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Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy.

Authors
  • Gregson, Florence K A1
  • Shrimpton, Andrew J2, 3
  • Hamilton, Fergus4
  • Cook, Tim M5
  • Reid, Jonathan P1
  • Pickering, Anthony E2, 6
  • Pournaras, Dimitri J7
  • Bzdek, Bryan R1
  • Brown, Jules8
  • 1 School of Chemistry, University of Bristol, Bristol, UK.
  • 2 School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
  • 3 Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK.
  • 4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
  • 5 Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals NHS Trust, Bath, and Bristol Medical School, University of Bristol, Bristol, UK.
  • 6 Bristol Anaesthesia, Pain and Critical Care Sciences, Translational Health Sciences, Bristol Medical School, Bristol, UK.
  • 7 Department of Upper Gastrointestinal and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Bristol, UK.
  • 8 Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK [email protected]
Type
Published Article
Journal
Gut
Publisher
BMJ
Publication Date
May 01, 2022
Volume
71
Issue
5
Pages
871–878
Identifiers
DOI: 10.1136/gutjnl-2021-324588
PMID: 34187844
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To determine if oesophago-gastro-duodenoscopy (OGD) generates increased levels of aerosol in conscious patients and identify the source events. A prospective, environmental aerosol monitoring study, undertaken in an ultraclean environment, on patients undergoing OGD. Sampling was performed 20 cm away from the patient's mouth using an optical particle sizer. Aerosol levels during OGD were compared with tidal breathing and voluntary coughs within subject. Patients undergoing bariatric surgical assessment were recruited (mean body mass index 44 and mean age 40 years, n=15). A low background particle concentration in theatres (3 L-1) enabled detection of aerosol generation by tidal breathing (mean particle concentration 118 L-1). Aerosol recording during OGD showed an average particle number concentration of 595 L-1 with a wide range (3-4320 L-1). Bioaerosol-generating events, namely, coughing or burping, were common. Coughing was evoked in 60% of the endoscopies, with a greater peak concentration and a greater total number of sampled particles than the patient's reference voluntary coughs (11 710 vs 2320 L-1 and 780 vs 191 particles, n=9 and p=0.008). Endoscopies with coughs generated a higher level of aerosol than tidal breathing, whereas those without coughs were not different to the background. Burps also generated increased aerosol concentration, similar to those recorded during voluntary coughs. The insertion and removal of the endoscope were not aerosol generating unless a cough was triggered. Coughing evoked during OGD is the main source of the increased aerosol levels, and therefore, OGD should be regarded as a procedure with high risk of producing respiratory aerosols. OGD should be conducted with airborne personal protective equipment and appropriate precautions in those patients who are at risk of having COVID-19 or other respiratory pathogens. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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