The risk of coronavirus to healthcare providers during aerosol-generating procedures: A systematic review and meta-analysis.

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From: Annals of Thoracic Medicine(Vol. 16, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 2,729 words
Lexile Measure: 1510L

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Byline: Sharafaldeen. Bin Nafisah, Bandr. Mzahim, Bakhitah. Aleid, Shahad. Sheerah, Daliah. Almatrafi, Gregory. Ciottone, Khalid. AlAnazi, Anas. Khan

CONTEXT: Several medical procedures are thought to increase the risk of transmission of infectious agents to health-care providers (HCPs) through an aerosol-generating mechanism. AIMS: Given the significant influenza and coronavirus pandemics that have occurred in the 20th and 21st century, including the current severe acute respiratory syndrome coronavirus 2 global pandemic, the objective of this analysis is to assess the occurrence of disease transmission to HCPs from the performance aerosol-generating procedures (AGPs). SETTINGS AND DESIGN: This was a systematic review and meta-analysis SUBJECTS AND METHODS: We performed a systematic meta-analysis looking at the odds ratio (OR) of AGP, causing infection among HCPs. We searched the following databases: MEDLINE (PubMed), ProQuest, Cochrane databases, and the Gray literature ( and World Health Organization International Clinical Trials Registry Platform). In addition, we conducted nondatabase search activities. The search terms used were 'MERS-CoV,' 'COVID,' and 'SARS' combined with 'provider' or 'healthcare provider.' STATISTICAL ANALYSIS USED: RevMan meta-analysis was used for statistical analysis. RESULTS: Following the search, we reviewed 880 studies, of which six studies were eligible. The estimated odd ratio utilizing a control group of HCPs who were exposed to AGP but did not develop the infection was 1.85 (95% confidence interval [CI]: 1.33, 2.57). The OR remained the same when we added another control group who, despite not being exposed to AGP, had developed the infection. The OR remained 1.85 (95% CI: 1.33, 2.55). However, there is an increase in the OR to 1.89 (95% CI: 1.38, 2.59) when we added HCPs who did not use adequate personal protective equipment (PPE) during the procedures to the total estimates. CONCLUSIONS: The performance of AGP with inadequate PPE can result in an increased risk of disease transmission to HCWs.

Several medical procedures are thought to increase the risk of transmission of infection to health-care providers (HCPs), in particular those which are aerosol generating in nature, for example, endotracheal intubation, respiratory suctioning, adjustment of oxygen masks, bag-valve-mask ventilation, and other forms of noninvasive ventilation, in addition to the performance of cardiopulmonary resuscitation (CPR).[1],[2],[3],[4]

Coronavirus is known to have three strains, including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS coronavirus 2 (SARS-CoV-2). All share a similar mode of droplet transmission. As such, aerosol-generating procedures (AGPs) are thought to play a significant role in disease transmission among HCP.[5],[6],[7] Due to the widespread infections over the last two decades caused by novel viruses in the Coronaviridae family, the objective of this analysis is to assess the effects of AGP on the transmission of infectious agents among HCPs. Our review seeks to examine the risk of HCPs working during the current SARS-CoV-2 pandemic from the performance of AGPs.

Subjects and Methods


Search strategy

The eligibility criteria utilize a systematic search strategy for study selection to include observational studies of case-control and cohort studies that had 'MERS-CoV,' 'COVID,' and 'SARS' combined with 'provider' or 'healthcare provider.'...

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Gale Document Number: GALE|A660154802