eprintid: 10130781
rev_number: 40
eprint_status: archive
userid: 608
dir: disk0/10/13/07/81
datestamp: 2021-07-08 16:13:53
lastmod: 2022-08-14 06:10:20
status_changed: 2021-12-14 16:48:24
type: article
metadata_visibility: show
creators_name: Wilson, J
creators_name: Garson, G
creators_name: Fitzgerald, S
creators_name: Llewelyn, MJ
creators_name: Jenkins, D
creators_name: Parker, S
creators_name: Bois, A
creators_name: Thomas, J
creators_name: Sutcliffe, K
creators_name: Sowden, A
creators_name: O'Mara-Eves, A
creators_name: Stansfield, C
creators_name: Harriss, E
creators_name: Reilly, J
creators_name: Members of Independent High Risk AGP Review Panel, 
title: What is the evidence that medical procedures which induce coughing or involve respiratory suctioning are associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review
ispublished: pub
divisions: UCL
divisions: B16
divisions: B14
divisions: J81
keywords: Aerosol-generating procedure, Respiratory infection, SARS-CoV-2, Epidemiology, Nasendoscopy, Lung function test
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
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.
date: 2021-10
date_type: published
publisher: WB Saunders
official_url: https://doi.org/10.1016/j.jhin.2021.06.011
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1875157
doi: 10.1016/j.jhin.2021.06.011
lyricists_name: O'Mara-Eves, Alison
lyricists_name: Stansfield, Claire
lyricists_name: Sutcliffe, Katy
lyricists_name: Thomas, James
lyricists_id: AJOMA15
lyricists_id: CMSTA07
lyricists_id: KSUTC11
lyricists_id: JTHOA32
actors_name: Zahnhausen-Stuber, Petra
actors_id: PMZAH20
actors_role: owner
full_text_status: public
publication: Journal of Hospital Infection
volume: 116
pagerange: 37-46
citation:        Wilson, J;    Garson, G;    Fitzgerald, S;    Llewelyn, MJ;    Jenkins, D;    Parker, S;    Bois, A;                                 ... Members of Independent High Risk AGP Review Panel; + view all <#>        Wilson, J;  Garson, G;  Fitzgerald, S;  Llewelyn, MJ;  Jenkins, D;  Parker, S;  Bois, A;  Thomas, J;  Sutcliffe, K;  Sowden, A;  O'Mara-Eves, A;  Stansfield, C;  Harriss, E;  Reilly, J;  Members of Independent High Risk AGP Review Panel;   - view fewer <#>    (2021)    What is the evidence that medical procedures which induce coughing or involve respiratory suctioning are 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.    10.1016/j.jhin.2021.06.011 <https://doi.org/10.1016/j.jhin.2021.06.011>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10130781/1/Review%20procedures%20of%20concern%20Final%20Rev%2028-6-21.pdf