Measurement of the Aerosol Generating Potential of Intubation, Extubation and associated airway procedures 'Äì MAGPIE study

Aims of the Research Measure the amount of particles (aerosol) released into the air during medical procedures Measure how long particles (aerosol) remain in the air following medical procedures Develop ways to reduce the amount of particles (aerosol) released into the air during medical procedures Background The COVID-19 pandemic has had a huge effect on global health and the world economy. Coronavirus spread during hospital procedures is a big concern. Safe delivery of essential NHS services is affected by the need to reduce coronavirus spread to staff and patients. Aerosols can be created during medical procedures and occur when tiny particles are suspended in the air. Aerosols can carry viruses, like the coronavirus. These aerosols may cause infection by allowing hospital staff or patients to breathe coronavirus into their lungs. Many operations need a general anaesthetic, where a patient is not awake for surgery. A breathing tube is placed to allow surgery to be performed. Insertion and removal of the breathing tube may produce an aerosol which risks spreading coronavirus to staff in the operating theatre. This risk means all staff present must wear enhanced personal protective equipment (PPE) such as 'respirator-type' face masks. It is unknown how much aerosol is produced for many procedures and how long aerosols remain in the air. The use of enhanced PPE: Is expensive for the NHS Increases the risk of medical mistakes Reduces staff and patient contact Makes talking and hearing more difficult for healthcare workers and patients Increases stress and anxiety for healthcare workers and patients Is uncomfortable Makes teamworking more difficult Produces lots of non-recyclable waste The amount of PPE is limited. PPE needs to be used where it is most needed. At the moment, staff wear enhanced PPE for every patient having an operation to reduce coronavirus spread. Staff and patients are not allowed to move in or out of a room for 10 minutes at the start and end of surgery because of the risk from aerosols. This increases the time taken for every operation and has almost halved the number of patients having an operation each day. This includes operations for life-threatening conditions like cancer. Design and Methods This research will be performed with an experienced team of aerosol specialists and airway doctors. Workstream 1: Using highly accurate scientific equipment I will measure the amount of aerosol produced during medical procedures to help patients breathe. These procedures include insertion and removal of breathing tubes for patients having a surgical operation, and facemasks used on intensive care. Workstream 2: I will perform a national survey of medical staff at risk of viral infections from aerosols. The aim is to find out barriers that may prevent new guidelines being used. Workstream 3: I will produce methods to reduce aerosols when a breathing tube is inserted or removed Patient and Public Involvement I undertook a survey of local anaesthetists. The survey showed aerosols were their biggest concern for catching coronavirus. It also showed enhanced PPE increased stress and anxiety, increased the risk of mistakes and caused operations to take longer. Input from a patient representative in a local hospital was supportive: 'Having read your proposal the benefits that would be created are clear. The loss or reduction of staff/patient contact is key in my view, certainly in terms of reassurance and also clear understanding of procedures taking place.' Dissemination The results will be shared with: Participants Government policy makers The Royal College of Anaesthetists and Intensive Care Society Journals/conferences Twitter The results will help produce regulations for safe NHS working, improve NHS efficiency, reduce non-recyclable waste and save the NHS money.