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Several epidemics of novel respiratory pathogens have occurred in the past century. These have caused widespread morbidity and mortality and imposed a considerable burden on health care personnel, equipment, and supplies. Observations during the COVID-19 pandemic and research motivated by the virus have advanced our understanding of the pathogenesis of respiratory diseases spread by airborne infectious particles. When the next pandemic inevitably emerges, anesthesiologists must be prepared.
The COVID-19 pandemic advanced our medical knowledge of airborne transmission and understanding of how diseases spread through air currents. Anesthesiologists currently encounter airborne-transmitted diseases that include, but are not limited to, chickenpox, COVID-19, influenza, measles, respiratory syncytial virus, and tuberculosis. Several other viruses, bacteria, and fungi have been shown to spread through airborne means.
Airborne-transmitted diseases are spread by liquid particles produced by an infected source through coughing, sneezing, singing, or talking. Although finer particles can travel in air currents and spread further than six feet, larger particles are deposited closer to the source. High velocity of airflow and turbulence within the air passages of an infected source create fine infectious particles through a process called aerosolization. Particles less than 100 micrometers, especially those less than 5 micrometers (the diameter of a typical red blood cell), can be carried by air currents, travel long distances, and remain infectious from minutes to, in some cases, hours.
When indoors, ambient airflow and ventilation are important factors determining the probability that aerosolized particles will reach a susceptible host. Airflow control and specially designed ventilation systems reduce the potential for disease transmission. Air filtration and UV light exposure will also reduce or eliminate infectious pathogens.
Anesthesiologists and their groups should determine local policies and procedures for triaging and treating patients with known or suspected airborne-transmitted respiratory diseases. A feature of those policies should be directed toward protecting other patients and healthcare workers. When performed on patients infected with respiratory diseases, airway procedures such as bronchoscopy, laryngoscopy and intubation, manual ventilation using a bag-valve-mask device, and airway suctioning can produce aerosols. Patients with known or suspected airborne-transmitted respiratory diseases should wear a surgical mask and ideally should be placed in a room with special air handling (e.g. negative pressure, high air turnover, and air recycled after filtration or exhausted outside the building). When treating those patients, healthcare workers should don a well-fitted N95 mask or a similarly protective device. Because infectious particles are deposited on surrounding surfaces, hand hygiene should be performed before and after entering the patient’s room. Environmental cleaning and disinfection are essential to break the cycle of transmission from surrounding surfaces.
Anesthesiologists would be well-served to review the ASA Committee on Occupational Health’s “Recommendations for Infection Control for the Practice of Anesthesiology: Preventing Infectious Transmission During Anesthetic Care” and incorporate those recommendations into local policy. Anesthesiologists are also encouraged to use the ASA Community to share information, ask questions, or communicate with other members on best practices. Anesthesiologists, their groups, and their facility executives would likewise benefit from routinely reviewing and updating their policies and procedures with the most recent evidence on airborne-transmitted diseases.
ASA recognizes that most hospitals, facilities, and anesthesiologists have incorporated COVID-19 protocols into larger policies regarding airborne-transmitted diseases. Of note, anesthesiologists and the facilities where they work may wish to consider the ASA and APSF Joint Statement on Elective Surgery Procedures and Anesthesia for Patients After COVID-19 Infection with regard to treating patients recently infected with COVID-19.
ASA Contact
Please e-mail ASA Department of Quality and Regulatory Affairs at qra@asahq.org with any inquiries, including those related to COVID-19.
American Society of Anesthesiologists. Recommendations for Infection Control for the Practice of Anesthesiology: Preventing Infectious Transmission During Anesthesia Care. Committee on Occupational Health Work Product. Accessed 11/27/2025
https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/recommendations-for-infection-control.
Wang CC, Prather KA, Sznitman J, et al. Airborne transmission of respiratory viruses. Science. 2021 Aug 27;373(6558):eabd9149. doi: 10.1126/science.abd9149.
This page is curated by Quality and Regulatory Affairs, and was last updated January 2026.
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