Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1 (5-Year IF – 2.0)
Journal Citation Indicator (JCI) (2023) – 0.4
Scopus CiteScore – 3.7 (CiteScore Tracker 3.8)
Index Copernicus  – 171.00; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 9, September, p. 1021–1028

doi: 10.17219/acem/126296

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Additive manufacturing technologies enabling rapid and interventional production of protective face shields and masks during the COVID-19 pandemic

Jędrzej Wierzbicki1,A,B,C,D, Maciej Nowacki1,A,D,E,F, Marta Chrzanowska1,B,C,D, Rafał Matkowski2,3,E,F, Marcin Ziętek2,3,E, Katarzyna Nowacka4,E, Adam Maciejczyk2,3,E,F, Edyta Pawlak-Adamska5,E,F

1 The Minimally Invasive and Experimental Surgery Unit, Chair and Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland

2 Department of Oncology, Wroclaw Medical University, Poland

3 Wroclaw Comprehensive Cancer Center, Wrocław, Poland

4 Chair of Cosmetology and Aesthetic Dermatology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland

5 Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland

Abstract

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through respiratory droplets and contact routes, hence the demand for personal protective equipment (PPE) has increased during the outbreak of coronavirus disease 2019 (COVID-19). Among the most noticeable shortages was the lack of face shields. The urgent demand for PPE induced interdisciplinary cooperation to overcome the shortages, and additive manufacturing proved to be ideal for the crisis situation.
Objectives. To investigate the possibilities of implementing additive manufacturing technologies in the interventional fabrication of protective face shields for medical staff.
Material and Methods. An Ender 3 Pro 3D printer was used to print headbands and Cura 4.4 was chosen as the slicing software. Open source face shield designs were downloaded as standard tessellation language (STL) files and compared. Only models with scientific support were taken under consideration.
Results. The mean time for producing the headbands tested ranged from 59 min to almost 3 h, depending on the design. After setting up our low budget printer and choosing the Prusa RC 3 protective face shield as the main product, we were able to fabricate about 30 face shields per week at a cost of about €1 each. During 4 weeks, 126 face shields were produced and delivered to various hospital wards, which substantially eased the shortages.
Conclusion. Additive manufacturing enables immediate responses to needs in emergency situations, and allows for mass production of personal protective equipment in a short time due the rapid exchange of data among printer users. Despite the unregulated legal situation and insufficient scientific evidence, such protective equipment has been approved by clinicians and is currently used by medical personnel around the world.

Key words

personal protective equipment, additive manufacturing, 3-dimensional printing, COVID-19, face shield

References (54)

  1. Mossad SB. Influenza update 2018–2019: 100 years after the great pandemic. Cleve Clin J Med. 2018;85(11):861–869. doi:10.3949/ccjm. 85a.18095
  2. Indini A, Aschele C, Cavanna L, et al. Reorganization of medical oncology departments during the novel coronavirus disease-19 pandemic: A nationwide Italian survey. Eur J Cancer. 2020;6(132):17–23. doi:10.1016/j.ejca.2020.03.024
  3. Jakovljevic M, Bjedov S, Jaksic N, et al. COVID-19 pandemia and public and global mental health from the perspective of global health security. Psychiatr Danub. 2020;32(1):6–14. doi:10.24869/psyd.2020.6
  4. Gully PR. Pandemics, regional outbreaks, and sudden-onset disasters. Health Manage Forum. 2020;33(4):164-169. doi:10.1177/084047 0420901532
  5. Nickol ME, Kindrachuk J. A year of terror and a century of reflection: Perspectives on the great influenza pandemic of 1918–1919. BMC Infect Dis. 2019;6;19(1):117. doi:10.1186/s12879-019-3750-8
  6. Bramanti B, Dean KR, Walløe L, Chr Stenseth N. The third plague pandemic in Europe. Proc Biol Sci. 2019;286(1901):20182429. doi:10.1098/rspb.2018.2429
  7. Graham BS, Sullivan NJ. Emerging viral diseases from a vaccinology perspective: Preparing for the next pandemic. Nat Immunol. 2018;19(1):20–28. doi:10.1038/s41590-017-0007-9
  8. Morse SS, Mazet JA, Woolhouse M, et al. Prediction and prevention of the next pandemic zoonosis. Lancet. 2012;380(9857):1956–1965. doi:10.1016/S0140-6736(12)61684-5
  9. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species severe acute respiratory syndrome-related coronavirus: Classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–544. doi:10.1038/s41564-020-0695-z
  10. Zhang JJ, Dong X, Cao YY et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7): 1730–1741. doi:10.1111/all.14238
  11. Nassar MS, Bakhrebah MA, Meo SA, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics. Eur Rev Med Pharmacol Sci. 2018;22(15):4956–4961. doi:10.26355/eurrev_201808_15635.
  12. Po-Ren H, Cheng-Hsiang H, Shiou-Hwei Y, et al. Microbiologic characteristics, serologic responses, and clinical manifestations in severe acute respiratory syndrome, Taiwan. Emerg Infect Dis. 2003;9(9): 1163–1167. doi:10.3201/eid0909.030367
  13. Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3): 105924. doi:10.1016/j.ijantimicag.2020.105924
  14. Zhou P, Yang X, Wang X, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270–273. doi:10.1038/s41586-020-2012-7
  15. Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020;13;7(1):11. doi:10.1186/s40779-020-00240-0
  16. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;15(395): 497–506. doi:10.1016/S0140-6736(20)30183-5
  17. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single- centered, retrospective, observational study. Lancet Respir Med. 2020; 8:475–481. doi:10.1016/S2213-2600(20)30079-5
  18. Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406-1407. doi:10.1001/jama.2020.2565
  19. Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020;63:706–711. doi:10.1007/s11427-020-1661-4
  20. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–1567. doi:10.1056/NEJMc2004973
  21. Ong SWX, Tan YK, Chia PY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020; 323(16):1610–1612. doi:10.1001/jama.2020.3227
  22. Ranney ML, Griffeth V, Jha AK. Critical supply shortages: The need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020;30;382(18):e41. doi:10.1056/NEJMp 2006141
  23. Tino R, Moore R, Antoline S, et al. COVID-19 and the role of 3D printing in medicine. 3D Print Med. 2020;6(1):11. Published on April 27, 2020 doi:10.1186/s41205-020-00064-7
  24. Liaw CY, Guvendiren M. Current and emerging applications of 3D printing in medicine. Biofabrication. 2017;7;9(2):024102. doi:10.1088/ 1758-5090/aa7279
  25. Tappa K, Jammalamadaka U. Novel biomaterials used in medical 3D printing techniques. J Funct Biomater. 2018;9(1):17. doi:10.3390/jfb9010017
  26. Ventola CL. Medical applications for 3D printing: Current and projected uses. Pharmacy and Therapeutics. 2014;39(10):704–711. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189697/
  27. Mikołajewska E, Macko M, Mikołajewski D, et al. Medical and military applications of 3D printing. Scientific Journal of the Military University of Land Forces. 2016;1:128–141. doi:10.5604/17318157.1201744
  28. Konta A, García-Piña M, Serrano D. Personalised 3D-printed medicines: Which techniques and polymers are more successful? Bio­engineering. 2017;4(4):79.
  29. Zuniga JM, Cortes A. The role of additive manufacturing and antimicrobial polymers in the COVID-19 pandemic [published online ahead of print, on April 30, 2020]. Expert Rev Med Devices. 2020;1–5. doi:10.3390/bioengineering4040079
  30. Zastrow M. Open science takes on the coronavirus pandemic. Nature. 2020;581(7806):109–110. doi:10.1038/d41586-020-01246-3
  31. Herrmann KH, Gärtner C, Güllmar D, et al. 3D printing of MRI compatible components: why every MRI research group should have a low-budget 3D printer. Med Eng Phys. 2014;36(10):1373–1380. doi:10.1016/ j.medengphy.2014.06.008
  32. Oth O, Dauchot C, Orellana M, Glineur R. How to sterilize 3D-printed objects for surgical use? An evaluation of the volumetric deformation of 3D-printed genioplasty guide in PLA and PETG after sterilization by low-temperature hydrogen peroxide gas plasma. Open Dent J. 2019;13:410–417. doi:10.2174/1874210601913010410
  33. Stabile L, Scungio M, Buonanno G, Arpino F, Ficco G. Airborne particle emission of a commercial 3D printer: The effect of filament material and printing temperature. Indoor Air. 2016;27(2):398–408. doi:10.1111/ina.12310
  34. Sapoval M, Gaultier AL, Del Giudice C, et al. 3D-printed face protective shield in interventional radiology: Evaluation of an immediate solution in the era of COVID-19 pandemic [published online ahead of print, on April 18, 2020]. Diagn Interv Imaging. 2020;S2211-5684 (20)30097-8. doi:10.1016/j.diii.2020.04.004
  35. U.S. Food and Drug Administration. Center for Devices and Radiological Health. Enforcement Policy for Face Masks and Respirators During the Coronavirus Disease (COVID‐19) Public Health Emergency (Re-vised). 2020. https://www.fda.gov/regulatory‐information/search‐fda‐guidance‐documents/enforcement‐policy‐face‐masks‐and‐respirators‐during‐coronavirus‐disease‐covid‐19‐public‐health. Accessed April 25, 2020.
  36. Wesemann C, Pieralli S, Fretwurst T, et al. 3-D printed protective equipment during COVID-19 pandemic. Materials (Basel). 2020;24; 13(8). doi:10.3390/ma13081997
  37. Gregor A, Filová E, Novák M, et al. Designing of PLA scaffolds for bone tissue replacement fabricated by ordinary commercial 3D printer. J Biol Eng. 2017;11(31). doi:10.1186/s13036-017-0074-3
  38. Amin D, Nguyen N, Roser SM, Abramowicz S. 3D printing of face shields during COVID-19 pandemic: A technical note [published online ahead of print, on May 1, 2020]. J Oral Maxillofac Surg. 2020. doi:10. 1016/j.joms.2020.04.040
  39. Ishack S, Lipner SR. Applications of 3D printing technology to address COVID-19 related supply shortages [published online ahead of print, on April 21, 2020]. Am J Med. 2020;S0002-9343(20)30332-6. doi:10. 1016/j.amjmed.2020.04.002
  40. Pecchia L, Piaggio D, Maccaro A, Formisano C, Iadanza E. The inadequacy of regulatory frameworks in time of crisis and in low-resource settings: Personal protective equipment and COVID-19 [published online ahead print, on May 2, 2020]]. Health Technol (Berl). 2020;1–9. doi:10.1007/s12553-020-00429-2
  41. Tipnis NP, Burgess DJ. Sterilization of implantable polymer-based medical devices: A review. Int J Pharm. 2018;544(2):455–460. doi:10. 1016/j.ijpharm.2017.12.003
  42. Kim E, Shin Y-J and Ahn S-H. The effects of moisture and temperature on the mechanical properties of additive manufacturing components: Fused deposition modeling. Rapid Prototyp J. 2016;22: 887–894. doi:10.1108/RPJ-08-2015-0095
  43. Rogers WJ. Sterilization Techniques for Polymers. In: Lerouge S and Simmons A. Sterilization of Biomaterials and Medical Devices. 1st ed. Cambridge, United Kingdom: Elsevier Science & Technology; 2012: 151–211. doi:10.1533/9780857096265.151
  44. Gondi S, Beckman AL, Deveau N, et al. Personal protective equipment needs in the USA during the COVID-19 pandemic. Lancet. 2020; 395(10237):e90–e91. doi:10.1016/S0140-6736(20)31038-2
  45. Newman M. Covid-19: Doctors’ leaders warn that staff could quit and may die over lack of protective equipment. BMJ. 2020;368:m1257. Published on March 26, 2020 doi:10.1136/bmj.m1257
  46. Nelson R. Lack of protective gear disrupts oncology care. Lancet Oncol. 2020;21(5):631–632. doi:10.1016/S1470-2045(20)30223-0
  47. Rimmer A. Covid-19: Doctors still do not have proper PPE. BMJ. 2020; 369:m1423. doi:10.1136/bmj.m1423
  48. Mahase E. Novel coronavirus: Australian GPs raise concerns about shortage of face masks. BMJ. 2020;368:m477. doi:10.1136/bmj.m477
  49. Ranney ML, Griffeth V, Jha AK. Critical supply shortages – the need for ventilators and personal protective equipment during the covid-19 pandemic. N Engl J Med. 2020;30;382(18):e41. doi:10.1056/NEJMp 2006141
  50. Reusken CB, Buiting A, Bleeker-Rovers C, et al. Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(12):2000334. doi:10.2807/1560-7917
  51. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect. 2020;6:S0195-6701(20)30101-8. doi:10.1016/j.jhin. 2020.03.002
  52. Cai H, Tu B, Ma J, et al. Psychological Impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Med Sci Monit. 2020;15;26:e924171. doi:10.12659/MSM.924171
  53. Kang L, Li Y, Hu S, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14. doi:10.1016/S2215-0366(20)30047-X
  54. Xiao H, Zhang Y, Kong D, et al. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020;26:e923549. doi:10.12659/MSM.923549
© Wroclaw Medical University