Exposure of home-attending healthcare workers to aerosolized medications (simulation study)

Elmashae, Yousef; Yermakov, Michael; Frank, Evan A.; Benjamin, Michael; Maier, Andrew; Newman, Nicholas; Reponen, Tiina; Grinshpun, Sergey A.

doi:10.1016/j.jaerosci.2019.04.006

Cited by 10 publications

(12 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7, which indicate particles of larger median diameter at 0.8 m distance, compared with 2.0 m distance) and this knowledge can inform policy on hospital bed spacing and visitor positioning. The observed decrease in larger particle transport with distance can be attributed to a range of factors, including deposition and localised airflow effects; additionally, the findings of Elmashae et al (2019) suggest that evaporation could also be a consideration, and this may merit investigation in a future study.…”

Section: Accepted Manuscriptmentioning

confidence: 92%

“…These studies focused on a visual approach and did not obtain quantitative data regarding fugitive emissions. Recent studies have proceeded to quantify aerosol mass concentrations of fugitive emissions from various nebulisers and patient interfaces including; facemasks, mouthpiece combination, nasal cannula and tracheostomy reporting mass fugitive emissions as high as 0.370 ± 0.046 mg m −3 (Elmashae et al, 2019;McGrath et al, 2019a;McGrath et al, 2019b;Oilier et al, 2019). It is evident from these studies that aerosol is emitted into the surrounding environment when a patient undergoes respiratory therapy, and secondary exposure is a factor for HCWs and bystanders to consider.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

See 1 more Smart Citation

Fugitive Aerosol Therapy Emissions during Mechanical Ventilation: In Vitro Assessment of the Effect of Tidal Volume and Use of Protective Filters

O’Toole,

McGrath,

Joyce

et al. 2020

Aerosol Air Qual. Res.

View full text Add to dashboard Cite

Background: During mechanical ventilation of a patient requiring ventilatory support bystanders could potentially be exposed to aerosolised drug. Methods: Fugitive drug aerosol emissions during simulated adult mechanical ventilation was assessed on a dual limb circuit. Tidal volume was set at 270 mL and 820 mL. The use of a protective filter on the exhalation port of the mechanical ventilator was assessed. Results: Higher fugitive aerosol mass concentrations in the local environment were associated with larger tidal volume (0.077 (0.073, 0.091) mg m-3 at Vt = 820 ml vs. 0.062 (0.056, 0.065) mg m-3 at Vt = 270 ml) when no protective filter was used. The range of mass median aerodynamic diameters recorded was from 0.93 to 2.96 µm. When a filter was placed on the exhalation port of the mechanical ventilator, no fugitive emissions were recorded. Conclusion: This study confirms that an appropriate filtration protocol mitigates the risk of fugitive emissions being released when patients undergo aerosol therapy during mechanical ventilation. A larger tidal volume resulted in higher fugitive aerosol mass.

show abstract

Section: Accepted Manuscriptmentioning

confidence: 92%

Section: Accepted Manuscriptmentioning

confidence: 99%

Fugitive Aerosol Therapy Emissions during Mechanical Ventilation: In Vitro Assessment of the Effect of Tidal Volume and Use of Protective Filters

O’Toole,

McGrath,

Joyce

et al. 2020

Aerosol Air Qual. Res.

View full text Add to dashboard Cite

show abstract

“…It is known that factors such as the physicochemical characteristics of formulations can affect droplet size, but the effect on emissions is less well characterised. A 2019 study did examine potential exposure of home healthcare workers to aerosolized medication (37). Five drugs were tested including; ipratropium bromide, budesonide, albuterol sulfate, sodium chloride and deionised water at three distances under 0.55 m. Deionised water droplets had a smaller particle size distribution compared to all of the other four drug solutions.…”

Section: Therapeutic Typementioning

confidence: 99%

Fugitive aerosols in the intensive care unit: a narrative review

O’Toole¹,

Joyce

McGrath³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

The risk of unintended inhalation of fugitive aerosols is becoming a topic of increasing interest in the healthcare arena. These fugitive aerosols may be bioaerosols, generated by the patient themselves through cough or sneeze, or they may be therapeutic medical aerosols, generated by therapeutic medical aerosol generators with the intent of delivery to a specific patient's respiratory tract. This review focus' on therapeutic aerosols in the intensive care unit (ICU) only, those typically generated by nebulisers. In the intensive care environment, patients are generally in receipt of ventilatory support, and the literature suggests that these different support interventions influence fugitive therapeutic medical aerosol emissions in a variety of ways. Predominant ventilatory support interventions include, but are not limited to, invasive mechanical ventilation (MV), non-invasive mechanical ventilation (NIV), high flow nasal therapy (HFNT), and supplemental oxygen delivery in spontaneously breathing patients. Further, factors such as nebuliser type, patient interface, patient breathing pattern, nebuliser position in the patient breathing circuit and medication formulation characteristics also have been shown to exert influence on aerosol concentrations and distance from the source. Here we present the state of the art knowledge in this, as yet, poorly described field of research, and identify the key risks, and subsequently, opportunities to mitigate the risks of unintended exposure of both patients and bystanders during and for periods following the administration of therapeutic aerosols.

show abstract

“…[ 12 13 14 15 16 ] The device used for aerosolization, patient interface, type of patient characteristics, and flow rate influence the characteristics and quantity of the fugitive emissions, while the air turbulence, airflow rates, layout and size of the room, and temperature affect the dispersion and decay. [ 14 17 18 ] Recently, in an in vitro study,[ 19 ] a manikin using a facemask was simulated for health-care workers at home and was positioned at three different distances. Based on the distance of the manikin with respect to the source of aerosol, the results obtained from this study demonstrated that the concentration of total aerosol varied from 0.002 to 0.10 mg/m 3 .…”

Section: Aerosol Emissions: Fugitive Emissions and Medical And Bio-aerosolsmentioning

confidence: 99%

Guidance for nebulization during the COVID-19 pandemic

et al. 2021

View full text Add to dashboard Cite

Exposure of home-attending healthcare workers to aerosolized medications (simulation study)

Cited by 10 publications

References 9 publications

Fugitive Aerosol Therapy Emissions during Mechanical Ventilation: In Vitro Assessment of the Effect of Tidal Volume and Use of Protective Filters

Fugitive Aerosol Therapy Emissions during Mechanical Ventilation: In Vitro Assessment of the Effect of Tidal Volume and Use of Protective Filters

Fugitive aerosols in the intensive care unit: a narrative review

Guidance for nebulization during the COVID-19 pandemic

Contact Info

Product

Resources

About