Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.
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ABSTRACT:
SUBMITTER: Bolton L
PROVIDER: S-EPMC7300802 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Publications
Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.
Bolton Lee L Mills Claire C Wallace Sarah S Brady Marian C MC
International journal of language & communication disorders 20200601 4
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| S-EPMC7287440 | biostudies-literature
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| S-EPMC7560802 | biostudies-literature
Project description:BackgroundIn many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations.Main textWe searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were included; 23 studies on COVID-19, 10 on SARS, and 5 on MERS/ influenza/other respiratory viruses. Two of the 16 studies which assessed associations found that HCWs were 1.7 to 2.5 times more likely to contract COVID-19 after exposure to AGMPs vs. not exposed to AGMPs. Eight studies reported statistically significant associations for nine specific AGMPs and transmission of SARS to HCWS. Intubation was consistently associated with an increased risk of SARS. HCWs were more likely (OR 2.05, 95% CI 1.2-3.4) to contract human coronaviruses when exposed to an AGMP in one study. There were no reported associations between AGMP exposure and transmission of influenza or in a single study on MERS. There was limited evidence supporting the use of a respirator over a medical/surgical mask during an AGMP to reduce the risk of viral transmission. One study described outcomes of HCWs exposed to a pediatric patient during intubation.ConclusionExposure to an AGMP may increase the risk of transmission of COVID-19, SARS, and human coronaviruses to HCWs, however the evidence base is heterogenous and prone to confounding, particularly related to COVID-19. There continues to be a significant research gap in the epidemiology of the risk of VRIs among HCWs during AGMPs, particularly for pediatric patients. Further evidence is needed regarding what constitutes an AGMP.
| S-EPMC9366810 | biostudies-literature
Project description:Aerosol particles generated by dental procedures could facilitate the transmission of infectious diseases and contain carcinogen particles. Such particles can penetrate common surgical masks and reach the lungs, leading to increased risk for dental care professionals. However, the risk of inhaling contaminated aerosol and the effectiveness of aerosol reduction measures in dental offices remain unclear. The present study aimed to quantify aerosols produced by drilling and scaling procedures and to evaluate present recommendations for aerosol reduction. The concentration of aerosol particles released from the mock scaling and drilling procedures on dental mannequin were measured using a TSI Optical Particle Sizer (OPS 3330) during 15-min sessions carried out in a single-patient examination room. Using a drilling procedure as the aerosol source, the aerosol reduction performance of two types of high-volume evacuators (HVEs) and a commercial off-the-shelf air purifier was evaluated in a simulated clinical setting. Using either HVEs or the air purifier individually reduced the aerosol accumulated over the course of a 15-minutes drilling procedure at a reduction rate of 94.8 to 97.6%. Using both measures simultaneously raised the reduction rate to 99.6%. The results show that existing HVEs can effectively reduce aerosol concentration generated by a drilling procedure and can be further improved by using an air purifier. Following current regulatory guidelines can ensure a low risk of inhaling contaminated aerosol for dentists, assistants, and patients.
| S-EPMC9616072 | biostudies-literature
Project description:OBJECTIVE:Given high COVID-19 viral load and aerosolization in the head and neck, otolaryngologists are subject to uniquely elevated viral exposure in most of their inpatient and outpatient procedures and interventions. While elective activity has halted across the board nationally, the slow plateau of COVID-19 case rates prompts the question of timing of resumption of clinical activity. We sought to prospectively predict geographical "hot zones" for otolaryngological exposure to COVID-19 based on procedural volumes data from 2013 to 2017. METHODS:Otolaryngologic CPT codes were stratified based on risk-level, according to recently published specialty-specific guidelines. Using the Medicare POSPUF database, aerosol-generating procedures (AGPs) were mapped based on hospital referral regions, against up-to-date COVID-19 case distribution data, as of April 24, 2020. RESULTS:The most common AGPs were diagnostic flexible laryngoscopy, diagnostic nasal endoscopy, and flexible laryngoscopy with stroboscopy. The regions with the most AGPs per otolaryngologist were Iowa City, IA, Detroit, MI, and Burlington, VT, while the states with the most COVID-19 cases as of April 24th are New York, New Jersey, and Massachusetts. CONCLUSIONS:Our study provides a model for predicting possible "hot zones" for otolaryngologic exposure based on both COVID-19 case density and AGP-density. As the focus shifts to resuming elective procedures, these potential "hot zones" need to be evaluated for appropriate risk-based decision-making, such as "reopening strategies" and allocation of resources.
| S-EPMC7251363 | biostudies-literature
Project description:INTRODUCTION:Coronavirus disease 2019 (COVID-19) is a contagious disease that is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Health care workers are at risk of infection from aerosolisation of respiratory secretions, droplet and contact spread. There are a number of procedures that represent a high risk of aerosol generation during cardiothoracic surgery. It is important that adequate training, equipment and procedures are in place to reduce that risk. RECOMMENDATIONS:We provide a number of key recommendations, which reduce the risk of aerosol generation during cardiothoracic surgery and help protect patients and staff. These include general measures such as patient risk stratification, appropriate use of personal protective equipment, consideration to delay surgery in positive patients, and careful attention to theatre planning and preparation. There are also recommended procedural interventions during airway management, transoesophageal echocardiography, cardiopulmonary bypass, chest drain management and specific cardiothoracic surgical procedures. Controversies exist regarding the management of low risk patients undergoing procedures at high risk of aerosol generation, and recommendations for these patients will change depending on the regional prevalence, risk of community transmission and the potential for asymptomatic patients attending for these procedures. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT:This statement reflects changes in management based on expert opinion, national guidelines and available evidence. Our knowledge with regard to COVID-19 continues to evolve and with this, guidance may change and develop. Our colleagues are urged to follow national guidelines and institutional recommendations regarding best practices to protect their patients and themselves. ENDORSED BY:Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Anaesthetic Continuing Education Cardiac Thoracic Vascular and Perfusion Special Interest Group.
| S-EPMC7675478 | biostudies-literature
Project description:The world is going through the COVID-19 pandemic, which has high virulence and transmission rate. More significant the viral load during exposure, the greater is the likelihood of contracting a severe disease. Healthcare workers (HCWs) involved in airway care of COVID-19 patients are at high risk of getting exposed to large viral loads during aerosol-generating actions such as coughing or sneezing by the patient or during procedures such as bag-mask ventilation, intubation, extubation, and nebulization. This viral load exposure to airway caregivers decreases considerably with the use of an aerosol box during intubation. The safety tent proposed in this article is useful in limiting the viral load that HCWs are exposed to during airway procedures. Its role can be expanded beyond just intubation to protect against all aerosol-generating actions and procedures involving the patient's airway.
| S-EPMC7574005 | biostudies-literature
Project description:ObjectivesThis study evaluated particle spread associated with various common periodontal aerosol-generating procedures (AGPs) in simulated and clinical settings.Materials and methodsA simulation study visualized the aerosols, droplets, and splatter spread with and without high-volume suction (HVS, 325 L/min) during common dental AGPs, namely ultrasonic scaling, air flow prophylaxis, and implant drilling after fluorescein dye was added to the water irrigant as a tracer. Each procedure was repeated 10 times. A complementary clinical study measured the spread of contaminated particles within the dental operatory and quantified airborne protein dispersion following 10 min of ultrasonic supragingival scaling of 19 participants during routine periodontal treatment.ResultsThe simulation study data showed that air flow produced the highest amount of splatters and the ultrasonic scaler generated the most aerosol and droplet particles at 1.2 m away from the source. The use of HVS effectively reduced 37.5-96% of splatter generation for all three dental AGPs, as well as 82-93% of aerosol and droplet particles at 1.2 m for the ultrasonic scaler and air polisher. In the clinical study, higher protein levels above background levels following ultrasonic supragingival scaling were detected in fewer than 20% of patients, indicating minimal particle spread.ConclusionsWhile three common periodontal AGPs produce aerosols and droplet particles up to at least 1.2 m from the source, the use of HVS is of significant benefit. Routine ultrasonic supragingival scaling produced few detectable traces of salivary protein at various sites throughout the 10-min dental operatory.Clinical relevanceThe likelihood of aerosol spread to distant sites during common periodontal AGPs is greatly reduced by high-volume suction. Clinically, limited evidence of protein contaminants was found following routine ultrasonic scaling, suggesting that the the majority of the contamination consisits of the irrigant rather than organic matter from the oral cavity.
| S-EPMC9113070 | biostudies-literature
Project description:Transnasal flexible laryngoscopy is considered an aerosol generating procedure. A negative pressure face shield (NPFS) was developed to control aerosol from the patient during laryngoscopy. The purpose of this study was to determine the effectiveness of the NPFS at controlling virus aerosol compared to a standard disposable plastic face shield. The face shields were placed on a simulated patient coughing machine. MS2 bacteriophage was used as a surrogate for SARS-CoV-2 and was aerosolized using the coughing machine. The aerosolized virus was sampled on the inside and outside of the face shields. The virus aerosol concentration was not significantly different between the inside and outside of the traditional plastic face shield (p = 0.12). However, the particle concentrations across all particle sizes measured were significantly decreased outside the face shield. The virus and particle concentrations were significantly decreased (p < 0.01) outside the NPFS operating at a flow rate of 38.6 L per minute (LPM). When the NPFS was operated at 10 LPM, virus concentrations were not significantly different (p = 0.09) across the face shield. However, the number particle concentrations across all particle sizes measured were significantly different (p < 0.05).
| S-EPMC10511466 | biostudies-literature
Project description:BackgroundCOVID-19 is considered to be very contagious as it can be spread through multiple ways. Therefore, exposure risk of healthcare workers (HCWs) treating COVID-19 patients is a highly salient topic in exposure risk management. From a managerial perspective, wearing personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients are two interconnected issues encountered in all COVID-19 hospitals.ObjectiveThe study was conducted to understand the realistic impact of exposure risk management on HCWs exposed to risks of SARS-CoV-2 virus infection in a healthcare unit. In particular, this study discusses the role of personal protective equipment (PPEs) used in aerosol generating procedures (AGPs) to protect HCWs, and the related risk of accidents occurring when performing AGPs.MethodologyThis is a cross-sectional single-hospital study conducted at the "Sf. Ioan cel Nou" Hospital in Suceava, Romania, that had to ensure safety of healthcare workers (HCWs) getting in contact with COVID-19 cases. Data used in the study were collected between 10.12.2020-19.03.2021 by means of a questionnaire that collected information on risk assessment and healthcare workers' exposure management, and which was translated and adapted from the World Health Organization (WHO) and applied to respondents online. For this purpose, ethical approval was obtained, doctors and nurses from all hospital departments being invited to complete the questionnaire. Data processing, as well as descriptive, correlation and regression analyses have been done by using the 21.0 version of the Statistical Package for Social Sciences software.ResultsMost of the 312 HCWs reported having always used disposable gloves (98.13%), medical masks N95 (or equivalent) (92.86%), visors or googles (91.19%), disposable coverall (91.25%) and footwear protection (95.00%) during AGPs. The waterproof apron had always been worn only by 40% of the respondents, and almost 30% of staff had not used it at all during AGPs. Over the last three months, the period when the questionnaire was completed, 28 accidents were reported while performing AGPs: 11 accidents with splashing of biological fluids/ respiratory secretions in the eyes, 11 with splashing of biological fluids/ respiratory secretions on the non-idemn skin, 3 with splashing of biological fluids/ respiratory secretions in the oral/ nasal mucosa and 3 with puncture/ sting with any material contaminated with biological fluids/ respiratory secretions. Also, 84.29% of respondents declared having changed their routine, at least, moderately due to COVID-19.ConclusionAn effective risk exposure management is based on wearing protective equipment. The only protection offered by the disposable coverall, as it results from our analysis, is related to splashing of biological fluids/ respiratory secretions on the non-idemn skin. In addition, the results show that the number of accidents should decrease due to the fact that disposable gloves and footwear protection are used while performing AGPs on patients with COVID-19 and hand hygiene is practised before and after touching a patient with COVID-19 (regardless of glove wearing).
| S-EPMC9990922 | biostudies-literature