Aerosol generating procedures and COVID-19 (multiple reviews)
What is this? The COVID-19 pandemic has highlighted particular risks for healthcare workers, including those associated with aerosol generating procedures. Findings from relevant reviews are summarised here. More details for these reviews, including citations and links to the full text, are available lower down this page.
What was found: The reviews, covering a range of clinical areas, suggest that healthcare workers may be at increased risk of COVID-19 from aerosol generating procedures (AGPs).
Some reviews suggest that measures to reduce these risks include delaying procedures during the pandemic and the use of antimicrobial treatments before and after the procedures.
At the time of the Koletsi review of dental procedures (search done on 6 April 2020), the included studies showed that pre-procedural mouth rinse with tempered chlorhexidine 0.2% reduced post-procedural bacterial load and had the highest probability of being ranked the most effective of the treatments in their network meta-analysis. Significant reductions in microbial load were also found for conventional chlorhexidine 0.2% and chloride dioxide rinses, but not for chlorhexidine 0.12%, povidone iodine, ozone, high-volume evacuator, herbal mouthwash and cetylpyridinium chloride compared with control or any other active intervention examined. However, at the time of this review, the most effective intervention to reduce aerosolized microbes (particularly SARS-CoV-2) in dental practice was uncertain.
At the time of the Bolton review (which was published on 1 June 2020), the included studies show that aerosols were an important route of COVID-19 transmission. The review noted that as dysphagia assessments involve cough induction, speech and language therapists or other healthcare professionals undertaking these assessments might be at increased risk of COVID-19 infection.
Based on their review of guidelines (search done on 17 April 2020), Heldwein et al recommended that AGPs should be avoided during urology surgery during the COVID-19 pandemic.
The Tran review (search done in October 2010) found that some AGPs had been linked with high risk of acute respiratory disease (such as SARS) among frontline healthcare workers. Among the AGPs studied, tracheal intubation was linked with the highest risk of transmission to healthcare workers. Other AGPs identified with potential occupational risk included cardiopulmonary resuscitation and non-invasive ventilation.
What are the reviews:
Citation: Bolton L, Mills C, Wallace S, et al. Aerosol generating procedures, dysphagia assessment and COVID‐19: A rapid review. International Journal of Language & Communication Disorders. 2020;55(4):629-36.
In this rapid review, the authors searched for research and recommendations relating to dysphagia assessment, AGPs and the risk of COVID-19 transmission to healthcare workers. They did not restrict their searches by type or language of publication but do not state their search date. The manuscript was submitted to the journal on 23 April 2020. The amount of included material is not reported.
Citation: Heldwein FL, Loeb S, Wroclawski ML, et al. A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic. European Urology Focus. 2020;6(5):1070-85.
In this rapid review, the authors searched for guidelines on urology standards of care published during the COVID-19 pandemic. They restricted their searches to guidelines published in English between November 2019 and 17 April 2020. They identified 15 guidelines from Australia and New Zealand, Brazil, Canada, Europe and USA.
Citation: Koletsi D, Belibasakis GN, Eliades T. Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials. Journal of Dental Research. 2020;99(11):1228-38.
In this rapid review, the authors searched for randomized trials and non-randomized studies of interventions used in dental practice to reduce microbial load in aerosols. They did not restrict their searches by date, type or language of publication and did the search on 6 April 2020. They included 21 randomized trials and 8 non-randomized studies, and included 11 randomized trials in a network meta-analysis.
Citation: Tran K, Cimon K, Severn M, et al. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS One 2012;7(4):e35797.
In this systematic review, the authors searched for research into the associations between AGPs and acute respiratory infection in healthcare workers. They searched for studies published since 1 January 1990 on 22 October 2010. They included 5 case control studies and 5 cohort studies.
Other related Evidence Aid combined summaries: Antimicrobial mouthwashes and nasal sprays in the context of COVID-19