Classification of aerosol-generating procedures: a rapid systematic review

被引:125
|
作者
Jackson, Tanya [1 ]
Deibert, Danika [1 ]
Wyatt, Graeme [1 ]
Durand-Moreau, Quentin [1 ]
Adisesh, Anil [2 ]
Khunti, Kamlesh [3 ]
Khunti, Sachin [4 ]
Smith, Simon [5 ]
Chan, Xin Hui S. [6 ]
Ross, Lawrence [7 ]
Roberts, Nia [8 ]
Toomey, Elaine [9 ]
Greenhalgh, Trisha [10 ]
Arora, Isheeta [11 ]
Black, Susannah M. [11 ]
Drake, Jonathan [11 ]
Syam, Nandana [11 ]
Temple, Robert [11 ]
Straube, Sebastian [1 ]
机构
[1] Univ Alberta, Dept Med, Div Prevent Med, Edmonton, AB, Canada
[2] Univ Toronto, Dept Med, Div Occupat Med, Toronto, ON, Canada
[3] Univ Leicester, Diabet Res Ctr, Leicester, Leics, England
[4] Barts & London Queen Marys Sch Med & Dent, Sch Med & Dent, London, England
[5] Canadian Stand Assoc, Canadian Stand Biol Aerosols Grp, Toronto, ON, Canada
[6] Univ Oxford, Nuffield Dept Med, Ctr Trop Med & Global Hlth, Oxford, England
[7] Childrens Hosp Los Angeles, Div Infect Dis, Los Angeles, CA 90027 USA
[8] Univ Oxford, Bodleian Hlth Care Lib, Oxford, England
[9] Univ Limerick, Sch Allied Hlth, Limerick, Ireland
[10] Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford, Oxon, England
[11] Univ Oxford, Div Med Sci, Oxford, England
基金
英国科研创新办公室; 英国惠康基金;
关键词
infection control; TRANSMISSION;
D O I
10.1136/bmjresp-2020-000730
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by >= 90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.
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页数:9
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