Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review
By K. Tran, K. Cimon, M. Severn, C. Pessoa-Silva, J. Conly. PLoS ONE, 2012
1,684 citations recorded by the source corpus.
Aerosol generating procedures (AGPs) may expose health care workers (HCWs) to pathogens causing acute respiratory infections (ARIs), but the risk of transmission of ARIs from AGPs is not fully known. We sought to determine the clinical evidence for the risk of transmission of ARIs to HCWs caring for patients undergoing AGPs compared with the risk of transmission to HCWs caring for patients not undergoing AGPs. We searched PubMed, EMBASE, MEDLINE, CINAHL, the Cochrane Library, University of York CRD databases, EuroScan, LILACS, Indian Medlars, Index Medicus for SE Asia, international health technology agencies and the Internet in all languages for articles from 01/01/1990 to 22/10/2010. Independent reviewers screened abstracts using pre-defined criteria, obtained full-text articles, selected relevant studies, and abstracted data. Disagreements were resolved by consensus. The outcome of interest was risk of ARI transmission. The quality of evidence was rated using the GRADE system. We identified 5 case-control and 5 retrospective cohort studies which evaluated transmission of SARS to HCWs. Procedures reported to present an increased risk of transmission included [n; pooled OR(95%CI)] tracheal intubation [n = 4 cohort; 6.6 (2.3, 18.9), and n = 4 case-control; 6.6 (4.1, 10.6)], non-invasive ventilation [n = 2 cohort; OR 3.1(1.4, 6.8)], tracheotomy [n = 1 case-control; 4.2 (1.5, 11.5)] and manual ventilation before intubation [n = 1 cohort; OR 2.8 (1.3, 6.4)]. Other intubation associated procedures, endotracheal aspiration, suction of body fluids, bronchoscopy, nebulizer treatment, administration of O2, high flow O2, manipulation of O2 mask or BiPAP mask, defibrillation, chest compressions, insertion of nasogastric tube, and collection of sputum were not significant. Our findings suggest that some procedures potentially capable of generating aerosols have been associated with increased risk of SARS transmission to HCWs or were a risk factor for transmission, with the most consistent association across multiple studies identified with tracheal intubation.
Subfields: Infectious Diseases, Oncology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/04d9df812fd77e1231263d42ab45e570cd94d956
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Citations in the corpus
- Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) (2020, positive): “While SARS-CoV-2 appears to be predominantly spread by large respiratory droplets, intubation is likely a small particle (less than 5 μm) aerosol-generating procedure, which increases the risk of transmission to healthcare workers (29).”
- Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study (2020, positive): “Based on experience with other viruses spread by respiratory droplets, the consistent use of disposable personal protective equipment (PPE) is critical to reducing nosocomial transmission.(19,20) Recent guidelines from the Center for Disease Control (CDC) advocate for the use of medical-grade masks ”
- Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations (2020, neutral): “34,43 The most skilled operator available should perform the task with full personal protective equipment (PPE) and the necessary preparation for difficult airways.”
- ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies (2023, background): “In addition, concerns existed regarding the potential for increased aerosol transmission of the virus with NIV [73].”
- Consensus guidelines for managing the airway in patients with COVID‐19 (2020, background): “A systematic review of infection risk to HCWs [9], based on limited literature, ranked airway procedures in descending order of risk as: (1), tracheal intubation; (2), tracheostomy (and presumed for emergency front-of-neck airway (FONA)); (3), non-invasive ventilation (NIV); and (4), mask ventilatio”