee the maximum visibility, ergonomics and work area for the responsible physician, using either direct or videolaryngoscope for orotracheal intubation.

As the barrier enclosure is easily disassemble and all materials used are resistant to water and typical disinfecting agents used in hospitals, the asepsis and storage process is very simple and does not require specific care with corners or recesses.

The product is composed of 2 main components, the BASE and the TENT, and some fixation elements: 5 hooks and 5 tie-wraps.

Figures below represent some views of the Hygiea Shield:

Basic data:

  • Length: 605 mm
  • Width: 602 mm
  • Height: 500 mm
  • Weight: < 2 kg

Manufacturing and Assembly Instructions

The following is a detailed roadmap on how to obtain the Hygiea Shield from the drawings provided in this procedure.

Phase 1 – Obtaining the Molds and Bill of Materials

1) Print the drawings contained in the files “AKH001-000002 A0.pdf” (BASE) and “AKH001-000003 A0.pdf” (TENT) in an A0 sheet. Printing in size A0 the mold will already be in full scale, 1:1. The drawings contain all dimensions if you choose to cut the material mechanically;

DWG Files Download

 

2) The necessary materials list is:

  • 01 translucent 2 mm thick polycarbonate sheet, external dimensions 2000 mm long X 1000 mm wide. It is possible to have 3 TENTS from 1 sheet;
  • 01 6 mm thick acrylic sheet, external dimensions 1800 mm long X 1200 mm wide. It is possible to have 4 BASES from 1 sheet;
  • 05 self-adhesive plastic hooks;
  • 05 adjustable plastic cable ties (tie-wrap).

3) List of tools:

  • Scissors for cutting molds;
  • Jig saw for cutting the contours of the Base and the Tent;
  • Hand drilling machine;
  • Drills of  3 and 4 mm;
  • Sanding/grinding tool;
  • Sandpaper with 220 and 320 granulometry;
  • Permanent marker – tracer to mark the polycarbonate;
  • Straight cutting pliers.

 

Phase 2 – Cutting and Preparation

1) With scissors, cut out the BASE template (only the outer contour);

2) Using scissors, cut out the TENT template (only the outer contour and the 2 circular holes);

3) With the BASE template cut out, fix it on the acrylic sheet with adhesive tape (pasting by the contour);

4) With the TENT template cut out, fix it on the polycarbonate sheet with adhesive tape (pasting around the contour and the 2 circular holes);

5) Lay the acrylic and polycarbonate sheets with the drawings fixed on a flat and smooth bench;

6) With a jigsaw, cut out the contours of the BASE and TENT;

  • Tip – this step must be performed by two people: one with the saw, the other supporting from below to provide stability.

7) After cutting the parts, BASE and TENT, they must be deburred in all their contour and holes using a fine file and finishing files;

  • Tip – try to make it as smooth as possible to avoid possible accumulations of materials and particles.

8) Using a drilling machine and a 4mm diameter drill, drill the holes in the TENT’s ears;

9) Using fine sandpaper, clean the region of the holes in the TENT’s ears;

10) With a permanent marker, mark the positions of the BASE notches;

11) Produce the slots in the BASE. If available, machine the notches in the base with a 3 mm diameter cutter, if it is not possible to produce the notches with the drill and ensure the finish with the file and sandpaper;

  • Tip – First 1 hole at each end, then machine the thickness by removing the material between the holes;
  • Tip – With a fine sandpaper, clean the region of the BASE notches.

12) With a permanent marker, mark the positions of the self-adhesive hooks on the TENT;

13) Remove the paper from the BASE and TENT surfaces.

Phase 3 – Assembly

1) Position the BASE on a smooth and firm bench

2) Position the TENT in the slots of the BASE;

  • Tip – This operation must be performed by two people;
  • Tip – Start on the right side and progressively fit;
  • Tip – The first person maintains the position to prevent the TENT’s ears from leaving the BASE notches;
  • Tip – Another person passes the tie-wraps through the holes in the ears.

3) Start on the right side and progressively fit through the two holes in the TENT’s ears;

4) After firmly adjusting the plastic clamps (tie-wraps), cut off the excess / tips;

5) Check that the TENT’s ear has been securely fastened to the BASE notch (pull up slightly);

6) Place the self-adhesive hooks on the TENT in the previously marked positions;

  • Tip – Start on the right side and paste progressively;
  • Tip – Make sure that the tip of the self-adhesive hook is pointing back towards the patient’s head (the plastic curtain will be fixed on the hooks).

7) Make a cleaning with a simple clean cloth.

Phase 4 – Disassembly for Hygiene and / or Storage

1) Position the barrier enclosure on a smooth bench;

2) TENT Removal:

  • Tip – this operation must be performed by 2 people;
  • Tip – The first person holds the TENT in the region near the base with both hands. This person maintains the position to prevent the ears of the TENT from leaving the notches of the BASE;
  • Tip – The second person with diagonal cutting pliers cuts the plastic clamps;
  • Tip – Start on the right side and continue to progressively cut each of the plastic clamps;

3) Unplug the TENT from the BASE and open it on the flat bench

Phase 5 – Reassembly

1) Follow steps 1 to 5 of Phase 3;

2) If any hook has become loose or broken, remove and replace it with a new one;

3) Make a cleaning with simple cloth (be careful to be a clean cloth, without subject)

Comments

  • No glue is needed, as the joints are mechanical;
  • The TENT remains in shape due to the fit in the cracks of the BASE;
  • Using the tie-wraps ensures that TENT’s “ears” are fitted, avoiding accidents and improving the sealing between TENT and BASE.

Cleaning and Asepsis Suggestions

After dismantling the Hygiea Shield, the plastic cable ties must be discarded. The disassembled parts, BASE and TENT with hooks, must be immersed in a sanitizing substance such as hospital disinfectant detergent, alcohol> 70% or soap and water.

Additional suggestions

  • The cleaning time and sequence must follow the Hospital’s current protocol;
  • Sanitize the barrier enclosure before and after each use if there is a risk of contamination;
  • AVOID the use of abrasive materials to avoid damaging the polycarbonate surface and hamper the visibility of the team.

Usage Suggestions

In order to provide optimal isolation between the patient and the healthcare personnel, it is recommended to attach a translucent flexible polypropylene curtain (common plastic) to the hooks positioned on the Hygiea Shield barrier enclosure extending to at least the middle of the patient’s mid torso.

This curtain shall be carefully positioned/fixed aiming to segregate the barrier enclosure internal space.

To better segregate the intra-barrier enclosure environment, the hospital’s low vacuum system catheter can be used to generate slightly negative pressure containing aerosols generated during the procedure.

If possible, it is recommended to adapt iris-port sleeves in the access apertures to improve the barrier enclosure sealing. In the absence of these sleeves, the apertures reduction can be done applying PVC plastic film reducing apertures sizes to the minimum comfortable for the physician’s work.

Undoubtedly, the introduction of a barrier between the patient and the healthcare personnel conducting the procedure can cause some discomfort. So it is recommended a slight change on auxiliary personnel positioning, moving belly ward, aiming to provide the correct access to patient during the procedure.

All supporting material, such as plastic curtain and PVC film, must be properly discarded immediately after the procedure is finished.

Lastly, during the extubation process, it is suggested that extubation should be done by wrapping the endotracheal tube with the plastic curtain and discarding both, avoiding possible contact of the infected material with healthcare personnel.

All of these suggestions are illustrated in the figures and videos attached to this document.

Vídeo

Contact

  • Dr. Bruno Tadashi Misumi (Anesthesiologist CRM 113.373) +55 12 997067007
  • Waldemar de Carvalho (Structural Engineer CREA-SC: 098006-0) +55 12 981161780

Acknowledgements

We thank the companies Akaer, Troyaand Hospital viValle Rede D’Or São Luiz for supporting and providing resources, means and hours of their professionals in the development of the Hygiea Shield.

TERMS AND CONDITIONS OF USE

The design of the protection bell for intubation / extubation in patients affected by respiratory syndrome (Hygiea Shield), is made available for universal access as is (“as is”), and you are responsible for the execution of the project and the responsibility for the object final manufactured according to the project. The project and its authors, coordinators, supporters and partners are not responsible for (i) the execution and use of the project by you or any third parties and (ii) for any damage, failure or defect presented and / or caused by any executed object from the Project, for you or for third parties.

Licença Creative Commons
The project, assigned to Fernando Coelho Ferraz, Waldemar de Carvalho, Wanderson Eduardo de Oliveira, Bruno Tadashi Misumi as made available on this website, is licensed under a Creative Commons – Attribution-NonCommercial 4.0 Internacional, and is not subject to commercialization by you or any other third-party licensors.

All names, brands, logos and other distinctive signs used on this website are the exclusive property of their respective owners and may not be used, reproduced or, in any other way, linked to the reproductions of the Project made by third parties. Nothing in this website should be considered as authorization to use the name, brand, logos or any other distinctive sign of the Akaer Group or ViValle hospital and / or its authors, coordinators, supporters and partners by any third party, for any purpose.

The names and images of the authors, coordinators, supporters and partners of the Project may not be used by any third parties as linked to the Project’s campaigns by You or by third parties.