Comparison of droplet spread in standard and laminar flow operating theatres: SPRAY study group

Background: Reducing COVID-19 transmission relies on controlling droplet and aerosol spread. Fluorescein staining reveals microscopic droplets. Aim: To compare the droplet spread in non-laminar and laminar air flow operating theatres. Methods: A 'cough-generator' was fixed to a theatre trolley at 45 degrees. Fluorescein-stained 'secretions' were projected on to a series of calibrated targets. These were photographed under UV light and 'source detection' software measured droplet splatter size and distance. Findings: The smallest droplet detected was similar to 120 mm and the largest similar to 24,000 mm. An average of 25,862 spots was detected in the non-laminar theatre, comparedwith 11,430 in the laminar theatre (56% reduction). The laminar air flow mainly affected the smaller droplets (<1000 mm). The surface area covered with droplets was: 6% at 50 cm, 1% at 2 m, and 0.5% at 3 m in the non-laminar air flow; and 3%, 0.5%, and 0.2% in the laminar air flow, respectively. Conclusion: Accurate mapping of droplet spread in clinical environments is possible using fluorescein staining and image analysis. The laminar air flow affected the smaller droplets but had limited effect on larger droplets in our 'aerosol-generating procedure' cough model. Our results indicate that the laminar air flow theatre requires similar post-surgery cleaning to the non-laminar, and staff should consider full personal protective equipment for medium- and high-risk patients. (C) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Automated summary

Accurate mapping of droplet spread in clinical environments is possible using fluorescein staining and image analysis. Laminar air flow mainly affected smaller droplets, with limited impact on larger droplets.