Comparing the effectiveness of negative-pressure barrier devices in providing air clearance to prevent aerosol transmission

PURPOSE: To investigate the effectiveness of aerosol clearance using an aerosol box, aerosol bag, wall suction, and a high-efficiency particulate air (HEPA) filter evacuator to prevent aerosol transmission. METHODS: The flow field was visualized using three protective device settings (an aerosol box, and an aerosol bag with and without sealed working channels) and four suction settings (no suction, wall suction, and a HEPA filter evacuator at flow rates of 415 liters per minute [LPM] and 530 LPM). All 12 subgroups were compared with a no intervention group. The primary outcome, aerosol concentration, was measured at the head, trunk, and foot of a mannequin. RESULTS: The mean aerosol concentration was reduced at the head (p < 0.001) but increased at the feet (p = 0.005) with an aerosol box compared with no intervention. Non-sealed aerosol bags increased exposure at the head and trunk (both, p < 0.001). Sealed aerosol bags reduced aerosol concentration at the head, trunk, and foot of the mannequin (p < 0.001). A sealed aerosol bag alone, with wall suction, or with a HEPA filter evacuator reduced the aerosol concentration at the head by 7.15%, 36.61%, and 84.70%, respectively (99.9% confidence interval [CI]: -4.51–18.81, 27.48–45.73, and 78.99–90.40); trunk by 70.95%, 73.99%, and 91.59%, respectively (99.9% CI: 59.83–82.07, 52.64–95.33, and 87.51–95.66); and feet by 69.16%, 75.57%, and 92.30%, respectively (99.9% CI: 63.18–75.15, 69.76–81.37, and 88.18–96.42), compared with an aerosol box alone. CONCLUSIONS: As aerosols spread, an airtight container with sealed working channels is effective when combined with suction devices.