1887
  1. Home
  2. Eurosurveillance
  3. Volume 28, Issue 32, 10/Aug/2023
  4. Article
Perspective Open Access
Like 0
Download

Abstract

The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.32.2200718
2023-08-10
2024-12-21
/content/10.2807/1560-7917.ES.2023.28.32.2200718
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/32/eurosurv-28-32-3.html?itemId=/content/10.2807/1560-7917.ES.2023.28.32.2200718&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Prevention of hospital-acquired infections: a practical guide. 2nd ed. Ducel G, Fabry J, Nicolle L, editors. Geneva: WHO; 2002. Available from: https://apps.who.int/iris/handle/10665/67350
  2. Siegel JD, Rhinehart E, Jackson M, Chiarello R, the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Atlanta: CDC; 2007. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html
  3. World Health Organization (WHO). Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva: WHO; 2014. Available from: https://apps.who.int/iris/rest/bitstreams/515717/retrieve
  4. Roy CJ, Milton DK. Airborne transmission of communicable infection--the elusive pathway. N Engl J Med. 2004;350(17):1710-2. . Available from: https://www.ncbi.nlm.nih.gov/pubmed/15102996 https://doi.org/10.1056/NEJMp048051  PMID: 15102996 
  5. Tang JW. SARS-CoV-2 and aerosols-Arguing over the evidence. J Virol Methods. 2021;289:114033.  https://doi.org/10.1016/j.jviromet.2020.114033  PMID: 33285192 
  6. Randall K, Ewing ET, Marr LC, Jimenez JL, Bourouiba L. How did we get here: what are droplets and aerosols and how far do they go? A historical perspective on the transmission of respiratory infectious diseases. Interface Focus. 2021;11(6):20210049.  https://doi.org/10.1098/rsfs.2021.0049  PMID: 34956601 
  7. Association for Aerosol Research. Position paper of the Gesellschaft für Aerosolforschung on understanding the role of aerosol particles in SARS-CoV-2 infection. Köln: Gesellschaft für Aerosolforschung; 2020. Available from: https://www.info.gaef.de/_files/ugd/fab12b_0b691414cfb344fe96d4b44e6f44a5ab.pdf
  8. Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis. 2006;12(11):1657-62.  https://doi.org/10.3201/eid1211.060426  PMID: 17283614 
  9. Tellier R. Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface. 2009;6(Suppl 6) Suppl 6;S783-90.  https://doi.org/10.1098/rsif.2009.0302.focus  PMID: 19773292 
  10. Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. Lancet Infect Dis. 2007;7(4):257-65.  https://doi.org/10.1016/S1473-3099(07)70029-4  PMID: 17376383 
  11. van der Valk JPM, In ’t Veen JCCM. SARS-Cov-2: the relevance and prevention of aerosol transmission. J Occup Environ Med. 2021;63(6):e395-401.  https://doi.org/10.1097/JOM.0000000000002193  PMID: 33871953 
  12. Leal J, Farkas B, Mastikhina L, Flanagan J, Skidmore B, Salmon C, et al. Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review. Antimicrob Resist Infect Control. 2022;11(1):102.  https://doi.org/10.1186/s13756-022-01133-8  PMID: 35953854 
  13. Jefferson T, Heneghan CJ, Spencer E, Brassey J, Plüddemann A, Onakpoya I, et al. A hierarchical framework for assessing transmission causality of respiratory viruses. Viruses. 2022;14(8):1605.  https://doi.org/10.3390/v14081605  PMID: 35893670 
  14. Gwaltney JM Jr, Hendley JO. Rhinovirus transmission: one if by air, two if by hand. Am J Epidemiol. 1978;107(5):357-61.  https://doi.org/10.1093/oxfordjournals.aje.a112555  PMID: 208415 
  15. Onakpoya IJ, Heneghan CJ, Spencer EA, Brassey J, Rosca EC, Maltoni S, et al. Viral cultures for assessing fomite transmission of SARS-CoV-2: a systematic review and meta-analysis. J Hosp Infect. 2022;130:63-94.  https://doi.org/10.1016/j.jhin.2022.09.007  PMID: 36115620 
  16. Dick EC, Jennings LC, Mink KA, Wartgow CD, Inhorn SL. Aerosol transmission of rhinovirus colds. J Infect Dis. 1987;156(3):442-8.  https://doi.org/10.1093/infdis/156.3.442  PMID: 3039011 
  17. Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, et al. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice - Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(19):606-10.  https://doi.org/10.15585/mmwr.mm6919e6  PMID: 32407303 
  18. Chen PZ, Koopmans M, Fisman DN, Gu FX. Understanding why superspreading drives the COVID-19 pandemic but not the H1N1 pandemic. Lancet Infect Dis. 2021;21(9):1203-4.  https://doi.org/10.1016/S1473-3099(21)00406-0  PMID: 34352224 
  19. Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016;21(4):125-7.  https://doi.org/10.1136/ebmed-2016-110401  PMID: 27339128 
  20. Chou R, Dana T, Jungbauer R, Weeks C, McDonagh MS. Masks for prevention of respiratory virus infections, including SARS-CoV-2, in health care and community settings: a living rapid review. Ann Intern Med. 2020;173(7):542-55.  https://doi.org/10.7326/M20-3213  PMID: 32579379 
  21. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2020;11(11):CD006207. PMID: 33215698 
  22. Loeb M, Bartholomew A, Hashmi M, Tarhuni W, Hassany M, Youngster I, et al. Medical masks versus N95 respirators for preventing COVID-19 among health care workers: a randomized trial. Ann Intern Med. 2022;175(12):1629-38.  https://doi.org/10.7326/M22-1966  PMID: 36442064 
  23. Birgand G, Mutters NT, Otter J, Eichel VM, Lepelletier D, Morgan DJ, et al. Variation of national and international guidelines on respiratory protection for health care professionals during the COVID-19 pandemic. JAMA Netw Open. 2021;4(8):e2119257.  https://doi.org/10.1001/jamanetworkopen.2021.19257  PMID: 34347062 
  24. World Health Organization (WHO). Infection prevention and control in the context of coronavirus disease (COVID-19): a living guideline. Geneva: WHO; 2023. Available from: https://apps.who.int/iris/bitstream/handle/10665/365576/WHO-2019-nCoV-ipc-guideline-2023.1-eng.pdf
  25. Lyngse FP, Mortensen LH, Denwood MJ, Christiansen LE, Møller CH, Skov RL, et al. Household transmission of the SARS-CoV-2 Omicron variant in Denmark. Nat Commun. 2022;13(1):5573.  https://doi.org/10.1038/s41467-022-33328-3  PMID: 36151099 
  26. World Health Organization (WHO). Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed Geneva: WHO; 2021. Available from: https://apps.who.int/iris/bitstream/handle/10665/342620/WHO-2019-nCoV-IPC-2021.1-eng.pdf?sequence=1&isAllowed=y
  27. Glasziou PP, Michie S, Fretheim A. Public health measures for covid-19. BMJ. 2021;375(2729):n2729.  https://doi.org/10.1136/bmj.n2729  PMID: 34789507 
  28. Moberg J, Oxman AD, Rosenbaum S, Schünemann HJ, Guyatt G, Flottorp S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst. 2018;16(1):45.  https://doi.org/10.1186/s12961-018-0320-2  PMID: 29843743 
  29. Kratzel A, Todt D, V’kovski P, Steiner S, Gultom M, Thao TTN, et al. Inactivation of severe acute respiratory syndrome coronavirus 2 by WHO-recommended hand rub formulations and alcohols. Emerg Infect Dis. 2020;26(7):1592-5.  https://doi.org/10.3201/eid2607.200915  PMID: 32284092 
  30. Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023;1(1):CD006207. PMID: 36715243 
  31. World Health Organization (WHO). Guidelines on hand hygiene in health care. Geneva: WHO; 2009. Available from: https://apps.who.int/iris/rest/bitstreams/52455/retrieve
  32. Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, et al. "The dirty hand in the latex glove": a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol. 2011;32(12):1194-9.  https://doi.org/10.1086/662619  PMID: 22080658 
  33. Cusini A, Nydegger D, Kaspar T, Schweiger A, Kuhn R, Marschall J. Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions-Is less more? Am J Infect Control. 2015;43(9):922-7.  https://doi.org/10.1016/j.ajic.2015.05.019  PMID: 26122873 
  34. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86(Suppl 1):S1-70.  https://doi.org/10.1016/S0195-6701(13)60012-2  PMID: 24330862 
  35. Meda M, Gentry V, Reidy P, Garner D. Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic. J Hosp Infect. 2020;106(3):605-9.  https://doi.org/10.1016/j.jhin.2020.07.036  PMID: 32745589 
  36. Belan M, Charmet T, Schaeffer L, Tubiana S, Duval X, Lucet JC, et al. SARS-CoV-2 exposures of healthcare workers from primary care, long-term care facilities and hospitals: a nationwide matched case-control study. Clin Microbiol Infect. 2022;28(11):1471-6.  https://doi.org/10.1016/j.cmi.2022.05.038  PMID: 35777605 
  37. Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland Infection Control Team. Standard infection control precautions. Literature review. Personal protective equipment (PPE) footwear. Edinburgh: Public Health Scotland; 2021. Available from: https://www.nipcm.hps.scot.nhs.uk/media/1901/2021-07-22-ppe-footwear-v30-final.pdf
  38. Wilson NM, Marks GB, Eckhardt A, Clarke AM, Young FP, Garden FL, et al. The effect of respiratory activity, non-invasive respiratory support and facemasks on aerosol generation and its relevance to COVID-19. Anaesthesia. 2021;76(11):1465-74.  https://doi.org/10.1111/anae.15475  PMID: 33784793 
  39. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.  https://doi.org/10.1371/journal.pone.0035797  PMID: 22563403 
  40. National Health Service (NHS) England. A rapid review of aerosol generating procedures (AGPs). Leeds: NHS England. 2022. Available from: https://www.england.nhs.uk/wp-content/uploads/2022/04/C1632_rapid-review-of-aerosol-generating-procedures.pdf
  41. World Health Organization (WHO). Infection prevention and control in the context of coronavirus disease (COVID-19): a living guideline. Geneva: WHO; 2023. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-ipc-guideline-2022.2
  42. Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Viruses are prevalent in non-ventilated hospital-acquired pneumonia. Respir Med. 2017;122:76-80.  https://doi.org/10.1016/j.rmed.2016.11.023  PMID: 27993295 
  43. Coroneo MT, Collignon PJ. SARS-CoV-2: eye protection might be the missing key. Lancet Microbe. 2021;2(5):e173-4.  https://doi.org/10.1016/S2666-5247(21)00040-9  PMID: 33655228 
  44. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395(10242):1973-87.  https://doi.org/10.1016/S0140-6736(20)31142-9  PMID: 32497510 
  45. Jamrozik E, Selgelid MJ. COVID-19 human challenge studies: ethical issues. Lancet Infect Dis. 2020;20(8):e198-203.  https://doi.org/10.1016/S1473-3099(20)30438-2  PMID: 32479747 
  46. Killingley B, Mann AJ, Kalinova M, Boyers A, Goonawardane N, Zhou J, et al. Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults. Nat Med. 2022;28(5):1031-41.  https://doi.org/10.1038/s41591-022-01780-9  PMID: 35361992 
  47. Centers for Disease Control and Prevention (CDC). Hierarchy of controls. Atlanta: CDC. [Accessed: 28 Feb 2023]. Available from: https://www.cdc.gov/niosh/topics/hierarchy/default.html
  48. Puhach O, Meyer B, Eckerle I. SARS-CoV-2 viral load and shedding kinetics. Nat Rev Microbiol. 2023;21(3):147-61. PMID: 36460930 
  49. Jefferson T, Spencer EA, Conly JM, Rosca EC, Maltoni S, Brassey J, et al. Viral cultures, cycle threshold values and viral load estimation for assessing SARS-CoV-2 infectiousness in haematopoietic stem cell and solid organ transplant patients: a systematic review. J Hosp Infect. 2023;132:62-72.  https://doi.org/10.1016/j.jhin.2022.11.018  PMID: 36473552 
  50. Nomura T, Kitagawa H, Omori K, Shigemoto N, Kakimoto M, Nazmul T, et al. Duration of infectious virus shedding in patients with severe coronavirus disease 2019 who required mechanical ventilation. J Infect Chemother. 2022;28(1):19-23.  https://doi.org/10.1016/j.jiac.2021.09.006  PMID: 34538728 
  51. Jung J, Kim JY, Park H, Park S, Lim JS, Lim SY, et al. Transmission and infectious SARS-CoV-2 shedding kinetics in vaccinated and unvaccinated individuals. JAMA Netw Open. 2022;5(5):e2213606.  https://doi.org/10.1001/jamanetworkopen.2022.13606  PMID: 35608859 
  52. Knobloch JK, Franke G, Knobloch MJ, Knobling B, Kampf G. Overview of tight fit and infection prevention benefits of respirators (filtering face pieces). J Hosp Infect. 2023;134:89-96.  https://doi.org/10.1016/j.jhin.2023.01.009  PMID: 36738992 
  53. Jones RM, Bleasdale SC, Maita D, Brosseau LM, CDC Prevention Epicenters Program. A systematic risk-based strategy to select personal protective equipment for infectious diseases. Am J Infect Control. 2020;48(1):46-51.  https://doi.org/10.1016/j.ajic.2019.06.023  PMID: 31358421 
  54. Chughtai AA, Chen X, Macintyre CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control. 2018;46(12):1329-34.  https://doi.org/10.1016/j.ajic.2018.06.003  PMID: 30029796 
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error