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Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 During Aerosol-Generating Procedures in Critical Care: A Systematic Review and Meta-Analysis of Observational Studies.
Crit Care Med. 2021 07 01; 49(7):1159-1168.CC

Abstract

OBJECTIVES

To assess the risk of coronavirus transmission to healthcare workers performing aerosol-generating procedures and the potential benefits of personal protective equipment during these procedures.

DATA SOURCES

MEDLINE, EMBASE, and Cochrane CENTRAL were searched using a combination of related MeSH terms and keywords.

STUDY SELECTION

Cohort studies and case controls investigating common anesthetic and critical care aerosol-generating procedures and transmission of severe acute respiratory syndrome coronavirus 1, Middle East respiratory syndrome coronavirus, and severe acute respiratory syndrome coronavirus 2 to healthcare workers were included for quantitative analysis.

DATA EXTRACTION

Qualitative and quantitative data on the transmission of severe acute respiratory syndrome coronavirus 1, severe acute respiratory syndrome coronavirus 2, and Middle East respiratory syndrome coronavirus to healthcare workers via aerosol-generating procedures in anesthesia and critical care were collected independently. The Risk Of Bias In Non-randomized Studies - of Interventions tool was used to assess the risk of bias of included studies.

DATA SYNTHESIS

Seventeen studies out of 2,676 yielded records were included for meta-analyses. Endotracheal intubation (odds ratio, 6.69, 95% CI, 3.81-11.72; p < 0.001), noninvasive ventilation (odds ratio, 3.65; 95% CI, 1.86-7.19; p < 0.001), and administration of nebulized medications (odds ratio, 10.03; 95% CI, 1.98-50.69; p = 0.005) were found to increase the odds of healthcare workers contracting severe acute respiratory syndrome coronavirus 1 or severe acute respiratory syndrome coronavirus 2. The use of N95 masks (odds ratio, 0.11; 95% CI, 0.03-0.39; p < 0.001), gowns (odds ratio, 0.59; 95% CI, 0.48-0.73; p < 0.001), and gloves (odds ratio, 0.39; 95% CI, 0.29-0.53; p < 0.001) were found to be significantly protective of healthcare workers from contracting severe acute respiratory syndrome coronavirus 1 or severe acute respiratory syndrome coronavirus 2.

CONCLUSIONS

Specific aerosol-generating procedures are high risk for the transmission of severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2 from patients to healthcare workers. Personal protective equipment reduce the odds of contracting severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2.

Authors+Show Affiliations

School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong, China.JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.Department of Medicine, McMaster University, Hamilton, ON, Canada.S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33749225

Citation

Chan, Vinson Wai-Shun, et al. "Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 During Aerosol-Generating Procedures in Critical Care: a Systematic Review and Meta-Analysis of Observational Studies." Critical Care Medicine, vol. 49, no. 7, 2021, pp. 1159-1168.
Chan VW, Ng HH, Rahman L, et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 During Aerosol-Generating Procedures in Critical Care: A Systematic Review and Meta-Analysis of Observational Studies. Crit Care Med. 2021;49(7):1159-1168.
Chan, V. W., Ng, H. H., Rahman, L., Tang, A., Tang, K. P., Mok, A., Liu, J. H. P., Ho, K. S. C., Chan, S. M., Wong, S., Teoh, A. Y., Chan, A., Wong, M., Yuan, Y., & Teoh, J. Y. (2021). Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 During Aerosol-Generating Procedures in Critical Care: A Systematic Review and Meta-Analysis of Observational Studies. Critical Care Medicine, 49(7), 1159-1168. https://doi.org/10.1097/CCM.0000000000004965
Chan VW, et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 During Aerosol-Generating Procedures in Critical Care: a Systematic Review and Meta-Analysis of Observational Studies. Crit Care Med. 2021 07 1;49(7):1159-1168. PubMed PMID: 33749225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transmission of Severe Acute Respiratory Syndrome Coronavirus 1 and Severe Acute Respiratory Syndrome Coronavirus 2 During Aerosol-Generating Procedures in Critical Care: A Systematic Review and Meta-Analysis of Observational Studies. AU - Chan,Vinson Wai-Shun, AU - Ng,Helen Hoi-Lam, AU - Rahman,Laiba, AU - Tang,Audrey, AU - Tang,Kwan Pui, AU - Mok,Alex, AU - Liu,Jeremy Ho Pak, AU - Ho,Kenny Shiu Cheong, AU - Chan,Shannon Melissa, AU - Wong,Sunny, AU - Teoh,Anthony Yuen-Bun, AU - Chan,Albert, AU - Wong,Martin, AU - Yuan,Yuhong, AU - Teoh,Jeremy Yuen-Chun, PY - 2021/3/23/pubmed PY - 2021/7/2/medline PY - 2021/3/22/entrez SP - 1159 EP - 1168 JF - Critical care medicine JO - Crit Care Med VL - 49 IS - 7 N2 - OBJECTIVES: To assess the risk of coronavirus transmission to healthcare workers performing aerosol-generating procedures and the potential benefits of personal protective equipment during these procedures. DATA SOURCES: MEDLINE, EMBASE, and Cochrane CENTRAL were searched using a combination of related MeSH terms and keywords. STUDY SELECTION: Cohort studies and case controls investigating common anesthetic and critical care aerosol-generating procedures and transmission of severe acute respiratory syndrome coronavirus 1, Middle East respiratory syndrome coronavirus, and severe acute respiratory syndrome coronavirus 2 to healthcare workers were included for quantitative analysis. DATA EXTRACTION: Qualitative and quantitative data on the transmission of severe acute respiratory syndrome coronavirus 1, severe acute respiratory syndrome coronavirus 2, and Middle East respiratory syndrome coronavirus to healthcare workers via aerosol-generating procedures in anesthesia and critical care were collected independently. The Risk Of Bias In Non-randomized Studies - of Interventions tool was used to assess the risk of bias of included studies. DATA SYNTHESIS: Seventeen studies out of 2,676 yielded records were included for meta-analyses. Endotracheal intubation (odds ratio, 6.69, 95% CI, 3.81-11.72; p < 0.001), noninvasive ventilation (odds ratio, 3.65; 95% CI, 1.86-7.19; p < 0.001), and administration of nebulized medications (odds ratio, 10.03; 95% CI, 1.98-50.69; p = 0.005) were found to increase the odds of healthcare workers contracting severe acute respiratory syndrome coronavirus 1 or severe acute respiratory syndrome coronavirus 2. The use of N95 masks (odds ratio, 0.11; 95% CI, 0.03-0.39; p < 0.001), gowns (odds ratio, 0.59; 95% CI, 0.48-0.73; p < 0.001), and gloves (odds ratio, 0.39; 95% CI, 0.29-0.53; p < 0.001) were found to be significantly protective of healthcare workers from contracting severe acute respiratory syndrome coronavirus 1 or severe acute respiratory syndrome coronavirus 2. CONCLUSIONS: Specific aerosol-generating procedures are high risk for the transmission of severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2 from patients to healthcare workers. Personal protective equipment reduce the odds of contracting severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/33749225/Transmission_of_Severe_Acute_Respiratory_Syndrome_Coronavirus_1_and_Severe_Acute_Respiratory_Syndrome_Coronavirus_2_During_Aerosol_Generating_Procedures_in_Critical_Care:_A_Systematic_Review_and_Meta_Analysis_of_Observational_Studies_ L2 - https://dx.doi.org/10.1097/CCM.0000000000004965 DB - PRIME DP - Unbound Medicine ER -