Glove-Wall System for Respiratory Specimen Collection and COVID-19 Mass Screening

Dear Editor:

In response to the coronavirus disease 2019 (COVID-19) pandemic, Korea has devised an effective strategy for massive diagnostic testing combined with isolation [1, 2, 3]. Specimen collection for COVID-19 requires heavy personal protective equipment (PPE) which is exhausting for the examiner and difficult during mass screening. Therefore, we implemented the ‘Glove-Wall system' at a screening clinic since 10th February 2020 first reported ever in the literature.

The Glove-Wall is composed of a translucent plate window with a pair of sleeved gloves (Fig. 1A). A physician determines the patient eligibility according to the COVID-19 criteria. Respiratory specimen is collected from the suspected patient in the Glove-Wall area where the examiner and examinee are completely separated (Fig. 1B). The examiner needs minimum PPE and does not need to change PPE between patients; therefore, the wait time is minimal. Specimen containers dropped into a collection box are sent to a laboratory as a batch after each session.

Figure 1
Glove-Wall system in a COVID-19 screening clinic.
(A) Collection of respiratory specimen for a COVID-19 test using Glove-Wall: The Glove-Wall completely separates the examinee and examiner. (B) The layout of a COVID-19 screening clinic in Boramae Medical Center. The physician room is separated from the examination room. (C) Surface disinfection and cleaning with alcohol and quaternary ammonium wipes. (D) Use of single-use gloves that are worn over the fixed sleeved gloves. Informed consent was obtained from the individuals in the image for the publication of this report.

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To secure the safety of the examinees side and prevent cross-contamination from the surrounding environment, the examiner disinfects the fixed gloves between patients using alcohol and quaternary ammonium wipes approved for coronavirus (Fig. 1C) [4]. Each examinee is instructed to perform hand hygiene with alcohol products before and after exit. After each session, the entire room is cleaned and disinfected with diluted sodium hypochlorite [4]. The fixed gloves are regularly replaced. Single use gloves are worn over the fixed sleeved thin gloves for every procedure (Fig. 1D).

To prevent airborne transmission from previous candidates and allow rapid air change, the examinee's space is designed to be small (2.5 m x 1.3 m x 2.5 m) with a volume of 8.1 m³ and a 1 m x 2 m sized door leading to open air. For effective ventilation and filtration, a portable negative pressure machine is installed with an airflow rate at 530 m³/h and 65 air changes per hour that removes 99% of airborne contaminants in 5 minutes [5, 6]. The ventilation safety is secured during the 5-minute interval between patients.

About 1,000 diagnostic procedures were performed in a 5 week-period, and any procedure-related healthcare worker infection was not reported. The application may be flexible in different situations. Multiple units will be needed to handle large-scale testing. Additionally, the examinee's space can be modified as needed, for example, open air system can be adopted in warm climates.

In summary, the Glove-Wall system for respiratory specimen collection has improved examiner's safety, minimum PPE requirement, and limited examinee's safety.