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Review
. 2020 Dec;33(6):300-304.
doi: 10.1089/jamp.2020.1615. Epub 2020 Aug 12.

Reducing Aerosol-Related Risk of Transmission in the Era of COVID-19: An Interim Guidance Endorsed by the International Society of Aerosols in Medicine

James B Fink  1   2 , Stephan Ehrmann  3   4 , Jie Li  2 , Patricia Dailey  5 , Paul McKiernan  5 , Chantal Darquenne  6 , Andrew R Martin  7 , Barbara Rothen-Rutishauser  8 , Philip J Kuehl  9 , Sabine Häussermann  10 , Ronan MacLoughlin  5   11   12 , Gerald C Smaldone  13 , Bernhard Muellinger  14 , Timothy E Corcoran  15 , Rajiv Dhand  16
Affiliations
Review

Reducing Aerosol-Related Risk of Transmission in the Era of COVID-19: An Interim Guidance Endorsed by the International Society of Aerosols in Medicine

James B Fink et al. J Aerosol Med Pulm Drug Deliv. 2020 Dec.

Abstract

National and international guidelines recommend droplet/airborne transmission and contact precautions for those caring for coronavirus disease 2019 (COVID-19) patients in ambulatory and acute care settings. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, an acute respiratory infectious agent, is primarily transmitted between people through respiratory droplets and contact routes. A recognized key to transmission of COVID-19, and droplet infections generally, is the dispersion of bioaerosols from the patient. Increased risk of transmission has been associated with aerosol generating procedures that include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, noninvasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols. Guidelines for use of personal protective equipment (glove, gowns, masks, shield, and/or powered air purifying respiratory) during high-risk procedures are essential and should be considered for use with lower risk procedures such as administration of uncontaminated medical aerosols. Bioaerosols generated by infected patients are a major source of transmission for SARS CoV-2, and other infectious agents. In contrast, therapeutic aerosols do not add to the risk of disease transmission unless contaminated by patients or HCWs.

Keywords: COVID-19; aerosol generating procedures; bioaerosol dispersion; filters; medical aerosol; risk factors.

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Conflict of interest statement

J.B.F. is employed by Aerogen Pharma Corp. P.D., P.M.K., and R.M.L. are employed by Aerogen Limited. S.H. is employed by VisionHealth GmbH. B.M. is employed by Vectura GmbH. S.E. declares receiving unrestricted research grants, travel fee reimbursements, and speaker fees from Fisher & Paykel healthcare, consulting fees from La Diffusion Technique Française, consulting fees and unrestricted research grants from Aerogen Ltd., research support for Penn Century, unrestricted research grant from Hamilton Medical. J.L. discloses receiving research grants from Fisher & Paykel Healthcare and Rice Foundation. A.R.M. declares receiving current research support from Fisher & Paykel Healthcare, and has received consulting fees from Air Liquide. G.S. consults for and on the advisory board of InspiRx, Inc. R.D. declares personal fees from Astra-Zeneca, Boehringer-Ingelheim, Mylan, UptoDate, and Teva, outside the submitted work (this should include each author's COI). Other authors have no conflicts of interest to declare.

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