How should aerosol generating procedures be defined?

Chui, Jason; Hui, David S.; Chan, Matthew T.V.

doi:10.1136/bmj-2021-065903

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Finally, the National Health Service from the UK has omitted HFNO and NIV from their current guideline after their most recent (2022) rapid review, which stated that both treatments should be considered to be taken off the list . It has been advocated that the entire concept of AGPs needs to be abandoned . For example, personal protective equipment recommendations should be uniform for all suspected and infected patients, and room restrictions should be adapted on a patient-by-patient basis (eg, depending on viral load among other factors), but this approach may be difficult to implement …”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, these studies add to the discussion about proximity and the risk of infectious disease transmission. For instance, it has been advocated that the increased flow velocity and continuous jet by HFNO or NIV lead to particle dispersion that is more widespread over longer distances . At the same time, these effects on risk of transmission by airflow would likely be highly similar to situations in which mechanical room ventilation, air conditioning, heat sources, or open windows cause air movements, which transport, disperse, and dilute any dense aerosol clouds from patients.…”

Section: Discussionmentioning

confidence: 99%

“…26 , 56 It has been advocated that the entire concept of AGPs needs to be abandoned. 24 , 25 , 57 For example, personal protective equipment recommendations should be uniform for all suspected and infected patients, and room restrictions should be adapted on a patient-by-patient basis (eg, depending on viral load among other factors), but this approach may be difficult to implement. 25 , 57 , 58 …”

Section: Discussionmentioning

confidence: 99%

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Generation of Aerosols by Noninvasive Respiratory Support Modalities

Zhang,

Lilien,

van Etten-Jamaludin

et al. 2023

JAMA Netw Open

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ImportanceInfection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures.ObjectiveTo evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation.Data SourcesA systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed.Study SelectionObservational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected.Data Extraction and SynthesisThree reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice.Main Outcomes and MeasuresThe main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles.ResultsTwenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation.Conclusions and RelevanceThis systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Generation of Aerosols by Noninvasive Respiratory Support Modalities

Zhang,

Lilien,

van Etten-Jamaludin

et al. 2023

JAMA Netw Open

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“…Aerosol-generating procedures are defined as medical procedures that can result in the release of aerosol from the respiratory tract. The criteria for these procedures are a high risk of aerosol generation and an increased risk of respiratory transmission [ 15 ]. There is uncertainty around the levels of risk associated with various procedures because, in practice, there is no consensus on which are aerosol-generating.…”

Section: Introductionmentioning

confidence: 99%

Aerosol in the oral health-care setting: a misty topic

Weijden

2023

Clin Oral Invest

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Studies have shown that mouth and respiratory tract microorganisms can be transported in aerosol and spatter. Due to aerosol-generating procedures, there are potentially various infection risks for patients and those working in health care, especially in oral health care. Dental aerosol can contaminate not only the mucous membranes of the oral health-care professional’s mouth, respiratory passages, and eyes but also exposed surfaces and materials in the environment. As such, preventing disease transmission within oral health-care offices is important issue. Since the start of the COVID-19 pandemic, an innumerable amount of (mis)information and advice on how to stay safe and prevent the spread of coronavirus has been published. What preventive measures can and have been taken to counteract this, and what have we learned during the pandemic? This review summarizes relevant literature that has addressed the presence and dispersal of aerosol and spatter as a concern in health care. It includes the sources of dental aerosol, their potential health threats, and strategies for controlling and mitigating their impact. It shows that further research is needed to better understand the potential health risks of dental aerosol and to develop effective strategies for mitigating them. Clinical relevance Using personal protective equipment, high-volume evacuation systems and pre-procedural antimicrobial agents can help to reduce the potential for infection in oral health-care settings and protect the well-being of oral health-care workers and their patients.

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“…Dentistry is considered to be one of the most aerosol-generating fields in medicine, since the essential and commonly used instruments are rotatory or ultrasonic instruments, which are expected to be significantly aerosol generating. Aerosol generating procedures (AGPs) may cause a higher risk for infection via inhalation when these procedures involve manipulation of the tissue laden with pathogens capable of surviving in aerosols and infect cells in the respiratory tract [ 1 ]. However, even though multiple procedures have been listed as AGPs, the current classification is mainly based on experimental studies, expectations, and observational studies.…”

Section: Introductionmentioning

confidence: 99%