Table 2 Study characteristics of included studies (n = 38)
Author (Year), Country | Design/setting | Recruitment period | HCW population (n; role) | Patient population (age; disease status; symptoms; or stage of illness) | Aerosol-generating medical procedures (as described in the studies) | Viral respiratory infection/ laboratory tests | Outcome Data analysis presentation |
|---|---|---|---|---|---|---|---|
*Alraddadi (2016), Saudi Arabia [54] | Retrospective cohort/Single Centre – Medical intensive care unit, emergency department, neurology unit | May to June 2014 | n = 283; radiology technicians, nurses, respiratory therapists, physicians, clerical staff, patient transporters | NR; MERS-positive; NR; NR | Specific AGMPs and AGMPs Combined: Airway suctioning, bronchoscopy, CPR, intubation, extubation, non-invasive ventilation, manual ventilation, HFOV, nebulizer treatments, insertion of nasogastric tubes, insertion of peripheral line insertion of central venous line, chest physiotherapy, manipulating face mask or tubing, tracheostomy care, chest tube insertion/removal | MERS/ELISA | Number of events, stratified RR by mask type |
Brown (2021), USA [43] | Retrospective cohort/Multicentre – Emergency medical services | February 16 to July 31, 2020 | n = 1592; EMS providers | Adults; COVID-19-positive; fever, cough, shortness of breath, sore throat, nasal congestion, gastrointestinal symptoms, body aches, altered mental status, fatigue/weakness, headache, chest pain; NR | AGMPs Combined: Endotracheal intubation, supraglottic airway insertion, bag-valve-mask (BVM) ventilation (with or without chest compressions for CPR), continuous positive airway pressure nonrebreather mask oxygen (high-flow oxygen 15L/min), nebulizer medication therapy, CPR | COVID-19/ RT-PCR | Number of events, unadjusted IRR |
Caglayan (2021), Turkey [34] | Cross-sectional/Multicentre -thoracic societies | March 11 to May 15, 2020 | n = 15; physicians | NR; confirmed or suspected COVID-19-positive; fever and other COVID-19 symptoms; NR | Specific AGMP: Bronchoscopy | COVID-19/ Self-reported (type of diagnostic test not reported) | Number of events, statistical comparison of groups (i.e. p-values) |
Celebi (2020), Turkey [29] | Case–control/Single Centre – all units | March 20 and May 20, 2020 | n = 181; physicians, nurses, cleaning personnel, and other occupations | NR; suspected or confirmed COVID-19-positive; NR; NR | Specific AGMPs: CPR, intubation, bronchoscopy, endoscopy, mechanical ventilation | COVID-19/ RT-PCR | Number of events, statistical comparison of groups (i.e. p-values) |
*Chano (2021), Japan [46] | Prospective cross-sectional/Multicentre – COVID-19 designated hospitals | February 15 to February 26, 2021 | n = 1237; doctors, nurses, office workers, and others | NR | Not specifically identified in the paper but list of AGMPs combined received from personal communication with the author: Tracheal suction, tracheal intubation, extubation, bronchoscopy, nebulizer therapy | COVID-19/ Serology | Number of events, unadjusted OR |
Chatterjee (2020), India [28] | Case–control/Multicentre – all units | April to May 2020 | n = 751; doctor, nurses, housekeeping, security, lab techs, other | NR | Specific AGMPs: Respiratory suctioning, endotracheal intubation, nasopharyngeal swab collection | COVID-19/ RT-PCR | Number of events, unadjusted and adjusted OR |
Chen (2009), China [65] | Retrospective/Multicentre – all units involved in the care of SARS patients | 2003 | n = 758; doctors, nurses, health attendant, lab technician, other | NR; suspected or confirmed SARS-positive; NR; ‘caring for super spreading patient(s)’ | Specific AGMPs; Tracheal intubation, tracheotomy | SARS/ ELISA | Unadjusted and adjusted OR |
Cheng (2015), Hong Kong [53] | Retrospective cohort/Single Centre – adult ICU and general medical ward | April 1, 2013 to May 31, 2014 | n = 70; NR | One, 36-year old, female with verified influenza A H7N9; 6-days after onset of symptoms (fever, cough, sputum production, sore throat, dyspnoea); one 65-year old male with verified influenza A H7N9; 4-days after onset of community-acquired pneumonia | AGMPs Combined: Endotracheal intubation, CPR, bronchoscopy, open suction of respiratory tract, sputum induction, use of nebulizer therapy, non-invasive positive pressure ventilation, high-frequency oscillatory ventilation | Influenza A H7N9/ Serology | Number of events, statistical comparison of groups (i.e. p-values) |
Cummings (2020), USA [51] | Post-hoc analysis of RCT/Multicentre – outpatient clinics, ED | 2011 to 2016 | n = 2614; NR | NR; suspected respiratory illness; NR; NR | Specific AGMPs and AGMPs Combined: Respiratory/airway suctioning, intubation, nasopharyngeal aspiration, nebulizer treatment- | Coronavirus strains HKU1, OC43, NL63, 229E/ RT-PCR | Number of events, adjusted and unadjusted OR |
Dimcheff (2020), USA [30] | Cross-sectional/Single Centre – all units | June 8 to July 8, 2020 | n = 1476; advanced care practitioner (e.g., physician, dentist, NP, PA, nurse anesthetist), administrative, clinical support, nursing | Veterans; NR; NR; NR | Not specifically identified | COVID-19/ Serology | Number of events, unadjusted OR |
Firew (2020), USA [31] | Cross-sectional survey/Multicentre – Emergency medicine, ICU, inpatient hospital, pre-hospital, outpatient, long-term care facility/nursing home, other | May 2020 | n = 2040; physicians, nurses, EMTs, resident physicians or fellows, physician assistants and other HCW | NR | AGMPs Combined: Respiratory/airway suctioning, intubation, nasopharyngeal aspiration, nebulizer treatment- | COVID-19/ PCR and antibody | Number of events, unadjusted PR |
Fowler (2004), Canada [64] | Retrospective cohort/Single Centre—ICU | April 1 to April 22, 2003 | n = 122; physicians, registered nurses, respiratory therapist treating SARS patients | NR; SARS-positive treated with ventilator support; NR; NR | Specific AGMPs: Endotracheal intubation, high-airflow, noninvasive positive-pressure ventilation (NIPPV); high-frequency oscillatory (HFO) ventilation | SARS/ PCR or serology | Number of events, stratified and adjusted RR |
Ha (2004), Vietnam [61] | Prospective cohort/Single Centre – all units | May 12 to 14 2003 | n = 62; Physicians, nurses, nonclinical staff (housekeepers, clerks, elevator operators, laboratory technicians, and guards) | NR; SARS-positive; NR; NR | Specific AGMPs: Non-invasive positive pressure ventilation -, nebulizer medication | SARS/ Serology | Number of events only |
*Haller (2021), Switzerland[49] | Prospective observational cohort/Multicentre – all units | June 22nd to August 15th, 2020, data were analysed up to March 9th 2021 | n = 3259; primarily nurses and physicians | NR | AGMPs Combined: Bronchoscopies, intubation/extubation, gastroscopy, transesophageal echocardiography, reanimation, non-invasive ventilation, and suction of tracheal secretions | COVID-19/ RT-PCR, seroconversion | Number of events, unadjusted and adjusted OR, adjusted HR |
Heinzerling (2020), USA[48] | Cohort/Single Centre | February 15 to February 19, 2020 | n = 43; RN, RT, phlebotomist, certified nursing assistant, physician, environmental services worker, nutritionist, pharmacist, other | One index patient, assumed adult; COVID-19-positive; NR; NR | Specific AGMPs and AGMPs Combined: Airway suctioning, noninvasive positive pressure ventilation including BiPAP, manual ventilation, nebulizer treatments, breaking the ventilator circuit, sputum induction, intubation, bronchoscopy | COVID-19/ RT-PCR | Number of events and statistical comparison of groups (i.e. p-values) |
*Lai (2020), China[50] | Cross-sectional survey/Multicentre – all units | February 11 to February 15, 2020 | n = 325; nurses, doctors, technicians, security and cleaning staffs, and financial staffs | NR; COVID-19 confirmed or suspected; NR; NR | Not specifically identified | COVID-19/ nucleic acid test or clinical diagnosis | Number of events and statistical comparison of groups (i.e. p-values) |
Langella (2021), USA[34] | Ecological/Single Centre – emergency dental clinic | March 30 to May 8, 2020 | n = 267; dental care providers | Adult and pediatric; NR; NR | AGMPs Combined: High or low-speed dental handpieces, rotary instruments, ultrasonic scalers, air water syringes in a biologic environment (i.e. intraorally) including manipulation of gingival tissue, procedures likely to produce droplets at operative site, including extractions | COVID-19/ NR | Number of events |
*Lentz (2020), USA[32] | Case–control/Multicentre – international healthcare delivery settings | April 20 to May 5, 2020 | n = 1130; clinician, nurse, RT, other | NR; laboratory confirmed or persons under investigation for COVID-19; NR; NR | Specific AGMPs and AGMPs Combined: Intubation, extubation, open respiratory suctioning, bronchoscopy, nebulizer use, non-invasive positive pressure ventilation (NIPPV), tracheotomy, cardiopulmonary resuscitation | COVID-19/ RT-PCR | Unadjusted and adjusted OR |
Liu (2009), China [62] | Retrospective Case control; Single Centre – all units | March 5 to May 17, 2003 | n = 477; NR | NR; SARS-positive; NR; NR | Specific AGMPs: Chest compression, intubation, pulmonary lavage, respiratory secretion, sputum | SARS/ Serology (ELISA) | Number of events, unadjusted and adjusted OR |
Loeb (2004), Canada [63] | Retrospective cohort/Single Centre – critical care units | March 8 to March 21, 2003 | n = 32; nurses | Three adult index patients; suspected SARS; NR; nR | Specific AGMPs: Suctioning after intubation, suctioning before intubation, endotracheal aspirate, bronchoscopy, CPR, intubation, manual ventilation, nebulizer treatment, insertion of a nasogastric tube, manipulation of BiPAP mask, manipulation of oxygen mask, moth or dental care, nasopharyngeal swab obtained | SARS/ Serology | Number of events, unadjusted RR |
Lormans (2021), Belgium [36] | Cohort/Single Centre – COVID-19 and non-COVID-19 ICU | April to May 2020 | n = 142; nurses | NR | Specific AGMPs and AGMPs Combined: Broncho-alveolar lavage (more than 5 times), any assistance with either intubation or broncho-alveolar lavage, Intubation (more than once) | COVID-19/ RT-PCR | Unadjusted OR |
*Lucar (2020), USA[41] | Retrospective cohort/Single Centre – Operating room | NR | n = 11; anesthesiologist, certified registered nurse anesthetist, circulator, orthopedic surgeon, orthopedic resident, scrub technician | One 17-year-old, asymptomatic index patient; COVID-19-positive | AGMPs Combined: Extubation, intubation | COVID-19/ RT-PCR | Number of events |
Macintyre (2014), China [56] | Prospective cohort/Multicentre – emergency and respiratory wards | December 1, 2008 to January 15, 2009 | n = 481; doctors, nurses, other | NR | AGMPs Combined: Provision of nebulizer medications, suctioning, intubation, aerosol-generating procedures and chest physiotherapy | adenoviruses, human meta pneumovirus, coronaviruses, parainfluenza, influenza, respiratory syncytial virus, rhinovirus A/B; Streptococcus pneumoniae, Mycoplasma pneumoniae, B. pertussis, Legionella spp, Chlamydophila and Haemophilus influenza type B./ based on presence of symptoms | Number of events, unadjusted and adjusted RR |
Nakagama (2021), Japan [45] | Prospective cohort/Single Centre – all units | June 30th to July 2nd 2020 | n = 414; NR | NR | Specific AGMPs and AGMPs Combined: Airway suctioning, bronchoscopy, CPR, endotracheal intubation/extubation, bag mask ventilation, non-invasive ventilation, nebulizer administration, sputum induction, oxygen supplementation via tracheostomy, tracheotomy | COVID-19/ RT-PCR or serology | Number of events, unadjusted RR |
Ogawa (2020), Japan [33] | Cohort/Single Centre – ICU, general ward | NR | n = 15; doctors, nurses, speech-language-therapist, and physical therapists | One 81-year-old female index patient, COVID-19 positive; 10 days from symptom onset | AGMPs Combined: Ventilation, tracheotomy | COVID-19/ IgG antibody blood test, RT-PCR test | Number of events |
Paris (2021), France [44] | Cross-sectional survey/Single Centre – all units | May, 29th and July, 10th 2020 | n = 3234; nurses/midwives, students, residents, medical staff, administrative staff, cleaners | NR | Specific AGMPs and AGMPs Combined: Nasopharyngeal sampling, ear, nose and throat examinations, upper respiratory tract, nasogastric tube insertion, aerosol generating procedures (not specified but referred to as actions on upper respiratory tract) | COVID-19/ Serology (ELISA) | Number of events and statistical comparison of groups (i.e. p-values); adjusted OR |
Pei (2006), China [60] | Case–Control/Multicentre – all units | 2002–2003 SARS outbreak; questionnaire carried out in April-June 2004 | n = 443; doctors, nurses, nursing staff, workers, technicians, administrators, others | NR | Specific AGMPs: Tracheal intubation | SARS/ Serology | Number of events, unadjusted and adjusted OR |
Pérez-García (2020), Spain[47] | Cross-sectional/Single Centre – all units | March 5, 2020 to May 30, 2020 | n = 2963; medical staff, nurses, technical specialists, auxiliary nursing-care technician, hospital porter, resident physician, kitchen, administrative staff, others | NR | Not specifically described | COVID-19/ RT-PCR and/or serology | Unadjusted and adjusted OR |
*Raboud (2010), Canada [55] | Retrospective cohort/Multicentre | 2003 | n = 624; NR | Adults; SARS-positive requiring intubation; days of illness reported | Specific AGMPs; Suctioning after intubation, suctioning before intubation, bronchoscopy, CPR, defibrillation, intubation, manual ventilation after and before intubation, non-invasive ventilation, mechanical ventilation, nebulizer treatment, chest physiotherapy, insertion of NG tube, manipulation of oxygen mask, high flow oxygen (in room), collection of sputum sample, suction – sputum, bronchoscopy, tracheal intubation, tracheal tube removal, laryngoscope, tracheotomy | SARS/ RT-PCR | Number of events, unadjusted and adjusted OR |
Ran (2020), China [42] | Retrospective Cohort Study/Single Centre – high risk and low risk units | The follow-up was ended on Jan 28 2020 | n = 72; nurses and clinicians | NR | Specific AGMPs and AGMPs Combined: High exposure operation (medical or surgical procedures that generate respiratory aerosols including tracheal intubation, tracheotomy, tracheal tube removal, CPR, sputum suction, fiber bronchoscopy, laryngoscope) | COVID-19/ RT-PCR | Number of events, unadjusted RR |
Rosano (2021), Italy [38] | Cohort/Single Centre – ICU | February 20 to May 5, 2020 | n = 145; physicians and nurses | NR; COVID-19-positive; NR; NR | Specific AGMPs: Tracheotomy | COVID-19/ RT-PCR or antibody test | Number of events and statistical comparison of groups (i.e. p-values) |
Rzepliński (2021), Poland [37] | Cross-sectional/Single Centre – All units | April 21 to July 20, 2020 | n = 1572; NR | NR | Not specifically described | COVID-19/ Serology and RT-PCR | Number of events and statistical comparison of groups (i.e. p-values) |
Scales (2003), Canada [59] | Retrospective cohort/Single Centre—ICU | 2003 | n = 69; quarantined HCWs | One 74-year-old, signs and symptoms of community-acquired pneumonia; SARS-positive | Specific AGMPs: Intubation, non-invasive positive-pressure ventilation (present during procedure), contact with mucous membrane, contact with mucous membranes or respiratory secretions (performed procedure that involved contact with secretions) | SARS/ WHO criteria of SARS | Number of events |
Shah (2021), USA[40] | Retrospective cohort/Single Centre – emergency department, inpatient, outpatient | May 13 to November 20, 2020 | n = 345; RN, physician, RT, patient care assistant, housekeeping, other | NR; confirmed of suspected COVID-19-positive; NR; NR | AGMPs Combined: Tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy | COVID-19/ RT-PCR | Number of events and statistical comparisons of groups (i.e. p-values) |
Teleman (2004), Singapore [58] | Case–control/Single Centre – all units | March 1 to March 31, 2003 | n = 86; doctors, nurses, other | NR; SARS-positive; NR; NR | Specific AGMPs: Suction, intubation, oxygen administration, contact with respiratory secretions | SARS/ Serology | Number of events, unadjusted and adjusted OR |
Vitrat (2021), France [39] | Cross-sectional/Multicentre – all units | June 27 to September 31, 2020 | n = 3454; HCW, health-associated professionals, health management, support personals | NR | AGMPs Combined: Nasopharyngeal test, intubation, etc. (from survey), oral intubation, aerosolized therapy, high flow oxygen (in discussion) | COVID-19/ Serology | Unadjusted and adjusted OR |
Wong (2004), Hong Kong [57] | Retrospective cohort/Single Centre – general medical ward | March 4 to March 10, 2003 | n = 66; medical students | One index patient presumed adult; SARS-positive; NR; 8 days from symptom onset | Specific AGMPs: Nebulizer | SARS/ Serology | Number of events |
Zhang (2013), China [52] | 1:4 matched case–control study/Multicentre – high risk setting (intensive care, emergency, respiratory wards) | August 30, 2009 and January 31, 2010 | n = 255; nurse, doctor, or ward clerk | NR; patient with confirmed pandemic influenza A ⁄ (H1N1); NR; NR | AGMPs Combined: Suctioning, intubation, nebulizer medications, chest physiotherapy, other aerosol generating procedures | Influenza A/H1N1/ RT-PCR | Number of events and statistical comparison of groups (i.e. p-values) |