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 Table of Contents  
INNOVATION
Year : 2022  |  Volume : 60  |  Issue : 1  |  Page : 42-47

The Do-It-Yourself (DIY) novel, safe and cost-effective ophthalmic cubicle (coronicle) in COVID-19 era


1 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
3 Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
4 Department of Biostatistics, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
5 Department of Mahathma Centre of Moving Images, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
6 Department of Strabismus and Paediatric Ophthalmology, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India

Date of Submission20-Oct-2021
Date of Decision01-Dec-2021
Date of Acceptance06-Dec-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Tennur, Seshapuram, Trichy - 620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_161_21

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  Abstract 


The coronicle (corona + cubicle) provides state-of-the-art features required for comprehensive ocular evaluation. Assembling this cubicle requires acrylic sheets, aluminum beading, fevicol, araldite paste, and a jigsaw cutting blade, which can be done in a do-it-yourself template. Dimensions of the cubicle are 16 × 16 × 8 feet with only a total area of 256 square feet; thus, restricting patient movement inside hospital premises. Social distancing norms with three feet distance between the machines were incorporated while installing the ophthalmic gadgets within the cubicle. The cubicle encompasses slit-lamps, auto refractometer, lensometer, fundus capture device, optical coherence tomography, optical biometry, manual keratometry, corneal topography, and noncontact tonometer. Customized openings in the cubicle were made in front of each device, for the patient's head and chin rest positioning during the examination, and can be closed with sliding doors during times of disuse. An acrylic groove was provided to accommodate the patient's feet. Coronicle has helped instil, both patient and medical personal safety during COVID-19 and has withstood the test of time since its inception in May 2020. In this manuscript, we have discussed the economics and validated the utility of the cubicle, in terms of the quantitative usage of ophthalmic gadgets present inside the cubicle versus outside the cubicle for the past 19 months, since the installation of the cubicle; along with the cubicle's additive highlights and its role after the pandemic is over.

Keywords: Corona Cubicle, Do-It-Yourself, Eclectic Setup, Omicron Variant, Ophthalmic Outpatient Department Cubicle


How to cite this article:
Ramesh PV, Ramesh SV, Ray P, Devadas AK, Ansar SM, Raj PM, Ramesh MK, Rajasekaran R. The Do-It-Yourself (DIY) novel, safe and cost-effective ophthalmic cubicle (coronicle) in COVID-19 era. TNOA J Ophthalmic Sci Res 2022;60:42-7

How to cite this URL:
Ramesh PV, Ramesh SV, Ray P, Devadas AK, Ansar SM, Raj PM, Ramesh MK, Rajasekaran R. The Do-It-Yourself (DIY) novel, safe and cost-effective ophthalmic cubicle (coronicle) in COVID-19 era. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Jul 2];60:42-7. Available from: https://www.tnoajosr.com/text.asp?2022/60/1/42/340358




  Introduction Top


Post COVID-19 pandemic, many drastic changes were made in the ocular healthcare system to provide quality health care with a safe and effective method.[1],[2],[3] One such innovative practice pattern employed was the ophthalmic cubicle (coronicle) [Figure 1] which was constructed to ensure safety for both healthcare workers and outpatient department (OPD) patients. In this manuscript, we have provided the materials and methods to assemble this cubicle along with their economics. We have also validated the utility of the cubicle in terms of the quantitative usage of ophthalmic gadgets present inside the cubicle versus ophthalmic gadgets present outside the cubicle for the past 19 months, since the inception of the cubicle from May 04, 2020.
Figure 1: The novel coronicle (corona + cubicle), inside which all the essential ophthalmological instruments were installed. The red arrow depicts the outdoor outlet of the air conditioner provided exclusively for the air transmission from within the cubicle

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  The Inception of the Coronicle Top


With the emergence of the COVID-19 pandemic, we have converted the pre-COVID waiting hall of approximately 450 square feet into an OPD and investigation cubicle of 256 square feet [Figure 2] for ocular patient examination. This cubicle was constructed to create a barrier between the doctor and patient to prevent transmission of aerosol mediation infection. Since only a minimal area was utilized for patient examination, the extensive patient movement inside the hospital premises was avoided, thus simultaneously reducing the effective patient area occupied, contributing toward optimal surface sanitization.
Figure 2: (a) Pre-COVID waiting hall which was converted into an (b) OPD and investigation cubicle

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  Assembling the Coronicle in a Do-It-Yourself Template Top


Assembling this cubicle [Table 1] required acrylic sheets, aluminum beading, fevicol, araldite paste, and jigsaw cutting blade [Figure 3]. The fevicol was used to fix the aluminum beading to the floor and the araldite paste was used for fixing the aluminum beading to the roof as the adhesion is against gravity. Dimensions of the cubicle were 16 feet in length, 16 feet in breadth, and 8 feet in height with a total area of 256 square feet. Maintaining social distancing norms of 3 feet distance, ophthalmic machines [Figure 4] were installed inside the cubicle. This cubicle encompasses two slit-lamps, two electronic medical record computer systems, and one each of auto refractometer, lensometer, confocal fundus capture device, spectral-domain optical coherence tomography (OCT), optical biometer, manual keratometry, corneal topographer, and noncontact tonometer (NCT), [Figure 5] which were screen mirrored through a local area network (LAN) on the computer desktop present near the slit lamp [Video 1] for a smooth clinical workflow and e-counseling by showing the patient's their own images. Customized openings in the cubicle were made in front of each device for the patient's head and chin rest [Figure 6]a. Sliders were provided in front of the headrest openings to close the openings during times of disuse [Video 2]. An acrylic groove was provided to accommodate the patient's feet [Figure 6]c and [Figure 6]d for comfort during examination. A horizontal rectangular opening was made for easy access of the documents of the patient from outside to inside the cubicle and vice versa [Video 3]. In-between each patient examination, the entire surface of the headrest opening and chin rest was sterilized using 70% of isopropyl alcohol and was left to dry for 3 min [Video 4].[4]
Table 1: Materials used for assembly and their cost dynamics

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Figure 3: The materials required for recreation of the coronicle: (a) acrylic sheets (b) aluminum beading (c) jigsaw blade and (d) araldite and fevicol glue

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Figure 4: (a) All encompassed machines kept at three feet distance from one another. (b) The three feet social distancing maintained between the patient's sitting space

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Figure 5: All the essential ophthalmological instruments required for an eclectic setup inside the coronicle (a) corneal topography, (b) manual keratometry, (c) optical biometer, (d) optical coherence tomography, (e) confocal fundus photography, and (f) slit lamp

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Figure 6: (a) Customized opening (yellow arrows) in the cubicle in front of each device for the patient's head and chin rest. (b) Acrylic shield (red arrows) placed between the patient and the doctor to avoid face-to-face interaction. (c) Acrylic groove (red arrows) provided to accommodate the patient's feet when viewed from outside the cubicle. (d) Acrylic groove (red arrows) provided to accommodate the patient's feet when viewed from inside the cubicle

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  Additive Highlights of the Cubicle Top


An acrylic shield was installed in all the machines as a secondary physical barrier to prevent aerosol-mediated infections [Figure 6]b.[5] For the ease of communication between the doctor and patient, we have placed two sets of mikes and speakers; one for the doctor and another for the patient [Video 5], for smooth audio communication between them, from the insides and outsides of the cubicle [Figure 7]. The cubicle had only one mode of entry, which was provided with a sliding door. The sliding door can be opened or closed with the leg [Figure 8] without hand touch [Video 6]. All ophthalmic gadgets inside the cubicle are interconnected with LAN, thus amplifying the functionality of one with another for a holistic eye examination using a single internet connection.[6],[7]
Figure 7: (a) A set of mike (red arrow) and speaker (yellow arrow) placed inside the cubicle. (b) A set of mike (red arrow) and speaker (yellow arrow) placed outside the cubicle for smooth and effective communication

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Figure 8: (a) An aluminum piece attached to the inferior part of the door, outside the cubicle to open the door with the help of one's leg. (b) An aluminum piece attached to the inferior part of the door, inside the cubicle to close the door with the help of one's leg

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  Economics Top


The assembly of the cubicle costed Rs. 3,34,060. The detailed cost analysis of the materials and the cost of the assembly process involved in this do-it-yourself ophthalmic cubicle are shown in [Table 1].


  Validation of the Utility of the Corona Cubicle Top


In this manuscript, we have also validated [Table 2] the utility of the cubicle, in terms of the quantitative usage of ophthalmic gadgets present inside the cubicle versus ophthalmic gadgets present outside the cubicle for the past 19 months, since the installation of the cubicle from May 04, 2020 to November 27, 2021. This was a cross-sectional study conducted, and the number of examinations performed at various ophthalmic stations outside and inside the cubicle were taken into consideration. A total of 53,191 OPD patients who presented in the past 19 months were included for validation. Independent t-test (parametric test) was used to compare the utility of equipment's inside and outside the cubicle. 95.31% of the patients who came for eye examination underwent tests (such as slit-lamp biomicroscopic examination, optical biometry, corneal topography, fundus photography, NCT and OCT) inside the cubicle. Whereas, only the remaining 4.69% of the patients were examined with equipment outside the cubicle (such as synoptophore, B-scan, ultrasound pachymetry, specular microscopy, visual field examination, and indirect ophthalmoscopy), which was statistically significant (P = 0.00).
Table 2: Total number of ophthalmic examinations at various stations performed inside and outside the cubicle

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  Relevance of the Cubicle - Pandemic and After Top


The patient safety norms and ventilation requirements as proposed by the World Health Organization for COVID-19 to tackle aerosol-based transmission, were followed in the creation and functioning aspect of the cubicle. Every time the cubicle's door or sliders were opened, air flows from inside the cubicle to outside, thus ensuring a unidirectional flow of air from inside to outside the cubicle. The air conditioner inside the coronicle has a separate outdoor outlet, compared to the air conditioner of the surrounding environment; and there is no way for the air of the surrounding environment to communicate with the air inside the cubicle [Figure 1]. Hand sanitization, usage of masks, and physical distancing of 3 feet were strictly followed inside the cubicle. So far, 29 medical and paramedical staffs have worked inside the cubicle, and none of them have reported COVID positive within 2 weeks of their duty completion inside the cubicle.

The model proposed in this study is cost-effective, less space-consuming, easily constructible in a DIY template, and has given excellent results and safety for medical staff even before their two-dose vaccination, during the initial phase of the pandemic. It is universally applicable, though India is entering an endemic stage, because of its effective disposal of OPD patients consuming only a small working area of 256 square feet. It has stood the test of time during the pandemic, and will also help alleviate the fear of impending and inevitable Omicron variant of COVID-19. The cubicle cannot, however, be exclusive and completely substitute tertiary eye care setting where patient management is a dynamic process and needs constant physical interactions.


  Conclusion Top


In search of methods to eliminate aerosol mediated problems related to the close proximity of ophthalmic examination associated with COVID-19, the coronicle is a cost-effective do-it-yourself model which can deliver high-quality comprehensive eye care within a minimal operational area. The coronicle provides many state-of-the-art features necessary for an eclectic setup and has withstood the test of time during the pandemic for ocular patient evaluation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patient (s) understand that his/her/their name(s) and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Khanna RC, Honavar SG. All eyes on coronavirus – What do we need to know as ophthalmologists. Indian J Ophthalmol 2020;68:549-53.  Back to cited text no. 1
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Honavar SG. Prepare or perish – Readiness is the key to reopen for routine eye care. Indian J Ophthalmol 2020;68:677-8.  Back to cited text no. 2
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Ramesh PV, Ramesh SV, Ramesh MK, Rajasekaran R. Utilization of hospital car parking garage for COVID-19 triage and screening in a high-volume tertiary eye care center. TNOA J Ophthalmic Sci Res 2021;59:114-6.  Back to cited text no. 3
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How To Clean Effectively for COVID-19 Using What's Readily. Available from: https://www.contecinc.com/articles/how-to-clean-covid-19. [Last accessed on 2020 Aug 05].  Back to cited text no. 4
    
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Liu J, Wang AY, Ing EB. Efficacy of slit lamp breath shields. Am J Ophthalmol 2020;218:120-7.  Back to cited text no. 5
    
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Ramesh PV, Parthasarathi S, Ramesh SV, Rajasekaran R, Ramesh MK. Innovative utilization of patient's triage with integrated information system during COVID crisis. Kerala J Ophthalmol 2021;33:87-90.  Back to cited text no. 6
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Ramesh PV, Parthasarathi S, Ramesh SV, Rajasekaran R, Ramesh MK. Interconnecting ophthalmic gadgets (infinity stones) at finger tips (personal computer desktop) with local area network for safe and effective practice during COVID-19 crises. Indian J Ophthalmol 2021;69:449-52.  Back to cited text no. 7
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2]



 

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