OBJECTIVES: To assess the risk of coronavirus transmission to healthcare workers performing aerosol-generating procedures and the potential benefits of personal protective equipment during these procedures. DATA SOURCES: MEDLINE, EMBASE, and Cochrane CENTRAL were searched using a combination of related MeSH terms and keywords. STUDY SELECTION: Cohort studies and case controls investigating common anesthetic and critical care aerosol-generating procedures and transmission of severe acute respiratory syndrome coronavirus 1, Middle East respiratory syndrome coronavirus, and severe acute respiratory syndrome coronavirus 2 to healthcare workers were included for quantitative analysis. DATA EXTRACTION: Qualitative and quantitative data on the transmission of severe acute respiratory syndrome coronavirus 1, severe acute respiratory syndrome coronavirus 2, and Middle East respiratory syndrome coronavirus to healthcare workers via aerosol-generating procedures in anesthesia and critical care were collected independently. The Risk Of Bias In Non-randomized Studies - of Interventions tool was used to assess the risk of bias of included studies. DATA SYNTHESIS: Seventeen studies out of 2,676 yielded records were included for meta-analyses. Endotracheal intubation (odds ratio, 6.69, 95% CI, 3.81–11.72; p < 0.001), noninvasive ventilation (odds ratio, 3.65; 95% CI, 1.86–7.19; p < 0.001), and administration of nebulized medications (odds ratio, 10.03; 95% CI, 1.98–50.69; p = 0.005) were found to increase the odds of healthcare workers contracting severe acute respiratory syndrome coronavirus 1 or severe acute respiratory syndrome coronavirus 2. The use of N95 masks (odds ratio, 0.11; 95% CI, 0.03–0.39; p < 0.001), gowns (odds ratio, 0.59; 95% CI, 0.48–0.73; p < 0.001), and gloves (odds ratio, 0.39; 95% CI, 0.29–0.53; p < 0.001) were found to be significantly protective of healthcare workers from contracting severe acute respiratory syndrome coronavirus 1 or severe acute respiratory syndrome coronavirus 2. CONCLUSIONS: Specific aerosol-generating procedures are high risk for the transmission of severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2 from patients to healthcare workers. Personal protective equipment reduce the odds of contracting severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2.

A comprehensive literature search was performed using a combination of keywords (MeSH terms and free text words) including 'COVID-19'/ 'SARS-CoV*'/'SARS'/'MERS' , 'aerosol' , 'surgery' , 'operation/procedure' , 'endoscopy' , and 'healthcare workers' . MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to 18 July 2020. Preprint servers, medRxiv, and bioRxiv were also searched for information up to that date. The search was limited to studies published during or after 2003, when the SARS outbreak began. Only articles published in English or published in another language but containing an English abstract were included. The search strategy is presented in the online supplementary Appendix. The search results were supplemented by guidelines from professional bodies. Results Perioperative considerations Preoperative considerationsFor all specialties, only urgent and essential procedures should be performed during the pandemic, 6 with