Air filtration mitigates aerosol levels both during and after endoscopy procedures
Abstract Objectives Upper gastrointestinal endoscopies are aerosol‐generating procedures, increasing the risk of spreading airborne pathogens. We aim to quantify the mitigation of airborne particles via improved ventilation, specifically laminar flow theatres and portable high‐efficiency particulate...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | DEN Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/deo2.231 |
| _version_ | 1797837251648946176 |
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| author | Frank Phillips Jane Crowley Samantha Warburton Karren Staniforth Adolfo Parra‐Blanco George S.D. Gordon |
| author_facet | Frank Phillips Jane Crowley Samantha Warburton Karren Staniforth Adolfo Parra‐Blanco George S.D. Gordon |
| author_sort | Frank Phillips |
| collection | DOAJ |
| description | Abstract Objectives Upper gastrointestinal endoscopies are aerosol‐generating procedures, increasing the risk of spreading airborne pathogens. We aim to quantify the mitigation of airborne particles via improved ventilation, specifically laminar flow theatres and portable high‐efficiency particulate air (HEPA) filters, during and after upper gastrointestinal endoscopies. Methods This observational study included patients undergoing routine upper gastrointestinal endoscopy in a standard endoscopy room with 15–17 air changes per hour, a standard endoscopy room with a portable HEPA filtration unit, and a laminar flow theatre with 300 air changes per hour. A particle counter (diameter range 0.3 μm‐25 μm) took measurements 10 cm from the mouth. Three analyses were performed: whole procedure particle counts, event‐based counts, and air clearance estimation using post‐procedure counts. Results Compared to a standard endoscopy room, for whole procedures we observe a 28.5x reduction in particle counts in laminar flow (p < 0.001) but no significant effect of HEPA filtration (p = 0.50). For event analysis, we observe for lateral flow theatres reduction in particles >5 μm for oral extubation (12.2x, p < 0.01), reduction in particles <5 μm for coughing/gagging (6.9x, p < 0.05), and reduction for all sizes in anesthetic throat spray (8.4x, p < 0.01) but no significant effect of HEPA filtration. However, we find that in the fallow period between procedures HEPA filtration reduces particle clearance times by 40%. Conclusions Laminar flow theatres are highly effective at dispersing aerosols immediately after production and should be considered for high‐risk cases where patients are actively infectious or the supply of personal protective equipment is limited. Portable HEPA filers can safely reduce the fallow time between procedures by 40%. |
| first_indexed | 2024-04-09T15:22:47Z |
| format | Article |
| id | doaj.art-9f4e71a6bad44b50a4b6a5c0746e2909 |
| institution | Directory Open Access Journal |
| issn | 2692-4609 |
| language | English |
| last_indexed | 2024-04-09T15:22:47Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj.art-9f4e71a6bad44b50a4b6a5c0746e29092023-04-29T05:12:57ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.231Air filtration mitigates aerosol levels both during and after endoscopy proceduresFrank Phillips0Jane Crowley1Samantha Warburton2Karren Staniforth3Adolfo Parra‐Blanco4George S.D. Gordon5NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UKDepartment of Electrical and Electronic Engineering University of Nottingham Nottingham UKNIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UKUK Health Security Agency Seaton House City Link Nottingham UKNIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UKDepartment of Electrical and Electronic Engineering University of Nottingham Nottingham UKAbstract Objectives Upper gastrointestinal endoscopies are aerosol‐generating procedures, increasing the risk of spreading airborne pathogens. We aim to quantify the mitigation of airborne particles via improved ventilation, specifically laminar flow theatres and portable high‐efficiency particulate air (HEPA) filters, during and after upper gastrointestinal endoscopies. Methods This observational study included patients undergoing routine upper gastrointestinal endoscopy in a standard endoscopy room with 15–17 air changes per hour, a standard endoscopy room with a portable HEPA filtration unit, and a laminar flow theatre with 300 air changes per hour. A particle counter (diameter range 0.3 μm‐25 μm) took measurements 10 cm from the mouth. Three analyses were performed: whole procedure particle counts, event‐based counts, and air clearance estimation using post‐procedure counts. Results Compared to a standard endoscopy room, for whole procedures we observe a 28.5x reduction in particle counts in laminar flow (p < 0.001) but no significant effect of HEPA filtration (p = 0.50). For event analysis, we observe for lateral flow theatres reduction in particles >5 μm for oral extubation (12.2x, p < 0.01), reduction in particles <5 μm for coughing/gagging (6.9x, p < 0.05), and reduction for all sizes in anesthetic throat spray (8.4x, p < 0.01) but no significant effect of HEPA filtration. However, we find that in the fallow period between procedures HEPA filtration reduces particle clearance times by 40%. Conclusions Laminar flow theatres are highly effective at dispersing aerosols immediately after production and should be considered for high‐risk cases where patients are actively infectious or the supply of personal protective equipment is limited. Portable HEPA filers can safely reduce the fallow time between procedures by 40%.https://doi.org/10.1002/deo2.231aerosolsair conditioningCOVID‐19endoscopyinfection control |
| spellingShingle | Frank Phillips Jane Crowley Samantha Warburton Karren Staniforth Adolfo Parra‐Blanco George S.D. Gordon Air filtration mitigates aerosol levels both during and after endoscopy procedures DEN Open aerosols air conditioning COVID‐19 endoscopy infection control |
| title | Air filtration mitigates aerosol levels both during and after endoscopy procedures |
| title_full | Air filtration mitigates aerosol levels both during and after endoscopy procedures |
| title_fullStr | Air filtration mitigates aerosol levels both during and after endoscopy procedures |
| title_full_unstemmed | Air filtration mitigates aerosol levels both during and after endoscopy procedures |
| title_short | Air filtration mitigates aerosol levels both during and after endoscopy procedures |
| title_sort | air filtration mitigates aerosol levels both during and after endoscopy procedures |
| topic | aerosols air conditioning COVID‐19 endoscopy infection control |
| url | https://doi.org/10.1002/deo2.231 |
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