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Published in: Antimicrobial Resistance & Infection Control 1/2020

Open Access 01-12-2020 | SARS-CoV-2 | Review

Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19

Authors: Rami Sommerstein, Christoph Andreas Fux, Danielle Vuichard-Gysin, Mohamed Abbas, Jonas Marschall, Carlo Balmelli, Nicolas Troillet, Stephan Harbarth, Matthias Schlegel, Andreas Widmer, Swissnoso

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2020

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Abstract

Objectives

To determine the risk of SARS-CoV-2 transmission by aerosols, to provide evidence on the rational use of masks, and to discuss additional measures important for the protection of healthcare workers from COVID-19.

Methods

Literature review and expert opinion.

Short conclusion

SARS-CoV-2, the pathogen causing COVID-19, is considered to be transmitted via droplets rather than aerosols, but droplets with strong directional airflow support may spread further than 2 m. High rates of COVID-19 infections in healthcare-workers (HCWs) have been reported from several countries. Respirators such as filtering face piece (FFP) 2 masks were designed to protect HCWs, while surgical masks were originally intended to protect patients (e.g., during surgery). Nevertheless, high quality standard surgical masks (type II/IIR according to European Norm EN 14683) appear to be as effective as FFP2 masks in preventing droplet-associated viral infections of HCWs as reported from influenza or SARS. So far, no head-to-head trials with these masks have been published for COVID-19. Neither mask type completely prevents transmission, which may be due to inappropriate handling and alternative transmission pathways. Therefore, compliance with a bundle of infection control measures including thorough hand hygiene is key. During high-risk procedures, both droplets and aerosols may be produced, reason why respirators are indicated for these interventions.
Literature
1.
go back to reference Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020.
2.
go back to reference Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020.
3.
go back to reference Wong SC, Kwong RT, Wu TC, Chan JWM, Chu MY, Lee SY, et al. Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect. 2020. Wong SC, Kwong RT, Wu TC, Chan JWM, Chu MY, Lee SY, et al. Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong. J Hosp Infect. 2020.
4.
go back to reference Kluytmans M, Buiting A, Pas S, Bentvelsen R, van den Bijllaardt W, van Oudheusden A, et al. SARS-CoV-2 infection in 86 healthcare workers in two Dutch hospitals in March 2020. medRxiv. 2020:2020.03.23.20041913. Kluytmans M, Buiting A, Pas S, Bentvelsen R, van den Bijllaardt W, van Oudheusden A, et al. SARS-CoV-2 infection in 86 healthcare workers in two Dutch hospitals in March 2020. medRxiv. 2020:2020.03.23.20041913.
5.
go back to reference Team CC-R. Characteristics of health care personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):477–81.CrossRef Team CC-R. Characteristics of health care personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):477–81.CrossRef
6.
go back to reference Hunter E, Price DA, Murphy E, van der Loeff IS, Baker KF, Lendrem D, et al. First experience of COVID-19 screening of health-care workers in England. Lancet. 2020;395(10234):e77–e8.CrossRef Hunter E, Price DA, Murphy E, van der Loeff IS, Baker KF, Lendrem D, et al. First experience of COVID-19 screening of health-care workers in England. Lancet. 2020;395(10234):e77–e8.CrossRef
7.
go back to reference Chowell G, Abdirizak F, Lee S, Lee J, Jung E, Nishiura H, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med. 2015;13:210.CrossRef Chowell G, Abdirizak F, Lee S, Lee J, Jung E, Nishiura H, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med. 2015;13:210.CrossRef
8.
go back to reference World Health Organisation. Requirements and technical specifications of personal protective equipment (PPE) for the novel coronavirus (2019-ncov) in healthcare settings. Geneva 2020. Accessed 27.4.2020. World Health Organisation. Requirements and technical specifications of personal protective equipment (PPE) for the novel coronavirus (2019-ncov) in healthcare settings. Geneva 2020. Accessed 27.4.2020.
13.
go back to reference Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Effect of voicing and articulation manner on aerosol particle emission during human speech. PLoS One. 2020;15(1):e0227699.CrossRef Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Effect of voicing and articulation manner on aerosol particle emission during human speech. PLoS One. 2020;15(1):e0227699.CrossRef
16.
go back to reference Musher DM. How contagious are common respiratory tract infections? N Engl J Med. 2003;348(13):1256–66.CrossRef Musher DM. How contagious are common respiratory tract infections? N Engl J Med. 2003;348(13):1256–66.CrossRef
17.
go back to reference Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M, et al. Active monitoring of persons exposed to patients with confirmed COVID-19 - United States, January-February 2020. MMWR Morb Mortal Wkly Rep. 2020;69(9):245–6.CrossRef Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M, et al. Active monitoring of persons exposed to patients with confirmed COVID-19 - United States, January-February 2020. MMWR Morb Mortal Wkly Rep. 2020;69(9):245–6.CrossRef
18.
go back to reference Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. medRxiv. 2020:2020.03.03.20028423. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. medRxiv. 2020:2020.03.03.20028423.
19.
go back to reference Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, et al. High SARS-CoV-2 attack rate following exposure at a choir practice - Skagit County, Washington, march 2020. MMWR Morb Mortal Wkly Rep. 2020;69(19):606–10.CrossRef Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, et al. High SARS-CoV-2 attack rate following exposure at a choir practice - Skagit County, Washington, march 2020. MMWR Morb Mortal Wkly Rep. 2020;69(19):606–10.CrossRef
20.
go back to reference Frieden TR, Lee CT. Identifying and Interrupting Superspreading Events-Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26:6.CrossRef Frieden TR, Lee CT. Identifying and Interrupting Superspreading Events-Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26:6.CrossRef
21.
go back to reference Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020.
22.
go back to reference Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med. 2015;57(5):501–8.CrossRef Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med. 2015;57(5):501–8.CrossRef
23.
go back to reference Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis. 2019;19(1):101.CrossRef Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis. 2019;19(1):101.CrossRef
24.
go back to reference Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog. 2013;9(3):e1003205.CrossRef Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog. 2013;9(3):e1003205.CrossRef
25.
go back to reference Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza a in human beings. Lancet Infect Dis. 2007;7(4):257–65.CrossRef Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza a in human beings. Lancet Infect Dis. 2007;7(4):257–65.CrossRef
26.
go back to reference van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–7.CrossRef van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–7.CrossRef
27.
go back to reference Santarpia JL, Rivera DN, Herrera V, Morwitzer MJ, Creager H, Santarpia GW, et al. Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center. medRxiv. 2020. Santarpia JL, Rivera DN, Herrera V, Morwitzer MJ, Creager H, Santarpia GW, et al. Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center. medRxiv. 2020.
28.
go back to reference Liu Y, Ning Z, Chen Y, Guo M, Liu Y, Gali NK, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. 2020. Liu Y, Ning Z, Chen Y, Guo M, Liu Y, Gali NK, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. 2020.
29.
go back to reference Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020. Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020.
30.
go back to reference Chia PY, Coleman KK, Tan YK, Ong SWX, Gum M, Lau SK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nat Commun. 2020;11(1):2800.CrossRef Chia PY, Coleman KK, Tan YK, Ong SWX, Gum M, Lau SK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nat Commun. 2020;11(1):2800.CrossRef
31.
go back to reference Bin SY, Heo JY, Song MS, Lee J, Kim EH, Park SJ, et al. Environmental contamination and viral shedding in MERS patients during MERS-CoV outbreak in South Korea. Clin Infect Dis. 2016;62(6):755–60.CrossRef Bin SY, Heo JY, Song MS, Lee J, Kim EH, Park SJ, et al. Environmental contamination and viral shedding in MERS patients during MERS-CoV outbreak in South Korea. Clin Infect Dis. 2016;62(6):755–60.CrossRef
32.
go back to reference Leung NHL, Chu DKW, Shiu EYC, Chan K-H, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine. 2020. Leung NHL, Chu DKW, Shiu EYC, Chan K-H, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine. 2020.
33.
go back to reference Yan J, Grantham M, Pantelic J, Bueno de Mesquita PJ, Albert B, Liu F, et al. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci U S A. 2018;115(5):1081–6.CrossRef Yan J, Grantham M, Pantelic J, Bueno de Mesquita PJ, Albert B, Liu F, et al. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci U S A. 2018;115(5):1081–6.CrossRef
34.
go back to reference Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or droplet precautions for health workers treating COVID-19? J infect dis; 2020. Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or droplet precautions for health workers treating COVID-19? J infect dis; 2020.
35.
go back to reference Jennison MW. Atomizing of mouth and nose secretions into the air as revealed by high-speed photography. Aerobiology. 1942;17:106–28. Jennison MW. Atomizing of mouth and nose secretions into the air as revealed by high-speed photography. Aerobiology. 1942;17:106–28.
36.
go back to reference Hall CB. Prevention of infections with respiratory syncytial virus: the hopes and hurdles ahead. Rev Infect Dis. 1980;2(3):384–92.CrossRef Hall CB. Prevention of infections with respiratory syncytial virus: the hopes and hurdles ahead. Rev Infect Dis. 1980;2(3):384–92.CrossRef
37.
go back to reference Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26:7. Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26:7.
38.
go back to reference Olsen SJ, Chang HL, Cheung TY, Tang AF, Fisk TL, Ooi SP, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med. 2003;349(25):2416–22.CrossRef Olsen SJ, Chang HL, Cheung TY, Tang AF, Fisk TL, Ooi SP, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med. 2003;349(25):2416–22.CrossRef
40.
go back to reference Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.CrossRef Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.CrossRef
41.
go back to reference O'Neil CA, Li J, Leavey A, Wang Y, Hink M, Wallace M, et al. Characterization of aerosols generated during patient care activities. Clin Infect Dis. 2017;65(8):1335–41.CrossRef O'Neil CA, Li J, Leavey A, Wang Y, Hink M, Wallace M, et al. Characterization of aerosols generated during patient care activities. Clin Infect Dis. 2017;65(8):1335–41.CrossRef
42.
go back to reference Thompson KA, Pappachan JV, Bennett AM, Mittal H, Macken S, Dove BK, et al. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic--the risk of aerosol generation during medical procedures. PLoS One. 2013;8(2):e56278.CrossRef Thompson KA, Pappachan JV, Bennett AM, Mittal H, Macken S, Dove BK, et al. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic--the risk of aerosol generation during medical procedures. PLoS One. 2013;8(2):e56278.CrossRef
43.
go back to reference MacIntyre CR, Wang Q, Seale H, Yang P, Shi W, Gao Z, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Respir Crit Care Med. 2013;187(9):960–6.CrossRef MacIntyre CR, Wang Q, Seale H, Yang P, Shi W, Gao Z, et al. A randomized clinical trial of three options for N95 respirators and medical masks in health workers. Am J Respir Crit Care Med. 2013;187(9):960–6.CrossRef
44.
go back to reference Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis. Clin Infect Dis. 2017;65(11):1934–42.CrossRef Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of masks and respirators against respiratory infections in healthcare workers: a systematic review and meta-analysis. Clin Infect Dis. 2017;65(11):1934–42.CrossRef
45.
go back to reference Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: a systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses. 2020. Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: a systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses. 2020.
46.
go back to reference Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ. 2016;188(8):567–74.CrossRef Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ. 2016;188(8):567–74.CrossRef
47.
go back to reference Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the risk to health care workers: a case report. Ann Intern Med. 2020. Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the risk to health care workers: a case report. Ann Intern Med. 2020.
48.
go back to reference Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent persontoperson transmission of SARSCoV2 and COVID19: a systematic review and metaanalysis. Lancet 2020; published online June 1. https://doi.org/10.1016/S01406736(20)311429. Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent persontoperson transmission of SARSCoV2 and COVID19: a systematic review and metaanalysis. Lancet 2020; published online June 1. https://​doi.​org/​10.​1016/​S01406736(20)311429.
49.
go back to reference Seto WH. Airborne transmission and precautions: facts and myths. J Hosp Infect. 2015;89(4):225–8.CrossRef Seto WH. Airborne transmission and precautions: facts and myths. J Hosp Infect. 2015;89(4):225–8.CrossRef
50.
go back to reference Kampf G. Potential role of inanimate surfaces for the spread of coronaviruses and their inactivation with disinfectant agents. Infection Prevention in Practice 2020:100044. . Kampf G. Potential role of inanimate surfaces for the spread of coronaviruses and their inactivation with disinfectant agents. Infection Prevention in Practice 2020:100044. .
51.
go back to reference Ofner-Agostini M, Gravel D, McDonald LC, Lem M, Sarwal S, McGeer A, et al. Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series. Infect Control Hosp Epidemiol. 2006;27(5):473–8.CrossRef Ofner-Agostini M, Gravel D, McDonald LC, Lem M, Sarwal S, McGeer A, et al. Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series. Infect Control Hosp Epidemiol. 2006;27(5):473–8.CrossRef
52.
go back to reference Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA. 2009;302(17):1865–71.CrossRef Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA. 2009;302(17):1865–71.CrossRef
53.
go back to reference MacIntyre CR, Wang Q, Cauchemez S, Seale H, Dwyer DE, Yang P, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses. 2011;5(3):170–9.CrossRef MacIntyre CR, Wang Q, Cauchemez S, Seale H, Dwyer DE, Yang P, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses. 2011;5(3):170–9.CrossRef
54.
go back to reference Radonovich LJ Jr, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322(9):824–33.CrossRef Radonovich LJ Jr, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322(9):824–33.CrossRef
55.
go back to reference Brainard JS, Jones N, Lake I, Hooper L, Hunter P. Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review. medRxiv. 2020:2020.04.01.20049528. Brainard JS, Jones N, Lake I, Hooper L, Hunter P. Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review. medRxiv. 2020:2020.04.01.20049528.
56.
go back to reference Blachere FM, Lindsley WG, McMillen CM, Beezhold DH, Fisher EM, Shaffer RE, et al. Assessment of influenza virus exposure and recovery from contaminated surgical masks and N95 respirators. J Virol Methods. 2018;260:98–106.CrossRef Blachere FM, Lindsley WG, McMillen CM, Beezhold DH, Fisher EM, Shaffer RE, et al. Assessment of influenza virus exposure and recovery from contaminated surgical masks and N95 respirators. J Virol Methods. 2018;260:98–106.CrossRef
57.
go back to reference Alonso WJ, Nascimento FC, Shapiro J, Schuck-Paim C. Facing ubiquitous viruses: when hand washing is not enough. Clin Infect Dis. 2013;56(4):617.CrossRef Alonso WJ, Nascimento FC, Shapiro J, Schuck-Paim C. Facing ubiquitous viruses: when hand washing is not enough. Clin Infect Dis. 2013;56(4):617.CrossRef
58.
go back to reference Aiello AE, Perez V, Coulborn RM, Davis BM, Uddin M, Monto AS. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS One. 2012;7(1):e29744.CrossRef Aiello AE, Perez V, Coulborn RM, Davis BM, Uddin M, Monto AS. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS One. 2012;7(1):e29744.CrossRef
59.
go back to reference Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009;151(7):437–46.CrossRef Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W, et al. Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009;151(7):437–46.CrossRef
60.
go back to reference Ki HK, Han SK, Son JS, Park SO. Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea. BMC Pulm Med. 2019;19(1):190.CrossRef Ki HK, Han SK, Son JS, Park SO. Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea. BMC Pulm Med. 2019;19(1):190.CrossRef
61.
go back to reference Sepkowitz KA, Eisenberg L. Occupational deaths among healthcare workers. Emerg Infect Dis. 2005;11(7):1003–8.CrossRef Sepkowitz KA, Eisenberg L. Occupational deaths among healthcare workers. Emerg Infect Dis. 2005;11(7):1003–8.CrossRef
Metadata
Title
Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19
Authors
Rami Sommerstein
Christoph Andreas Fux
Danielle Vuichard-Gysin
Mohamed Abbas
Jonas Marschall
Carlo Balmelli
Nicolas Troillet
Stephan Harbarth
Matthias Schlegel
Andreas Widmer
Swissnoso
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2020
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-020-00763-0

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