A scoping review on bio-aerosols in healthcare and the dental environment

Abstract

BackgroundBio-aerosols originate from different sources and their potentially pathogenic nature may form a hazard to healthcare workers and patients. So far no extensive review on existing evidence regarding bio-aerosols is available.ObjectivesThis study aimed to review evidence on bio-aerosols in healthcare and the dental setting. The objectives were 1) What are the sources that generate bio-aerosols?; 2) What is the microbial load and composition of bio-aerosols and how were they measured?; and 3) What is the hazard posed by pathogenic micro-organisms transported via the aerosol route of transmission?MethodsSystematic scoping review design. Searched in PubMed and EMBASE from inception to 09-03-2016. References were screened and selected based on abstract and full text according to eligibility criteria. Full text articles were assessed for inclusion and summarized. The results are presented in three separate objectives and summarized for an overview of evidence.ResultsThe search yielded 5,823 studies, of which 62 were included. Dental hand pieces were found to generate aerosols in the dental settings. Another 30 sources from human activities, interventions and daily cleaning performances in the hospital also generate aerosols. Fifty-five bacterial species, 45 fungi genera and ten viruses were identified in a hospital setting and 16 bacterial and 23 fungal species in the dental environment. Patients with certain risk factors had a higher chance to acquire Legionella in hospitals. Such infections can lead to irreversible septic shock and death. Only a few studies found that bio-aerosol generating procedures resulted in transmission of infectious diseases or allergic reactions.ConclusionBio-aerosols are generated via multiple sources such as different interventions, instruments and human activity. Bio-aerosols compositions reported are heterogeneous in their microbiological composition dependent on the setting and methodology. Legionella species were found to be a bio-aerosol dependent hazard to elderly and patients with respiratory complaints. But all aerosols can be can be hazardous to both patients and healthcare workers.

Possible aerosol transmission of COVID-19 and special precautions in dentistry

“…A review conducted by Zemouri et al (2017) showed that 38 types of microorganisms could be found in the air of the dental clinic, including Legionella pneumophila, the causative agent of severe pneumonia. There have been reports of patients acquiring pneumonia after being treated at a dental clinic (Ricci et al, 2012).…”

Saliva is a non‐negligible factor in the spread of COVID‐19

“…Usually, splatters and droplets can contaminate a 3-ft diameter range, while aerosols produced can spread further and cause long-lasting contamination and potential transmission (Zemouri, de Soet, Crielaard, & Laheij, 2017). A recent study published in the New England Journal of Medicine demonstrated that aerosol and fomite transmission of SARS-CoV-2 is plausible, since coronavirus remains viable and infectious in aerosols for hours, and on inanimate surfaces up to days (van Doremalen et al, 2020).…”

A quantitative method to assess the role of indoor air decontamination to simultaneously reduce contamination of environmental surfaces: testing with vegetative and spore-forming bacteria

“…; Zemouri et al . ), and many technologies are used to remove/inactivate such airborne pathogens in healthcare and other settings (Rautemaa et al . ).…”

“…Indoor air is well recognized as a vehicle for the direct and indirect spread of a wide variety of human pathogens (Decraene et al 2008;Sattar et al 2016b;Zemouri et al 2017), and many technologies are used to remove/inactivate such airborne pathogens in healthcare and other settings (Rautemaa et al 2006). We had previously shown a HEPA filter-and UV-light-based indoor air decontamination device to reduce the levels of airborne vegetative Letters in Applied Microbiology 68, 206--211 © 2018 The Society for Applied Microbiology bacteria by ≥3Á0 log 10 (≥99Á9%) in~45 min Sattar et al 2016a;Zargar et al 2016).…”