Aerosol-generating Procedures Research Articles

Chapare virus infection and current perspectives on dentistry.

This narrative review addresses relevant points about Chapare virus (CHAV) entry in oral cells, CHAV transmission, and preventive strategies in dental clinical settings. It is critical in dentistry due to the frequent presence of gingival hemorrhage occurred in CHAV-infected patients. Studies related to CHAV were searched in MEDLINE/PubMed, Scopus, EMBASE, and Web-of-Science databases without language restriction or year of publication. Recently, the PAHO/WHO and CDC indicate a presence of human-to-human transmission of CHAV associated with direct contact with saliva, blood, or urine, and also through droplets or aerosols created in healthcare procedures. CHAV was detected in human oropharyngeal saliva and gingival bleeding was confirmed in all cases of CHAV hemorrhagic fever, including evidence of nosocomial CHAV transmission in healthcare workers. We revisited the human transferrin receptor 1 (TfR1) expression in oral, nasal, and salivary glands tissues, as well as, we firstly identified the critical residues in the pre-glycoprotein (GP) complex of CHAV that interacts with human TfR1 using cutting-edge in silico bioinformatics platforms associated with molecular dynamic analysis. In this multidisciplinary view, we also point out critical elements to provide perspectives on the preventive strategies for dentists and frontline healthcare workers against CHAV, and in the implementation of salivary diagnostic platforms for virus detection, which can be critical to an urgent plan to prevent human-to-human transmission based on current evidence. The preventive strategies in dental clinical settings are pivotal due to the aerosol-generating procedures in dentistry with infected patients or suspected cases of CHAV infection.

Pediatric Plastic Surgery in the COVID-19 Era.

The COVID-19 pandemic has forced the healthcare system to adopt novel strategies to treat patients. Pediatric plastic surgeons are uniquely exposed to high rates of infections during examinations and surgeries via aerosol-generating procedures, in part because of the predilection of viral particles for the nasal cavities and pharynx. Telemedicine has emerged as a useful virtual medium for encouraging prolonged patient follow-up while maintaining physical distance. It has proven beneficial in mitigating infection risks while decreasing the financial burden on patients, their families, and healthcare teams. New trends driven by the pandemic added multiple elements to the patient-physician relationship and have left a lasting impact on the field of pediatric plastic surgery in clinical guidelines, surgical care, and patient outcomes. Lessons learned help inform pediatric plastic surgeons on how to reduce future viral infection risk and lead a more appropriately efficient surgical team depending on early triage.

Healthcare Provider N95 Respirator Contamination Worn Behind Face Shields With SARS-CoV-2 During Routine Clinical Care of Patients With COVID-19.

N95 respirator contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during clinical care of patients with coronavirus disease 2019 is poorly understood. We performed a prospective observational study on healthcare provider's (HCP's) N95 respirators' and face shields' SARS-CoV-2 contamination during aerosol-generating procedures on SARS-CoV-2-positive patients housed in a COVID-19-specific unit. Medical masks worn on top of HCP's N95 respirators, and under face shields, during study aerosol-generating procedures were used as surrogates to detect contamination to avoid waste. Thirty-three HCPs were studied, and a total of 33 mask and 27 face shields were sampled. Masks were cut into 9 pieces and face shields were sampled twice, front and back, to determine locality of contamination; however, no positive samples were identified using standard polymerase chain reaction techniques with a CT value up to 40. All 9 mask piece samples were then pooled, as were face shield samples, using centrifugal concentration with polyethersulfone membranes. Once pooled and concentrated, overall, 9 (15%) samples were positive via real-time polymerase chain reaction: 5 from masks (15.2%) and 4 from face shields (14.8%).

Tracheostomy in Critically Ill Covid 19 Patients: A Review of Outcome

The novel human coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which can result in serious respiratory illness requiring endotracheal intubation, mechanical ventilation, and tracheostomy. Resources on the indication, ideal timing and outcomes for tracheostomy in COVID-19 patients are still limited. Tracheostomy is an aerosol generating procedure with risk of transmission of airborne disease to healthcare workers (HCWs)1. However, tracheostomy aids in ventilation liberation2 for mechanical ventilated patient in general but resources on overall outcome for tracheostomy in COVID-19 patients are not well reported. Thus, a trained surgeon, adequate safety equipment and measures are essential to reduce timing of exposure through this aerosol-generating procedures and reduce risk of complications.

Improving compliance with personal protective equipment among anaesthetists through behaviour-changing interventions during the coronavirus disease 2019(COVID-19) pandemic.

Since 2020, the coronavirus disease 2019 (COVID-19) pandemic has seen many changes in our daily infection prevention behaviours so as to reduce healthcare-associated transmission of COVID-19 in patients and healthcare workers. In the early phases of the COVID-19 pandemic of 2020, there was much emphasis on compliant personal protective equipment utilization in the operating theatres (OTs) for COVID-19-positive patients. However, during this period, there was a lack of international validated protocols on the appropriate handling and subsequent storage of personal protective equipment in the context of aerosol-generating procedures in OTs for asymptomatic antigen rapid test (ART)-negative patients. Given the potential for transmission even with a negative ART due to the incubation period, our team developed a checklist of eye protection (e.g. goggles/face shield) and N95 mask handling and storage in non-isolation OTs for these patients. We sought to improve the compliance of best practices from 20% to 80% amongst junior anaesthetists in Singapore General Hospital so as to prevent infection transmission and cross-contamination in the OT through education and behaviour-changing interventions. This quality improvement project took place over 19 weeks from June to October 2020 by our team of anaesthetists and nurse clinicians in the non-isolation OT setting. To analyse the problem, we performed a root cause analysis to understand attitudes and beliefs driving their behaviour. The top 80% of cited root causes for non-compliance then guided prioritization of resources for subsequent behaviour-changing interventions. Using the comprehensive infection control checklist, we conducted several plan-do-study-act cycles while implementing this new checklist amongst junior anaesthetists. A total of 227 assessments of junior anaesthetists were made in the care of asymptomatic ART-negative patients. Compliance with correctly handling goggles post-intubation started out as 33.3% in Week 1, which improved to 78.5% by Week 19. Compliance with goggle storage and face shield disposal started out at 13.6% in Week 1 and increased to 78.6% by Week 19. We attributed this improvement to education and behaviour-changing interventions. This quality improvement project focusing on improving compliance with personal protective equipment utilization during the COVID-19 pandemic in the management of asymptomatic ART-negative patients in non-isolation OTs demonstrated the importance of interventions of education, persuasion, modelling, and training in effecting and sustaining organizational behaviour change in physicians and other healthcare personnel.

Remotely supervised spirometry versus laboratory-based spirometry during the COVID-19 pandemic: a retrospective analysis

BackgroundThe COVID-19 pandemic has constrained access to spirometry, and the inherent risk of infectious transmission during aerosol-generating procedures has necessitated the rapid development of Remotely Supervised Spirometry (RSS). This innovative approach enables patients to perform spirometry tests at home, using a mobile connected spirometer, all under the real-time supervision of a technician through an online audio or video call.MethodsIn this retrospective study, we examined the quality of RSS in comparison to conventional Laboratory-based Spirometry (LS), using the same device and technician. Our sample included 242 patients, with 129 undergoing RSS and 113 participating in LS. The RSS group comprised 51 females (39.5%) with a median age of 37 years (range: 13–76 years). The LS group included 63 females (55.8%) with a median age of 36 years (range: 12–80 years).ResultsWhen comparing the RSS group to the LS group, the percentage of accurate Forced Expiratory Volume in one second (FEV1) measurements was 78% (n = 101) vs. 86% (n = 97), p = 0.177; for Forced Vital Capacity (FVC) it was 77% (n = 99) vs. 82% (n = 93), p = 0.365; and for both FEV1 and FVC, it was 75% (n = 97) vs. 81% (n = 92), p = 0.312, respectively.ConclusionsOur findings demonstrate no significant difference in the quality of spirometry testing between RSS and LS, a result that held true across all age groups, including patients aged over 65 years. The principal advantages of remote spirometry include improved access to pulmonary function tests, reduced infectious risk to curtail disease spread, and enhanced convenience for patients.

Variation in response to the coronavirus disease 2019 (COVID-19) at US dental school clinics.

Although the threat of coronavirus disease 2019 (COVID-19) was the same at different US dental schools, the response wasn't. There is no study that documents the variation in mitigation strategies, COVID-19 transmission, and clinical educational changes at US Dental schools during the ongoing pandemic that began in 2020 in the US. The current study was approved as exempt research (project number HUM00199261). Our survey of Associate Dean's of Clinical Operations was individually emailed in July 2021. There were no reminders and descriptive statistics were calculated using Microsoft Excel. We received 46 completed surveys from the 68 sent out. Note that 65.2% of respondents reported requiring N95 masks for aerosol-generating procedures. Note that 38.9% of respondents said they required student partnering as chairside dental assistants for aerosol-generating procedures. Note that 37.7% of respondents began using alternate cubicles. A total of 6.52% of schools reported a transmission of the severe acute respiratory syndrome coronavirus 2 virus from patient to provider. There were no reported transmissions from provider to patient or from patient to patient. In our study, we found a lot of similarities between the approach taken by Dental School Clinics across the US to mitigate the risks of COVID-19, however, we also observed many differences.

Bacterial species and factors influencing the contamination of the inner and outer layers of face masks used in dentistry.

Many patients are clinically consulted in dental clinics, where aerosol-generating procedures are widely used. In our previous study, we evaluated the temperature, humidity and contamination rates on the inner layer of masks according to the mask-wearing time. However, it is important to assess the contamination rates on the outer layer of masks used in dentistry as well. Previously, while examining the contamination rates, we only identified the associated bacteria; no detailed analysis of bacterial species depending on the mask-wearing time was conducted. Furthermore, we did not evaluate factors that could contribute to the contamination of masks. The present study was intended to supplement the limitations of our previous study. The used masks were collected. Thereafter, colony forming unit (CFU) quantification and 16S rDNA sequencing were performed to calculate the contamination rates and identify bacterial species. Data on the participants' medical and dental history was collected. The participants filled out a questionnaire and underwent saliva tests. On the inner and outer layers of the masks, 3.3 × 108 and 8.5 × 108 CFUs were found, respectively. The contamination rates of the masks increased with the increasing mask-wearing time. There was no correlation between the contamination rate on the inner layer and other factors, such as the probing depth (PD) ≥4 mm, the bleeding rate, the calculus rate, and saliva characteristics. The inner layer contamination rate increased as the number of treated teeth increased, and as the saliva buffering capacity decreased. The outer layer contamination rate increased with the number of times the mask was touched. The contamination rates were higher on the outer layer than on the inner one, and the CFU count increased with the mask-wearing time. The following bacterial species were found on the masks: Staphylococcus epidermidis (S. epidermidis); Staphylococcus aureus (S. aureus); Staphylococcus capitis (S. capitis); Streptococcus oralis (S. oralis); and Streptococcus koreensis (S. koreensis). Oral health conditions may have affected the contamination of the inner layer. In addition, the number of times the mask was touched may have affected the contamination of the outer layer.

Effectiveness of SplashGuard Caregiver prototype in reducing the risk of aerosol transmission in intensive care unit rooms of SARS-CoV-2 patients: a prospective and simulation study

The contagiousness of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is known to be linked to the emission of bioaerosols. Thus, aerosol-generating procedures (AGPs) could increase the risk of infection among healthcare workers (HCWs). To investigate the impact of an aerosol protection box, the SplashGuard Caregiver (SGGC) with suction system, by direct analysis of the presence of viral particles after an AGP, and by using the computational fluid dynamics (CFD) simulation method. This prospective observational study investigated HCWs caring for patients with SARS-CoV-2 admitted to an intensive care unit (ICU). Rooms were categorized as: SGCG present and SGCG absent. Virus detection was performed through direct analysis, and using a CFD model to simulate the movement dynamics of airborne particles produced by a patient's respiratory activities. Of the 67 analyses performed, three samples tested positive on quantitative polymerase chain reaction: one of 33 analyses in the SCCG group (3%) and two of 34 analyses in the non-SGCG group (5.9%). CFD simulations showed that: (1) reduction of the gaps of an SGCG could decrease the number of emitted particles remaining airborne within the room by up to 70%; and (2) positioning HCWs facing the opposite direction to the main air flow would reduce their exposure. This study documented the presence of SARS-CoV-2 among HCWs in a negative pressure ICU room of an infected patient with or without the use of an SGCG. The simulation will help to improve the design of the SGCG and the positioning of HCWs in the room.

Quantifying Ventilation Design, Room Layout, and Occupant Activity Parameters during Aerosol-Generating Medical Procedures in Hospitals

The risk of airborne disease transmission in hospital rooms during aerosol-generating medical procedures is known to be influenced by the size of the room, air ventilation rate, input-to-output flow ratio, vent surface area, and vent location. However, quantitative recommendations for each ventilation design parameter are scarce. Moreover, room layout and occupant activity parameters, such as furniture locations and healthcare worker movement, are often omitted from studies on airborne disease transmission in hospital settings. As a result, the development of policies and technologies aimed at mitigating airborne disease transmission in hospitals has been limited. To address this shortfall, this study is aimed at first characterizing existing ventilation, room layout, and occupancy parameters in hospital rooms where aerosol generation medical procedures (AGMPs) occur and then testing the hypotheses that ventilation, room layout, and occupancy parameters vary significantly between hospital rooms and, in some cases, with time. Information on AGMPs was collected via a survey circulated to healthcare workers within British Columbia’s Interior Health Authority (IHA), while hospital room and ventilation system information was collected by reviewing drawing packages of 37 IHA hospital rooms. The survey results indicate that AGMPs commonly occur in trauma, ICU, or general ward rooms with positive or negative pressure ventilation systems. Statistical tests, with room type (trauma, ICU, or general), room pressure (positive or negative), and/or time as independent variables, show that variables relating to ventilation (number of supply vents, supply and exhaust vent location, ventilation rate, and supply and exhaust area) and room layout (congestion score, room volume, light area, and number of lights) vary with room type but not with room pressure. Occupant activity variables (number of workers, number of moving workers, and speed score) also vary with room type, although to differing extent with room pressure and time. The survey and drawing review data presented in this study can help guide systematic comparisons of mitigative technologies as well as parametric investigations on how room layout, ventilation, and operational parameters influence airborne disease spread. This is a crucial first step in achieving quantitative and clinically relevant recommendations for mitigating airborne disease transmission in healthcare settings.

Negative pressure booth with HEPA filter reduces the risk of airborne infection associated with transoesophageal echocardiography

Abstract Background The pandemic of coronavirus infection 2019 has persisted, despite reductions in disease severity and deaths. Transoesophageal echocardiography (TOE) is one of the aerosol-generating procedures and increases the risk of airborne infection. However, the effective strategy to reduce the risk has not been fully established. Purpose To evaluate the effectiveness of negative-pressure booth with high-efficiency particulate air (HEPA) filter in control of aerosol generated by TOE. Methods and Results In the TOE examination room, we installed negative-pressure booth. This booth has an air supply port on the ceiling and exhaust port on the head side of examination table, and the airflow is controlled by a push-pull method (Figure 1). The air changes per hour (ACH) for the entire room with was only 8, but 38 inside the booth, meeting the CDC recommended standard for airborne infection isolation room (ACH≥12). Visualization of the airflow by laser light scattering showed that the airflow in the booth bent the trajectory of particulates produced by the patient's cough and sent them to the exhaust port (Figure 2A). The size-specific quantifications for >0.3μm-, >0.5μm-, >1.0μm-diameter particles by a particle counter revealed that the peak particle concentrations within the booth were reduced by approximately 70% after 7 min of ventilation (Figure 2B) in unattended situation. In clinical setting, we monitored particle counts during TOE in 70 cases. Echocardiologists were at greater risk of aerosol exposure than assistants. Multiple regression analysis revealed that patients’ discomfort level during TOE and less experienced echocardiologists were independently correlated with increased particle counts (β=0.376, p=0.003 and β=0.355, p=0.005, respectively). However, aerosols generated in the early time of TEE were almost eliminated by the end of the examination by negative pressure booth. Conclusion The negative pressure booth effectively and quickly reduces small particles equating aerosols. It might be effective to reduce the risk of airborne infection and shorten the patients turnover time of TOE room even in the pandemic of infectious diseases.Figure 1Figure 2

Does doffing the FEES Box generate a significant cloud of particles after aerosol-generating procedures? A proof-of-concept study

Purpose The spread of airborne diseases, including coronaviruses, remains a widespread public health concern. Published studies outline the use of protective barriers to limit the spread of pathogenic particles and droplets resulting from coughing, sneezing, and talking. The findings suggest a role for these barriers during aerosol-generating procedures, such as flexible endoscopic evaluation of swallowing (FEES). However, the question remains of whether doffing a protective barrier will create a concentrated cloud of particles that will increase health professionals’ exposure. Method We simulated four clinical scenarios of coughing and sneezing, talking, eating and drinking, and delivering supplemental oxygen to test whether doffing the FEES Box protective barrier would result in a particle cloud. Result For all scenarios simulated, doffing the FEES Box did not result in a significant increase in mean particle count. Further, the manner of FEES Box removal did not significantly influence mean particle counts on a consistent basis. Conclusion These results suggest that doffing the FEES Box does not increase exposure to airborne particles. Although more research is needed to confirm these findings, FEES Box usage should be considered during aerosol-generating procedures, to protect and reassure healthcare professionals who work with patients with COVID-19 or other airborne diseases.

Cytosponge procedures produce fewer respiratory aerosols and droplets than esophagogastroduodenoscopies.

Esophagogastroduodenoscopies (EGD) are aerosol-generating procedures that may spread respiratory pathogens. We aim to investigate the production of airborne aerosols and droplets during Cytosponge procedures, which are being evaluated in large-scale research studies and National Health Service (NHS)implementation pilots to reduce endoscopy backlogs. We measured 18 Cytosponge and 37 EGD procedures using a particle counter (diameters = 0.3-25μm), taking measurements 10cm from the mouth. Two particle count analyses were performed: whole procedure and event-based. Direct comparison with duration-standardized EGD procedures shows that Cytosponge procedures produce 2.16× reduction (P < 0.001) for aerosols and no significant change for droplets (P =0.332). Event-based analysis shows that particle production is driven by throat spray (aerosols: 138.1× reference, droplets: 16.2×), which is optional, and removal of Cytosponge (aerosols: 14.6×, droplets: 62.6×). Cytosponge burping produces less aerosols than EGD (2.82×, P < 0.05). Cytosponge procedures produce significantly less aerosols and droplets than EGD procedures and thus reduce two potential transmission routes for respiratory viruses.

Generation of Aerosols by Noninvasive Respiratory Support Modalities

Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.

Incidence of Acute Respiratory Infections in Dental Care Professionals

Introduction: A wide spread of causative agents of acute respiratory infections and an intensive use of aerosol-generating procedures in dentistry affect the disease incidence in dental care professionals. This issue, however, remains poorly studied. Objective: To study the incidence of acute respiratory infections in dental health personnel in order to optimize appropriate preventive measures. Materials and methods: In 2021, we conducted a descriptive retrospective epidemiological study of the workplace absence due to acute respiratory diseases among 352 dental care professionals (case study group) and 782 people unrelated to the medical field (control group). To assess the statistical significance of differences in the incidence rates, the Pearson criterion (χ2) was applied. The data were analyzed in Microsoft Office Excel 2013 and Epi Info v. 1.4.3. Results: We established that the incidence rates of viral respiratory diseases in the dental health personnel were 2.2 times higher than in the control group (301.14 and 136.83 ‰, respectively; p = 0.00001). During the respiratory illness season, the cases were 3.3 times more likely to get sick (p = 0.000001). At the same time, the incidence in the cases working in therapeutic and orthopedic departments and applying aerosol-generating procedures was 2.7 times higher compared to those working in other departments (p = 0.00153). Females generally prevailed among therapists and orthopedists (83.81 %) and the rates of viral respiratory infections in them were found to be 2.73 times higher than in male surgeons (p = 0.00134). Conclusions: The high incidence of acute respiratory infections observed in the dental care professionals, especially in those using aerosol-generating procedures in their everyday practice, shows the necessity of improving measures for prevention of respiratory tract infections in dentistry.

Comparison of the safety, effectiveness, and usability of swab robot vs. manual nasopharyngeal specimen collection

BackgroundHealthcare workers face a risk of infection during aerosol-generating procedures, such as nasal swabbing. Robot-assisted nasopharyngeal sampling aims to minimize this risk and reduce stress for healthcare providers. However, its effectiveness and safety require validation. MethodsWe conducted a controlled trial with 80 subjects at two teaching hospitals and compared robot-collected vs manually-collected nasopharyngeal swabs. The primary outcomes included specimen quality and success rate of nasopharyngeal swab collection. We also recorded the pain index, duration of the collection, and psychological stress using a post-collection questionnaire. ResultsDuring the study period, from September 23 to October 27, 2020, 40 subjects were enrolled in both the robotic and manual groups. The cycle threshold (Ct) value for nasopharyngeal specimens was statistically higher in the robotic group compared to the manual group (30.9 vs 28.0, p < 0.01). Both groups had Ct values under 35, indicating good quality specimens. In the robotic group, 3 out of 40 subjects required a second attempt at specimen collection, resulting in a success rate of 92.5 %. Further, although the pain levels were lower in the robotic group, the difference was not statistically significant (2.8 vs 3.6, p = 0.07). The manual group had a shorter sampling time, which was 29 s (201 vs 29, p < 0.05). However, when factoring in the time needed to put on personal protective equipment, the average time for the manual group increased to 251 s (201 vs 251, p < 0.05). Participants' questionnaire results show comparable psychological stress in both groups. Medical staff expressed that using a robot would reduce their psychological stress. ConclusionsWe propose a safe and effective robotic technology for collecting nasopharyngeal specimens without face-to-face contact, which may reduce the stress of physicians and nurses. This technology can also be optimized for efficiency, making it useful in situations where droplet-transmitted infectious diseases are a concern.

Bronchoscopy masks mitigate aerosols during upper gastrointestinal endoscopies.

Background and study aims Upper gastrointestinal endoscopies are considered aerosol-generating procedures (AGP) that risk spread of airborne diseases such as SARS-CoV-2. We aimed to investigate where clinically approved bronchoscopy masks applied to patients during esophagogastroduodenoscopies can mitigate spread of aerosols and droplets. Patients and methods This study included patients undergoing routine upper gastrointestinal endoscopy in a standard endoscopy room and used a particle counter to measure size and number of particles 10 cm from the mouths of 49 patients undergoing upper gastrointestinal endoscopies, of whom 12 wore bronchoscopy masks and 37 did not (controls). Particle counts in the aerosol (≤ 5 µm diameter) and droplet (> 5 µm-diameter) size ranges were measured and averaged over the duration of procedures. Results The use of bronchoscopy masks offers a 47% reduction ( P = 0.01) in particle count for particles < 5 μm in diameter over the procedure duration (aerosols). Conclusions Bronchoscopy masks or similar are a simple, low-cost mitigation technique that can be used during outbreaks of respiratory diseases such as COVID-19 to improve safety and reduce fallow times.

Assessment of knowledge, practices and attitudes of dentists toward coronavirus disease while performing aerosol-generating procedures in dentistry: A cross-sectional survey from India.

Dental procedures that generate aerosols, if not performed with precautions, are the source of infection during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the present study was to analyze dentists' awareness, knowledge and practice regarding the spread of coronavirus in India, to fill the knowledge gaps and to limit the spread of the virus while performing aerosol-generating procedures (AGPs). A cross-sectional survey containing 23 close-ended questions was conducted using the Google Forms platform. The questionnaire was knowledge, practice and attitude-based (KPA). It was completed by Indian dentists stratified according to gender, designation, years of experience, and residence type. Data was analyzed with the χ2 test, and summarized using frequency and percentage. The independent samples t test and the one-way analysis of variance (ANOVA) were used to analyze intergroup differences. With regard to knowledge, females, specialists with 10 years of experience and those living in metro cities scored higher. For practice-based questions, males, the teaching staff, dentists with less than 5 years of experience, and those living in suburban areas provided more correct answers. For attitude-based questions, females, general practitioners (GPs), dentists with less than 5 years of experience, and those residing in suburban areas provided more correct answers. Dentists in India demonstrated a high level of understanding with regard to COVID-19. However, they showed a limited understanding of the extra preventative procedures to safeguard against the disease. The study findings have significant implications for the measures aimed at increasing dentists' level of KPA toward coronavirus.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) RNA and viable virus contamination of hospital emergency department surfaces and association with patient coronavirus disease 2019 (COVID-19) status and aerosol-generating procedures.

Emergency departments are high-risk settings for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) surface contamination. Environmental surface samples were obtained in rooms with patients suspected of having COVID-19 who did or did not undergo aerosol-generating procedures (AGPs). SARS-CoV-2 RNA surface contamination was most frequent in rooms occupied by coronavirus disease 2019 (COVID-19) patients who received no AGPs.

Four key problems that will need to be addressed during the next pandemic

In June 2023, the UK began official hearings for its independent investigation into pandemic preparedness. Thus far, the inquiry has been told that planning has been wholly inadequate and that a future outbreak is inevitable. We present here four key problems that contributed to significant morbidity and mortality during the Coronavirus 2019 (COVID-19) pandemic over the past 3 years in the UK - and which will contribute to excess morbidity and mortality in the next outbreak. First, there was misunderstanding about what procedures were deemed as aerosol generating. Aerosol transmission has always been a component of respiratory viruses; however, no specific aerosol-generating procedures are required to transmit any respiratory pathogens over long distances. Second, policy-makers were too binary in their answers to the public in terms of questions about severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). This meant that, as evidence evolved and different conclusions were drawn, the public lost faith in both the UK Government and science. Third, public health guidance did not take into account that certain groups would be impacted differentially by public health guidelines and instead used a one-size-fits-all approach to non-pharmaceutical interventions. Finally, there was worsening of existing inequalities, especially in ethnic minority groups, that resulted in excessive numbers within certain cohorts becoming infected.