Risk of dispersion or aerosol generation and infection transmission with nasopharyngeal and oropharyngeal swabs for detection of COVID-19: a systematic review
Arnav Agarwal,
Bram Rochwerg,
Karen EA Burns,
Rachel Couban,
Srinivas Murthy,
Francois Lamontagne,
Shannon M Fernando,
Janet Diaz,
Dipayan Chaudhuri,
John Basmaji,
Kimia Honarmand,
David S Hui,
Per O Vandvik,
Neill K J Adhikari,
Fiona Muttalib,
Samira Mubareka,
Layla Bakaa,
Sonia Brar,
David Granton,
Devin Chetan,
Malini Hu,
Charles D Gomersall
Affiliations
Arnav Agarwal
internist, methods co-chair
Bram Rochwerg
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Karen EA Burns
11 Interdepartmental Division of Critical Care and the Li Ka Shing Knowledge Institute, St. Michael`s Hospital, Toronto, Ontario, Canada
Rachel Couban
Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
Srinivas Murthy
University of British Columbia, Vancouver, British Columbia, Canada
Francois Lamontagne
assistant professor
Shannon M Fernando
critical care fellow
Janet Diaz
World Health Organization, Geneva, Switzerland
Dipayan Chaudhuri
2 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
John Basmaji
Division of Critical Care, Western University, London, Ontario, Canada
Kimia Honarmand
2 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
David S Hui
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
Per O Vandvik
assistant professor
Neill K J Adhikari
lecturer
Fiona Muttalib
Department of Pediatrics, BC Children`s Hospital, Vancouver, British Columbia, Canada
Samira Mubareka
Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
Layla Bakaa
Faculty of Science, McMaster University, Hamilton, Ontario, Canada
Sonia Brar
School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York, USA
David Granton
1 Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
Devin Chetan
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
Malini Hu
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
Charles D Gomersall
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, Hong Kong
Objectives SARS-CoV-2-related disease, referred to as COVID-19, has emerged as a global pandemic since December 2019. While there is growing recognition regarding possible airborne transmission, particularly in the setting of aerosol-generating procedures and treatments, whether nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 generate aerosols remains unclear.Design Systematic review.Data sources We searched Ovid MEDLINE and EMBASE up to 3 November 2020. We also searched the China National Knowledge Infrastructure, Chinese Medical Journal Network, medRxiv and ClinicalTrials.gov up to 29 March 2020.Eligibility criteria All comparative and non-comparative studies that evaluated dispersion or aerosolisation of viable airborne organisms, or transmission of infection associated with nasopharyngeal or oropharyngeal swab testing.Results Of 7702 citations, only one study was deemed eligible. Using a dedicated sampling room with negative pressure isolation room, personal protective equipment including N95 or higher masks, strict sterilisation protocols, structured training with standardised collection methods and a structured collection and delivery system, a tertiary care hospital proved a 0% healthcare worker infection rate among eight nurses conducting over 11 000 nasopharyngeal swabs. No studies examining transmissibility with other safety protocols, nor any studies quantifying the risk of aerosol generation with nasopharyngeal or oropharyngeal swabs for detection of SARS-CoV-2, were identified.Conclusions There is limited to no published data regarding aerosol generation and risk of transmission with nasopharyngeal and oropharyngeal swabs for the detection of SARS-CoV-2. Field experiments to quantify this risk are warranted. Vigilance in adhering to current standards for infection control is suggested.
