Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures

Abstract

Recent nosocomial transmission events of emerging and re-emerging viruses, including Ebola virus, Middle East respiratory syndrome coronavirus, Nipah virus, and Crimean-Congo hemorrhagic fever orthonairovirus, have highlighted the risk of nosocomial transmission of emerging viruses in health-care settings. In particular, concerns and precautions have increased regarding the use of aerosol-generating medical procedures when treating patients with such viral infections. In spite of increasing associations between aerosol-generating medical procedures and the nosocomial transmission of viruses, we still have a poor understanding of the risks of specific procedures and viruses. In order to identify which aerosol-generating medical procedures and emerging viruses pose a high risk to health-care workers, we explore the mechanisms of aerosol-generating medical procedures, as well as the transmission pathways and characteristics of highly pathogenic viruses associated with nosocomial transmission. We then propose how research, both in clinical and experimental settings, could advance current infection control guidelines.

Keywords: aerosols; cross infection; ebolavirus; health personnel; hemorrhagic fevers; infection control; risk; viral; virus diseases; viruses.

Figure 1

Potential types of aerosol-generating medical procedures (AGMPs). AGMPs can be divided into procedures that induce the patient to produce aerosols and procedures that mechanically generate aerosols themselves.