1. Aerosol GenerationDuringPatientCare Activities
Authors:
JiayuLi,Anna Leavey,WangYang, Matthew Hink, Carrie ONeil,MeghanWallace,PratimBiswas,Carey-
AnnBurnham,HilaryBabcock
Background: Questionsremainaboutthe degree towhichaerosolsare generatedduringpatientcare
activitiesandwhethergeneratedaerosolscouldtransmitviable pathogenstohealthcare personnel
or to other patients. Thisprojectmeasuredaerosol productionduringpatientcare andtooksamples
for pathogenrecovery.
Methods:Sevenpatientcare activitieswere eachsampledfivetimes:patientbathing,changingbed
linens,pouringandflushingliquidwaste,bronchoscopy(withandwithoutnegative pressure
ventilation),non-invasiveventilationandnebulizedmedicationadministration. Five aerosol
characterizationinstrumentswere usedforeachsamplingepisode. A biosamplerwasusedfor
pathogenrecovery. Cultureswereperformedof all collectionmedia andanygrowthidentified. Patients
on contact precautionsfordrugresistantorganismswere selectedforroutine activities. Anypatient
undergoingbronchoscopywaseligible. Baselinesampleswere performedwhenpossible.
Results: There were 35 samplingepisodes. Onlytwoproceduresgeneratedasignificantchange in
particle presence overbaseline:bronchoscopywithnebulizedmedicationadministrationandnebulized
medicationadministration(figuresa& b). Bronchoscopywithoutnebulizedmedicationandnon-
invasive ventilationdidnotgenerate significantaerosols. Onlynebulizedmedicationadministration
generatedasignificantincreaseinthe total surface areaof particlesthatcoulddepositinthe alveolar
regionof the lung. Of 78 impingersamplescultured,only18were positive. Of baselinesamples,6/28
(21%) andof procedure samples12/50 (24%) were positive.Notargetedorganismswere recovered.The
mostfrequentlyisolatedwascoagulase-negative staphylococcus(12),followedbymicrococcus (6).
Conclusion: Inthissmall pilotstudy,significantaerosol generationwasonlyseenwithnebulized
medicationadministration.Minimalviable bacteriawererecovered,mostlycommonenvironmental
contaminants. Limitationsincludesmall numbers,lack of clinical data,one samplinglocationforeach
procedure,andlackof viral pathogenrecovery.