AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR)

Aerosol generation occurs when tiny droplets of liquid are suspended in the air. Aerosols can be generated during many medical procedures. Some procedures might produce more aerosols than others, and droplets of different sizes, but there is a lot of uncertainty about this at the moment. What is known is that aerosols can carry viruses, like coronavirus, which risks further infections if inhaled by healthcare staff or other patients. Due to this potential risk, many operations have been delayed or are being performed with extra equipment, greatly reducing the ability of the NHS to resume important services. The AERATOR study aims to rapidly study the amount and type of aerosol generated when medical procedures are performed, and how infectious this aerosol is. This will be performed using specialist equipment in operating theatres and wards to measure real-life aerosol generation. By using specialist equipment, only available at Bristol University, we can also investigate how long coronavirus survives in clinical environments. This vital information will show how best to organise operating theatres, medical procedures, out-patient clinics, wards and use of protective equipment, in order to protect patients and staff while maximising the ability of the NHS to resume life-saving work.

Aerosolisation of SARS-CoV-2 during clinical procedures is a major concern. The safe resumption of essential NHS services is impaired by the need to mitigate the theoretical risk of cross infection from procedural aerosolisation. This includes extensive preoperative planning, use of personal protective equipment (PPE) throughout, and delays in patient/staff movement before, during, and after the procedure. There is currently little to no evidence on aerosolisation risk for many procedures, hampering national guidance and greatly reducing NHS capacity. The AERATOR study will address a critical gap in evidence by quantifying the concentration, size and temporal and spatial dynamics of aerosols produced during routine medical & surgical procedures in different environments. This will focus on five clinical specialties particularly impacted by procedural aerosolisation: dental, orthopaedic, respiratory, critical care and ophthalmology. This work comprises three workstreams: Workstream 1: Within the Bristol Aerosol Research Centre (BARC) we will rapidly (within 4 weeks) validate instruments to study aerosolisation in clinical settings. Workstream 2: Instruments will be moved into clinical settings and, using multiple instruments and sampling techniques, will measure aerosolisation dynamics and size across time and space. Workstream 3: By using novel equipment, only available within Bristol, to levitate virus within a CL3 laboratory, we will investigate the survival of SARS-CoV-2 in aerosol particles and determine its infectivity. The information gathered in this study will allow us to inform hospital trusts, policy makers and Public Health England regarding the safe and maximally efficient NHS working across multiple specialties.