GB2601485A

GB2601485A - A clinical protective apparatus

Info

Publication number: GB2601485A
Application number: GB2018774.6A
Authority: GB
Inventors: Iravani Ebrahim; Baran Iravani Anna; Dyllan Iravani Araz
Original assignee: Individual
Current assignee: Individual
Priority date: 2020-11-28
Filing date: 2020-11-28
Publication date: 2022-06-08
Anticipated expiration: 2040-11-28
Also published as: GB202018774D0; GB2601485B

Abstract

A protective apparatus for protecting a clinician working on a patient from pathogen-carrying aerosols, comprising first air ducting means 10; second air ducting means 20; and a screen 4 attached to the first air ducting means 10 suitable for surrounding a part of a patient being treated. The second air ducting means 20 is arranged at least partially within the first air ducting means 10, and the first air ducting means 10 and second air ducting means 20 are connectable to suction means 8 for suctioning air through the first and second air ducting means. The screen is flexible and is removably attachable to the first air ducting means 10. The screen also comprises at least one access port (curved feature at bottom of screen) that enables admission of a hand of the clinician into an enclosed area bounded by the screen 4.

Description

A CLINICAL PROTECTIVE APPARATUS

BACKGROUND OF THE INVENTION

Field of the Invention

[0001] The invention relates to an apparatus for protection, specification for of a clinical team comprising, for example, a dentist, dental assistant and hygienist.

Description of the Related Art

[0002] During dental work on a patient, for example fillings, crown preparations and surgical extractions, there is typically a dentist operating on a patient with a dental tool, for example a dental drill, that generates particles. Dental operations such as drilling, polishing and the like require the use of high-speed hand-pieces. These are used either with a burr attachment in order to remove tissue or bone, or with a polishing attachment to smooth tooth and/or restoration material. These typically rotate at a few hundred thousand rpm. This high frequency of rotation results in the generation of significant amounts of heat energy, which can cause injury to or death of the dental pulp, the living tissue of the tooth. To protect the pulp, a constant stream of water is emitted at high speed to act as a coolant. When this water enters the oral cavity, an aerosol is generated containing water and carrying saliva, blood, and organic debris from the patient.

[0003] Aerosols are primarily generated by four instruments: ultrasonic scalers, straight surgical handpieces used in the removal of bone, handpieces used in the removal of tooth tissue, and the three-in-one used to clear the procedural area of debris.

Aerosol-generating procedures include: non-surgical periodontal therapy, fillings, crowns, endodontic treatment, some partial dentures, and surgical extractions.

[0004] A dental assistant may hold a suction device (a saliva ejector or large volume suction) for removing saliva and blood from the oral cavity of the patient, along with tooth and bone debris, and the water ejected from the aerosol-generating instrument. A saliva ejector is typically used during non-aerosol-generating procedures to remove the pooling saliva from a patient's mouth. These are not particularly powerful, and are not able to reduce aerosol spread to any notable degree. The large volume suction is typically used when water is being emitted from an instrument, and its main purpose is to remove the fluids pooling in the patient's mouth in order to prevent choking and overspill. The large volumes of water emitted from such instruments means that a significant amount of these substances are able to escape from the oral cavity, either in droplet or in aerosol form. Saliva ejectors or large volume suction can be used to effect some reduction in aerosol spread. The efficacy of existing suction methods is heavily reliant on suction positioning by the dental nurse, and the unpredictability of spray severely reduces the efficacy of aerosol removal. Compounding this, the rapid pooling of fluid in the patient's mouth makes it impossible for the suction to be consistently held at the source of the aerosol.

[0005] Typically, the larger droplets generated pool in the patient's mouth, and are removed with a saliva ejector or high volume suction. The high pressure water stream and centrifugal force created by high rotation rates may spread the aerosols for more than a metre. In these instances, the point of suction is typically some distance away from the source of the spray, and so there is a limited ability to reduce the volume of aerosol generated. The smaller particles generated travel out from the source and become aerosols that linger in the air. Current COVID-19 guidelines (Implications of COVID-19 for the safe management of general dental practice, A practical guide, version 1.1, 16 June 2020, College of General Dentistry and Faculty of General Dental Practice (UK)) advise that such aerosols do not settle until up to an hour after the water source has stopped generating the aerosol. The ejection of such particles from the patient's mouth gives rise to an increase in risk to the dental team, exposing the team to pathogens propelled from a patient with influenza, other viruses, or such.

[0006] The aerosol aspirators currently on the market act primarily as an extra powerful extra-oral high volume suction. Such aspirators consist of a large funnel which is placed in the appropriate position to reduce the spread of the aerosol generated and filters the particles it captures.

[0007] However, dental operations generate an omni-directional water spray, and many droplets are not captured by the suction provided by currently available protection systems. 3 The spread of COVID-19 coronavirus has raised awareness of the need to provide safe and effective care for patients and the dental team. Aerosol-generating dental procedures continue to pose a significant risk of virus transmission. Aspirators remove most of the water produced in aerosol-generating procedures (AGPs), but a small fraction spreads in droplet form. Thus, there remains a need to protect the dental team and pat ient from cross-contamination during the dental examination.

[0008] Current guidelines and practice solely rely on effective personal protective equipment and the allowance of 'fallow periods' to prevent transmission of disease via droplets. Personal protective equipment (PPE) does this by reducing the exposure of a clinician to particle and droplet matter in the air, and by reducing the ability of the clinician to emit droplets and thereby expose patients (dependent on the type of PPE used). The enhanced PPE usage advised in current guidelines poses several challenges. It is uncomfortable and cumbersome for clinicians, and hampers their ability to provide patient care to the best of their ability. It is also much more expensive than the previous standard PPE, and many dental practices are struggling to afford it. Global shortages have meant that even those who are able to afford it may not be able to obtain the correct PPE.

[0009] Fallow periods refer to the period of time that clinicians must wait for aerosol particles to settle before they are able to disinfect the clinical area in preparation for their next patient. For aerosol-generating procedures, the current advice is to wait for the air in a surgery to be replaced twenty times. For most practices, this entails waiting one hour before beginning sterilization protocols. The use of fallow periods to reduce the risk of transmission has substantially reduced the number of patients that practices are able to treat, and the range of treatments that they are able to provide. Many dentists will provide fewer sessions of aerosol-generating procedures a day, in order to minimize the proportion of the work day lost to inactivity, and to maximize the number of patients seen. This is, first and foremost, to the detriment of patient care. Fewer patients may be seen, and the range of treatment that clinicians are able to provide is significantly reduced. Most definitive treatment involves an aerosol-generating instrument, and often clinicians are only able to provide supportive treatment to their patients.

[0010] In theory, the guidelines indicate that all aspects of dental treatment maybe carried out providing the dental team use PPE and observe fallow periods. However, these guidelines do not attempt to prevent the general circulation of aerosol droplets in the surgery, and it is for this reason that fallow periods are an important measure to prevent transmission. In practice, the new protocols severely limit the volume of treatment able to be provided, and have left many dentists providing mostly non-AGP treatments to emergency and urgent care patients.

SUMMARY OF THE INVENTION

[0011] The present invention has been made in order to solve at least one of the problems mentioned above.

[0012] According to an aspect of the present invention, there is provided a protective apparatus as specified in claims 1 to 7.

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] Fig. 1 illustrates a protective apparatus according to an embodiment of the present invention, in use.

[0014] Fig. 2 is a schematic of air flow within a protective apparatus according to an embodiment of the present invention.

DESCRIPTION OF THE EMBODIMENTS

[0015] In the following, a detailed description will be given of an embodiment of the present invention with reference to the accompanying drawings.

[0016] Figure 1 illustrates a clinical team comprising a dentist and dental nurse working on a reclining patient. A first captor hood 2 is positioned above the patient. The apparatus may be held above the patient by an adjustable framework or by a hydraulic arm (not shown), enabling appropriate positioning. For example, the captor hood may be suspended above the patient and may be adjusted according to the patient's position, for example as the height of the dental chair is changed.

[0017] A protective screen 4 is attached to the first captor hood 2 such that it shields the clinical team from the patient's mouth. Preferably, the screen 4 surrounds the entirety of the patient's head and chest, and extends vertically past the dental chair. The protective screen 4 is sufficiently transparent for the clinical team to see through to the area on which they are working. The screen is preferably made of a material with a refractive index such that reflections are minimized, thereby enabling the clinical team to more easily see the patient. The screen is preferably made of water-repellent plastic or plastic with water-repellent windows. This will reduce any fogging which might reduce visibility of the dentist and the nurse. The screen maybe rigid or more flexible, as the clinician prefers. The screen may be single use or disinfectable, as the clinical practice requires.

[0018] A first hose 6 connects the first captor hood 2 to an extraction motor 8 (suction means). The first hose 6 and the first captor hood 2 in combination are referred to as the first ducting system 10.

[0019] A second captor hood 12 is positioned above the patient within the region bounded by the protective screen 4. A second, smaller hose 14 is connected to the second captor hood 12; the combination is referred to as the second ducting system 20. The second hose 14 is positioned at least partially within the first ducting system 10. Dental team members typically operate near the face of the patient and in particular the oral cavity from which foreign matter is ejected. As it can be necessary for the clinician's hands to be positioned anywhere in relation to the patient's mouth, the second captor hood 12 is positioned where it does not hinder the work of the dental team. Preferably, the second captor hood may be repositioned underneath the screen as required by the clinical team for maximum efficacy. In this case, the second hose 14 may be made of flexible and/or adjustable pipe (s) which maybe adjusted to the optimal position and then held there. This will allow the clinician to adjust the position of the second captor hood 12 as close to the patient's mouth as practically possible for immediate capture of generated droplets and aerosols.

[0020] The first ducting system 10 is used in combination with the second ducting system 20, as the second ducting system 20 alone fails to capture all the droplets and aerosols, and therefore does not eliminate the need for additional PPE. The suction within the first ducting system 10 will be most effective for smaller particles which have escaped the second ducting system 20 and are freely circulating underneath the first captor hood 2. The second ducting system 20 is provided to reduce the concentration and spread of the aerosol generated closer to the source of the aerosol, as well as targeting larger droplets generated.

[0021] To enable the clinician to work on the patient, the protective screen 4 may be provided with at least one port for the clinicians' hand(s). The port may comprise a hole in the screen 4, or may comprise sleeves or gloves or attachments for disposable sleeves/gloves.

[0022] The suction powers in each ducting syshem will be optimized by motor power and the ratio of the hose diameters. Preferably the extraction motor 8 generates air flow of 230 to 500 litres per second.

[0023] Alternatively, more than one motor could be used, for example with the two ducting systems each connected to a separate motor.

[0024] This device will remove respiratory droplets (5-10 pm) and droplet nuclei (<5 pm). The bigger drops will fall under gravity on the patients bib (or cover).

[0025] Figure 2 illustrates the air flow within an apparatus according to the embodiment utilizing one extraction motor 8. The use of a second ducting system in combination with the first ducting system enables the provision of high suction power close to the patient's mouth. At position A-A illustrated in Figure 2, the air flow withinthe first (outer) hose 6 has, for example, a speed of air/aerosol molecules of 25m/s. The air flow within the second (inner) hose 14 is the same as that within the first (outer) hose 6; at position B-B the air flow within both the first hose 6 and the second hose 14 would, in this example, have a speed of 25m/s. At position C-C illustrated in Figure 2, the screen 4 has a larger diameter than the first hose 6; this increase in diameter results in a decrease in air flow, for example to an air flow having a speed of 0.2m/s at position C-C. At position C-C, the inner hose 14 has the same diameter as at position B-B, and thus the speed of the air flow withinthe inner hose 14 remains at 25m/s. By using a second small suction device positioned inside larger suction system, the present invention enables high suction power to be provided close to the aerosol generating zone, whilst creating an air flow in the region bounded by the screen that enables aerosol not caught by the second smaller system to be removed. Thus, the present invention enables a clinician or clinical team to treat a patient whilst minimizing the risk of infection from viruses transmitted via [0026] This apparatus will be most effective as an aerosol aspirator when aerosol-generating procedures are being carried out, as these are the procedures which pose the greatest risk of transmission, and require the longest disinfection procedures. Considering that a sneeze creates 100,000 droplets which travel 100mph, uncontrolled aerosol and droplets created by handpieces and ultrasonic Instruments can easily fill a typical treatment room with a volume of 401113. By preventing the aerosol from entering general circulation in the surgery, and by more effectively removing the aerosol generated from the surgical area, this apparatus reduces the risk of transmission between people and allows for more efficient disinfection protocols. It will dramatically reduce the time in which the aerosol contaminated air may be replaced twenty times, as recommended by current advice.

[0027] By reducing the risk of transmission of pathogens, and reducing the procedural burden of the disinfection process, this apparatus allows for the provision of a greater range of treatments and for a greater treatment capacity per surgery.

[0028] While description of the apparatus has been made in a dental context, it will of course be understood that the same protective apparatus could be used in other medical environments, and is not limited to use by a dental team. For example, in the case of patients with contagious, airborne diseases such as measles, tuberculosis, SARS, MERS, and COVIE-10, this apparatus maybe used in non-dental environments prone to aerosol generation, such as those utilizing endoscopy or gastroscopy procedures. In these applications, removing the aerosols coming out of the patient's lungs or other organs and tissues are the main sources of risks.

[0029] While the present invention has been described with reference to embodiments, it is to be understood that the invention is not limited to the disclosed embodiments. The scope of the following claims is to be accorded the broadest interpretation so as to encompass all modifications, equivalent structures and functions. 7_1

Claims

CLAIMS1. A protective apparatus for protecting a clinician working on a patient from pathogen-carrying aerosols, comprising: first air ducting means (10); second air ducting means (20); a screen (4) attached to the first air ducting means (10) suitable for surrounding a part of a patient being treated, wherein the second air ducting means (20) is arranged at least partially within the first air ducting means (10), and wherein the first air ducting means (10) and second air ducting means (20) are connectable to suction means (8) for suctioning air through the first and second air ducting means.
2. The protective apparatus according to claim 1 wherein the first air ducting means (10) is connectable to a first suction means and second air ducting means (20) is connectable to a second suction means.
3. The protective apparatus according to any preceding claim further comprising means for positioning at least one of the air ducting means in a desired position with respect to the patient.
4. The protective apparatus according to any preceding claim wherein the screen (4) is flexible. 12
5. The protective apparatus according to any preceding claim wherein the screen (4) is removably attached to the first air ducting means (10).
6. The protective apparatus according to any preceding claim wherein the screen (4) is single use.
7. The protective apparatus according to any preceding claim wherein the screen (4) comprises at least one access port for enabling admission of a hand of the clinician into an enclosure bounded by the screen (4).