Protecting healthcare workers from inhaled SARS-CoV-2 virus

Cherrie, John W.; Loh, Miranda; Aitken, Robert J.

doi:10.1093/occmed/kqaa077

Cited by 23 publications

(26 citation statements)

References 13 publications

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“…Prior investigations have highlighted the pathogenic load of bio-aerosols in dentistry [33], or undertaken endorsements to identify potentially effective measures against bio-aerosol content from a microbiologic perspective [34]. This becomes especially alarming under the light of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic [35], where healthcare workers are in the frontline of suspended droplet or aerosol-related contamination and inhalation/respiration protection measures are crucial [36]. Acute or chronic health effects of airborne particles of the ultrafine and nanoscale fraction, in general, have long been investigated and reported [37,38]; however, their impact on dentistry and healthcare workers related to dental practice is still not known and potentially ignored [39].…”

Section: Findings In Contextmentioning

confidence: 99%

Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

et al. 2020

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Composite dust generation is most likely a continuous and daily procedure in dental practice settings. The aim of this systematic review was to identify, compile and evaluate existing evidence on interventions and composite material properties related to the production of aerosolized dust during routine dental procedures. Seven electronic databases were searched, with no limits, supplemented by a manual search, on 27 April 2020 for published and unpublished research. Eligibility criteria comprised of studies of any design, describing composite dust production related to the implementation of any procedure in dental practice. Study selection, data extraction and risk of bias (RoB) assessment was undertaken independently either in duplicate, or confirmed by a second reviewer. Random effects meta-analyses of standardized mean differences (SMD) with associated 95% confidence intervals (CIs) were employed where applicable. A total of 375 articles were initially identified, resulting in 13 articles being included in the qualitative synthesis, of which 5 contributed to meta-analyses overall. Risk of bias recordings ranged between low and high, pertaining to unclear/raising some concerns, in most cases. All types of composites, irrespective of the filler particles, released significant amounts of nano-sized particles after being ground, with potentially disruptive respiratory effects. Evidence supported increased % distribution of particles < 100 nm for nanocomposite Filtek Supreme XTE compared to both conventional hybrid Z100MP (SMD: 1.96, 95% CI: 0.85, 3.07; p-value; 0.001) and nano- hybrid Tetric EvoCeram (SMD: 1.62, 95% CI: 0.56, 2.68; p-value: 0.003). For cytotoxicity considerations of generated aerosolized particles, both nanocomposites Filtek Supreme XTE and nanohybrid GradiO revealed negative effects on bronchial epithelial cell viability, as represented by % formazan reduction at 330–400 μg/mL for 24 hours, with no recorded differences between them (SMD: 0.19; 95% CI: −0.17, 0.55; p-value: 0.30). Effective and more rigorous management of dental procedures potentially liable to the generation of considerable amounts of aerosolized composite dust should be prioritized in contemporary dental practice. In essence, protective measures for the clinician and the practices’ personnel should also be systematically promoted and additional interventions may be considered in view of the existing evidence.

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Section: Findings In Contextmentioning

confidence: 99%

Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

et al. 2020

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“…A health or social care worker managing suspected cases of covid-19, and not engaged in so-called ‘aerosol generating procedures’ should have worn an IIR surgical mask as respiratory protective equipment (RPE) according to PHE [ 8 ]. However, many concerns have been raised, including in this journal [ 2 , 9 ] that PHE guidance was not adequately precautionary because of spread of the virus in aerosols arising even from breathing. Therefore, it has been asserted [ 10 ] that the higher standard of RPE in the European Centre for Disease Control guidance [ 11 ] recommending respirators should have been applied.…”

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confidence: 99%

Disease and death from work: RIDDOR and covid-19

Agius

2020

Occupational Medicine

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“…As the results show, coroners have had very little experience of generating PFDs relevant to industrial disease and PPE, though some clinical inquests might have had analogous considerations. Coroners cannot be expected to be competent in aerosol science or in determining what PPE would have been adequately precautionary [ 22 ] and might need training to better address these issues. Under these circumstances coroners can call for HSE assistance [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Covid-19: statutory means of scrutinizing workers’ deaths and disease

Agius

2020

Occupational Medicine

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Background By law, covid-19 disease and deaths in workers may lead to coroners’ inquests and/or Health and Safety Executive (HSE) investigations. Aims This study assesses the adequacy of these statutory means to yield recommendations for prevention of acquiring covid-19 infection from work. Methods Covid-19 guidance from the chief coroner and the HSE was appraised, including using Office for National Statistics (ONS) data. Practitioners were asked to estimate the likelihood that covid-19 disease may have arisen from ‘near-miss’ scenarios. Data from the judiciary and the HSE were analysed. Results The coroners’ guidance allowed a wider range of reports of death than did the HSE and conformed better with ONS data on covid-19 mortality by occupation. In the practitioner survey, 62 respondents considered a higher likelihood that reported covid-19 cases would have arisen from the scenario deemed unreportable as a ‘dangerous occurrence’ by HSE than the reportable scenario (P < 0.001). On average there was only one coroner’s report to prevent future death from occupational disease every year in England and Wales. The HSE dealt with a yearly average of 1611 reports of work-related disease including 104 on biological agents, but has received about 9000 covid-19 reports. Conclusions Current HSE guidance for reporting work-related covid-19 may miss many thousands of cases and needs further iteration. Coroners have very limited experience of inquiry into occupational disease caused by biological agents compared with the HSE. Concerns regarding national policy such as on protective equipment warrant a full public inquiry.

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Protecting healthcare workers from inhaled SARS-CoV-2 virus

Cited by 23 publications

References 13 publications

Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

Disease and death from work: RIDDOR and covid-19

Covid-19: statutory means of scrutinizing workers’ deaths and disease

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