Difference Between Aerosolized Covid-19 and Droplet Transmission
A report of the World Health Organization (WHO) notes that respiratory droplets are usually considered to be greater than 5-10 micrograms. This is in contrast to aerosols (also termed droplet nuclei) which are typically less than 5 micrograms in diameter. This WHO report also notes that coughing, sneezing, and talking within one meter of another person are three recognized ways that Covid-19 droplets can be transmitted to other people (inclusive of healthcare clinicians such as outpatient and homecare nurses).
Notably, the WHO has not ruled out the possibility that aerosol transmission is occurring in addition to droplet transmission, although the proper utilization of Personal Protective Equipment (PPE) has been linked to decreased likelihood of clinician infection from Covid-19 patient respiratory droplets.
If aerosol transmission is exacerbating the spread of community-acquired Covid-19, ventilation needs to be improved from its current acceptable standards in not only hospitals but outpatient clinics, airplanes, and anywhere people congregate (e.g., restaurants) – in tandem with increased disinfection of frequently-touched objects (e.g., door knobs). Aerosols generally linger in the air longer than viral droplets, as well.
In a recent article in Environmental Research, the authors suggest that aerosols are more susceptible to being deeply-inhaled (thereby resulting in lung infection). The authors also note that – while droplets are strongly-linked to transmission to someone nearby – they are also more likely to fall to the ground rather than linger in the air.
Use by Nurses of N-95 Masks versus Surgical Masks
The inability of nurses to obtain adequate proper Personal Protective Equipment (PPE) such as N-95 masks during surges in Covid-19 cases in certain locales has led to re-wearing of N-95 masks between presumed non-infected patients and/or the wearing of the less-protective surgical masks. This can lead to transmission between hospital personnel, nurses and patients, and between various patients. This is particularly considered a possible reason for the high transmission rate documented in nursing homes and psychiatric facilities.
Since large-scale stockpiling of masks and other PPE is not always possible due to lack of “space” in a given facility, an unanticipated surge in positive Covid-19 test results in a locale can quickly lead to a lack of sufficient PPE for nurses.
Due to the possibility that Covid-19 aerosolized particles can linger in the air, the American Nurses Association (ANA) especially recommends the following:
Adhere to the latest infection control standards for putting on, taking off, and wearing PPE when caring for Covid-19 infected patients.
Avoid touching the N-95 mask, eye goggles, and face shield with hands while wearing, and immediately wash hands following removal of them.
Adhere strictly to hand hygiene protocol after using any restroom and eating.
Disinfect cell phones frequently, and utilize a clear, sealable bag to hold the cell phone so it cannot become contaminated by aerosolized Covid-19.
Infection Risk for Homecare Nurses
Some of the nurses at highest risk of contracting Covid-19 are those caring for patients in their homes. Due to the high level of anxiety experienced by older-aged patients, many post-surgical patients are choosing to recover at home rather than in a rehab center. Since not every Covid-19-infected person will immediately test “positive” for the virus and/or display symptoms, nurses visiting patients in their homes have to be extremely careful not to return home at the end of the work-day and infect loved ones.
An article in Nature titled Mounting Evidence Suggests Coronavirus is Airborne — but Health Advice Has Not Caught Up concludes that solely exhaling air is contributing to the Covid-19 spread. While droplets may contain a higher viral load, nurses may still be able to be infected by being in an indoor area where people incorrectly assumed to be non-infected previously entered (such as an elevator). This article notes that the WHO has not yet altered its public guidelines to reflect the latest scientific beliefs regarding aerosolized viral transmission, which contributes to hesitation to tighten existing infection control policies to curtail Covid-19 resurgence.
Call to Action
Nurses who provide nursing home care and homecare to older-aged and vulnerable patients need to be at the forefront of promoting measures to decrease community Covid-19 transmission. Not only can nurses better-protect their patients in this way, but this subset of nurses can also better protect themselves. Please view the philanthropic website of Darebs.com at: www.darebs.com to purchase one of the offered products (such as a tee-shirt), a portion of the paid amount will be contributed to the cause associated with the product. As an example, you can own the Frontline Warrior shirt today and the purchase will donate 10% to the American Nurses Foundations’ Coronavirus Response Fund for Nurses.