Sixth form design student helps develop Covid-secure screen allowing life-saving medical examinations to resume
- D&T student interprets simple sketches by ENT consultant to produce practical safety screens
- 1000s of patients can now be safely examined and treated
An 18-year-old student at Dulwich College used rough drawings by a specialist consultant as the starting point for a screen allowing nasendoscopy examinations to take place safely for the first time since the onset of the Covid-19 pandemic.
Nasendoscopy is a test that looks at the inside of the nose, throat and larynx using a tiny camera passed through the nasal passages. It is used to diagnose polyps and lesions as well as identifying potential signs of cancer.
Since March 18, ENT clinicians have not been able to carry out the procedure safely because of the risk from patients sneezing or coughing as the camera is inserted. This has led to a considerable backlog and many patients suffering pain and discomfort, in some cases with potentially life-threatening conditions going undiagnosed.
Christian Lyons, MD of Communitas Clinics, explains “Our clinics usually carry out around 600 nasendoscopies each month. The advice given early on during the pandemic was for clinicians to use a visor to ensure safety.
“However, with nasendoscopies and other ENT procedures, it is imperative to use an eyepiece – a visor simply isn’t practical.”
As well as risks for the clinician, if a patient does sneeze the room has to be shut for at least an hour and then deep cleaned; adversely impacting on appointment wait times which could lead to too many patients sitting together in the reception area – another risk.
Plamen Donev, ENT Consultant with Communitas Clinics, was so concerned for those patients unable to get help that he came up with a solution – a fixed screen with apertures for hands and gloves. He said:
“I borrowed the idea partly from the clinical room dividers and screen protectors which were starting to be used in banks, at supermarket tills and on buses, or similar to the protective screens in restaurants introduced in Spain.
“In practical terms, this promised to provide excellent protection without compromising the quality of patient care, as well as requiring less restrictive PPI.”
He showed his simple sketches to Lyons who in turn approached Dr Joseph Spence, Master of Dulwich College, whose Head of D&T James Humphries recommended student Sam Williams to make a prototype of the specialist screen.
Sam had been going into school during lockdown to make visors for NHS staff and clinics and was pleased to be given the new project. “The initial drawings and ideas were good. I made alterations to the designs and created a 1:5 scale model using the school’s facilities and materials.
“There were many challenges; the screen has to be able to be kept really clean so there couldn’t be bolts or crevices, there had to be smooth surfaces everywhere and everything had to be easy to sanitise. For my A level project, I made a firepit so this was at the opposite end of the cleanliness scale!”
The metal fabrication was outsourced to Cableduct, and the acrylic was cut out of house. When Sam had all the components, he assembled the prototype. A collaborative process through Zoom meetings gave Plamen the opportunity to provide feedback and suggest modifications. These included the need for a short, supple disposable sleeve to provide a relative seal around the hand whilst allowing flexibility during an examination. Factoring in differing heights of patients led to a vertical line rather than a round hole, and a small rectangular hole with silicon taping was added into the middle of the screen for the camera to be fed through.
Plamen says he was overwhelmed with the result: “I had been really nervous about going back to work because, as we all now know, medical staff are disproportionally affected by Covid-19. I’m going to be a grandfather soon which gave me an additional level of anxiety. When I saw the screen made up with the modifications, I quickly realised that this piece of kit would make me feel safer and considerably reduce the risk of infection.
“I couldn’t have got better results if I’d gone to a professional design business,” he added.
After guidance from the Medical & Healthcare products Regulatory Agency with regard to the categorisation of the product and the regulatory requirements, Sam was commissioned to make four screens, one for each of the Communitas ENT clinics in Croydon, Barking & Dagenham, Havering & Redbridge, Herts Valley and City and Hackney.
“There were 4,398 appointments scheduled in our clinics in March alone, and many of these were nasendoscopies – so we have a major backlog to cope with,” says Lyons.
“The screen will help put us back on track and allow us to help patients who have been left high and dry during lockdown. By October we expect to be hitting our target of 350 nasendoscope examinations a month.”
Communitas clinicians are impressed with the design. Plamen says “It’s just brilliant, it has made everyone feel that we can carry out these procedures safely – not just in terms of our own safety but patients and other staff.”
For the future, Lyons thinks that ENT doctors are all going to want these screens. “They will reduce the infection risk across many procedures – as well as nasendoscopy, anterior rhinoscopy, oral examination and nasal cautery will be made much safer.”
Sam has been recompensed for his development work and for making the screens. He is now taking a gap year and will be looking for an apprenticeship within the construction sector. Lyons adds “Whatever he decides to do, his ability to respond so quickly to our requirement and come up with an ideal solution from basic sketches shows that he has a bright future ahead of him.”