Tracheal intubation is an essential procedure in the induction of general anesthesia; however, it is also a main source of infectious aerosols such as severe acute respiratory virus 2 (SARS-CoV-2). For protection from infectious aerosols, an air conditioning system which provides continuous laminar air flow from the ceiling and a local isolating device are widely used in typical operating rooms. However, how aerosols spread in an actual operating room has not been visualized, especially during tracheal intubation. In this study, we observed the spread of aerosols under several circumstances. To recreate the scenario of general anesthesia induction, we substituted aerosol spray with smoke from a smoke tester device in the mouth of a human body model placed on the operating table. Then we measured the maximum height of aerosol spread every second for 9 seconds. To verify the contribution of air conditioning and an isolating device, we compared four situations based on their presence or absence. The maximum height of aerosol spread was significantly lower in the presence of laminar air flow from the ceiling. An isolating device contributed to initially enclosing the aerosol; however, some aerosol leaked and diffused depending on the air flow outside the device. During tracheal intubation in typical operating room, air-conditioned laminar air flow can contribute to prevent infectious aerosol spread, and an isolating device can provide supplementary protection.

The introduction of health products to low- and middle-income countries (LMICs) is hindered by several barriers. Even when these barriers are overcome, improper use of health products can have a negative effect on health outcomes. Health products may go unused due to a mismatch of product needs as well as a lack of public infrastructure, spare parts and consumables, or trained technicians. This study presents a comprehensive framework of the essential steps for effectively delivering quality health products to people in need based on our document reviews and case studies. We divide the value chain of health products into seven steps: 1) situation analysis, 2) research and development, 3) regulatory authorization, 4) selection and prioritization, 5) public procurement, 6) distribution and storage, and 7) health service delivery. We find that the practice of undertaking one step at a time leads to enormous costs in terms of time and resources, often with little success. Failed attempts sometimes necessitate starting over from the beginning. Therefore, it is important to attempt each step while looking ahead to the end through the entire chain of seven steps. More in-depth analysis and lessons from best practices for each of the seven steps may need to be investigated further to consider possible interventions.