Quantification of Health Care Worker Model to Secondhand Exposure of Aerosols During Nebulization Treatment

Background: Nebulization therapy is crucial for treating respiratory conditions by delivering medication directly to patients' lungs. However, it also exposes health care workers (HCWs) to secondhand aerosols, potentially posing health risks. This study aimed to quantify inhalation exposure of model HCWs during nebulization treatments, an area where exposure levels remain uncertain. Methods: Experiments were conducted in a climate controlled ICU room at 22°C using 3 adult models simulating a patient and 2 HCWs positioned at 1 ft and 3 ft from the patient model. Nebulization was administered through either an aerosol mask for mouth-breathing or a tracheostomy tube with a T-piece or tracheostomy mask. A jet nebulizer delivered albuterol sulfate (15 mg/3 mL) in 2 consecutive sessions, totaling 30 mg in 30 min. Inhaled drug doses were captured by filters placed between the trachea and model lung, and the inhaled dose was measured using ultraviolet spectrophotometry (276 nm). Particle concentrations at 1 ft and 3 ft from the patient were continuously measured with particle counters. Each experiment was repeated 3 times, with 30-min intervals to reset baseline conditions. Results: Albuterol inhaled doses for the HCW model ranged from 0.1% to 0.3%, consistent across interfaces and distances (P > .05). The highest dose occurred with the tracheostomy mask (0.29 ± 0.05% at 1 ft and 0.22 ± 0.05% at 3 ft). Particle concentrations were similar across distances, except with the tracheostomy mask, which showed higher concentrations at 1 ft compared with 3 ft. A strong linear correlation was found between inhaled doses and fugitive aerosol concentrations at 1 ft (r² = 0.794). Conclusions: The HCW models were exposed to fugitive aerosol particles during nebulization, with inhaled doses from 0.1% to 0.3%. Although exposure was low, further in vivo studies are needed to assess potential health risks with prolonged exposure.