Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures

Katy Anne Thompson; John V. Pappachan; Allan M. Bennett; Himanshu Mittal; Susan Macken; Brian K. Dove; Jonathan S. Nguyen-Van-Tam; Vicky R. Copley; Sarah O'Brien; Peter Hoffman; Simon Parks; Andrew Bentley; Barbara Isalska; Gail Thomson

doi:10.1371/journal.pone.0056278

Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures

Katy Anne Thompson^*, John V. Pappachan, Allan M. Bennett, Himanshu Mittal, Susan Macken, Brian K. Dove, Jonathan S. Nguyen-Van-Tam, Vicky R. Copley, Sarah O'Brien, Peter Hoffman, Simon Parks, Andrew Bentley, Barbara Isalska, Gail Thomson

^*Corresponding author for this work

Division of Immunology, Immunity to Infection and Respiratory Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Nosocomial infection of health-care workers (HCWs) during outbreaks of respiratory infections (e.g. Influenza A H1N1 (2009)) is a significant concern for public health policy makers. World Health Organization (WHO)-defined 'aerosol generating procedures' (AGPs) are thought to increase the risk of aerosol transmission to HCWs, but there are presently insufficient data to quantify risk accurately or establish a hierarchy of risk-prone procedures. Methodology/Principal Findings: This study measured the amount of H1N1 (2009) RNA in aerosols in the vicinity of H1N1 positive patients undergoing AGPs to help quantify the potential risk of transmission to HCWs. There were 99 sampling occasions (windows) producing a total of 198 May stages for analysis in the size ranges 0.86-7.3 μm. Considering stages 2 (4-7.3 μm) and 3 (0.86-4 μm) as comprising one sample, viral RNA was detected in 14 (14.1%) air samples from 10 (25.6%) patients. Twenty three air samples were collected while potential AGPs were being performed of which 6 (26.1%) contained viral RNA; in contrast, 76 May samples were collected when no WHO 2009 defined AGP was being performed of which 8 (10.5%) contained viral RNA (unadjusted OR = 2.84 (95% CI 1.11-7.24) adjusted OR = 4.31 (0.83-22.5)). Conclusions/Significance: With our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI) = 4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams.

Original language	English
Article number	e56278
Journal	PLoS ONE
Volume	8
Issue number	2
DOIs	https://doi.org/10.1371/journal.pone.0056278
Publication status	Published - 13 Feb 2013

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10.1371/journal.pone.0056278

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Thompson, K. A., Pappachan, J. V., Bennett, A. M., Mittal, H., Macken, S., Dove, B. K., Nguyen-Van-Tam, J. S., Copley, V. R., O'Brien, S., Hoffman, P., Parks, S., Bentley, A., Isalska, B., & Thomson, G. (2013). Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures. PLoS ONE, 8(2), Article e56278. https://doi.org/10.1371/journal.pone.0056278

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title = "Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures",

abstract = "Background: Nosocomial infection of health-care workers (HCWs) during outbreaks of respiratory infections (e.g. Influenza A H1N1 (2009)) is a significant concern for public health policy makers. World Health Organization (WHO)-defined 'aerosol generating procedures' (AGPs) are thought to increase the risk of aerosol transmission to HCWs, but there are presently insufficient data to quantify risk accurately or establish a hierarchy of risk-prone procedures. Methodology/Principal Findings: This study measured the amount of H1N1 (2009) RNA in aerosols in the vicinity of H1N1 positive patients undergoing AGPs to help quantify the potential risk of transmission to HCWs. There were 99 sampling occasions (windows) producing a total of 198 May stages for analysis in the size ranges 0.86-7.3 μm. Considering stages 2 (4-7.3 μm) and 3 (0.86-4 μm) as comprising one sample, viral RNA was detected in 14 (14.1%) air samples from 10 (25.6%) patients. Twenty three air samples were collected while potential AGPs were being performed of which 6 (26.1%) contained viral RNA; in contrast, 76 May samples were collected when no WHO 2009 defined AGP was being performed of which 8 (10.5%) contained viral RNA (unadjusted OR = 2.84 (95% CI 1.11-7.24) adjusted OR = 4.31 (0.83-22.5)). Conclusions/Significance: With our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI) = 4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams.",

author = "Thompson, {Katy Anne} and Pappachan, {John V.} and Bennett, {Allan M.} and Himanshu Mittal and Susan Macken and Dove, {Brian K.} and Nguyen-Van-Tam, {Jonathan S.} and Copley, {Vicky R.} and Sarah O'Brien and Peter Hoffman and Simon Parks and Andrew Bentley and Barbara Isalska and Gail Thomson",

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doi = "10.1371/journal.pone.0056278",

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volume = "8",

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Thompson, KA, Pappachan, JV, Bennett, AM, Mittal, H, Macken, S, Dove, BK, Nguyen-Van-Tam, JS, Copley, VR, O'Brien, S, Hoffman, P, Parks, S, Bentley, A, Isalska, B & Thomson, G 2013, 'Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures', PLoS ONE, vol. 8, no. 2, e56278. https://doi.org/10.1371/journal.pone.0056278

TY - JOUR

T1 - Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures

AU - Thompson, Katy Anne

AU - Pappachan, John V.

AU - Bennett, Allan M.

AU - Mittal, Himanshu

AU - Macken, Susan

AU - Dove, Brian K.

AU - Nguyen-Van-Tam, Jonathan S.

AU - Copley, Vicky R.

AU - O'Brien, Sarah

AU - Hoffman, Peter

AU - Parks, Simon

AU - Bentley, Andrew

AU - Isalska, Barbara

AU - Thomson, Gail

PY - 2013/2/13

Y1 - 2013/2/13

N2 - Background: Nosocomial infection of health-care workers (HCWs) during outbreaks of respiratory infections (e.g. Influenza A H1N1 (2009)) is a significant concern for public health policy makers. World Health Organization (WHO)-defined 'aerosol generating procedures' (AGPs) are thought to increase the risk of aerosol transmission to HCWs, but there are presently insufficient data to quantify risk accurately or establish a hierarchy of risk-prone procedures. Methodology/Principal Findings: This study measured the amount of H1N1 (2009) RNA in aerosols in the vicinity of H1N1 positive patients undergoing AGPs to help quantify the potential risk of transmission to HCWs. There were 99 sampling occasions (windows) producing a total of 198 May stages for analysis in the size ranges 0.86-7.3 μm. Considering stages 2 (4-7.3 μm) and 3 (0.86-4 μm) as comprising one sample, viral RNA was detected in 14 (14.1%) air samples from 10 (25.6%) patients. Twenty three air samples were collected while potential AGPs were being performed of which 6 (26.1%) contained viral RNA; in contrast, 76 May samples were collected when no WHO 2009 defined AGP was being performed of which 8 (10.5%) contained viral RNA (unadjusted OR = 2.84 (95% CI 1.11-7.24) adjusted OR = 4.31 (0.83-22.5)). Conclusions/Significance: With our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI) = 4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams.

AB - Background: Nosocomial infection of health-care workers (HCWs) during outbreaks of respiratory infections (e.g. Influenza A H1N1 (2009)) is a significant concern for public health policy makers. World Health Organization (WHO)-defined 'aerosol generating procedures' (AGPs) are thought to increase the risk of aerosol transmission to HCWs, but there are presently insufficient data to quantify risk accurately or establish a hierarchy of risk-prone procedures. Methodology/Principal Findings: This study measured the amount of H1N1 (2009) RNA in aerosols in the vicinity of H1N1 positive patients undergoing AGPs to help quantify the potential risk of transmission to HCWs. There were 99 sampling occasions (windows) producing a total of 198 May stages for analysis in the size ranges 0.86-7.3 μm. Considering stages 2 (4-7.3 μm) and 3 (0.86-4 μm) as comprising one sample, viral RNA was detected in 14 (14.1%) air samples from 10 (25.6%) patients. Twenty three air samples were collected while potential AGPs were being performed of which 6 (26.1%) contained viral RNA; in contrast, 76 May samples were collected when no WHO 2009 defined AGP was being performed of which 8 (10.5%) contained viral RNA (unadjusted OR = 2.84 (95% CI 1.11-7.24) adjusted OR = 4.31 (0.83-22.5)). Conclusions/Significance: With our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI) = 4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams.

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Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures

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