Oxygen Therapy and Risk of Infection for Health Care Workers Caring for Patients With Viral Severe Acute Respiratory Infection: A Systematic Review and Meta-analysis

Abstract

Study objective To synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. Health care workers face significant risk of infection when treating patients with a viral severe acute respiratory infection. To ensure health care worker safety and limit nosocomial transmission of such infection, it is crucial to synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to April 1, 2020, for studies describing the risk of infection associated with the modalities of oxygen therapy used for patients with severe acute respiratory infection. The study selection, data extraction, and quality assessment were performed by independent reviewers. The primary outcome measure was the infection of health care workers with a severe acute respiratory infection. Random-effect models were used to synthesize the extracted data. Results Of 22,123 citations, 50 studies were eligible for qualitative synthesis and 16 for meta-analysis. Globally, the quality of the included studies provided a very low certainty of evidence. Being exposed or performing an intubation (odds ratio 6.48; 95% confidence interval 2.90 to 14.44), bag-valve-mask ventilation (odds ratio 2.70; 95% confidence interval 1.31 to 5.36), and noninvasive ventilation (odds ratio 3.96; 95% confidence interval 2.12 to 7.40) were associated with an increased risk of infection. All modalities of oxygen therapy generate air dispersion. Conclusion Most modalities of oxygen therapy are associated with an increased risk of infection and none have been demonstrated as safe. The lowest flow of oxygen should be used to maintain an adequate oxygen saturation for patients with severe acute respiratory infection, and manipulation of oxygen delivery equipment should be minimized.

Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department

“…HCWs are among the groups at the highest risk of both contracting the SARS-CoV-2 virus and developing severe COVID-19. 4 Using healthy subjects, our study suggests that lower flow HFNC, a NRB, CPAP, and patient mask usage can modestly reduce the generation of smaller-sized aerosols. Our study further suggests that aerosol-sized PM may be generated even in healthy subjects, without coughing or increased sputum, because of airway shear stress, vibration, and sporadic collapse/reopening of terminal bronchioles.…”

“…1,2 There have been heightened safety concerns during the SARS-CoV-2 pandemic 3 , as HCWs are among the highest risk groups for both acquisition of SARS-CoV-2 and severe coronavirus disease 2019 (COVID-19). 4 In general, viruses can be passed from person to person in 3 ways:…”

The NICE COVID-19 search strategy for Ovid MEDLINE and Embase: developing and maintaining a strategy to support rapid guidelines

“…The next test found that using only headings from lower in the hierarchy ("Severe acute respiratory syndrome coronavirus 2" or "Coronavirus disease 2019") reduced results by 204, of which 22 were relevant to COVID-19 and one to NICE. The one relevant reference that NICE would miss (Cournoyer et al, 2021) discussed respiratory viruses in general (e.g. influenza) and had been indexed with the Emtree heading for SARS-CoV-1.…”

“…The final strategy is presented in Figure 4 with limits applied (Table 12). This increase in specificity from Strategy A has been achieved with the loss of only one reference of minimal relevance to NICE that does not directly refer to COVID-19 (Cournoyer et al, 2021).…”

Best Practices in Managing Cardiac Arrest in the Emergency Department During the COVID-19 Pandemic

“…If the patient arrives via emergency medical service and the patient is being ventilated via a bag-valve-mask, ventilations should be paused as the patient is transported from the ambulance bay to the designated ED area as this is an AGP. 23 Once in a controlled environment, if there is a prehospital airway, placement should be confirmed and secured by those in modified droplet and airborne precautions PPE, a viral filter placed or confirmed, and a mechanical CPR device attached if available and not already present. An attempt to exchange a prehospital supraglottic airway to an endotracheal tube (ETT) when the prehospital device is functional is not recommended given the risk of aerosolization.…”