Purpose:
For a patient with coronavirus disease 2019 (COVID-19) with chest drain inserted for pneumothorax, air leakage from the chest drain system, which is not a closed system, can aerosolize when bubbling through the underwater seal and cause viral spreading. There are limited reports suggesting means to prevent viral spread with modification of the chest drain systems for patients with COVID-19. We would like to test the effectiveness of the modifications of the chest drain system to prevent COVID-19 spreading via aerosol in COVID-19 patients with chest drain system in our ICU.
Methodology & Sample collection:
We suggest three modifications to the chest drain system: use of 0.05% Aqueous-based chlorhexidine gluconate solution in water seal chamber, water column in the suction control chamber and use of bacterial viral filter at the suction port. The modified chest drain system was connected to a patient with COVID-19 who required mechanical ventilation. Several swabs from the modified chest drain system were taken and test for polymerase chain reaction (PCR) for COVID-19.
Findings:
Only sample from the chest drain tubing directly connected to patient side was tested positive with COVID-19. Samples from water seal chamber, chest drain tubing to connect for suction and area beyond the bacterial viral filter are all tested negative with COVID-19.
Limitations:
Continuous suction was not applied to the modified chest drain system. The effect of the modifications in the prevention of spread of COVID-19 if continuous suction is applied to the chest drain system needs further study.
Practical implications:
The modifications of chest drain system are easy to apply and the equipment are readily available in ICU. The modification could help the prevention of spread of COVID-19 in patients with pneumothorax using the chest drain system.
