Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ontario, Canada.
PLoS One. 2012;7(4):e35797. doi: 10.1371/journal.pone.0035797. Epub 2012 Apr 26.
Aerosol generating procedures (AGPs) may expose health care workers (HCWs) to pathogens causing acute respiratory infections (ARIs), but the risk of transmission of ARIs from AGPs is not fully known. We sought to determine the clinical evidence for the risk of transmission of ARIs to HCWs caring for patients undergoing AGPs compared with the risk of transmission to HCWs caring for patients not undergoing AGPs. We searched PubMed, EMBASE, MEDLINE, CINAHL, the Cochrane Library, University of York CRD databases, EuroScan, LILACS, Indian Medlars, Index Medicus for SE Asia, international health technology agencies and the Internet in all languages for articles from 01/01/1990 to 22/10/2010. Independent reviewers screened abstracts using pre-defined criteria, obtained full-text articles, selected relevant studies, and abstracted data. Disagreements were resolved by consensus. The outcome of interest was risk of ARI transmission. The quality of evidence was rated using the GRADE system. We identified 5 case-control and 5 retrospective cohort studies which evaluated transmission of SARS to HCWs. Procedures reported to present an increased risk of transmission included [n; pooled OR(95%CI)] tracheal intubation [n = 4 cohort; 6.6 (2.3, 18.9), and n = 4 case-control; 6.6 (4.1, 10.6)], non-invasive ventilation [n = 2 cohort; OR 3.1(1.4, 6.8)], tracheotomy [n = 1 case-control; 4.2 (1.5, 11.5)] and manual ventilation before intubation [n = 1 cohort; OR 2.8 (1.3, 6.4)]. Other intubation associated procedures, endotracheal aspiration, suction of body fluids, bronchoscopy, nebulizer treatment, administration of O2, high flow O2, manipulation of O2 mask or BiPAP mask, defibrillation, chest compressions, insertion of nasogastric tube, and collection of sputum were not significant. Our findings suggest that some procedures potentially capable of generating aerosols have been associated with increased risk of SARS transmission to HCWs or were a risk factor for transmission, with the most consistent association across multiple studies identified with tracheal intubation.
气溶胶生成程序（AGP）可能使医护人员（HCW）暴露于引起急性呼吸道感染（ARI）的病原体，但 AGP 传播 ARI 的风险尚不完全清楚。我们旨在确定与照顾未接受 AGP 患者的 HCW 相比，照顾接受 AGP 患者的 HCW 发生 ARI 传播的临床证据。我们检索了 PubMed、EMBASE、MEDLINE、CINAHL、Cochrane 图书馆、约克大学 CRD 数据库、EuroScan、LILACS、印度 Medlars、东南亚医学索引、国际卫生技术机构和所有语言的互联网，以获取 1990 年 1 月 1 日至 2010 年 10 月 22 日的文章。独立审查员使用预定义标准筛选摘要，获取全文文章，选择相关研究，并提取数据。分歧通过共识解决。关注的结果是 ARI 传播的风险。使用 GRADE 系统对证据质量进行评级。我们确定了 5 项病例对照和 5 项回顾性队列研究，评估了 SARS 向 HCW 的传播。报告为增加传播风险的程序包括[ n; 汇总 OR（95%CI）]气管插管[ n = 4 队列；6.6（2.3，18.9）和 n = 4 病例对照；6.6（4.1，10.6）]、无创通气[ n = 2 队列；OR 3.1（1.4，6.8）]、气管切开术[ n = 1 病例对照；4.2（1.5，11.5）]和插管前手动通气[ n = 1 队列；OR 2.8（1.3，6.4）]。其他与插管相关的程序，如气管内吸痰、体液抽吸、支气管镜检查、雾化治疗、O2 给药、高流量 O2、O2 面罩或 BiPAP 面罩的操作、除颤、胸外按压、鼻胃管插入和痰液采集没有显著相关性。我们的研究结果表明，一些可能能够产生气溶胶的程序与 SARS 向 HCW 传播的风险增加有关，或与传播有关，在多个研究中，气管插管的相关性最一致。
