Infectious Diseases Division, Washington University School of Medicine, St Louis, MS
School of Engineering and Applied Science, Department of Energy, Environmental, and Chemical Engineering, Aerosol and Air Quality Research Laboratory, Washington University, St Louis, Missouri.
Clin Infect Dis. 2017 Oct 15;65(8):1335-1341. doi: 10.1093/cid/cix535.
Questions remain about the degree to which aerosols are generated during routine patient care activities and whether such aerosols could transmit viable pathogens to healthcare personnel (HCP). The objective of this study was to measure aerosol production during multiple patient care activities and to examine the samples for bacterial pathogens.
Five aerosol characterization instruments were used to measure aerosols during 7 patient care activities: patient bathing, changing bed linens, pouring and flushing liquid waste, bronchoscopy, noninvasive ventilation, and nebulized medication administration (NMA). Each procedure was sampled 5 times. An SKC BioSampler was used for pathogen recovery. Bacterial cultures were performed on the sampling solution. Patients on contact precautions for drug-resistant organisms were selected for most activity sampling. Any patient undergoing bronchoscopy was eligible.
Of 35 sampling episodes, only 2 procedures showed a significant increase in particle concentrations over baseline: NMA and bronchoscopy with NMA. Bronchoscopy without NMA and noninvasive ventilation did not generate significant aerosols. Of 78 cultures from the impinger samples, 6 of 28 baseline samples (21.4%) and 14 of 50 procedure samples (28.0%) were positive.
In this study, significant aerosol generation was only observed during NMA, both alone and during bronchoscopy. Minimal viable bacteria were recovered, mostly common environmental organisms. Although more research is needed, these data suggest that some of the procedures considered to be aerosol-generating may pose little infection risk to HCP.
目前仍不清楚在常规患者护理活动中会产生多大程度的气溶胶，以及这些气溶胶是否会将有活力的病原体传播给医护人员（HCP）。本研究的目的是测量多种患者护理活动期间产生的气溶胶，并检查样本中的细菌病原体。
使用 5 种气溶胶特征化仪器在 7 种患者护理活动期间测量气溶胶：患者沐浴、更换床单、倾倒和冲洗液体废物、支气管镜检查、无创通气和雾化药物给药（NMA）。每次操作采样 5 次。使用 SKC BioSampler 进行病原体回收。对采样溶液进行细菌培养。选择对耐药菌进行接触预防的患者进行大多数活动采样。所有接受支气管镜检查的患者均符合条件。
在 35 次采样事件中，只有 2 种程序显示粒子浓度比基线显著增加：NMA 和 NMA 支气管镜检查。支气管镜检查而不进行 NMA 或无创通气不会产生显著的气溶胶。在撞击器样本的 78 个培养物中，28 个基线样本中有 6 个（21.4%）和 50 个操作样本中有 14 个（28.0%）为阳性。
在这项研究中，仅在 NMA 期间，无论是单独进行还是在支气管镜检查期间，才观察到明显的气溶胶生成。回收的活菌很少，主要是常见的环境生物体。尽管需要进一步研究，但这些数据表明，一些被认为是产生气溶胶的操作可能对 HCP 构成的感染风险很小。
