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The AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR) study aims to rapidly study the amount and type of aerosol generated when medical procedures are performed, and how infectious this aerosol is.

Aerosol generation occurs when tiny droplets of liquid are suspended in the air. Aerosols can be generated during many medical procedures. Some procedures might produce more aerosols than others, and droplets of different sizes, but this is largely unknown at the moment. However, aerosols can carry viruses, like coronavirus, which risks further infections if inhaled by healthcare staff or other patients.

Many medical and surgical guideline groups have made decisions that certain procedures are aerosol generating, based on limited or no evidence. As a result, many procedure lists have been cancelled or are being performed with authorised delays between procedures and full PPE for staff. These delays can add more than 30 minutes to routine procedures such as cataract surgery, pulmonary function tests, and joint replacement surgery, reducing capacity at a time when the NHS is facing a huge backlog that will have an impact on patients.  

The AERATOR study will be carried out using specialist equipment in operating theatres and wards to measure real-life aerosol generation in five clinical settings: dental, orthopaedic, respiratory, critical care and ophthalmology. By using specialist equipment, only available at the University of Bristol, the research team will also investigate how long coronavirus survives while airborne and how environmental conditions impact on the infectivity of the virus.

The research will also advise guidelines on the appropriate level of PPE for staff, as well as the length of time aerosol is present for and how it spreads in a real-world clinical setting.

Nick Maskell, Professor of Respiratory Medicine at NBT and Bristol Medical School: Translational Health Sciences (THS), and principal investigator for the project, said:

“A systematic improvement of the evidence would then allow procedures that are truly low risk to go ahead without the need for patient testing, air-cycling protocols or extensive PPE. Our study will ensure that higher risk procedures are performed efficiently in the appropriate clinical settings and without risk to staff or patients. 

Given how often these routine procedures are performed across the NHS, even a small improvement in efficiency will have a vast impact on clinical services, waiting times and costs.”

Jonathan Reid, Director of Bristol Aerosol Research Centre and Professor of Physical Chemistry in the School of Chemistry at the University of Bristol, and co-investigator on the project, added:

“We hope our research will show how best to organise operating theatres, medical procedures, out-patient clinics, wards and use of PPE, in order to protect patients and staff while maximising the ability of the NHS to resume life-saving work.”

The research findings will help inform hospital trusts, policy makers and Public Health England about the safe reopening of essential NHS services.

The project ‘AERosolisation And Transmission Of SARS-CoV-2 in Healthcare Settings (AERATOR)’ is funded by a grant award of £433,000 from the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) COVID-19 rapid response initiative. The 12-month study will run until August 2021.

Study Results:

Aerosol emission from the respiratory tract: An analysis of relative risks from oxygen delivery systems

Study Visual Story:

AERATOR: A study from the Bristol Academic Respiratory Unit

View/Download the complete visual story:

AERATOR Results Visual Story - PDF 4.4MB4.35 MB

 

Thank you to all of our research teams who are making such a different to people’s lives, and also to Southmead Hospital Charity which is raising much-needed funds for COVID-19 research.

GMC Number: 6122646

Year & location of first qualification: 2005, Birmingham

Specialty: Renal Transplant / General Surgery 

Clinical interests: Surgical management of patients with kidney failure which include transplantation, haemodialysis and peritoneal dialysis. Additional interests are the management of abdominal hernias, both open and laparoscopic.

Secretary: Daisy Headington

Telephone number: 0117 414 0835

Year of first qualification: 2005, University of Oxford

Specialty: Clinical Immunology and Allergy 

Secretary: Helen Harris

Telephone: 0117 414 8392

Dr Alexandros Grammatikos completed his MSc, at the University of Oxford in 2005. He then undertook a PhD at Aristotle University of Thessaloniki, Greece in 2009. Other training includes the United States Medical Licensing Examination in 2012 and  the FRCPath in 2020. 

Dr Grammatikos has been involved in multiple research publications, reviews & book chapters and oral presentations including at the South West Immunology Network Meeting.

Specialty: Emegency Medicine and Paediatric Emergency Medicine

Clinical interests: High impact users

Secretary telephone number: 0117 414 7470

GMC Number: 6102589

Year & location of first qualification: 2005, Leicester Warwick Medical School, University of Leicester

Specialty: Urological Surgery

Clinical interests: Robotic surgery, Pelvic uro-oncology, Prostate and Bladder Cancer

Secretary: Morgan Kettle

Telephone number: 0117 414 5001

Mr Raj Pal is a Consultant Urological Surgeon at the Bristol Urological Institute. He has a specialist interest in the management of prostate and bladder cancer, and performs robotic surgery for these conditions. He qualified at Leicester Warwick Medical School and carried out his Urology Specialist training in the East Midlands before completing a Robotic fellowship at Southmead Hospital in 2018. He spent a year as a consultant at University Hospitals of Nottingham NHS Trust before being appointed at NBT as a Consultant in 2019.

Professional memberships:
British Medical Association
Fellow of the Royal College of Surgeons
British Association of Urological Surgeons European Association of Urology
BSc (Hons), MBChB, MD, FRCS (Urol)

GMC Number: 3216703

Year & location of first qualification: 1987, Universität Autonoma de Barcelona (Spain)

Specialty: Plastic and Reconstructive Surgery

Clinical interests: Acute and reconstruction of Burns injuries

Secretary: Jane Baker

Telephone number: 0117 414 7629

Miss Catalina Estela trained in the South West region and became a consultant in plastic surgery in 2005. She works as part of the multidisciplinary burns team, caring for paediatric and adult burns.

Miss Estela is actively involved in training and teaching as Educational and Clinical supervisor. She is also the organiser and lead instructor in the EMSB (Burns) course and is also Co-Dean at North Bristol Trust Medical Academy part of the University of Bristol Medical School.

GMC Number: 3583904

Year & location of first qualification: 1992, MBChB Aberdeen

Specialty: Obstetrics

Clinical interests: Specialist in maternal medicine, caring for women with pre-existing medical conditions during pregnancy. I also offer pre-pregnancy advice clinics for those women with medical conditions considering pregnancy.

Secretary: Lauren Dunphy

Telephone number: 0117 4146749

Dr Standing is a member of RCOG, British Maternal Fetal Medicine Society and MacDonald Obstetric Medicine Society.

GMC Number: 3454918

Year & location of first qualification: 1990, Southampton Medical School

Specialty: Emergency Medicine

GMC Number: 6078818 

Year & location of first qualification: MB BS, MA (Oxon), PhD, FRCS (SN)  

Specialty: Complex Spine Surgery

Clinical interests: Craniocervical pathology, cervical spondylosis, lumbar disc disease, minimally invasive spine surgery, intradural pathology.

Secretary: Lydia Cooley

Telephone number: 0117 414 6699

Mr Nowell is a Consultant Neurosurgeon and Spinal Surgeon at Southmead Hospital, Bristol.

Following completion of neurosurgical training in Bristol, Mr Nowell developed a subspecialty interest in Spinal Surgery. He completed the Complex Spine Fellowship at the Leeds General Infirmary and the Sir Victor Horsley Spinal Fellowship at the National Hospital for Neurology and Neurosurgery (NHNN) and the Royal Orthopaedic Hospital, Stanmore.

As a true dual trained surgeon in Neurosurgical and Orthopaedic Spine Surgery, he is equipped with the skills and experience to provide the most appropriate treatments across the entire spectrum of Spinal Surgery. This includes degenerative disease, trauma, tumour and infection across the whole spine.

Mr Nowell’s particular clinical interests include cervical and lumbar degenerative disease, minimally invasive surgery and navigation intradural surgery.

Mr Nowell trained in medicine at Oriel College, Oxford and Imperial College School of Medicine, London, and achieved a first-class honours degree in Physiological Sciences from Oxford.

He also completed a PhD at University College London. This focused on the development of advanced imaging tools and computer navigation for use in the operating theatre, which is increasingly relevant in Spinal Surgery today.

Mr Nowell has presented widely at National and International meetings and has published extensively. He was awarded the British Association of Spinal Surgeons Travelling Fellowship in 2017. As a member of BASS and the Society of British Neurosurgeons (SBNS), he regularly attends meetings which promote engagement and collaboration with colleagues and other professions allied to surgery. He is the current Spinal Surgery Academic Lead for the SBNS.

Mr Nowell believes strongly in patient-centred care. He offers a range of treatment options and supports patients to make informed decisions that is right for them.