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. 2021 Mar 17;11(3):e040616.
doi: 10.1136/bmjopen-2020-040616.

Risk of dispersion or aerosol generation and infection transmission with nasopharyngeal and oropharyngeal swabs for detection of COVID-19: a systematic review

Arnav Agarwal  1   2 , Shannon M Fernando  3   4 , Kimia Honarmand  5 , Layla Bakaa  6 , Sonia Brar  7 , David Granton  8 , Dipayan Chaudhuri  9 , Devin Chetan  10   11 , Malini Hu  8 , John Basmaji  5 , Fiona Muttalib  12 , Bram Rochwerg  2   8 , Neill K J Adhikari  13   14 , Francois Lamontagne  15   16 , Srinivas Murthy  17 , David S Hui  18   19 , Charles D Gomersall  20 , Samira Mubareka  21   22 , Janet Diaz  23   24 , Karen Ea Burns  14   25   26 , Rachel Couban  2   27 , Per O Vandvik  28
Affiliations

Risk of dispersion or aerosol generation and infection transmission with nasopharyngeal and oropharyngeal swabs for detection of COVID-19: a systematic review

Arnav Agarwal et al. BMJ Open. .

Abstract

Objectives: SARS-CoV-2-related disease, referred to as COVID-19, has emerged as a global pandemic since December 2019. While there is growing recognition regarding possible airborne transmission, particularly in the setting of aerosol-generating procedures and treatments, whether nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 generate aerosols remains unclear.

Design: Systematic review.

Data sources: We searched Ovid MEDLINE and EMBASE up to 3 November 2020. We also searched the China National Knowledge Infrastructure, Chinese Medical Journal Network, medRxiv and ClinicalTrials.gov up to 29 March 2020.

Eligibility criteria: All comparative and non-comparative studies that evaluated dispersion or aerosolisation of viable airborne organisms, or transmission of infection associated with nasopharyngeal or oropharyngeal swab testing.

Results: Of 7702 citations, only one study was deemed eligible. Using a dedicated sampling room with negative pressure isolation room, personal protective equipment including N95 or higher masks, strict sterilisation protocols, structured training with standardised collection methods and a structured collection and delivery system, a tertiary care hospital proved a 0% healthcare worker infection rate among eight nurses conducting over 11 000 nasopharyngeal swabs. No studies examining transmissibility with other safety protocols, nor any studies quantifying the risk of aerosol generation with nasopharyngeal or oropharyngeal swabs for detection of SARS-CoV-2, were identified.

Conclusions: There is limited to no published data regarding aerosol generation and risk of transmission with nasopharyngeal and oropharyngeal swabs for the detection of SARS-CoV-2. Field experiments to quantify this risk are warranted. Vigilance in adhering to current standards for infection control is suggested.

Keywords: Diagnostic microbiology; Infection control; Public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram for review on aerosol generation associated with nasopharyngeal and oropharyngeal swabs. CMJN, Chinese Medical Journal Network; CNKI, China National Knowledge Infrastructure; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

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