• David M Turer, Cameron H Good, Benjamin K Schilling, Robert W Turer, Nicholas R Karlowsky, Lucas A Dvoracek, Heng Ban, Jason S Chang, and J Peter Rubin.
• Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: turerdm@upmc.edu.
• Ann Emerg Med. 2021 Jan 1; 77 (1): 1101-10.

Study ObjectiveThroughout the coronavirus disease 2019 pandemic, many emergency departments have been using passive protective enclosures ("intubation boxes") during intubation. The effectiveness of these enclosures remains uncertain. We sought to quantify their ability to contain aerosols using industry standard test protocols.MethodsWe tested a commercially available passive protective enclosure representing the most common design and compared this with a modified enclosure that incorporated a vacuum system for active air filtration during simulated intubations and negative-pressure isolation. We evaluated the enclosures by using the same 3 tests air filtration experts use to certify class I biosafety cabinets: visual smoke pattern analysis using neutrally buoyant smoke, aerosol leak testing using a test aerosol that mimics the size of virus-containing particulates, and air velocity measurements.ResultsQualitative evaluation revealed smoke escaping from all passive enclosure openings. Aerosol leak testing demonstrated elevated particle concentrations outside the enclosure during simulated intubations. In contrast, vacuum-filter-equipped enclosures fully contained the visible smoke and test aerosol to standards consistent with class I biosafety cabinet certification.ConclusionPassive enclosures for intubation failed to contain aerosols, but the addition of a vacuum and active air filtration reduced aerosol spread during simulated intubation and patient isolation.Copyright © 2020. Published by Elsevier Inc.

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