Dr. Robert Bazuro says putting a patient on a ventilator requires caregivers to place themselves in a vulnerable position.
“When somebody has an infection, intubating them is one of the highest-risk procedures we do,” says Bazuro, trauma director for the Emergency Department at Danbury Hospital, which is part of Nuvance Health.
The procedure requires a doctor or advanced practice nurse to stand over the patient, getting close to his or her face, as the doctor carefully guides a tube through the mouths of patients and down their tracheas. During the process, patients often cough and gasp, spreading saliva and mucus.
“The secretions from the airway are thought to be the most infectious,” notes Dr. Karl Kulikowski, interim chairman of anesthesia for Danbury, New Milford and Norwalk hospitals. “Those droplets are expelled directly into the face of the person doing the procedure.”
Even with a mask and protective face shield, it’s conceivable that viral particles can get through.
But now in Connecticut, many health care workers performing the procedure have an added layer of protection thanks to easy-to-make plexiglass intubation boxes that can be placed between patients and doctors during the procedure and have holes through which doctors can put their hands. The devices were virtually unheard of two weeks ago, but the concept for them was spread via social media as coronavirus cases rose in the state. Scores of the boxes have been built in Connecticut in recent days by glass companies and private individuals.
At Danbury Hospital it started when a colleague of Bazuro’s tagged him in a Facebook post at the end of March detailing how to make the boxes. That post went viral locally and Bazuro says there were 10 delivered to him within 24 hours. They came from local glass companies as well as private individuals.
“It’s been amazing, the community support we’ve been having. It shows you in a crisis how everybody comes together,” Bazuro says.
PMC Engineering LLC in Danbury started making the boxes as did Danbury Glass, Apex Glass, Brookfield Glass and many others throughout the state. Billy Vasaturo, Brookfield Glass’ shop manager, built two over the weekend of March 28, right after he became aware of the need. “They’re not difficult to build, just a little time consuming,” he says. “It’s a matter of cutting it on a circular table saw and then drilling the holes and then gluing everything together.”
Kulikowski notes that the boxes are being used as an additional layer of protection in addition to traditional personal protective equipment. While there is no research of which he is aware demonstrating their effectiveness, he says “it’s pretty intuitive” why they would work.
He adds that after receiving the first boxes, he and others at Nuvance Health have fine-tuned the design and are now having glass companies produce them according to their specifications, which include replacing the right arm hole with a slot that allows for greater movement, as during the procedure, doctors need to move their right arms.
The hospital has received enough of the boxes that they’ve been providing them to other hospitals both within and outside their network, but Kulikowski says they could use one or two more made to their specifications.
Though Gov. Ned Lamont this week noted a glimmer of hope that the number of new novel coronavirus cases in the state might be decreasing, doctors say conditions at hospitals remain intense. Many patients are still being placed on ventilators daily, and health care workers have contracted the virus. This is why, Bazuro says, anything that potentially helps limit exposure to the virus among health care workers is helpful and possibly lifesaving.
“If one of the health care providers go down, if you lose a nurse a doc, a technician, if you lose those people, you’re losing people that can take care of others, and we can't afford for that to happen,” he says.