Protecting frontline healthcare workers

IntuBox

InSPIREation from PARAMOUNT and the CMJAH ED to help minimize staff exposure to COVID-19 infection.

Charlotte Maxeke Johannesburg Academic Hospital Emergency Department

WHY THE NEED FOR THE INTUBOX

InSPIREation from PARAMOUNT and the CMJAH ED to help minimize staff exposure to COVID 19 infection.

The INTUBOX was created out of the desperate need from senior clinicians in the ED to protect the frontline staff exposed to patients who might have been infected with COVID.

The creation of a perspex aerosol box by Lai Hsien-yung, an anesthesiologist in Taiwan in March 2020(1) for COVID-19 patients, paved the way for the team of Emergency Physicians at CMJAH ED to make significant modifications to make it safer and more operator friendly. Thus was born the INTUBOX.

Charlotte Maxeke Johannesburg Academic Hospital Emergency Department

THE INCEPTION

The original rudimentary prototype was created out of a cardboard box with pieces of paper and tape to create the functionality that was required. The first box was manufactured with generous funding from a private cardiologist, Dr Riaz Motara. This was modified with input from CMJAH clinicians in Intensive Care, Internal Medicine and Aneasthetic departments. This ensured that the INTUBOX was fit for purpose and satisfied the needs of many clinicians who would potentially use the device.

How the concerns with the Taiwanese box are addressed

The modifications ( as shown in the video) ensured that the concerns with the Taiwanese box are addressed.
1. The box was made larger to fit any standard stretcher in the ED/ICU.
2. The two holes for the intubating doctor were covered with movable circular flaps – ensuring that the box sealed off any aerosolized viral particles still within the box
3. A side flap, also with movable flap was inserted to allow for suction, assistant to pass equipment such as syringes, ventilator tubing to be passed through
4. A top flap with seal was placed to help with the removal of introducer or pass rescue devices such as an LMA
5. A movable flap replaced the fixed distal panel ensuring the INTUBOX could accommodate larger patients by enabling it to be lifted if needed
6. The box was made collapsible for easy storage and transport ( the fixed box would be difficult to store in limited areas in the ED/ICU
7. The attachment of a thick plastic sheeting to the distal flap ensured that the patient was encased in a complete “bubble”
8. A storage stand for the storage of 4 INTUBOXES to ensure they are easily and securely stored.
Charlotte Maxeke Johannesburg Academic Hospital Emergency Department

funding for the production of the box

Funding for the production of the box was made possible with support from the Private sector. SPIRE (South African Pandemic Intervention Relief Effort) and Paramount Industrial Holdings (Aeronautical engineering company)
Charlotte Maxeke Johannesburg Academic Hospital Emergency Department

rolling out the intubox

500 INTUBOXES will be produced by Paramount Holdings for distribution to the Public and Private hospitals in Gauteng Province. It will then be rolled out across other Provinces in SA. An NGO, Gift of the Givers (an international search,rescue and aid relief organization) has volunteered its services in distributing the INTUBOX to the various hospitals during the SA COVID lockdown. The Public- Private-Clinician initiative has led to the creation of a device which will protect staff across all facilities in SA – especially in a country with very limited numbers of critical care and emergency doctors and nurses.
Charlotte Maxeke Johannesburg Academic Hospital Emergency Department

the intubox post the covid-19 pandemic

The use of the INTUBOX is seen as wider than only the ED for use by frontline staff for intubation. It can be used for patients who require high flow nasal oxygen, polymask, NIV, extubation, nebulization, suction or any aerosolizing procedures. It can be used as a temporary barrier device for intubation or as a more permanent device over the patient who requires ongoing oxygen therapy. As a country with the highest pulmonary TB infection rate, the INTUBOX will have a role to play in treating MDR, XDR and PTB patients post the COVID pandemic. There may also be a use for treating patients with Viral Hemorrhagic Fevers. Cleaning of the INTUBOX after use should be with a 1000ppm hypochlorite solution .

Prerequisites for use of the INTUBOX

Prerequisites for use of the INTUBOX are :
1. Video laryngoscopy – direct laryngoscopy is difficult using the INTUBOX
2. Experienced intubator – preferably with intubation teams
3. Practise/ simulation training with the INTUBOX to be comfortable in its usage
4. All required equipment/drugs for RSI – preferably available in a prepacked kit available on the resusc trolley
5. Rescue devises in case required/ difficult airway trolley
6. The use of standard PPE and standard precautions is an absolute requirement in addition to the INTUBOX

IntuBox Media Highlights

CBS

South Africa uses lessons learned from Ebola outbreak to fight coronavirus.

AFP

South Africans develop ‘Intubox’ to prevent infections.

BBC

South Africans develop ‘Intubox’ to prevent infections.

EWN

SA Doctors Design Virus ‘Box’ to Prevent Infection.

News24

South African scientists curb the Covid-19 spread by invention

TimeLive

South Africans develop ‘Intubox’ to prevent infections.

MSN

South African doctors develop ‘Intubox’ to prevent COVID-19 ICU infections

AfricaNews

(French)'”intubox”, un dispositiif de protection contre le COVID-19.

healthcare providers

Download Intubox Pamphlet

Download the IntuBox pamphlet and learn more about it.