HealthTech Solutions Initiative

Berytech is welcoming in its Digital Fabrication Lab anyone and any team working on a Health Technology solution that can respond immediately to the Coronavirus crisis and the current emergency medical needs for Lebanon. The Berytech Fab Lab team worked on the Aerosol Box under the HealthTech Solutions Initiative. The design of the Aerosol Box was tested and improved with the medical team from Rafic Hariri University Hospital. The hospital ordered 14 boxes which are now being used by the staff.

The Aerosol Box Solution

Tracheal intubation is frequently performed on critically ill COVID-19 patients to facilitate ventilation of the lungs. This procedure is becoming more common as cases ramp up in number and severity.

During intubation patients often cough, spraying sputum and putting front-line medical workers at significant risk of infection. This risk is heightened by the large number of staff who take part in the procedure (as many as 3-7) and by the increasingly limited availability of adequate personal protective equipment for these staff (e.g. masks, face shields, goggles).

Hospitals and clinicians will exhaust their supply of respirators and N95 masks and have no choice but to treat infectious patients without personal protective equipment (mask, face shield, goggles) to reduce exposure to airborne droplets and contagious body fluids.

An aerosol containment box or intubation box may reduce medical staff exposure to virus-containing aerosols when they are performing intubations.

Proposed Designs

A variety of designs is now available on the internet. Feedback from intubation simulations run by doctors at multiple hospitals worldwide indicates that ergonomics (e.g. arm hole sizes/heights/positions) are a key design factor[1].

Based on multiple reviews and input from medical professionals who are on the front line, the Berytech Fab La team reached two final designs that could be helpful. “We have created improvements to Dr. Lai Hsien-Yung brilliant Aerosol Box, an improvised piece of equipment to protect health workers when intubating patients. It cost us $80 in materials and 24 minutes in machining,” explains Wael Khalil, Berytech Fab Lab Coordinator. 

A series of iterations for the design of the Aerosol Box were done in collaboration with Medical Professionals and Doctors from the Rafic Hariri University Hospital. We have designed and produced 3 different prototypes that were tested by the hospital professionals on real cases and we received their feedback, which helped us reach the final best design. The boxes were designed and produced in the Fab Lab to reach the best dimensions and specifications.

Result: The final design also has 2 versions, one that is a Flat Pack and another that is one Box that is fully assembled and delivered as one piece.

Version 1: Solid Box

This version is produced as one full solid block and cannot be disassembled. It is made of 3 pieces that are glued and sealed to make one big box. The top part is made of one full piece that is bent to dimension, creating easy-to-clean corners using any cleaning agent (except acetone).

Material: one box can be cut from a 124cm × 124 cm × 4.0mm thick sheet of clear acrylic or polycarbonate

Size: Box outer envelope dimensions are approximately L58cm × W58cm × H60cm

Weight: Approximately 7.0 kg (Acrylic)

Shape:

• One big piece
• approximately cubic with a slanted face at the front and an open back
• Angled top provides unobstructed view to patient
• Front arm holes 33cm apart
• Arm hole glove lips: used to fix gloves and sleeves for full insulation. Those parts can easily be dissembled and assembled.
• Side hole with covers that out allows side access for assistant when needed
• Can be used by right or left-handed individuals
• Increased width and height for additional range of motion as compared to original Aerosol Box design
• Increased hole diameter to 125 mm as compared to original Aerosol Box design

Shipping details: Shipped as one block.

Version 2: Flatpack Box

This version is a flatpack version made from 6 pieces that are assembled to produce one full solid block. It can easily be disassembled for cleaning and storage.

Material: one box can be cut from a 124cm × 144 cm × 4.5mm thick sheet of clear acrylic or polycarbonate

Size: Box outer envelope dimensions are approximately L58cm × W58cm × H60cm

Weight: Approximately 7.4 kg (Acrylic)

Shape:

• Made of 6 pieces that are assembled to form approximately a cube with a slanted face and an open back
• Angled top provides unobstructed view to patient
• Front arm holes 33cm apart
• Arm hole glove lips: used to fix gloves and sleeves for full insulation. Those parts can be easily dissembled and assembled.
• Side hole with covers that out allows side access for assistant when needed.
• Can be used by right or left-handed individuals
• Slot at the back side to fix a film sheet or curtain if needed
• Increased width and height for additional range of motion as compared to original Aerosol Box design
• Increased hole diameter to 125 mm as compared to original Aerosol Box design
• Locking features ensure box does not come apart unintentionally
• Individual parts can be replaced if damaged
• Overhang on sides and edges to prevent fluids from crossing at joints

Shipping details: Shipped directly from the manufacturer without assembly as parts that can be easily assembled locally in less than 5mins, no glue include.

Assembly/Fabrication Requirements

• 3 – 5 mm thick acrylic: can be laser cut or sawed/machined but laser cut edges are susceptible to cracking/crazing upon exposure to cleaning solvents such as ethanol.
• Edges : File down sharp edges, Reduce risk of snags.

 Aerosol Box – Parametric Design – Bent 3 parts V2.2 Drawings

The Original Design

The idea and the original design for the intubation box was first shared by Dr. Lai Hsien-Yung. From Taiwan. In his proposed original solution, the box encloses the patient’s head is enclosed in a clear plastic box. His design was tested and evaluated in Boston Medical Center. You can check out the tests done by checking out this video. 

Prototyping Phase with Rafik Hariri University Hospital

 Resources

• Vancouver General Hospital Covid19 Airway Intubation Simulation
• Nosocomial transmission of emerging viruses via aerosol-Generating Medical Procedures
• Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group
• Human body size data
• https://michiganaerosolbox.blogspot.com/p/aerosol-box.html
• https://helpfulengineering.slack.com/archives/C010HBBG82Y
• https://www.aerosolblock.org/

[1] Source : the #aerosol-box channel on the Helpful Engineering Slack Group