Surgical Team Becomes Innovative in the Pandemic Era by Creating a Bubble Environment

    Plastic adapted from operating room biohazard bags are used in the creation a bubble environment for high-risk COVID-19 surgeries. Using ordinary materials available in the hospital, surgical teams at Mercy Hospital St. Louis practice in a Mercy simulation lab.

     “The simulation lab is invaluable,” said Dr. Alison Gildehaus, medical director of trauma and acute care surgery. “We practice together in a safe space before each procedure and in the beginning were able to try new materials to see what worked best to keep our patients safe.”

    Finding ways to keep everyone safe during a pandemic takes innovation, creativity and quick thinking.

    “We took the idea of the aerosol box, designed by a Taiwanese doctor, and built upon it,” Dr. Gildehaus explained.

    This new operating method allows surgeons to have the patient’s entire body in a “bubble” so they can perform an open tracheostomy on the sickest COVID-19 patients without having to move them to the operating room.

    “We move the OR to the intensive care unit,” said Gildehaus. “Patients stay in their negative pressure, ICU rooms – removing the added risk of transport – and the surgery team comes to them. We limit the number of people in the room, thus conserving PPE, yet have added support right outside.”

    Tracheostomy surgeries are high risk for health care workers because of the aerosolization that occurs when a breathing tube is inserted into the windpipe. The surgery becomes necessary when a very sick COVID-19 patient spends prolonged time on a ventilator. It protects their vocal cords and makes it safer to wean them from breathing support when their condition improves.

    Gildehaus said she hopes their innovation might lead others to come up with a more permanent solution.

    “We feel like this is a technique we want to get out as soon as possible so that others can benefit and hone the technique further.”

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