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Received May 21, 2020, accepted June 25, 2020, date of publication July 6, 2020

Redesigning protective gear for health workers during 
the COVID-19 pandemic: leveling up the “aerosol box” 
By R. Moreno1, E. Pedraza2, F. Morales, R. Mijares2, R. Boccardo2 and M.A. García2  
1 Hospital de Clinicas Caracas (HCC) / Clinica Santa Paula (CSP), Caracas-Venezuela.
2 Universidad Simon Bolivar (USB), Caracas-Venezuela.

ABSTRACT

Background and Objective: During the last decade, Venezuela has suffered several crises concerning its health, socio-economic, 
and political institutions. While having a minimum wage of roughly $2.32 US dollars per month, and a precarious quality and 
coverage of public services (such as water, public transportation, electricity, and Internet services), the COVID-19 virus struck 
the nation. This pathology became a pandemic quickly since its transmission occurs mainly through contact with the secretions 
of infected patients or with contaminated surfaces. Health workers face a higher risk of infection than the rest of the population. 
For this reason, the objective of this work is to reduce the threat that medical personnel face while working with COVID-19 
patients and redesigning the original "spray box,” to avoid further deterioration of the health institutions. The cooperation and 
support of the Universidad Simon Bolivar (USB) and the Hospital de Clinicas Caracas (HCC), as well as the job of the manufac-
turer companies, was exceptional for accomplishing this work.
Materials and Methods: To develop the prototype, the following phases were carried out: (a) A sketch was created; (b) A 3-D 
CD model was created; (c) The prototype was manufactured; (d) The prototype was improved; and (e) The effectiveness and 
safety tests were carried out. 
Results: The research team produced protective gear for the safety and health of medical personnel when attending patients 
with COVID-19 to help limit the spread of the virus. This instrument was called "Cube de Vie" (CubeDV).
Conclusions: The work demonstrates that disregarding the struggling circumstances Venezuela faces daily, it was possible to 
solve a problem that threatened public health globally, to fight the serious COVID-19 pandemic. CubeDV was a result in a time 
of crisis and added another tool in the fight against the virus. This gear is just one example of our longing to win this fight and 
we hope it will represent significant help for people involved in fighting against this crisis.

Keywords – SARS-CoV-2, COVID-19, protection, personnel, health, CubeDV, box, aerosol, workers, protective gear, pandemic, 
infection risk. 

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

INTRODUCTION
The United Nations (UN) and international health agen-

cies have indicated that Venezuela's health crisis is caus-
ing an increase in infectious diseases, and the resurgence 
of others that were once considered eradicated, such as 
malaria or tuberculosis. The World Health Organization 
(WHO) considers that the political and socio-economic 

situations in Venezuela are responsible for the collapse of 
the healthcare system since those conditions have caused 
a severe scarcity of medical supplies, the closure of many 
clinics and hospitals, and a significant decrease of medical 
personnel who have emigrated from the country.

Since February 23, 2020, the closure of Wuhan in 
China alarmed the world population with the presence 

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Moreno, Pedraza, Morales, Mijares, Boccardo and García: Redesigning protective gear for health workers during the 
COVID-19 pandemic: leveling up the “aerosol box” 

29 J Global Clinical Engineering Vol.3 Issue 1: 2020J Global Clinical Engineering Vol.3 Issue 1: 2020  28

Moreno, Pedraza, Morales, Mijares, Boccardo and García: Redesigning protective gear for health workers during the 
COVID-19 pandemic: leveling up the “aerosol box” 

• More length to cover the patient, since the redesigned 
box measures approximately 60 cm (23.6 inches) 
from the patient's head to the upper chest (Figure 1).

• The incorporation of a distal flange that reduces 
the possibility of particle expansion outside the box 
(Figure 2).

• The addition of two lateral closing holes to reduce 
the risk of infection of the auxiliary personnel in the 
following procedures: intubation, Sellick’s maneuvers, 
BURP, cuff inflation, or endotracheal tube fixation.

A 3-D model Was Created 
The sketch is represented in a three-dimensional 

shape and was analyzed by specialists. This new gear was 
named "Cube de Vie" (CubeDV). After some corrections, 
we moved on to the next step.

The Prototype Was Manufactured
CubeDV is made entirely of 3-mm polymethylmethac-

rylate (PMMA). In order to keep costs as low as possible, 
the team aimed for the use of the smallest possible caliber 
of sheets that could provide stability. To shape the box, the 
surface on which it is supported was heated. Afterwards, 
gutters were drilled at the joint points of the three main 
pieces of the box, this allowed the sheets to fit into a 
channel that also added support and stability to the entire 
system. Additionally, at these joint points, chloroform was 
used as a chemical weld, since it dissolves a small layer 
of the plastic, to allow the pieces to combine and harden.

The Prototype was Improved 
After some stability tests, it was decided to make a 

thicker prototype, using 5-mm PMMA. The material used 
on the CubeDV, PMMA, is probably the most transparent 
plastic material and is also resistant to degradation by UV 
radiation. PMMA is not heavy due to its low density (1190 
kg/m), which is less than half that of glass making it is 
easy to transport. It is also 15 times more resistant than 
ordinary non-tempered glass of the same thickness. As 
well, PMMA is washable and not affected by detergents 
and commercial solutions commonly used in hospitals 
for cleaning and disinfecting potentially infected medical 
equipment.

The CubeDV is an economical, reusable, easy to trans-
port tool, with the ideal dimensions to carry out proce-
dures with great comfort and protection. To comply with 
Venezuelan national regulations, quality certification of 
the medical device was necessary, to demonstrate its ef-
fectiveness and safety.

The Effectiveness and Safety Tests were Carried 
Out 

To simulate the dispersion of the virus, a test was 
performed in the operating room area of the Hospital 
de Clinicas Caracas (HCC) with a volunteer as a patient, 
who simulated sneezing with a fluorescent liquid aerosol 
device (Figure 3), which he squeezed at mouth level at 

of a new coronavirus (SARS-CoV-2), which causes the 
COVID-19 disease. This virus managed to spread globally 
in a considerably short time becoming a pandemic. Glob-
ally, public health has been facing significant challenges in 
consequence of this situation,1 to this date (04-30-2020), 
the WHO has confirmed 3,090,445 cases and 217,769 
deaths worldwide.2

The transmission of COVID-19 occurs mainly through 
droplets which are responsible for spreading the virus when 
they come in contact with healthy individuals, whether 
directly or indirectly through contaminated surfaces. 
Coughs, sneezes, and some medical airway management 
procedures can also produce aerosols made up of smaller 
airborne particles (droplets), which may contain this virus. 
These airborne particles can travel long distances and be 
inhaled, increasing the risk of transmission of COVID-19.1–5

During the SARS-CoV outbreak in Canada (2002), half 
of all SARS-CoV cases were nosocomially transmitted to 
healthcare workers. During these high-demand times, 
the available human resources to attend to patients may 
decrease significantly, especially in countries with strug-
gling healthcare institutions as considerable personnel 
have been subjected to quarantine and isolation measures 
to try to prevent further transmission of the virus. In 
healthcare institutions, the virus is widely distributed in 
the air and on the surfaces of objects (for example floors, 
garbage cans, handrails for sickbeds, and computer mouse 
devices). This can include general rooms, intensive care 
units,6 and cardiac laboratory rooms.7 

In this regard, healthcare workers are threatened 
with an increased risk of infection, while managing CO-
VID-19 positive patients or by performing procedures 
that may generate aerosolized saliva particles, such as 
mechanical ventilation, misting medication, non-invasive 
ventilation, manual ventilation, tracheal intubation and 
aspiration, secretion aspiration, bronchoscopy, endos-
copy, bronchoalveolar lavage, surgical tracheostomy, or 
cardiopulmonary resuscitation. Several guidelines and 
recommendations have been published and introduced 
to reduce these risks; however, the cases of infections 
and deaths in health professionals due to COVID-19 are 
still increasing in institutions with patients with serious 
complications.8

Recently, Robert Canelli et al9, published a study in 
which they tested the effectiveness of a barrier that they 

called an "aerosol box", which consisted of a transparent 
plastic that could cover the head of a patient, and incor-
porated two circular ports to perform medical airway 
procedures. To demonstrate the effectiveness of the box, 
they simulated a “strong cough” with a small latex balloon 
containing 10 mL of fluorescent dye in the hypopharynx 
of an anatomical model. The explosion of this balloon 
produced an expansion of dyed particles in the area. They 
repeated the experiment with and without the aerosol 
box and illuminated the scene with ultraviolet light to 
visualize the spread of the dye. With the use of the aerosol 
box, the simulated cough was only able to “contaminate” 
the internal surface of the box, and the covered arms 
and gloves of the worker performing the laryngoscopy. 
However, with further examination, they concluded that 
the simulation method was not valid enough to prove 
an accurate direction of the liquid, its speed, turbulence, 
or particle size distribution, as it would happen with 
real coughs. Taking this background into account, this 
“aerosol box” was redesigned to increase the protection 
of healthcare workers performing high-risk procedures 
on COVID-19 patients.9

MATERIAL AND METHODS
The following phases were carried out: (a) A sketch was 

created; (b) A 3-D CD model was created; (c) The prototype 
was manufactured; (d) The prototype was improved; and 
(e) The effectiveness and safety tests were carried out. 

RESULTS

A Sketch was Created
Analyzing the original design of the aerosol box, with 

the experience of medical anesthesiologists, and with 
the support of the multidisciplinary team, the medical 
device was redesigned with two specific criteria: safety 
and effectiveness.

To achieve those criteria, the following improvements 
were made:

• An inclined front panel that limits the particles to the 
distal plane of the patient, and that allows a complete 
visualization of the procedure to be performed on 
the patient (Figure 1 in annexes).

FIGURE 1. Inclined front panel and CubeDV extension.

FIGURE 2. CubeDV sketches of the design.



Moreno, Pedraza, Morales, Mijares, Boccardo and García: Redesigning protective gear for health workers during the 
COVID-19 pandemic: leveling up the “aerosol box” 

31 J Global Clinical Engineering Vol.3 Issue 1: 2020J Global Clinical Engineering Vol.3 Issue 1: 2020  30

Moreno, Pedraza, Morales, Mijares, Boccardo and García: Redesigning protective gear for health workers during the 
COVID-19 pandemic: leveling up the “aerosol box” 

the time of intubation. The test was carried out in two 
stages, with and without the CubeDV. In both cases, the 
expansion of the aerosol particles was recorded with the 
addition of ultraviolet light through photographs, filming, 
and testimony of the medical team in the operating room. 
In the first step of the investigation (without CubeDV) the 
results showed that the distribution of the fluorescent 
aerosol particles from the position of the patient (where 
the spray was triggered), was: 1.2 meters (47.2 inches) 
away in both right and left sides, 1 meter (39.4 inches) 
in the air, the superior plane of the patient (Figure 4), 1.1 
meters (43.3 inches) in the coronal plane and 1 meter 
(39.4 inches) in the distal plane. Moreover, there was an 
evident presence of particles in the facial protection masks 
of the operator (Figure 5). Subsequently, the second step 
of the investigation was carried out with the CubeDV, re-
porting the distribution of the aerosol particles only on 
the internal part of the box (Figure 6) and on the covered 
hands and forearms of the operator (Figure 7). The use 
of CubeDV was also tested in other medical procedures 
such as: bronchoscopy, upper digestive endoscopy, and 
induction of inhalation anesthesia in pediatric patients.

The Use of the CubeDV
From the tests carried out on the CubeDV to prove its 

effectiveness, the following results were obtained: (a) The 
sloped front panel allows an important improvement of 
the visibility of the patient; (b) The CubeDV’s improved 
length played an important role in protecting health work-
ers during procedures with high risk of infection; (c) The 
distal flange decreases the possibility of particle expan-
sion outside the box. The tests showed that the CubeDV 
contained both the droplets and the large diameter drops, 
thus avoiding dispersion and contamination of the area; 
(d) The lateral closing holes reduced the risk of exposure 
of assisting personnel during different procedures.

CONCLUSIONS
This work demonstrates that in spite of the the strug-

gling circumstances Venezuela faces daily, it is possible to 
solve a problem that threatens global public health and 
to fight the serious COVID-19 pandemic.

Taking into consideration the length of the box, the 
improved panel, and its material, it is possible to conclude 
that the team of HCC and USB obtained an effective result 
when redesigning the aerosol box. Our analysis and tests 
suggested that the CubeDV may play an exceptional job 
protecting the health workers while attending to infected 
patients. 

CubeDV is a result in a time of crisis and another tool in 
our fight against the COVID-19. This protective gear is just 
one materialized example of our efforts to win this fight, 
and we hope, and to provide significant help in this crisis.

ACKNOWLEDGMENTS
To the group of anesthesiologists of the Hospital de 

Clinicas Caracas, who supported the financing of the 
prototype and facilitated their working hours to carry 
the tests out. 

REFERENCES

1. Huang C, Wang Y, Li X, et al. Clinical features of patients 
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FIGURE 3. Inclined front panel and CubeDV extension.

FIGURE 4. Upper extension of the fluorescent ink to the surgi-
cal lamp.

FIGURE 5. IFluorescent ink spread to operator and assistant 
facial protection.

FIGURE 6. Containment of the fluorescent ink inside the CubeDV.

FIGURE 7. Fluorescent ink spread limited to operator's forearms 
with use of CubeDV.



Moreno, Pedraza, Morales, Mijares, Boccardo and García: Redesigning protective gear for health workers during the 
COVID-19 pandemic: leveling up the “aerosol box” 

J Global Clinical Engineering Vol.3 Issue 1: 2020  32

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