Given COVID-19’s airborne transmission, the healthcare industry has understandably acted conservatively when it comes to the use of aerosol drug delivery.
The education surrounding bioaerosols, medical aerosols, and aerosol-generating procedures to healthcare providers varies significantly depending on one’s specialty. While the safety concern of infection transmission with bio-aerosols, or tiny airborne particles that come directly from the patient (when they cough, for example) are valid, it is important not to confuse bioaerosol with medical aerosols produced by nebulizers and inhalers3. When administered correctly, medical aerosols can actually be a safe and effective way to treat COVID-19 symptoms and other respiratory conditions3–5. Medical aerosols do not contain any viral particles unless they are contaminated by the health care worker or the patient, which is largely preventable by device selection and provider training3,4.
The pandemic presents us with a teaching opportunity to not only spend time discussing the difference between bio-aerosols and medical aerosols to support current infection control and care practices, but also to determine how we best prepare the next generation of healthcare professionals to understand the nuances of respiratory care.
Educating our Next Generation of Frontline Clinicians
The virus has brought with it a lot of uncertainty, but one thing has been made abundantly clear: our frontline workers are incredible. Both during “normal” times and especially during this pandemic, we’ve seen clinicians and support staff put themselves in harm’s way, work overtime, and do whatever they can to be there for their patients. But the virus has also underscored some of the challenges that come with a medical crisis of this magnitude.
In the typical pre-COVID care environment, nurses, physicians and respiratory therapists were the ones to determine what therapy is required including when to put a patient on a ventilator or administer drugs with a nebulizer. But in today’s healthcare environment, many health systems are responding to various guidelines1,6,7 by prohibiting or greatly reducing the use of “Aerosol Generating Procedures” which may or may not add to the risk of transmission of the virus. For example, intubation has been shown to have a 4 fold risk of infection, while medical aerosol posed no additional risk8. The bottom line is we need to do all the necessary procedures in a safe manner. Dealing with an influx of critically ill patients and COVID-19 has required an all-hands-on-deck approach to respiratory care, putting healthcare workers under a tremendous amount of stress. Because of this, all caregivers – not just respiratory specialists – need to be well versed in respiratory care and relevant infection control, which historically has not been a major emphasis in practice or training. So, how do we go about that?
Integrate More Aerosol Education in Medical Training
By incorporating more education around aerosol drug delivery into all medical school textbooks, we can create a better baseline of understanding and get to the heart of some of the confusion that exists. A review of common textbooks found that basic training for respiratory therapists includes hundreds of textbook pages on the indication, use, and safety of medical aerosol administration while medical students may have less than 2 pages and nursing students only 20 pages. All of these texts need to address the distinction between safe and dangerous aerosols and aerosol-generating procedures (AGPs) vs procedures that disperse aerosols generated by the patient. We need to start with consistency in aerosol understanding at the very beginning of medical training.
Promote and Support Respiratory Care Cross-Training in the Field
Respiratory therapists and specialists have always played an important role in the critical care team, providing support and expertise to the team with a wide range of respiratory care provided. This pandemic has clearly shown that in a crisis scenario brought on by a respiratory virus, well trained respiratory care personnel are essential to help healthcare providers be more comfortable and effective working with respiratory-related medical equipment. Education should start in textbooks and curriculum, but it needs to continue into medical practice, and respiratory therapists continue to play a crucial role in training physicians and nurses to be well-versed in working with ventilators, nebulizers, and other respiratory care devices essential in critical care settings.
Understand the Nuances to Aerosol Drug Delivery
aerosol drug delivery in a closed-circuit ventilator system is a safe means of delivering medication to critically ill patients.
Despite the confusion around bioaerosols and medical aerosols, aerosol drug delivery in a closed-circuit ventilator system is a safe means of delivering medication to critically ill patients. COVID-19 has made us rethink and readjust respiratory care practices in a way that will improve patient care in the long run. But be assured, after COVID-19 is in the history books, there will be a “NEXT” airborne virus. I’m hopeful that these changes we make today will prepare our future healthcare professionals for the months and years to come, including the next global crisis which might not be so severe if we remember our lessons from the past.
Jim Fink, Chief Scientific Officer, Aerogen Pharma Corporation
