Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review

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Wilson, Jennie ORCID: https://orcid.org/0000-0002-4713-9662, Carson, G., Fitzgerald, S., Llewelyn, M.J., Jenkins, D., Parker, S., Boies, A., Thomas, J., Sutcliffe, K., Sowden, A.J., O'Mara-Eves, A., Stansfield, C., Harriss, E. and Reilly, J. (2021) Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review. Journal of Hospital Infection, 116. pp. 37-46. ISSN 0195-6701

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Official URL: https://doi.org/10.1016/j.jhin.2021.06.011

Abstract

Background
The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern.

Aim
To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing.

Methods
The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice.

Findings
Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions.

Conclusion
There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.

Item Type:	Article
Identifier:	10.1016/j.jhin.2021.06.011
Keywords:	aerosol generating procedure, respiratory infection, SARS-CoV-2, rapid systematic review, aerobiology, epidemiology, cough, suction, nasoendoscopy, nasogastric tube, lung function test
Subjects:	Medicine and health > Health promotion and public health Medicine and health > Health promotion and public health > Infection prevention Medicine and health > Microbiology Medicine and health > Clinical medicine Medicine and health Medicine and health > Nursing
Related URLs:	Publisher Publisher
Depositing User:	Jennie Wilson
Date Deposited:	02 Jul 2021 13:08
Last Modified:	06 Feb 2024 16:06
URI:	https://repository.uwl.ac.uk/id/eprint/8044