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Aerosol generation during percutaneous tracheostomy insertion

The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) pandemic has resulted in significant changes to the use of personal protective equipment (PPE) in healthcare institutions worldwide. It is thought transmission is primarily via droplet spread but there are fears that aerosolized particles (generally <5 micron diameter) could cause airborne transmission. Many organisations have advised the use of PPE for those undertaking certain activities that have been designated as aerosol generating procedures (AGPs) to minimise this risk. Examples include percutaneous tracheostomy and bronchoscopy but the quantitative evidence base for AGP designation is weak and the relative risk of each procedure unknown. To date aerosols generated during percutaneous tracheostomy have not been measured. Our previous study identified that background particle counts in most settings are too high to allow reliable aerosol detection. We had a unique opportunity to measure aerosol generation during percutaneous tracheostomy insertion in an ultra-clean operating theatre.