Since the severe acute respiratory syndrome (SARS) outbreak in 2003, there has been heightened attention toward minimizing the risk of occupational hazards for health care workers.1,2 This includes a better understanding of donning and doffing personal protective equipment (PPE) for certain situations.3,4 One situation particularly important for respiratory therapists is that revolving around aerosol-generating medical procedures (AGMPs).1 AGMPs are classified as medical procedures that produce aerosols and droplets, increasing the risk of disease transmission to health care workers involved.5,6 These concerns were amplified since the beginning of the SARS-CoV-2 (COVID-19) pandemic, as transmission occurs by inhaling respiratory droplets and aerosols.5,7 Currently, the World Health Organization lists a handful of AGMPs as high risk for transmission (eg, intubation, extubation, bronchoscopy, cardiopulmonary resuscitation, noninvasive ventilation),6 but high-flow nasal cannula (HFNC) oxygen therapy and nebulized treatments are not included even though they both produce aerosols and droplets.8,9
Although there is minimal evidence to support the increased risk of COVID-19 transmission from patients receiving HFNC oxygen therapy,8 or nebulized treatments,9-11 there are still concerns regarding their aerosol-generating properties.2 When combined together, nebulized treatments given during HFNC oxygen therapy elicit more uncertainties.10,12 Fugitive aerosols are defined as aerosols that have escaped the system, either before inhalation or after exhalation.13 This emphasizes the concerns of secondary exposure to others within proximity of the patient and the risks of transmission.9,13-15 As a response to minimize the potential for aerosol generation, clinicians opted to intubate patients early to treat all severity of COVID-19 respiratory complications,16 and nebulized treatments were substituted for pressurized metered-dose inhalers (pMDIs) to prevent continuous aerosol generation.10 However, the assumed benefits of …
Correspondence: Shirley Quach MHSc RRT HBSc, School of Rehabilitation Sciences, Institute for Applied Health Sciences Building, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada. E-mail: quach.shirley{at}gmail.com