10th International Aerosol Conference September 2 - September 7, 2018 America's Center Convention Complex St. Louis, Missouri, USA
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Defining Pathogen Transmission Risks during Aerosol Generating Procedures in Healthcare Settings
Jiayu Li, Carrie O'neil, Ramesh Raliya, Yang Wang, Anna Leavey, Meghan Wallace, Carey-Ann Burnham, Adrianus Boon, HILARY BABCOCK, Pratim Biswas, Washington University in St Louis
Abstract Number: 369 Working Group: Infectious Bioaerosol
Abstract Questions remain about the degree to which aerosols are generated during patient-care activities and whether generated aerosols could transmit viable pathogens to healthcare personnel or to other patients. We measured aerosol production during common patient-care activities and collected samples for pathogen recovery. Some patient-care activities were included: patient bathing, changing bed linens, pouring and flushing liquid waste, bronchoscopy (with and without negative pressure ventilation), non-invasive ventilation, nebulized medication administration, extubation, and mechanical ventilation. Multiple aerosol characterization instruments were used to measure aerosols generated during each procedure. SKC BioSamplers were used for pathogen recovery1, along with a NIOSH personal aerosol sampler and a viable virus aerosol sampler (VIVAS) for a small subset of samples. All samples were subjected to bacterial culture. Samples collected from patients known to have influenza also received viral culture. During the first stage of the study, patients on contact precautions for drug-resistant organisms were prioritized for sampling2. In the second stage of the study, patients with influenza or other respiratory viruses were prioritized for sampling. Baseline samples were collected when possible. Results of both stages of the study indicate that nebulized medication administration and bronchoscopy with nebulized medication administration generated a significant change in particle presence over baseline. For the first stage of the study, of 78 samples subjected to bacterial culture, 18 were positive for clinically insignificant bacteria, however, none of the targeted drug-resistant organisms were recovered. The most frequently isolated organism was coagulase-negative staphylococcus, followed by micrococcus, which are common environmental contaminants, rather than targeted pathogens. For the second stage of our study, although none of the samples have been positive for the respiratory virus, similar to the first stage of the study, we have had several bacterial cultures that were positive for normal skin/environmental bacteria.
Strengths of this study include the use of multiple real-time aerosol measurement instruments, use of culture to determine the presence of viable microbes as a metric to assess the infection risk posed by medically generated aerosols, testing for viral pathogens during the second round of sampling, and sampling during multiple types of medical procedures in a real-world healthcare setting. Although additional research is needed, the results of this study suggest that some of the procedures that are widely considered to be high risk for the generation of infectious aerosols may actually pose little infection risk to protect healthcare personnel (HCP).
1. Li, J., Leavey, A., Wang, Y., O’Neil, C., Wallace, M. A., Burnham, C. A. D., ... & Biswas, P. (2018). Comparing the performance of 3 bioaerosol samplers for influenza virus. Journal of Aerosol Science, 115, 133-145.
2. O’neil, C. A., Li, J., Leavey, A., Wang, Y., Hink, M., Wallace, M., ... & Babcock, H. M. (2017). Characterization of Aerosols Generated During Patient Care Activities. Clinical Infectious Diseases.