Using HoloLens2™ to reduce staff exposure to aerosol generating procedures during a global pandemic

Abstract

RATIONALE: COVID-19 poses a unique challenge; caring for patients with a novel, infectious disease whilst protecting staff. Some interventions used to give oxygen therapy are aerosol generating procedures. Staff delivering such interventions require PPE and are exposed to a significant viral load resulting in sick days and even death. We aim to reduce this risk using an augmented-reality communication device: The HoloLens by Microsoft. OBJECTIVES: In a tertiary centre in London we aim to implement HoloLens technology, allowing other medical staff to remotely join the consulting clinician when in a high-risk patient area delivering oxygen therapy. The study primary outcome was to reduce the exposure to staff and demonstrate non-inferiority staff satisfaction when compared to not using the device. Our secondary outcome was to reduce extrapolated PPE costs when using the device. METHODS: Our study was conducted in March and April 2020, within a respiratory unit delivering aerosolising oxygen therapies (High flow nasal oxygen, Continuous positive airway pressure and non-invasive ventilation) to patients with suspected or confirmed COVID-19 infection. MEASUREMENTS: Self-reported questionnaires to assess satisfaction in key areas of patient care. An infrared people counting device was also used to assess staff in and out of the unit. MAIN RESULTS: Mean self-reported time in the high-risk zone was less when using HoloLens (2.69 hours) compared to usual practice (3.96 hours) although this difference was not statistically significant (p = 0.3657). HoloLens showed non-inferiority when compared to usual practice in staff satisfaction score for all domains. Furthermore, mean staff satisfaction score encouragingly improved when using HoloLens. Self-reported PPE counts from this study showed 12 staff members changing PPE 25.8 times per shift, almost double the 13.5 times in the HoloLens count. CONCLUSIONS: We have demonstrated HoloLens can reduce the number of staff exposed to aerosol generating areas in a novel infectious disease. Our results show it did not impair communication, medical staff availability or end of life care. HoloLens technology may also reduce the use of PPE, which has equipment availability and cost benefits. This study provides grounding for further use of the HoloLens device by bringing a bedside experience to experts remote to the situation.

The mixed reality medical ward round with the MS HoloLens 2: Innovation in reducing COVID-19 transmission and PPE usage

“…Cafferkey et al have recently shown that the use of the HoloLens 2 reduced PPE usage in a ward with extensive use of non-invasive ventilation (continuous positive airway pressure; aerosol generating). 5 Our study shows that use of HoloLens 2 can also reduce PPE usage by at least 50% on a medical ward with no aerosol generating procedures. Given the concerns regarding PPE shortages that have arisen during the COVID-19 pandemic, this is an important benefit of using the HoloLens 2 for medical ward rounds.…”

“…Given the concerns regarding PPE shortages that have arisen during the COVID-19 pandemic, this is an important benefit of using the HoloLens 2 for medical ward rounds. 5 The reduction in PPE resulting from fewer staff members on the ward round also directly linked with shorter duration of ward rounds, as donning and doffing PPE is a time-consuming process.…”

“…[2][3][4] Cafferkey et al have also recently reported the use of HoloLens 2 to reduce exposure of healthcare professionals (HCPs) to aerosol generating procedures (AGPs). 5 However, there are no studies on its usefulness for medical ward rounds. This study was a pilot conducted at the height of the COVID-19 pandemic in London, and aimed to ascertain the value and acceptability of using the HoloLens 2 in a renal medicine ward that cared for patients with COVID-19.…”

The smartphone: an evolution or revolution in virtual patient healthcare during and beyond the COVID-19 pandemic ? An evaluation and comparison of the smartphone against other currently available wearable technologies in a secondary care setting during the COVID-19 pandemic

“…[18] Up to 20%-70% patient files and charts harbour infection due to frequent handling by staff [19][20][21] COVID-19 spreads by droplet transmission, poor hand hygiene and contact between staff and patients [22] and up to 80% of staff may be asymptomatic carriers of COVID-19 [23] risking nosocomial spread from staff to patients. [24 -27] Virtual ward rounds have been reported previously, with less staff on the ward, using a double telepresence robot (iPad on a trolley), [28] Microsoft Hololens [29] and laptops carried onto the ward. [30] The adoption of an office based team (OBT) and remote ward team (RWT) in our practice reduced staff numbers by 50% on the ward round.…”

“…Virtual ward rounds have been reported previously, with less staff on the ward, using a double telepresence robot (iPad on a trolley),[28] Microsoft Hololens [29] and laptops carried onto the ward. [30] The adoption of an office based team (OBT) and remote ward team (RWT) in our practice reduced staff numbers by 50% on the ward round.…”