INNOVATIVE TESTING STRATEGY CONSERVES PPE DURING THE COVID-19 PANDEMIC

Personal protective equipment (PPE) constraints are creating a great challenge for hospitals and health systems across the nation as the number of COVID-19 cases continues to rise. To address this problem, a team of staff from across Brigham and Women’s Hospital came together to develop an innovative COVID-19 testing booth. The Brigham Protective Equipment for Clinical Test Environment and Diagnostics (B-PROTECTED) booth preserves PPE and keeps clinicians on the front lines protected.

The booth was developed by resident physician and Deland Fellow, Sherry Yu, MD, Kevin Giordano, senior vice president, Clinical Services, Douglas Carney, senior vice president, Real Estate, Facilities and Operations and a team of engineers and safety and infection control experts.

Protecting Clinicians from COVID-19 and Preserving PPE

The freestanding B-PROTECTED booth is one of the first of its kind in New England. The first booth in use is located in a tent outside of the Brigham and Women’s Emergency Department (ED). The walk-up testing booth keeps the ED nursing staff protected as they stand behind clear polycarbonate panels to collect samples.

The Brigham is testing hundreds of patients per day causing additional draws on PPE. “By using the booth we don’t have to don and doff gloves and masks and gowns,” said Giordano. “It acts as a highly protective barrier between the patient and the provider as testing occurs.”

To test patients for COVID-19, a clinician stands inside the protective booth, wearing no PPE. They slip their hands and arms through two portholes with built-in rubber gloves. With the gloves protruding outward towards the patient, the clinician can obtain a sample and bag the specimen in a biohazard bag. The bag with the sample is then dropped into a box which is sent to the lab for testing. This is all done without having the clinician leave the booth.

While inside the booth, the clinician has the dexterity to sanitize and clean the outside surface of the booth that the patient may have come in contact with, including the rubber gloves.

The B-PROTECTED booth has been in use at the Brigham for just over one week and has received positive feedback from the ED nursing teams conducting the tests. “They are still able to obtain the samples the same way as they did before the booths,” Yu said.

COVID-19 Testing Booth: From Ideation to Development

Drawing on inspiration from a design used in South Korea, Yu and Carney shared a sketch of the idea with the Brigham’s Engineering Department and the team brought the design to life. “It just started as a sketch on a whiteboard and within 96 hours the first model was built,” Yu said.

Yu and Carney visited the Brigham Research Institute to refine the vision. It was at that point where they identified the critical glove solution. “We went to our engineering services shop with the idea and within two days they had built us a working prototype,” said Carney.

Engineering Services worked closely with Yu, Carney, and safety and infection control experts to ensure the booth would meet the clinical needs for visibility, safety, ergonomics, durability and ease of disinfection. The collaboration between the engineering and clinical teams led to the inclusion of several booth details.

Some of the added features include non-slip flooring material with step warning tape for clinical staff safety, aluminum rivet construction instead of screws or bolts to minimize sharp edges that might catch clothing or gloves, and integral shelving on the outside of the booth for “at hand” disinfecting and testing supplies.

Colin MacLachlan, director of Engineering, said, “Dr. Yu’s excellent conceptual description allowed our team to fully grasp her intent and permitted us to work with her to integrate some very useful touches into our design. Our tradespeople stepped up to the plate to deliver and we’re quite pleased with the positive reception the booths have received from the clinical team.”

After the working prototype was complete, the team brought frontline clinicians and infection control experts to Engineering Services to review the working prototype. “With their help, we refined a method of procedure for use of the booth and quickly put one in use for validation in the ED walk-up area of Brigham and Women’s Hospital,” Carney stated.

B-PROTECTED Booths Across Brigham Health

There is currently one B-PROTECTED booth fully implemented, with nine more in development for a total of 10 booths for testing throughout the Brigham Health system. The addition of 10 booths will help the Brigham conserve the limited PPE supplies for the providers treating patients inside the hospital.

The durability of the booth material, clear polycarbonate panels, allows for day-to-day use and regular cleaning. Along with the testing centers, the team has plans to use the booths in the respiratory illness clinic and other locations.

Hospitals and organizations from around world have inquired about how to build this type of testing booth and schematics have been shared widely. Carney explained, “With the help of our innovation team and the Office of General Counsel, Brigham and Women’s Hospital was able to provide plans under an open source license agreement to dozens of hospitals across the U.S. and even a few overseas.”

Hospitals Come Together in the Fight Against COVID-19

On Monday, April 6 NYU Langone Health in Manhattan inquired about the B-PROTECTED booth development and the staff at Brigham and Women’s Hospital were quick to respond. Brigham staff shared engineering details with NYU Langone virtually the next morning.

Giordano offered to send one of the Brigham’s 10 booths to New York to help. “From what we see and hear,” Giordano wrote to his NYU Langone brethren, “New York City is at a critical time and if we can help in any way – we would want to do that.”

Carney worked with Turner Construction in NYC and Boston to have one of their trucks deliver the booth to NYU Langone.

Ten hours after the offer was made, the booth arrived at NYU Langone. As the fight against COVID-19 continues, hospitals across the country are coming together to extend support to one another while treating patients and keeping frontline clinicians safe.

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