SINGAPORE – A hospital has come up with new box shields that offer added protection for healthcare workers performing high-risk aerosol-generating procedures on critically ill patients, including Covid-19 cases.

The box shields will also help patients in life-threatening emergencies in the intensive care unit (ICU), with first responders able to use one to immediately provide oxygen therapy for them.

The three different shields, called bio-aerosol containment units (BCU), are detachable and can be fixed onto intensive care unit (ICU) and transfer beds, unlike existing ones that are placed over patients who are reclined flat on the bed. This means that the devices can be used while patients are propped up on the bed.

When performing aerosol-generating procedures on ICU patients, healthcare workers have to don a powered air-purifying respirator (PAPR), a battery-powered air purifying mask, which can take three to five minutes to put on.

During emergencies in the ICU, the first responder can provide oxygen therapy for patients through the box shield, while the rest of the medical team don the PAPR.

The three box shields were designed by a medical team from Ng Teng Fong General Hospital (NTFGH) in collaboration with Ngee Ann Polytechnic’s Robotics Research and Innovation Centre. Work on the shields started in March this year.

“Unlike many of the currently seen box shields, we have designed a bigger and custom-made isolation chamber to easily retrofit our ICU and transfer beds,” said Dr Tan Chee Keat, head and senior consultant of intensive care medicine, who led the project.

The team of eight from NTFGH comprised staff from intensive care and emergency medicine, and respiratory therapists and anaesthesiologists.

On top of intubation and extubation that can induce coughing, other medical procedures that can put healthcare workers at risk include nebulisation, where patients inhale medication in mist form through a mouthpiece, and high flow nasal cannula, where warmed oxygen is rapidly delivered to patients.

The box shields are of different sizes and are used in different settings – one for ICU beds, one for patient transfer and one for intubation.

The one for ICU beds, called the treatment BCU, has the same width as an ICU bed at 92cm, and can incline safely up to 60 degrees with the bed, allowing patients to be propped up as they receive treatment. This 11kg shield is also the largest, with a length of 60cm and a height of 70cm, which can contain intubation equipment.

The transport BCU, attached to transfer beds, can be used for Covid-19 patients who are wheeled to different facilities in the hospital. Since the patients may be coughing or are on non-invasive ventilation, this box shield can prevent environmental contamination.

The intubation BCU is similar to the treatment BCU, but smaller, at 50cm by 68cm at its base, and 60cm high.

The shields are 4mm thick and weigh between 6.7kg and 11kg.

The team believes that the detachable and purpose-built qualities of the box shields make them a first-of-their-kind.

The two openings at the head end of the shield box are used for medical procedures, and the openings at the sides are for serving water and medicine to patients, said Dr Tan.

Similar to other existing shields, the BCUs can be connected to a vacuum that sucks contaminated air from inside the box.

In June this year, researchers from the National University of Singapore invented a similar device called the droplet- and aerosol-reducing tent that is foldable, but smaller than the BCUs and cannot be fixed to beds.

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