Abstract
To evaluate the evidence of aerosol generation across tasks involved in voice and speech assessment and intervention, to inform better management and to reduce transmission risk of such diseases as COVID-19 in healthcare settings and the wider community. Systematic literature review. Medline, Embase, Scopus, Web of Science, CINAHL, PubMed Central and grey literature through ProQuest, The Centre for Evidence-Based Medicine, COVID-Evidence and speech pathology national bodies were searched up until August 13th, 2020 for articles examining the aerosol-generating activities in clinical voice and speech assessment and intervention within speech pathology. Of the 8288 results found, 39 studies were included for data extraction and analysis. Included articles were classified into one of three categories: research studies, review articles or clinical guidelines. Data extraction followed appropriate protocols depending on the classification of each article (e.g. PRISMA for review articles). Articles were assessed for risk of bias and certainty of evidence using the GRADE system. Six behaviours were identified as aerosol generating. These were classified into three categories: vegetative acts (coughing, breathing), verbal communication activities of daily living (speaking, loud voicing), and performance-based tasks (singing, sustained phonation). Certainty of evidence ranged from very low to moderate with variation in research design and variables. This body of literature helped to both identify and categorise the aerosol-generating behaviours involved in speech pathology clinical practice and confirm the low level of evidence throughout the speech pathology literature pertaining to aerosol generation. As many aerosol-generating behaviours are common human behaviours, these findings can be applied across healthcare and community settings. Registration number CRD42020186902 with PROSPERO International Prospective Register for Systematic Reviews.
Highlights
Aerosol generation is the suspension in air of liquid or solid particles [1]
This body of literature helped to both identify and categorise the aerosol-generating behaviours involved in speech pathology clinical practice and confirm the low level of evidence throughout the speech pathology literature pertaining to aerosol generation
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 is a highly contagious virus [4] with a high mortality rate [5] and emerging morbidity associated with long COVID [6], which has resulted in an enormous burden upon the healthcare system globally [7, 8]
Summary
Aerosol generation (or aerosolisation) is the suspension in air of liquid or solid particles [1]. Aerosols form part of a continuum of particle sizes generated through a range of respiratory activities in humans, which can carry infective viral material and facilitate respiratory disease transmission [2]. Aerosol-generating procedures (AGPs) have been defined in the literature as medical procedures which lead to the generation of aerosols of sufficient size to enable viral transmission [3]. Despite this restricted consideration of AGPs as occurring in medicine, there is an imperative to investigate what is known about other human aerosolising activities or aerosol-generating behaviours (AGBs) that occur in other healthcare settings and by extension, in everyday life. Healthcare workers (HCWs) face an especially high risk of contracting COVID-19 in their patient interactions, owing to the ease of virus transmission through airborne aerosols, droplets and fomite contact [8, 9] and preliminary evidence that the highest viral load of coronavirus in the body is localised in the oro- and nasopharynx, with sputum and nasal/throat swabs containing significantly higher traces of the virus than samples taken from other bodily fluids, such as blood and urine [10, 11]
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