With the world significantly impacted by Covid-19 in 2020, a key problem in the initial stages of the pandemic was to source adequate Personal Protective Equipment (PPE) for front line workers. Simply, the supply of PPE was nowhere near the sharply increased demand from all over the world, as it became a basic but critical tool to support them to help flatten the curve.
Sri Lanka also had a similar challenge in sourcing PPE in the initial stages of the pandemic despite the best efforts of the health authorities. Having PPE was critical to protect healthcare workers from getting infected and ensuring that they were able to successfully treat and manage suspected and confirmed patients.
Healthcare workers initially adapted to these challenges by using standard PPE (Goggles, Face Masks & Face Shields etc). However there were other limitations. Extended wearing of goggles would create a layer of mist from the moisture in their breath, thus fogging up the goggles and limiting their visibility while treating patients. N95 masks also caused breathing difficulties, which would cause medical workers to become tired faster. PPE was never designed to be worn for so long, but wearing this was a critical part of the effort. In addition, the lack of N95 masks globally meant rationing the use of such gear along with the fact they were made only for single use.
In March 2020, Dr. Lakmal Fernando, an Intensive Care Unit (ICU) doctor from the Sri Jayawardenepura General Hospital had a light bulb moment in the midst of this challenge. He wondered whether it was possible to convert a scuba diving mask into a PPE as he had used scuba masks before and recalled that it did not mist inside due to its an anti-fogging design. It was also comfortable to wear compared to the N95 masks and was reusable, which was important in the midst of a shortage. It also had an air intake from the back of the mask, so that the medical worker would only be exposed to a lower infectious droplet intake from infected patients during face to face interactions. It also supported those who wear glasses, and overall seemed like an ideal fix to the problem.
He called Decathlon, a sportswear company and requested for a scuba mask to trial out his concept. A key modification was done in adding a viral and bacterial filter, and then the modified mask was trialed out. The initial reviews from staff who used the modified gear at ICUs were firmly positive and this was a key driver for further development. Dr. Lakmal then presented his idea to the GMOA New Inventions Committee and obtained their approval and certification for production and they also provided additional information and guidance to further improve the design. Decathlon, also offered to donate a few more scuba masks to the Sri Jayewardenepura ICU to use as PPE for health staff as a result of the initial success.
This new innovation came highly recommended by Dr. Harsha Samarasinghe, Consultant Cardiologist and head of the GMOA New Inventions Committee and has approved the mask for use and further production.
Among the many positive reviews, Dr. Prageeth Pathirage, Consultant Anaesthetist at Sri Jayawardenepura General Hospital stated, “The modified Scuba mask is a safe and comfortable innovation for health care workers and a much needed addition to the ICU. The reusability of this mask is of utmost significance.”
The modification is made using the scuba mask with a standard 22mm ventilator tubing adaptor which allows use a standard ventilator Bacterial and Viral filter which filters inspiratory and expiratory air. Studies have shown viral filtration efficiency rating is 99.99% in Bacterial and Viral filter which gives a good protection.
(Reference:https://www.apsf.org/faq-on-anesthesia-machine-use-protection-and-decont... )
Dr. Lakmal posted about the trial on his personal Facebook page on the 6th April 2020, and this generated tremendous interest and requests for the mask, by which time the Decathlon stocks were exhausted. Doctors from the National Hospital then obtained a similar product from the Glory Swimming Shop and requested for modifications, which were then provided to their medical ICU. Further masks were provided to the dental doctors at Peradeniya. Interest in this mask was growing and inquiries started coming in from multiple overseas doctors on how to effect the conversion, so Dr. Lakmal wrote a tutorial for them on how to modify the scuba mask and freely provided this to anyone who inquired about it.
Dr. Manoj Edirisooriya, Consultant in Critical Care Medicine at the National Hospital Medical ICU stated, “Safety of Health care staff remains a priority in the battle against COVID19. The modified Scuba mask is an innovative solution for the shortage of quality N95 masks. Among the many advantages, this mask is particularly useful for ICUs as it is reusable”.Dr Lakmal added: “It was the need of the moment and we needed a modified mask to protect frontline staff and to help the country manage this pandemic. We were able to accommodate the need for this despite the initial difficulties in getting PPE. I was also inspired to see other doctors using my modified scuba mask for their daily tasks, while some had even made further modifications depending on their own needs.”
He also stated, “Please do contact me if you wish to know how to modify any masks that you currently have and I will certainly support you to do the same as I wish to give this idea free of charge to those who need it.”
On a personal note he wished to convey his appreciation to Viraj Rodrigo, a senior nursing officer who works at the General ICU at Sri Jayawardenepura hospital, for his valuable support for this project and also wished to thank Migara Liyanage from Decathlon, who generously supported him by providing the masks for modification. He also extended his thanks toall his consultants and superiors for the guidance and support given. He is especially thankful to the GMOA for organizing the New Inventions Committee to access the new inventions and supporting the inventors to succeed.
While hoping we are able to adjust to the ‘New Normal’ soon, Dr. Lakmal is interested in developing the mask further to utilize in hospital setups where personal safety of the healthcare staff is of paramount importance.
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