Pena Mirle, Neu Dylan T, Feng H Amy, Hammond Duane R, Mead Kenneth R, Banerjee Rupak K
Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221.
Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226.
J Med Device. 2023 Mar 1;17(1):011009. doi: 10.1115/1.4056694. Epub 2023 Jan 31.
Emergency medical service (EMS) providers have a higher potential exposure to infectious agents than the general public (Nguyen et al., 2020, "Risk of COVID-19 Among Frontline Healthcare Workers and the General Community: A Prospective Cohort Study," Lancet Pub. Health, (9), pp. e475-e483; Brown et al., 2021, "Risk for Acquiring Coronavirus Disease Illness Among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures," Emer. Infect. Disease J., (9), p. 2340). The use of protective equipment may reduce, but does not eliminate their risk of becoming infected as a result of these exposures. Prehospital environments have a high risk of disease transmission exposing EMS providers to bioaerosols and droplets from infectious patients. Field intubation procedures may be performed causing the generation of bioaerosols, thereby increasing the exposure of EMS workers to pathogens. Additionally, ambulances have a reduced volume compared to a hospital treatment space, often without an air filtration system, and no control mechanism to reduce exposure. This study evaluated a containment plus filtration intervention for reducing aerosol concentrations in the patient module of an ambulance. Aerosol concentration measurements were taken in an unoccupied research ambulance at National Institute for Occupational Safety and Health (NIOSH) Cincinnati using a tracer aerosol and optical particle counters (OPCs). The evaluated filtration intervention was a containment pod with a high efficiency particulate air (HEPA)-filtered extraction system that was developed and tested based on its ability to contain, capture, and remove aerosols during the intubation procedure. Three conditions were tested (1) baseline (without intervention), (2) containment pod with HEPA-1, and (3) containment pod with HEPA-2. The containment pod with HEPA-filtered extraction intervention provided containment of 95% of the total generated particle concentration during aerosol generation relative to the baseline condition, followed by rapid air cleaning within the containment pod. This intervention can help reduce aerosol concentrations within ambulance patient modules while performing aerosol-generating procedures.
与普通公众相比，紧急医疗服务（EMS）提供者接触传染源的可能性更高（Nguyen等人，2020年，“一线医护人员和普通社区中COVID-19的风险：一项前瞻性队列研究”，《柳叶刀公共卫生》，第9期，第e475 - e483页；Brown等人，2021年，“暴露于产生气溶胶程序的紧急医疗服务人员感染冠状病毒病的风险”，《新发传染病杂志》，第9期，第2340页）。使用防护设备可能会降低但不能消除他们因这些接触而感染的风险。院前环境存在疾病传播的高风险，使EMS提供者暴露于来自感染患者的生物气溶胶和飞沫中。现场插管程序可能会导致生物气溶胶的产生，从而增加EMS工作人员接触病原体的机会。此外，与医院治疗空间相比，救护车的空间较小，通常没有空气过滤系统，也没有减少接触的控制机制。本研究评估了一种用于降低救护车患者舱内气溶胶浓度的围堵加过滤干预措施。在美国国家职业安全与健康研究所（NIOSH）辛辛那提分部的一辆无人使用的研究用救护车上，使用示踪气溶胶和光学粒子计数器（OPC）进行了气溶胶浓度测量。评估的过滤干预措施是一个带有高效空气过滤器（HEPA）过滤抽取系统的围堵舱，该系统是根据其在插管过程中容纳、捕获和去除气溶胶的能力而开发和测试的。测试了三种情况：（1）基线（无干预），（2）带有HEPA - 1的围堵舱，以及（3）带有HEPA - 2的围堵舱。与基线情况相比，带有HEPA过滤抽取干预的围堵舱在气溶胶产生期间能够容纳95%的总产生颗粒浓度，随后围堵舱内的空气迅速得到净化。这种干预措施有助于在进行产生气溶胶的程序时降低救护车患者舱内的气溶胶浓度。
