Protective Boxes to Prevent Airborne Transmission of SARS-COV-2: Hospital-Based Experiences and a Narrative Literature Review

Objective: Occupational safety in healthcare settings is an integral part of treating COVID-19. A growing body of evidence suggests that the inhalation of both respiratory droplets (>5 microm) and tiny aerosols (<5 microm) is a possible route of virus transmission. Recently, innovative barrier enclosures (aerosol boxes) have been designed to cover patients' heads while allowing the implementation of airway management procedures through fitted holes. The initial design has undergone a series of modifications to improve staff safety, operators' ergonomics, and the efficacy of airway procedures. Methods: We reviewed the literature concerning different box modifications and provided an insight into our experience of using the box. Aerosol boxes have garnered the attention of clinicians who are frequently exposed to aerosols while performing aerosol-generating medical procedures, particularly endotracheal intubation. Current evidence comes from simulation-based studies rather than real-life clinical investigations. Results: The reports indicated that the box has significantly reduced the diffusion of aerosols into the room;however, the operators have experienced difficulties in the maneuverability of airway devices. Conclusion: Aerosol boxes should be used for patients necessitating simple elective intubations after healthcare providers are adequately trained. Customized designs can be further made based on clinicians' experiences.