Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, UK.
Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK.
Anaesthesia. 2022 Sep;77(9):959-970. doi: 10.1111/anae.15803. Epub 2022 Jul 21.
The evidence base surrounding the transmission risk of 'aerosol-generating procedures' has evolved primarily through quantification of aerosol concentrations during clinical practice. Consequently, infection prevention and control guidelines are undergoing continual reassessment. This mixed-methods study aimed to explore the perceptions of practicing anaesthetists regarding aerosol-generating procedures. An online survey was distributed to the Membership Engagement Group of the Royal College of Anaesthetists during November 2021. The survey included five clinical scenarios to identify the personal approach of respondents to precautions, their hospital's policies and the associated impact on healthcare provision. A purposive sample was selected for interviews to explore the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed thematically. The sample was broadly representative of the UK anaesthetic workforce. Most respondents and their hospitals were aware of, supported and adhered to UK guidance. However, there were examples of substantial divergence from these guidelines at both individual and hospital level. For example, 40 (12%) requested respiratory protective equipment and 63 (20%) worked in hospitals that required it to be worn whilst performing tracheal intubation in SARS-CoV-2 negative patients. Additionally, 173 (52%) wore respiratory protective equipment whilst inserting supraglottic airway devices. Regarding the use of respiratory protective equipment and fallow times in the operating theatre: 305 (92%) perceived reduced efficiency; 376 (83%) perceived a negative impact on teamworking; 201 (64%) were worried about environmental impact; and 255 (77%) reported significant problems with communication. However, 269 (63%) felt the negative impacts of respiratory protection equipment were appropriately balanced against the risks of SARS-CoV-2 transmission. Attitudes were polarised about the prospect of moving away from using respiratory protective equipment. Participants' perceived risk from COVID-19 correlated with concern regarding stepdown (Spearman's test, R = 0.36, p < 0.001). Attitudes towards aerosol-generating procedures and the need for respiratory protective equipment are evolving and this information can be used to inform strategies to facilitate successful adoption of revised guidelines.
本研究旨在探讨执业麻醉师对产生气溶胶程序的看法。我们于 2021 年 11 月向皇家麻醉师学院会员参与小组在线分发了一份调查问卷。该调查包括五个临床场景，以确定受访者对预防措施的个人方法、他们所在医院的政策以及对医疗保健服务的相关影响。选择了一个有针对性的样本进行访谈，以更深入地探讨他们的看法和行为背后的原因。共分析了 333 份调查回复的定量数据。对 18 次访谈的文字记录进行了编码和主题分析。样本在很大程度上代表了英国麻醉师队伍。大多数受访者及其所在医院了解、支持并遵守英国指南。然而，在个人和医院层面都存在与这些指南有很大差异的情况。例如，40 人（12%）要求使用呼吸防护设备，63 人（20%）在 SARS-CoV-2 检测结果为阴性的患者进行气管插管时，工作所在医院要求佩戴呼吸防护设备。此外，173 人（52%）在插入声门上气道装置时佩戴呼吸防护设备。关于在手术室使用呼吸防护设备和隔离时间：305 人（92%）认为效率降低；376 人（83%）认为对团队合作有负面影响；201 人（64%）担心对环境的影响；255 人（77%）报告说与沟通有很大问题。然而，269 人（63%）认为佩戴呼吸防护设备的负面影响与 SARS-CoV-2 传播的风险相平衡。关于是否不再使用呼吸防护设备，人们的态度两极分化。参与者对 COVID-19 的感知风险与对降级的担忧相关（Spearman 检验，R=0.36，p<0.001）。对产生气溶胶程序的态度和对呼吸防护设备的需求正在发生变化，这些信息可用于为制定策略提供信息，以促进对修订后的指南的成功采用。
