Abstract
Anaesthetists perform many interventions during their routine practice that are defined as aerosol
generating procedures. The evidence base surrounding the transmission risk of these procedures has
evolved primarily through measurements of aerosol generation. Consequently, infection prevention
and control guidelines are undergoing reassessment. This mixed methods study aims to explore the
views of practicing anaesthetists about these aerosol generating procedures. An online survey was
distributed to anaesthetists belonging to the Membership Engagement Group of the Royal College of
Anaesthetists during November 2021. The survey included five clinical scenarios to identify
anaesthetist’s personal approach to precautions, their hospital’s policies and the impact on
healthcare provision. A purposive sample of anaesthetists were selected for interviews to explore
the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey
responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed
thematically. The sample was representative of the UK anaesthetic workforce. Most anaesthetists
and their hospitals were aware of, supported and adhered to the UK guidance. However, there were
examples of substantial divergence from these guidelines at individual and hospital level. For
example, 12% of anaesthetists requested and 20% of hospitals required respiratory protective
equipment to be worn while intubating the trachea of SARS-CoV-2 negative patients. Additionally,
52% of anaesthetists wore respiratory protective equipment while inserting supraglottic airways. An
overwhelming majority of anaesthetists reported the use of respiratory protective equipment and
the associated fallow times: decreased efficiency (92%); worsened team-working (83%); had an
unacceptable environmental cost (64%); and impaired communication (77%). However, 63% of
anaesthetists felt the negative impacts of RPE were appropriately balanced against the risks of SARSCoV-2 transmission. Attitudes were polarised about the prospect of moving away from using
respiratory protective equipment. Participants’ perceived risk from COVID-19 correlated with
concern regarding stepdown (Spearman’s test, R=0.36, p>0.0001). Anaesthetists’ attitudes towards
aerosol generating procedures and the need for respiratory protective equipment are evolving and
this information can be used to inform strategies to facilitate successful adoption of revised
guidelines.
| Original language | English |
|---|---|
| Pages (from-to) | 959-970 |
| Number of pages | 12 |
| Journal | Anaesthesia |
| Volume | 77 |
| Issue number | 9 |
| Early online date | 21 Jul 2022 |
| DOIs | |
| Publication status | Published - 1 Sept 2022 |
Bibliographical note
Funding Information:AS is an NIHR‐funded doctoral Research Fellow, the MAGPIE study is part of the NIHR301520 grant. This report presents independent research commissioned by the NIHR. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, UKRI, or the Department of Health. AS and CO contributed equally to this study and are joint first authors. AP and LR are joint senior and last authors. AP declares advisory board work for Lateral Pharma and consultancy for and research grants from Eli Lilly for projects unrelated to this study. No other competing interests declared.
Funding Information:
AS is an NIHR-funded doctoral Research Fellow, the MAGPIE study is part of the NIHR301520 grant. This report presents independent research commissioned by the NIHR. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, UKRI, or the Department of Health. AS and CO contributed equally to this study and are joint first authors. AP and LR are joint senior and last authors. AP declares advisory board work for Lateral Pharma and consultancy for and research grants from Eli Lilly for projects unrelated to this study. No other competing interests declared.
Publisher Copyright:
© 2022 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.
Research Groups and Themes
- Anaesthesia Pain and Critical Care