Defining Aerosol Generating Procedures and Pathogen Transmission Risks in Healthcare Settings

BACKGROUND: Questions remain about the degree to which small particle aerosols are generated during patient care activities and whether such aerosols could transmit viable pathogens to healthcare personnel. This project measured aerosol production during common medical procedures and collected samples for pathogen recovery. METHODS: Six procedures were targeted for aerosol sampling: extubation, bronchoscopy, mechanical ventilation, noninvasive ventilation, suctioning (open or tracheostomy), and nebulized medication administration. Any patient undergoing one of these procedures was eligible for sampling, with a preference for patients with a respiratory viral infection. Baseline samples were collected when possible. Four real-time aerosol characterization instruments were used to detect small particle aerosols generated during procedures. SKC Biosamplers, placed at 3 feet and 6 feet from the patient, were used for pathogen recovery. All samples were subjected to bacterial culture; viral PCR, and viral culture were added depending on the patient’s respiratory disease profile. RESULTS: Samples were collected during extubation (n = 1), bronchoscopy (n = 3), mechanical ventilation (n = 13), noninvasive ventilation (n = 6), suctioning (n = 6), and nebulized medication administration (n = 9). Only nebulized medication administration exhibited differences in particle mass concentration between baseline and procedure aerosol measurements. None of the Biosampler samples were PCR positive for a respiratory virus and none had a positive influenza culture. Five samples had positive bacterial cultures, mainly with common environmental or skin contaminants such as Micrococcus luteus, Staphylococcus pasturei, and Bacillus flexus. CONCLUSION: Significant small particle aerosol generation was only seen with nebulized medication administration. No viruses were recovered and minimal viable bacteria were recovered. Additional study is needed to confirm these findings and examine aerosol generation during other procedures commonly considered to be aerosol-generating. DISCLOSURES: C. A. D. Burnham, bioMerieux: Grant Investigator, Research grant; ThermoFisher: Consultant, Salary; Cepheid: Grant Investigator, Research grant