An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

Eain, Marc Mac Giolla; Joyce, Mary; O’Sullivan, Andrew; McGrath, James J.; MacLoughlin, Ronan

doi:10.1016/j.jhin.2020.11.029

Cited by 3 publications

(3 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The addition of the capture filter to the expiratory port of the mouthpiece greatly reduced the release of fugitive aerosols into the atmosphere, with reductions in the peak values ranging from 47.3 to 77.7% for a normal breathing pattern and 61.3 to 83.6% for a distressed breathing pattern. Although the reductions were not as significant as those reported in other studies (Wittgen et al., 2006 ; Ari et al., 2016 ; McGrath et al., 2019a ; Mac Giolla Eain et al., 2021 ), the images and data highlight the effectiveness of filters in limiting the release and spread of fugitive aerosols.…”

Section: Discussioncontrasting

confidence: 60%

“…However, preventing the release of said emissions at source would be the most effective means of protection. Using aerodynamic particle sizers (APSs) (McGrath et al., 2019a ; Mac Giolla Eain et al., 2021 ) quantified the release of fugitive medical aerosols during aerosol therapy. These works demonstrated that the addition of capture filters on the expiratory ports of face masks and mouthpieces and use of vibrating mesh nebulizers over jet nebulizers yielded mass concentration levels similar to ambient levels.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Aerosol release, distribution, and prevention during aerosol therapy: a simulated model for infection control

Eain

MacLoughlin

et al. 2021

Drug Delivery

View full text Add to dashboard Cite

Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the release of fugitive aerosols, both patient derived and medical, into the environment and the subsequent exposure of caregivers and bystanders to potential viral infections. This study examined the release of these fugitive aerosols during a standard aerosol therapy to a simulated adult patient. An aerosol holding chamber and mouthpiece were connected to a representative head model and breathing simulator. A combination of laser and Schlieren imaging was used to non-invasively visualize the release and dispersion of fugitive aerosol particles. Time-varying aerosol particle number concentrations and size distributions were measured with optical particle sizers at clinically relevant positions to the simulated patient. The influence of breathing pattern, normal and distressed, supplemental air flow, at 0.2 and 6 LPM, and the addition of a bacterial filter to the exhalation port of the mouthpiece were assessed. Images showed large quantities of fugitive aerosols emitted from the unfiltered mouthpiece. The images and particle counter data show that the addition of a bacterial filter limited the release of these fugitive aerosols, with the peak fugitive aerosol concentrations decreasing by 47.3–83.3%, depending on distance from the simulated patient. The addition of a bacterial filter to the mouthpiece significantly reduces the levels of fugitive aerosols emitted during a simulated aerosol therapy, p ≤ .05, and would greatly aid in reducing healthcare worker and bystander exposure to potentially harmful fugitive aerosols.

show abstract

Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Aerosol release, distribution, and prevention during aerosol therapy: a simulated model for infection control

Eain

MacLoughlin

et al. 2021

Drug Delivery

View full text Add to dashboard Cite

show abstract

“…In the setting of providing nebulized therapies to COVID-19-infected people, several publications have provided guidance and practical strategies over the last two years [7][8][9][10][11][12]. They mostly advocate for appropriate consideration for the inhaled medication delivery method, including the type of nebulizer (standard jet, vibrating mesh, and breath-actuated devices) and breathing interfaces (mouthpiece versus a facemask) [7,8,[13][14][15].…”

Section: Introductionmentioning

confidence: 99%

The Laboratory Characterization of Fugitive Aerosol Emissions From a Standard Jet Nebulizer With and Without a Filtered Mouthpiece

Dhanak,

Verma,

Hughes

et al. 2023

Cureus

View full text Add to dashboard Cite

Background and objective The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from patients with coronavirus disease 2019 (COVID-19) during nebulization is unclear. In this study, we aimed to address this issue. Methods Fugitive emissions of aerosolized saline during nebulization were observed using a standard jet nebulizer fitted with unfiltered and filtered mouthpieces connected via a mannequin to a breathing simulator. Fugitive emissions were observed by using a laser sheet and captured on high-definition video, and they were measured by using optical particle counters positioned where a potential caregiver may be administering nebulization and three other locations in the sagittal plane at various distances downstream of the mannequin. Results The use of a standard unfiltered mouthpiece resulted in significant emission of fugitive aerosols ahead of and above the mannequin (spread over 2 m in front). A mouthpiece with a filter-adaptor effectively suppressed the emissions, with only minor leakage from the nebulizer cup. Particle count measurements supported the visual observations, providing total particle count levels and aerosol concentration levels at the measurement locations. The levels decayed slowly with downstream distance. Conclusions The visualization described above captured the dispersion of emitted aerosols in the plane of the laser sheet, aligned with the sagittal plane. The particle count measurements provided temporal and spatial distributions of the aerosol concentration levels over the time and locations considered. However, the exhaled air and aerosolized droplets spread three-dimensionally in front of and above the mannequin. The results visually highlight the effectiveness of using a filtered mouthpiece in suppressing the fugitive aerosols and identify an approach for limiting the occupational exposure of healthcare workers to these emissions while administering nebulized therapies.

show abstract

Place of nebulizer therapy in the treatment of bronchial asthma in children

Potapova

2022

Medicinskij sovet

View full text Add to dashboard Cite

The review article presents an analysis of the data of foreign and domestic researchers characterizing the effectiveness of nebulizer therapy for bronchial asthma in children. The paper considers new data comparing the effectiveness of aerosol delivery devices. The advantage of inhalation therapy, which determines its widespread use in childhood, is its rapid delivery to the respiratory tract, high local and low systemic concentrations of the drug in target organs. Difficulties in observing the correct inhalation technique due to the difficulty of synchronizing inhalation and drug delivery, especially in young children, remain an urgent problem in the practice of treating chronic bronchopulmonary diseases, which leads to a severe and uncontrolled course, disability and adverse outcomes. The main disadvantage of ultrasonic nebulizers is the inactivation of suspensions, antibiotics and other drugs. Widely used jet nebulizers create noise during inhalation, have a large residual volume in the nebulizer chamber. In this regard, the improvement of delivery forms continues, taking into account the anatomical and physiological characteristics of the respiratory organs, the age of patients and comorbid conditions. The characteristics of the optimal inhaler include simplicity and ease of use, reliability, the possibility of effective inhalation of various drugs in combination with economical consumption. From this point of view, one of the universal means of transporting aerosols is membrane or electronic mesh (mesh) nebulizers, which provide excellent regional drug deposition in all age groups of children. The rapid achievement of clinical effect, compactness, mobility expand the possibilities of using mesh nebulizers at all levels of medical care.

show abstract

An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

Cited by 3 publications

References 38 publications

Aerosol release, distribution, and prevention during aerosol therapy: a simulated model for infection control

Aerosol release, distribution, and prevention during aerosol therapy: a simulated model for infection control

The Laboratory Characterization of Fugitive Aerosol Emissions From a Standard Jet Nebulizer With and Without a Filtered Mouthpiece

Place of nebulizer therapy in the treatment of bronchial asthma in children

Contact Info

Product

Resources

About