Anaesthetists' current practice and perceptions of aerosol‐generating procedures: a mixed‐methods study

Abstract

Summary The evidence base surrounding the transmission risk of ‘aerosol‐generating procedures’ has evolved primarily through quantification of aerosol concentrations during clinical practice. Consequently, infection prevention and control guidelines are undergoing continual reassessment. This mixed‐methods study aimed to explore the perceptions of practicing anaesthetists regarding aerosol‐generating procedures. An online survey was distributed to the Membership Engagement Group of the Royal College of Anaesthetists during November 2021. The survey included five clinical scenarios to identify the personal approach of respondents to precautions, their hospital's policies and the associated impact on healthcare provision. A purposive sample was selected for interviews to explore the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed thematically. The sample was broadly representative of the UK anaesthetic workforce. Most respondents and their hospitals were aware of, supported and adhered to UK guidance. However, there were examples of substantial divergence from these guidelines at both individual and hospital level. For example, 40 (12%) requested respiratory protective equipment and 63 (20%) worked in hospitals that required it to be worn whilst performing tracheal intubation in SARS‐CoV‐2 negative patients. Additionally, 173 (52%) wore respiratory protective equipment whilst inserting supraglottic airway devices. Regarding the use of respiratory protective equipment and fallow times in the operating theatre: 305 (92%) perceived reduced efficiency; 376 (83%) perceived a negative impact on teamworking; 201 (64%) were worried about environmental impact; and 255 (77%) reported significant problems with communication. However, 269 (63%) felt the negative impacts of respiratory protection equipment were appropriately balanced against the risks of SARS‐CoV‐2 transmission. Attitudes were polarised about the prospect of moving away from using respiratory protective equipment. Participants' perceived risk from COVID‐19 correlated with concern regarding stepdown (Spearman's test, R = 0.36, p < 0.001). Attitudes towards aerosol‐generating procedures and the need for respiratory protective equipment are evolving and this information can be used to inform strategies to facilitate successful adoption of revised guidelines.

Aerosol‐generating procedures: research, guidance and implementation

“…The study by Shrimpton et al. comprised a survey between November and December 2021 (333 respondents) and interviews between December 2021 and February 2022 (18 respondents) [1]. The study period therefore spanned the surge in the omicron BA1 variant and was conducted in the context of a vaccination programme that had been established for 12 months in the UK [3].…”

“…The study by Shrimpton et al. shows that as the pandemic has progressed, anaesthetists have become alert to the dynamic nature of the evidence base and are well placed to make judgements accordingly [1]. Whilst it may be convenient to match modes of transmission to PPE requirements in national guidance, this does little to accommodate staff, patient or institutional factors.…”

“…In this issue of Anaesthesia , Shrimpton et al. report a mixed methods study of the perceptions and practices of UK anaesthetists in relation to PPE and COVID‐19 [1]. The study showed that AGPs were initially a major focus for anaesthetists but that, over time, the perceived significance of these procedures diminished.…”

“…In the current phase of the pandemic, PPE guidelines are called on to meet the needs of multiple stakeholders: to be standardised but individualised; evidence-based but consistent; and safe but expedient. The study by Shrimpton et al shows that as the pandemic has progressed, anaesthetists have become alert to the dynamic nature of the evidence base and are well placed to make judgements accordingly [1]. Whilst it may be convenient to match modes of transmission to PPE requirements in national guidance, this does little to accommodate staff, patient or institutional factors.…”

“…Some of these practices deviated substantially from infection prevention and control guidance, for example, by abandoning certain elements of PPE [1,2]. This was justified, in part, by perceptions that February 2022 (18 respondents) [1]. The study period therefore spanned the surge in the omicron BA1 variant and was conducted in the context of a vaccination programme that had been established for 12 months in the UK [3].…”