期刊
CLINICAL INFECTIOUS DISEASES
卷 75, 期 1, 页码 E89-E96出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciac161
关键词
virus transmission; aerosol-generating procedures; infection control; inhalation exposure
资金
- AFA Insurance [180113, 200109]
- Swedish Research Council for Sustainable Development [2017-00383, 2020-01490]
- Swedish Research Council for Health, Working Life and Welfare [2017-00690]
- SciLifeLab National COVID-19 Research Program - Knut and Alice Wallenberg Foundation
- Swedish Research Council [2020-02344]
- Osterlund Foundation
- Sven Olof Jansons livsverk Foundation
- Swedish Research Council [2020-02344, 2017-00383] Funding Source: Swedish Research Council
- Formas [2017-00383, 2020-01490] Funding Source: Formas
- Forte [2020-01490, 2017-00690] Funding Source: Forte
Our study indicates that major risk factors for airborne transmission of SARS-CoV-2 include close physical proximity to the patient, high viral load in the patient, and inadequate room ventilation. Traditional definitions of AGPs appear to be of secondary importance.
Background Transmission of coronavirus disease 2019 (COVID-19) can occur through inhalation of fine droplets or aerosols containing infectious virus. The objective of this study was to identify situations, patient characteristics, environmental parameters, and aerosol-generating procedures (AGPs) associated with airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Methods Air samples were collected near hospitalized COVID-19 patients and analyzed by RT-qPCR. Results were related to distance to the patient, most recent patient diagnostic PCR cycle threshold (Ct) value, room ventilation, and ongoing potential AGPs. Results In total, 310 air samples were collected; of these, 26 (8%) were positive for SARS-CoV-2. Of the 231 samples from patient rooms, 22 (10%) were positive for SARS-CoV-2. Positive air samples were associated with a low patient Ct value (OR, 5.0 for Ct 25; P = .01; 95% CI: 1.18-29.5) and a shorter physical distance to the patient (OR, 2.0 for every meter closer to the patient; P = .05; 95% CI: 1.0-3.8). A mobile HEPA-filtration unit in the room decreased the proportion of positive samples (OR, .3; P = .02; 95% CI: .12-.98). No association was observed between SARS-CoV-2-positive air samples and mechanical ventilation, high-flow nasal cannula, nebulizer treatment, or noninvasive ventilation. An association was found with positive expiratory pressure training (P < .01) and a trend towards an association for airway manipulation, including bronchoscopies and in- and extubations. Conclusions Our results show that major risk factors for airborne SARS-CoV-2 include short physical distance, high patient viral load, and poor room ventilation. AGPs, as traditionally defined, seem to be of secondary importance. Healthcare infection-control guidelines emphasize breathing protection during aerosol-generating procedures with COVID-19 patients. Our study suggests that SARS-CoV-2 in air is mainly determined by distance, patient viral load, and room ventilation. We found weak support for emissions during aerosol-generating procedures.
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