Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence

Harding, H. A.; Broom, Alex; Broom, Jennifer

doi:10.1016/j.jhin.2020.05.037

Cited by 109 publications

(108 citation statements)

References 51 publications

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“…However, there has been concern from an infection control perspective as these strategies are deemed to be AGPs with an increased risk of aerosol transmission and environmental contamination via droplet dispersion. The extent of transmission risk with regard to environmental contamination from these procedures remains unclear, and recommendations from different regulatory authorities have varied as to their definition as AGPs and their relative risk 11 .…”

Section: Introductionmentioning

confidence: 99%

Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

Ong

Lee

Tan

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background: The risk of environmental contamination by SARS-CoV-2 in the intensive care unit (ICU) is unclear. We aimed to evaluate the extent of environmental contamination in the ICU and correlate this with patient and disease factors, including the impact of different ventilatory modalities. Methods: Observational study where surface environmental samples collected from ICU patient rooms and common areas were tested by SARS-CoV-2 PCR, with select samples from the common area tested on cell culture. Clinical data were collected and correlated to presence of environmental contamination. Results were compared to historical data from a previous study in general wards (GW). Results: 200 samples from 20 patient rooms, and 75 samples from common areas and the staff pantry, were tested. 14 rooms had at least one site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol generating procedures, or viral load. There was lower frequency of environmental contamination in ICU compared to GW rooms. Eight samples from the common area were positive, though all were negative on cell culture. Conclusion: Environmental contamination in the ICU is lower compared to the GW. Use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.

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Section: Introductionmentioning

confidence: 99%

Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

Ong

Lee

Tan

et al. 2020

Infect. Control Hosp. Epidemiol.

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“… Commonly used dental equipment known to create aerosols and airborne contamination include:  Therefore, it is not possible to develop a definitive and comprehensive list of procedures that should be considered aerosol-generating for the purposes of PPE recommendations. 9  Research on this issue is ongoing, but in the absence of data, some level of uncertainty is unavoidable.…”

Section: Dental Health Care Settingsmentioning

confidence: 99%

Nebulized therapy in the COVID-19 era

Ирина

Analytics²,

Prozherina³

2020

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Nebulized therapy is one of the most reliable and affordable respiratory treatments for patients of all ages. Meanwhile, despite the clear advantages of nebulized therapy and the increasing recognition that it is gaining, serious disagreements have arisen concerning the feasibility of the use of nebulizers due to the risk of coronavirus infection during the COVID-19 pandemic. We tried to go further into the matter.

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“…5 It is argued, however, that there is limited evidence to link AGPs with transmission of respiratory infections, including COVID-19. 6 Air samples taken during tracheostomy procedures, high flow nasal oxygen treatment, non-invasive ventilation and nebulisation have not contained SARS-CoV-2 RNA 7 and HCWs exposed to unrecognised COVID-19 patients undergoing similar high-risk…”

Section: Introductionmentioning

confidence: 99%

Detection of SARS-CoV-2 within the healthcare environment: a multicentre study conducted during the first wave of the COVID-19 outbreak in England

Moore

Rickard

Stevenson

et al. 2020

Preprint

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Understanding how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is spread within the hospital setting is essential if staff are to be adequately protected, effective infection control measures are to be implemented and nosocomial transmission is to be prevented. The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalised patients, with and without respiratory symptoms, was investigated. Environmental sampling was carried out within eight hospitals in England during the first wave of the COVID-19 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (RT-PCR) and virus isolation assays. SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Ct values ranged from 28.8 to 39.1 equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken < 1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from < 10 to 460 genomic copies per m3 of air. Infectious virus was not recovered from any of the PCR positive samples analysed. Effective cleaning can reduce the risk of fomite (contact) transmission but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific PPE ensembles for aerosol and non-aerosol generating procedures.

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Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence

Cited by 109 publications

References 51 publications

Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

Nebulized therapy in the COVID-19 era

Detection of SARS-CoV-2 within the healthcare environment: a multicentre study conducted during the first wave of the COVID-19 outbreak in England

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