scholarly journals AEROSOL GENERATION DURING COUGHING - QUANTITATIVE DEFINITION FOR AEROSOL GENERATING PROCEDURES: OBSERVATIONAL STUDY

2021 ◽  
Author(s):  
Enni Sanmark ◽  
Lotta-Maria Oksanen ◽  
Noora Rantanen ◽  
Mari Lahelma ◽  
Veli-Jukka Anttila ◽  
...  
Keyword(s):  
High Risk ◽  
Operating Room ◽  
Aerosol Particles ◽  
Aerosol Concentration ◽  
Medical Procedures ◽  
Aerosol Generation ◽  
Limit Value ◽  
Aerosol Exposure ◽  
Particle Sizer ◽  
Quantitative Definition

ABSTRACT Aim: The purpose of the study was to determine aerosol exposure generated by coughing in operation room environments to create a quantitative limit value for high risk aerosol generating medical procedures. Background: Coughing is known to produce a significant amount of aerosols and is thus commonly used as a best reference for high-risk aerosol-generation. Accordingly, procedures during which aerosol generation exceeds the amount of aerosol generated in instances of coughing are seen as high risk aerosol generating procedures. However, no reliable quantitative values are available for high risk aerosol-generation. Methods: Coughing was measured from 37 healthy volunteers in the operating room environment. Aerosol particles generated during coughing within the size range of 0.3 - 10 microm were measured with Optical Particle Sizer from 40cm, 70cm, and 100cm distances. The distances reflected potential exposure distances where personnel are during surgeries. Results: A total of 306 coughs were measured. Average aerosol concentration during coughing was 1.580 +/- 13.774 particles/cm3 (range 0.000 - 195.528). Discussion: The aerosol concentration measured in this study can be used as a limit for high-risk aerosol generation in the operating room environment when assessing the aerosol generating procedures and the risk of operating room staff s exposure for aerosol particles. AUTHOR APPROVAL:All authors have approved the manuscript and have made significant contributions.

scholarly journals Microdebrider is less aerosol-generating than CO2 laser and cold instruments in microlaryngoscopy

2021 ◽  
Author(s):  
Enni Sanmark ◽  
Lotta-Maria A. H. Oksanen ◽  
Noora Rantanen ◽  
Mari Lahelma ◽  
Veli-Jukka Anttila ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Procedures ◽  
Particle Concentration ◽  
Aerosol Particles ◽  
Aerosol Generation ◽  
Laryngeal Surgery ◽  
Step Down ◽  
Particle Sizer ◽  
Measured Particle ◽  
Cold Dissection

Abstract Objective COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. Methods We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. Results Thirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. Conclusions Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.

scholarly journals Aerosolization During Common Ventilation Scenarios

2020 ◽  
Vol 163 (4) ◽  
pp. 702-704 ◽  
Author(s):  
Roy Xiao ◽  
Alan D. Workman ◽  
Elefteria Puka ◽  
Jeremy Juang ◽  
Matthew R. Naunheim ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Aerosol Generation ◽  
Aerosol Exposure ◽  
Increased Risk ◽  
Particle Sizer ◽  
Second Period

Otolaryngologists are at increased risk for exposure to suspected aerosol-generating procedures during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In the present study, we sought to quantify differences in aerosol generation during common ventilation scenarios. We performed a series of 30-second ventilation experiments on porcine larynx-trachea-lung specimens. We used an optical particle sizer to quantify the number of 1- to 10-µm particles observed per 30-second period (PP30). No significant aerosols were observed with ventilation of intubated specimens (10.8 ± 2.4 PP30 vs background 9.5 ± 2.1, P = 1.0000). Simulated coughing through a tracheostomy produced 53.5 ± 25.2 PP30, significantly more than background ( P = .0121) and ventilation of an intubated specimen ( P = .0401). These data suggest that undisturbed ventilation and thus intubation without stimulation or coughing may be safer than believed. Coughing increases aerosol production, particularly via tracheostomy. Otolaryngologists who frequently manage patient airways and perform tracheostomy are at increased risk for aerosol exposure and require appropriate personal protective equipment, especially during the ongoing COVID-19 pandemic.

scholarly journals A quantitative evaluation of aerosol generation from upper airway suctioning during tracheal intubation and extubation sequences.

2021 ◽  
Author(s):  
Andrew James Shrimpton ◽  
Julian M Brown ◽  
Timothy M Cook ◽  
Chris M Penfold ◽  
Jonathan P Reid
Keyword(s):  
Tracheal Intubation ◽  
Upper Airway ◽  
Aerosol Concentration ◽  
Tidal Breathing ◽  
Aerosol Generation ◽  
Operating Theatres ◽  
Particle Sizer ◽  
Post Intubation ◽  
Induction Of Anaesthesia ◽  
Airway Suctioning

Background: Open respiratory suctioning is considered to be an aerosol generating procedure (AGP) and laryngopharyngeal suction, used to clear secretions during anaesthesia, is widely managed as an AGP. It is uncertain whether such upper airway suctioning should be designated an aerosol generating procedure (AGP) because of a lack of both aerosol and epidemiological evidence of risk. Aim: To assess the relative risk of aerosol generation by upper airway suction during tracheal intubation and extubation in anaesthetised patients. Methods: Prospective environmental monitoring study in ultraclean operating theatres to assay aerosol concentration during intubation and extubation sequences including upper airway suctioning for patients undergoing surgery (n=19 patients). An Optical Particle Sizer (particle size 300nm-10μm) was used to sample aerosol 20cm above the mouth of the patient. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of oropharyngeal suction were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation and pre- and post-extubation. Findings: Aerosol from breathing was reliably detected (65[39-259] particles.L-1 (median[IQR])) above background (4.8[1-7] particles.L-1, p<0.0001 Friedman). The procedure of upper airway suction was associated with much lower average concentrations of aerosol than breathing (6.0[0-12] particles.L-1, P=0.0007) and was indistinguishable from background (P>0.99). The peak aerosol concentration recorded during suctioning (45[30-75] particles.L-1) was much lower than both volitional coughs (1520[600-4363] particles.L-1, p<0.0001, Friedman) and tidal breathing (540[300-1826] particles.L-1, p<0.0001, Friedman). Conclusion: The procedure of upper airway suction during airway management is associated with no higher concentration of aerosol than background and much lower than breathing and coughing. Upper airway suction should not be designated as a high risk AGP.  

scholarly journals Quantification of Aerosol Particle Concentrations During Endoscopic Sinonasal Surgery in the Operating Room

2020 ◽  
pp. 194589242096233
Author(s):  
Alex Murr ◽  
Nicholas R. Lenze ◽  
William Colby Brown ◽  
Mark W. Gelpi ◽  
Charles S. Ebert ◽  
...  
Keyword(s):  
Operating Room ◽  
Particle Concentration ◽  
Surgical Techniques ◽  
Indirect Evidence ◽  
Airborne Particle ◽  
Endoscopic Endonasal ◽  
Aerosol Generation ◽  
Particle Sizer ◽  
Endoscopic Sinonasal Surgery ◽  
Live Patient

Background Recent indirect evidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission during endoscopic endonasal procedures has highlighted the dearth of knowledge surrounding aerosol generation with these procedures. As we adapt to function in the era of Coronavirus Disease 2019 (COVID-19) a better understanding of how surgical techniques generate potentially infectious aerosolized particles will enhance the safety of operating room (OR) staff and learners. Objective To provide greater understanding of possible SARS-CoV-2 exposure risk during endonasal surgeries by quantifying increases in airborne particle concentrations during endoscopic sinonasal surgery. Methods Aerosol concentrations were measured during live-patient endoscopic endonasal surgeries in ORs with an optical particle sizer. Measurements were taken throughout the procedure at six time points: 1) before patient entered the OR, 2) before pre-incision timeout during OR setup, 3) during cold instrumentation with suction, 4) during microdebrider use, 5) during drill use and, 6) at the end of the case prior to extubation. Measurements were taken at three different OR position: surgeon, circulating nurse, and anesthesia provider. Results Significant increases in airborne particle concentration were measured at the surgeon position with both the microdebrider (p = 0.001) and drill (p = 0.001), but not for cold instrumentation with suction (p = 0.340). Particle concentration did not significantly increase at the anesthesia position or the circulator position with any form of instrumentation. Overall, the surgeon position had a mean increase in particle concentration of 2445 particles/ft3 (95% CI 881 to 3955; p = 0.001) during drill use and 1825 particles/ft3 (95% CI 641 to 3009; p = 0.001) during microdebrider use. Conclusion Drilling and microdebrider use during endonasal surgery in a standard operating room is associated with a significant increase in airborne particle concentrations. Fortunately, this increase in aerosol concentration is localized to the area of the operating surgeon, with no detectable increase in aerosol particles at other OR positions.

scholarly journals 491. Aerosol-Generating Medical Procedures: Transmission of SARS-CoV-2 and Emerging Viruses

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S312-S312
Author(s):  
Seth D Judson ◽  
Vincent J Munster
Keyword(s):  
High Risk ◽  
Severe Disease ◽  
Experimental Studies ◽  
Virus Transmission ◽  
Nosocomial Transmission ◽  
Medical Procedures ◽  
Emerging Viruses ◽  
Zoonotic Viruses ◽  
Increased Risk ◽  
Hospital Acquired

Abstract Background During the pandemic of coronavirus disease 2019 (COVID-19), many questions arose regarding risks for hospital-acquired or nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aerosol generating medical procedures (AGMPs), techniques that can generate infectious, virus-laden aerosols, could potentially amplify transmission among healthcare workers (HCWs). Thus, it was widely recommended that HCWs use airborne precautions when performing AGMPs. However, in clinical settings it is often unclear what procedures constitute AGMPs and how the risk varies by procedure or pathogen. We set out to further define AGMPs and assess the risk for nosocomial transmission of SARS-CoV-2 and other high-risk viruses via AGMPs. Methods We identified potential AGMPs and emerging viruses that were high-risk for nosocomial transmission through reviewing experimental and clinical data. Potential AGMPs were those associated with previous virus transmission or mechanically capable of transmission. High-risk viruses were defined as those that cause severe disease in humans for which limited therapies or interventions exist, are infectious via aerosols in humans or non-human primates (NHPs), found in the respiratory tract of infected humans or NHPs, and had previous evidence of nosocomial transmission. Results We identified multiple potential AGMPs, which could be divided into those that generate aerosols or induce a patient to form aerosols, as well as eight families of high-risk viruses. All of the viruses were emerging zoonotic RNA viruses. In the family Coronaviridae, we identified potential evidence for SARS-CoV-1, MERS-CoV, and SARS-CoV-2 transmission via AGMPs. SARS-CoV-1 and SARS-CoV-2 were also found to be similarly stable when aerosolized. Conclusion Multiple emerging zoonotic viruses pose a high risk for nosocomial transmission through a variety of AGMPs. Given the similar stability of SARS-CoV-2 with SARS-CoV-1 when aerosolized and prior nosocomial transmission of SARS-CoV-1 via AGMPs, we suspect that certain AGMPs pose an increased risk for SARS-CoV-2 transmission. Additional experimental studies and on-site clinical sampling during AGMPs are necessary to further risk stratify AGMPs. Disclosures All Authors: No reported disclosures

scholarly journals A survey of aerosol exposure systems relative to the analysis of cytotoxicity: A Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA) perspective

2021 ◽  
Vol 5 ◽  
pp. 239784732110222
Author(s):  
David Thorne ◽  
Roman Wieczorek ◽  
Toshiro Fukushima ◽  
Han-Jae Shin ◽  
Robert Leverette ◽  
...  
Keyword(s):  
Scientific Research ◽  
Toxicity Testing ◽  
User Preferences ◽  
In Vitro Toxicity ◽  
Aerosol Generation ◽  
Aerosol Exposure ◽  
Comprehensive Survey ◽  
Survey Results ◽  
System Data

During a Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA) meeting, the in vitro toxicity testing Sub-Group (IVT SG) met to discuss the evolving field of aerosol exposure research. Given the diversity of exposure parameters and biological endpoints being used, it was considered a high priority to investigate and contextualise the responses obtained. This is particularly driven by the inability to compare between studies on different exposure systems due to user preferences and protocol differences. Twelve global tobacco and contract research companies met to discuss this topic and formulate an aligned approach on how this diverging field of research could be appropriately compared. Something that is becoming increasingly important, especially in the light of more focused regulatory scrutiny. A detailed and comprehensive survey was conducted on over 40 parameters ranging from aerosol generation, dilution and data analysis across eight geographically independent laboratories. The survey results emphasise the diversity of in vitro exposure parameters and methodologies employed across the IVT SG and highlighted pockets of harmonisation. For example, many of the biological protocol parameters are consistent across the Sub-Group. However, variables such as cell type and exposure time remain largely inconsistent. The next steps for this work will be to map parameters and system data against biological findings and investigate whether the observed inconsistencies translate into increased biological variability. The results from the survey provide improved awareness of parameters and nuances, that may be of substantial benefit to scientists in intersecting fields and in the development of harmonised approaches.

scholarly journals A Novel Cough Simulation Device for Education of Risk Mitigation Techniques During Aerosol-Generating Medical Procedures

2021 ◽  
pp. 019459982110003
Author(s):  
Ernest D. Gomez ◽  
John J. Ceremsak ◽  
Akiva Leibowitz ◽  
Scharukh Jalisi
Keyword(s):  
User Study ◽  
Risk Mitigation ◽  
Medical Procedures ◽  
Medical Specialties ◽  
Aerosol Generation ◽  
Safety Awareness ◽  
Potential Mode ◽  
Educational Need ◽  
And Training ◽  
Design Construction

The COVID-19 pandemic has drawn attention to aerosol-generating medical procedures (AGMPs) in health care environments as a potential mode of transmission. Many organizations and institutions have published AGMP safety guidelines, and several mention the use of simulation in informing their recommendations; however, current methods used to simulate aerosol generation are heterogenous. Creation of a high-fidelity, easily producible aerosol-generating cough simulator would meet a high-priority educational need across all medical specialties. In this communication, we describe the design, construction, and user study of a novel cough simulator, which demonstrates the utility of simulation in raising AGMP safety awareness for providers of all roles, specialties, and training levels.

Innovative Draping Method to Mitigate Aerosolization During Coronavirus Pandemic

2020 ◽  
Vol 3 (2) ◽  
pp. 73-76
Author(s):  
Kripa Dongol ◽  
Yogesh Neupane ◽  
Dipesh Shakya
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Operating Room ◽  
Healthcare Workers ◽  
Operative Procedure ◽  
High Viral Load ◽  
Upper Airways ◽  
Self Confidence ◽  
Additional Form

Otolaryngologists are at high risk of acquiring coronavirus because most of the procedures are aerosol generating and we have to deal with upper airways which contain high viral load. The objective of this study is to elaborate the draping technique which diminishes aerosol in the operating room. Use of a framework and a drape with customized hand insertion ports help to contain the aerosol generated during the operative procedure. The draping technique acts as an additional form of protection from aerosol along with an increase in self-confidence to the healthcare workers during this pandemic.

scholarly journals High-Risk Surgeries during the COVID-19 Epidemy

2021 ◽  
Vol 7 (2) ◽  
pp. 035-041
Author(s):  
Raziyeh Ghafouri ◽  
Maryam Vosoghian ◽  
Zahra Malmir ◽  
Zahra Arasteh ◽  
Sepideh Khodadadi
Keyword(s):  
High Risk ◽  
Head And Neck ◽  
Operating Room ◽  
Treatment Process ◽  
Inclusion Criteria ◽  
Safe Surgery ◽  
Nose And Throat

Introduction: The prevalence of coronavirus has led to minimal and emergency surgeries. It is recommended that surgery should be performed if it is necessary during the treatment process in order not to interfere with the treatment of patients, but surgery, which are more likely to transmit COVID-19, should be identified in order to have a safe surgery and improve the safety of patients and staff. Therefore, the present study aimed to identify surgeries with the possibility of transmitting COVID-19. Method: The present study was conducted by an integrated review method. Searching was performed by keywords COVID-19, surgery, operating room, anesthesia, and instructions on PUBMED, Science Direct, Ovid, and ProQuest databases; and 98 studied were obtained. It decreased to 42 items after removing the duplicate items and reviewing the abstract of articles, and finally 23 studies were selected for review based on the inclusion criteria. The inclusion criteria were English and Persian languages; the relevance of articles on COVID-19, surgery and anesthesia. Results: Tracheostomy, ear, nose and throat, maxillofacial, and head and neck surgeries such thoracotomy are high-risk surgeries for the COVID-19 transmission. Conclusion: High-risk surgeries should be performed the full preventive precautions against the COVID-19 transmission.

Abstract 17362: A Multidisciplinary Heart Team Approach to High Risk Transvenous Pacemaker and Defibrillator Lead Extraction Improves Mortality

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ryan G Aleong ◽  
Matthew Zipse ◽  
Christine Tompkins ◽  
Tamas Seres ◽  
David Fullerton ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Operating Room ◽  
Cardiac Electrophysiology ◽  
Lead Extraction ◽  
Team Approach ◽  
Heart Team ◽  
Hybrid Operating Room ◽  
Icd Leads ◽  
The Creation

Introduction: There is a risk of serious complications with high-risk lead extraction (LE) that may increase mortality. Current guidelines do not provide definitive guidance on collaborative involvement of cardiac surgery as compared to other procedures such as TAVR procedures. We report a single center experience of the benefits of a collaborative approach between cardiac surgery and cardiac electrophysiology (EP). Hypothesis: MDHT will improve outcomes in LE Methods: High risk lead extractions had dwell times of at least 4 years for pacemaker leads and 2 years for ICD leads. A multidisciplinary heart team (MDHT) was created based on the TAVR model that includes a combined lead management clinic and a monthly multidisciplinary conference. Prior to MDHT creation, high risk lead extractions were performed either in the hybrid operating room (OR) and cardiology procedure lab with a surgeon on call as needed. After the MDHT creation all cases were performed in the hybrid operating room by a cardiac surgeon, cardiac anesthesiologist and EP together with an interventional radiologist readily available. Results: Prior to MDHT, 169 patients underwent 344 leads extractions. There were six major procedural complications (3.6%) that included 2 procedural deaths (1.2%) during that period (SVC tear, Tricuspid valve avulsion). Following the creation of MDHT, there have been 47 cases performed with 85 leads extracted. There have been two complications requiring surgical repair (one SVC laceration, one RV laceration), which were surgically repaired. With the creation of a MDHT, the rate of major complications was unchanged (Pre vs. Post MDHT 3.6% vs. 4.3%) but there was a lower mortality rate (Pre vs. Post MDHT 1.2% vs. 0%). Conclusions: High risk lead extraction had a fixed complication rate at our institution however a MDHT decreased mortality. A structured multidisciplinary approach, involving EP and cardiac surgery, decreased mortality in a medium sized lead extraction center and should be considered at all centers.

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