Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures

Abstract

Recent nosocomial transmission events of emerging and re-emerging viruses, including Ebola virus, Middle East respiratory syndrome coronavirus, Nipah virus, and Crimean–Congo hemorrhagic fever orthonairovirus, have highlighted the risk of nosocomial transmission of emerging viruses in health-care settings. In particular, concerns and precautions have increased regarding the use of aerosol-generating medical procedures when treating patients with such viral infections. In spite of increasing associations between aerosol-generating medical procedures and the nosocomial transmission of viruses, we still have a poor understanding of the risks of specific procedures and viruses. In order to identify which aerosol-generating medical procedures and emerging viruses pose a high risk to health-care workers, we explore the mechanisms of aerosol-generating medical procedures, as well as the transmission pathways and characteristics of highly pathogenic viruses associated with nosocomial transmission. We then propose how research, both in clinical and experimental settings, could advance current infection control guidelines.

Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks

“…[21] Surgeries performed with general anesthesia involve multiple, In addition to the routine , multiple aerosol-generating procedures (AGPs) such as bag-valve mask ventilation and intubation. [22] These AGPs have been associated with that promote nosocomial virus infections transmissioduring previous coronavirus epidemics.n [22,23] and accompany any surgery involving general anesthesia, [20] head Head and neck oncologic surgery often also often involves other additional, formal AGPs including such as nasogastric tube placement, tracheotomy, repeated endotracheal tube removal and replacement during total laryngectomy, and airway suctioning, which in some cases is continuous. [22] Routine use of cautery and suction in upper aerodigestive tract (UADT) surgery, such as transoral robotic surgery, is a continuous AGP.…”

“…Therefore, we submit that head and neck oncologic surgeries involving the UADT are extraordinarily high-risk for COVID-19SARS-CoV-2 viral aerosolization and transmission to operating room personnel and viral aerosolization could jeopardize the safety of all operating room personnel. [22,23] Although SARS-CoV-2 circulates in the blood of COVID-19-positive patients, [11] there is inadequate data to assess the risk of viral aerosolization in routine, non-UADT oncologic surgeries such as neck dissections, parotidectomies or thyroidectomies.…”

Special Issue “Emerging Viruses: Surveillance, Prevention, Evolution, and Control”

“…Wubshet et al [37] review data on the foot and mouth disease virus in Ethiopia from 2008 to 2018. Judson et al [38] examine nosocomial transmission of emerging viruses via aerosol-generating medical procedures.…”

Swivel-HEPA-ETT (SHE) bougie and HEPA-ETT (HE) methods for safe intubation while managing patients with COVID-19

“…To reduce the risk of aerosol transmission during the intubation, usage of personal protective equipment (PPE, preferably PAPRs (Powered Air-Purifying Respirators)) and video laryngoscopy (VL) are recommended, along with sedation and paralysis of the patient. [1][2][3] Current intubation recommendations for patients with COVID-19 focus on high-efficiency particulate air (HEPA) filter usage connected between the bag valve and the patient mask during preoxygenation. After intubation, the HEPA filter is then disconnected from the bag valve mask and reconnected to the endotracheal tube (ETT).…”