Turbulent Airflow Costume Compromises Occupational Safety and Infection Control: A Hospital Risk Management Case Report

Objectives: To inform hospital infection control, risk management, hospital administrators, and healthcare workers about a new and surprising threat to infection control: air-powered costumes Background: Air-powered costumes use a small motor to create positive pressure within the costume This mechanism is similar to Powered Air Purifying Respirator (PAPR) 1 However, unlike a PAPR the air-powered costume does not filter the incoming air through a HEPA filter Nor does it capture the air inside a contained space and filter it before it is released into the environment The affect is that droplets from the person in the costume or from air that is drawn into the costume, which would normally be too heavy to travel farther than 6 feet, are aerosolized by traveling through the turbulent blower These small particles can easily penetrate the thin fabric that makes the costume This creates an infection control problem by aerosolizing the particles and then propelling them with the force of positive pressure " Case Description: In January of 2021, a Covid-19 outbreak in San Jose, CA, was contact traced back to a surprising source On Christmas day, a worker wishing to lift spirits, unknowingly spread Covid-19 via an air-powered Christmas tree costume The worker did not have symptoms of SARS-COV-2 and did not know they were infected The result is tragic In San Jose, at least 60 people were infected, and one person died " Conclusion: This case manifests a tragic outcome to what was meant to be a benevolent action All evidence points to lack of information guiding this well-intentioned action What was meant to decrease the stress and burden of the pandemic, became a greater stress and burden Tragically with a loss of life and unknown morbidity Further, there is the potential for a psychologic toll on the person who thought they were helping others, only to learn that they had harmed them Given that these costumes in hospitals are rare, further tragedies such as this one should be preventable Covid-19 is not the only pathogen that could theoretically be spread by this mechanism Hospital should have a policy that restricts the use of these costumes Education about the danger of these costumes should be provided to staff Given that personal may act by finding replacement, risk management and infection control should create an adequate policy to address the mental health needs of staff and patients, while maintain appropriate infection control Now that there is documentation of this methods of pathogenic spread, hospitals may face liability if they fail to establish a reasonable policy and education regarding turbulent flow air-powered costumes