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Santarpia JL, Klug E, Ravnholdt A, Kinahan SM. Environmental sampling for disease surveillance: Recent advances and recommendations for best practice. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2023; 73:434-461. [PMID: 37224401 DOI: 10.1080/10962247.2023.2197825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/15/2023] [Accepted: 03/10/2023] [Indexed: 05/26/2023]
Abstract
The study of infectious diseases includes both the progression of the disease in its host and how it transmits between hosts. Understanding disease transmission is important for recommending effective interventions, protecting healthcare workers, and informing an effective public health response. Sampling the environment for infectious diseases is critical to public health since it can provide an understanding of the mechanisms of transmission, characterization of contamination in hospitals and other public areas, and the spread of a disease within a community. Measurements of biological aerosols, particularly those that may cause disease, have been an ongoing topic of research for decades, and so a wide variety of technological solutions exist. This wide field of possibilities can create confusion, particularly when different approaches yield different answers. Therefore, guidelines for best practice in this area are important to allow more effective use of this data in public health decisions. This review examines air, surface and water/wastewater sampling methods, with a focus on aerosol sampling, and a goal of recommending approaches to designing and implementing sampling systems that may incorporate multiple strategies. This is accomplished by developing a framework for designing and evaluating a sampling strategy, reviewing current practices and emerging technologies for sampling and analysis, and recommending guidelines for best practice in the area of aerosol sampling for infectious disease.
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Affiliation(s)
- Joshua L Santarpia
- The Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
- National Strategic Research Institute, Omaha, NE, USA
| | - Elizabeth Klug
- The Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ashley Ravnholdt
- The Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sean M Kinahan
- The Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
- National Strategic Research Institute, Omaha, NE, USA
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Billman CL, Flinn J, Gadala A, Bowman C, McIlquham T, Sulmonte CJ, Garibaldi BT. Creating a Safety Officer Program to Enhance Staff Safety During the Care of COVID-19 Patients. Health Secur 2022; 20:S54-S59. [PMID: 35483094 DOI: 10.1089/hs.2021.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Staff safety is paramount when managing an infectious disease event. However, early data from the COVID-19 pandemic suggested that staff compliance with personal protective equipment and other safety protocols was poor. In response to patient surges, many hospitals created dedicated "biomode" units to provide care for patients infected with SARS-CoV-2, the virus that causes COVID-19. To enhance staff safety on biomode units and during patient transports, our hospital created a safety officer/transport safety officer (SO/TSO) program. The first SOs/TSOs were nurses, clinical technicians, and other support staff who were redeployed from their home units when the units closed during the initial surge. During subsequent COVID-19 surges, dedicated SOs/TSOs were hired to maintain the program. SOs/TSOs provided just-in-time personal protective equipment training and helped staff safely enter and exit COVID-19 clinical units. SOs/TSOs participated in the transport of over 1,000 COVID-19 patients with no safety incidents reported. SOs/TSOs conducted safety audits throughout the hospital and observed 86% compliance with COVID-19 precautions across 32,500 activities. During contact tracing of frontline staff who became infected with SARS-CoV-2, potential deviations from COVID-19 precautions were identified in only 7.7% of cases. The SO/TSO program contributed to a culture of safety in the biomode units and helped to enhance infection prevention throughout the hospital. This program can serve as a model for other health systems during the response to the current pandemic and during future infectious disease threats.
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Affiliation(s)
- Carrie L Billman
- Carrie L. Billman, RN, BSN, CIC, is a Senior Infection Control Epidemiologist, Hospital Epidemiology and Infection Control, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Jade Flinn
- Jade Flinn, MSN, RN, is a Nurse Educator, Johns Hopkins Biocontainment Unit, Department of Medicine, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Avinash Gadala
- Avinash Gadala, PhD, MS, BPharm, is a Clinical Analytics Systems Architect, Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD
| | - Chad Bowman
- Chad Bowman, MSN, RN, CFRN, NR-P, is Lead Clinical Nurse, Lifeline Critical Care Transport Team, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Taylor McIlquham
- Taylor McIlquham, MPH, CIC, is an Infection Control Epidemiologist, Hospital Epidemiology and Infection Control, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Christopher J Sulmonte
- Christopher J. Sulmonte, MHA, is a Project Administrator, Johns Hopkins Biocontainment Unit, Department of Medicine, all at The Johns Hopkins Hospital, Baltimore, MD
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEPH, is Medical Director, Johns Hopkins Biocontainment Unit, Department of Medicine, all at The Johns Hopkins Hospital, Baltimore, MD
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Rufino de Sousa N, Steponaviciute L, Margerie L, Nissen K, Kjellin M, Reinius B, Salaneck E, Udekwu KI, Rothfuchs AG. Detection and isolation of airborne SARS-CoV-2 in a hospital setting. INDOOR AIR 2022; 32:e13023. [PMID: 35347788 PMCID: PMC9111425 DOI: 10.1111/ina.13023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 05/15/2023]
Abstract
Transmission mechanisms for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are incompletely understood. In particular, aerosol transmission remains unclear, with viral detection in air and demonstration of its infection potential being actively investigated. To this end, we employed a novel electrostatic collector to sample air from rooms occupied by COVID-19 patients in a major Swedish hospital. Electrostatic air sampling in conjunction with extraction-free, reverse-transcriptase polymerase chain reaction (hid-RT-PCR) enabled detection of SARS-CoV-2 in air from patient rooms (9/22; 41%) and adjoining anterooms (10/22; 45%). Detection with hid-RT-PCR was concomitant with viral RNA presence on the surface of exhaust ventilation channels in patients and anterooms more than 2 m from the COVID-19 patient. Importantly, it was possible to detect active SARS-CoV-2 particles from room air, with a total of 496 plaque-forming units (PFUs) being isolated, establishing the presence of infectious, airborne SARS-CoV-2 in rooms occupied by COVID-19 patients. Our results support circulation of SARS-CoV-2 via aerosols and urge the revision of existing infection control frameworks to include airborne transmission.
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Affiliation(s)
- Nuno Rufino de Sousa
- Department of Microbiology, Tumor and Cell Biology (MTC)Karolinska InstitutetStockholmSweden
| | - Laura Steponaviciute
- Department of Microbiology, Tumor and Cell Biology (MTC)Karolinska InstitutetStockholmSweden
| | - Lucille Margerie
- Department of Microbiology, Tumor and Cell Biology (MTC)Karolinska InstitutetStockholmSweden
| | - Karolina Nissen
- Department of Medical SciencesInfectious DiseasesUppsala UniversityUniversity Hospital UppsalaUppsalaSweden
| | - Midori Kjellin
- Department of Medical SciencesInfectious DiseasesUppsala UniversityUniversity Hospital UppsalaUppsalaSweden
| | - Björn Reinius
- Department of Medical Biochemistry and Biophysics (MBB)Karolinska InstitutetStockholmSweden
| | - Erik Salaneck
- Department of Medical SciencesInfectious DiseasesUppsala UniversityUniversity Hospital UppsalaUppsalaSweden
| | - Klas I. Udekwu
- Department of Aquatic Sciences and AssessmentSwedish University of Agricultural SciencesUppsalaSweden
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Ribaric NL, Vincent C, Jonitz G, Hellinger A, Ribaric G. Hidden hazards of SARS-CoV-2 transmission in hospitals: A systematic review. INDOOR AIR 2022; 32:e12968. [PMID: 34862811 DOI: 10.1111/ina.12968] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/17/2021] [Accepted: 11/19/2021] [Indexed: 05/04/2023]
Abstract
Despite their considerable prevalence, dynamics of hospital-associated COVID-19 are still not well understood. We assessed the nature and extent of air- and surface-borne SARS-CoV-2 contamination in hospitals to identify hazards of viral dispersal and enable more precise targeting of infection prevention and control. PubMed, ScienceDirect, Web of Science, Medrxiv, and Biorxiv were searched for relevant articles until June 1, 2021. In total, 51 observational cross-sectional studies comprising 6258 samples were included. SARS-CoV-2 RNA was detected in one in six air and surface samples throughout the hospital and up to 7.62 m away from the nearest patients. The highest detection rates and viral concentrations were reported from patient areas. The most frequently and heavily contaminated types of surfaces comprised air outlets and hospital floors. Viable virus was recovered from the air and fomites. Among size-fractionated air samples, only fine aerosols contained viable virus. Aerosol-generating procedures significantly increased (ORair = 2.56 (1.46-4.51); ORsurface = 1.95 (1.27-2.99)), whereas patient masking significantly decreased air- and surface-borne SARS-CoV-2 contamination (ORair = 0.41 (0.25-0.70); ORsurface = 0.45 (0.34-0.61)). The nature and extent of hospital contamination indicate that SARS-CoV-2 is likely dispersed conjointly through several transmission routes, including short- and long-range aerosol, droplet, and fomite transmission.
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Affiliation(s)
- Noach Leon Ribaric
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Günther Jonitz
- German Medical Association, Berlin, Germany
- State Chamber of Physicians Berlin, Berlin, Germany
| | - Achim Hellinger
- Department of General, Visceral, Endocrine and Oncologic Surgery, Fulda Hospital, University Medicine Marburg Campus Fulda, Fulda, Germany
| | - Goran Ribaric
- Johnson & Johnson Institute, Norderstedt, Germany
- MedTech Europe, Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAI) Sector Group, Brussels, Belgium
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