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Aerosol-generating device led to A/H3N2 outbreak in acute ward setting

Wong BCK. Clin Inf Dis. 2010;51:1176–1183.

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An aerosol-generating device may have been the cause of an influenza A/H3N2 outbreak at Prince of Wales Hospital in Hong Kong. Therefore, researchers suggest avoiding aerosol generation and improving ventilation design to help prevent nosocomial outbreaks in this setting.

“We showed that infectious aerosols generated by a respiratory device applied to an influenza patient might have been blown across the hospital ward by an imbalanced indoor airflow, causing a major nosocomial outbreak,” Nelson Lee, MD, of the Chinese University of Hong Kong, said in a press release. “The spatial distribution of affected patients was highly consistent with an aerosol mode of transmission, as opposed to that expected from droplet transmission.

For the study, Lee and colleagues assessed the role of aerosol transmission of an A/H3N2 outbreak in an acute ward setting during 2008. Researchers pooled clinical and epidemiological data during the outbreak; infection risk, airflow measurements and concentrations of hypothetical virus-laden aerosols were also assessed.

Nine inpatients tested positive for an identical strain of influenza A/H3N2 virus.

Compared with an attack rate of 20% and 22.2% in patients in the same and adjacent hospital bays, patients in the distant bay had an attack rate of 0% (P=.04). The risk for infection was increased the day noninvasive ventilation was used in the primary patient (OR=14.9; 95% CI, 1.7-131.3).

Further, computational fluid dynamics modeling indicated dispersal pattern of aerosols originated from the primary patient was associated with the bed locations of infected patients, according to the researchers.

“Suitable personal protective equipment…will need to be considered when aerosol-generating procedures are performed on influenza patients,” Lee said. “Avoiding such procedures in open wards and improving ventilation design in health care facilities may also help to reduce the risk of nosocomial transmission of influenza.”

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