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Tandjaoui-Lambiotte Y, Elabbadi A, Marouane B, Besset S, Roux D, Ebstein N, Pineau P, Marchio A, Bloch-Queyrat C, Lomont A, Alloui CA, Gerber A, Delagrèverie H, Cohen Y, Zahar JR, Voiriot G. Routes of SARS-Cov2 transmission in the intensive care unit: A multicentric prospective study. J Infect Public Health 2024; 17:102454. [PMID: 38936235 DOI: 10.1016/j.jiph.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/04/2024] [Accepted: 05/15/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The risk of SARS-CoV-2 transmission to health care workers in intensive care units (ICU) and the contribution of airborne and fomites to SARS-CoV-2 transmission remain unclear. To assess the rate of air and surface contamination and identify risk factors associated with this contamination in patients admitted to the ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. METHODS Prospective multicentric non-interventional study conducted from June 2020 to November 2020 in 3 French ICUs. For each enrolled patient, 3 predefined surfaces were swabbed, 2 air samples at 1 m and 3 m from the patient's mouth and face masks of 3 health care workers (HCW) were collected within the first 48 h of SARS-CoV-2 positive PCR in a respiratory sample. Droplet digital PCR and quantitative PCR were performed on different samples, respectively. RESULTS Among 150 included patients, 5 (3.6%, 95%CI: 1.2% to 8.2%) had positive ddPCR on air samples at 1 m or 3 m. Seventy-one patients (53.3%, CI95%: 44.5% to 62.0%) had at least one surface positive. Face masks worn by HCW were positive in 6 patients (4.4%, CI: 1.6% to 9.4%). The threshold of RT-qPCR of the respiratory sample performed at inclusion (odds ratio, OR= 0.88, 95%CI: 0.83 to 0.93, p < 0.0001) and the presence of diarrhea (OR= 3.28, 95%CI: 1.09 to 9.88, p = 0.037) were significantly associated with the number of contaminated surfaces. CONCLUSION In this study, including patients admitted to the ICU for acute respiratory failure " contact route " of transmission, i.e. through fomites, seems dominant. While presence of SARS-CoV-2 in the air is rare in this specific population, the presence of diarrhea is associated to surface contamination around Covid patients.
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Affiliation(s)
- Yacine Tandjaoui-Lambiotte
- Delafontaine Hospital, Department of Pulmonology and Infectious Diseases, Saint Denis, France; INSERM UMR 1272 Hypoxia & Lung, Bobigny, France; INSERM UMR 1137 IAME, Paris, France.
| | - Alexandre Elabbadi
- Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Boubaya Marouane
- University Sorbonne Paris Nord, APHP, Avicenne hospital, Clinical Research Unit, Bobigny, France
| | - Sebastien Besset
- University Paris Cité, APHP, Louis Mourier Hospital, DMU ESPRIT, Intensive Care Unit, Colombes, France
| | - Damien Roux
- University Paris Cité, APHP, Louis Mourier Hospital, DMU ESPRIT, Intensive Care Unit, Colombes, France
| | - Nathan Ebstein
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Intensive Care Unit, Bobigny, France
| | - Pascal Pineau
- Pasteur Institute, Nuclear organization and oncogenesis, INSERM U993, France
| | - Agnes Marchio
- Pasteur Institute, Nuclear organization and oncogenesis, INSERM U993, France
| | - Coralie Bloch-Queyrat
- University Sorbonne Paris Nord, APHP, Avicenne hospital, Clinical Research Unit, Bobigny, France
| | - Alexandra Lomont
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department, Infection Control Unit, Bobigny, France Sorbonne Paris Nord University, Bobigny, France
| | - Chakib-Ahmed Alloui
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department Virology Unit, Bobigny, France, Sorbonne Paris Nord University, Bobigny, France
| | - Athenaïs Gerber
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department Virology Unit, Bobigny, France, Sorbonne Paris Nord University, Bobigny, France
| | - Heloise Delagrèverie
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Microbiology Department Virology Unit, Bobigny, France, Sorbonne Paris Nord University, Bobigny, France
| | - Yves Cohen
- University Sorbonne Paris Nord, APHP, Avicenne Hospital, Intensive Care Unit, Bobigny, France
| | - Jean Ralph Zahar
- University Paris Cité, APHP, Louis Mourier Hospital, DMU ESPRIT, Intensive Care Unit, Colombes, France
| | - Guillaume Voiriot
- Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
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Aranega-Bou P, Pottage T, Fenwick A, D'Costa W, Brown NF, Yaxley N, King MF, Parker ST, Miller D, López-García M, Noakes CJ, Moore G, Bennett A. A 17-month longitudinal surface sampling study carried out on public transport vehicles operating in England during the COVID-19 pandemic identified low levels of SARS-CoV-2 RNA contamination. J Appl Microbiol 2024; 135:lxae095. [PMID: 38637309 DOI: 10.1093/jambio/lxae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
AIMS To monitor severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA contamination in vehicles operating in England during the pandemic, to better understand transmission risk of SARS-CoV-2 on public transport. METHODS AND RESULTS We collected 1314 surface samples between December 2020 and April 2022 on trains and buses managed by five different transport operators. The presence of SARS-CoV-2 RNA was investigated through reverse transcription polymerase chain reaction (RT-PCR). SARS-CoV-2 RNA was found on 197 (15%) of the 1314 surfaces sampled, including seat head rests, handholds, and air extract grilles, but the levels of RNA recovered on those samples (median value of 23.4, interquartile range: 14.3-35.4, N gene copies per extraction) made the presence of infectious virus at the time of sampling extremely unlikely. However, detection rates varied over time with peaks broadly coinciding with times of high community transmission, when it was more likely that people infected with SARS-CoV-2 were travelling on public transport. CONCLUSION During the pandemic, and as in other public spaces, low levels of SARS-CoV-2 RNA were found on surfaces associated with public transport.
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Affiliation(s)
- Paz Aranega-Bou
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Thomas Pottage
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Abigail Fenwick
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Wilhemina D'Costa
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Natalie F Brown
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Nicola Yaxley
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Marco-Felipe King
- School of Civil Engineering, University of Leeds, Woodhouse Lane, LS29JT Leeds, United Kingdom
| | - Simon T Parker
- Defence Science and Technology Laboratory, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Daniel Miller
- Defence Science and Technology Laboratory, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Martín López-García
- School of Mathematics, University of Leeds, Woodhouse Lane, LS2 9JT Leeds , United Kingdom
| | - Catherine J Noakes
- School of Civil Engineering, University of Leeds, Woodhouse Lane, LS29JT Leeds, United Kingdom
| | - Ginny Moore
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
| | - Allan Bennett
- Biosafety, Air and Water Microbiology Group, UK Health Security Agency, Porton Down, SP4 0JG Salisbury, United Kingdom
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Matsui H, Suzuki Y, Nakayama S, Asakura T, Takeuchi O, Kusatsugu K, Ueda C, Nakajima E, Suzuki Y, Endo H, Sugamata M, Takarabe Y, Yamaguchi Y, Horie K, Kobayashi Y, Kuronuma S, Imoto Y, Hanaki H. Levels of environmental contamination with SARS-CoV-2 in hospital rooms and salivary viral loads of patients with coronavirus disease 2019. J Infect Chemother 2024; 30:315-322. [PMID: 37940039 DOI: 10.1016/j.jiac.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/23/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Clarifying the presence of viable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rather than SARS-CoV-2 viral RNA in inpatient rooms is important for infection control of coronavirus disease 2019 (COVID-19). In this study, we investigated levels of viral RNA and viable virus on environmental surfaces and in patient saliva. METHODS Environmental samples from 23 sites in hospital rooms were collected every other day until patient discharge. Saliva specimens and samples from the inner surface of patient masks were also collected. Additionally, environmental samples were collected from 46 sites in hospital rooms on discharge day. The samples were examined using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and plaque assays. RESULTS The 10 enrolled cases were classified as mild COVID-19, and patients were discharged after 6-9 days. The viral RNA was detected in 12.4% (105/849) of serially collected environmental samples during hospitalization, whereas viable virus was detected only in 0.47% (4/849), which were from sinks and tap levers. Although all patients recovered, three cases retained viable virus in the last saliva specimen collected. In the 15 discharged rooms, viral RNA was detected in 6.6% (45/682) of the samples, and viable virus was detected in only one sample from the sink. CONCLUSIONS Although environmental surfaces surrounding patients with COVID-19 were frequently contaminated with viral RNA, the presence of viable virus was rare and limited only to areas around sinks. These results suggest that contact infection risk via fomites in hospital rooms is extremely rare.
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Affiliation(s)
- Hidehito Matsui
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Yusuke Suzuki
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Sohei Nakayama
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Takanori Asakura
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Osamu Takeuchi
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Kaori Kusatsugu
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Chihiro Ueda
- The Japan Textile Products Quality and Technology Center, 5-7-3 Yamate-dori, Chuo-Ku, Kobe City, Hyogo, 650-0011, Japan
| | - Eri Nakajima
- The Japan Textile Products Quality and Technology Center, 5-7-3 Yamate-dori, Chuo-Ku, Kobe City, Hyogo, 650-0011, Japan
| | - Yumiko Suzuki
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Harumi Endo
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Miho Sugamata
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Yukiko Takarabe
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Yukie Yamaguchi
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Kazuhito Horie
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Yoshikazu Kobayashi
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Satoshi Kuronuma
- Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8642, Japan
| | - Yasuo Imoto
- The Japan Textile Products Quality and Technology Center, 5-7-3 Yamate-dori, Chuo-Ku, Kobe City, Hyogo, 650-0011, Japan
| | - Hideaki Hanaki
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan.
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Hilton J, Nanao Y, Flokstra M, Askari M, Smith TK, Di Falco A, King PDC, Wahl P, Adamson CS. The role of ion dissolution in metal and metal oxide surface inactivation of SARS-CoV-2. Appl Environ Microbiol 2024; 90:e0155323. [PMID: 38259079 PMCID: PMC10880620 DOI: 10.1128/aem.01553-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/28/2023] [Indexed: 01/24/2024] Open
Abstract
Anti-viral surface coatings are under development to prevent viral fomite transmission from high-traffic touch surfaces in public spaces. Copper's anti-viral properties have been widely documented, but the anti-viral mechanism of copper surfaces is not fully understood. We screened a series of metal and metal oxide surfaces for anti-viral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease (COVID-19). Copper and copper oxide surfaces exhibited superior anti-SARS-CoV-2 activity; however, the level of anti-viral activity was dependent on the composition of the carrier solution used to deliver virus inoculum. We demonstrate that copper ions released into solution from test surfaces can mediate virus inactivation, indicating a copper ion dissolution-dependent anti-viral mechanism. The level of anti-viral activity is, however, not dependent on the amount of copper ions released into solution per se. Instead, our findings suggest that degree of virus inactivation is dependent on copper ion complexation with other biomolecules (e.g., proteins/metabolites) in the virus carrier solution that compete with viral components. Although using tissue culture-derived virus inoculum is experimentally convenient to evaluate the anti-viral activity of copper-derived test surfaces, we propose that the high organic content of tissue culture medium reduces the availability of "uncomplexed" copper ions to interact with the virus, negatively affecting virus inactivation and hence surface anti-viral performance. We propose that laboratory anti-viral surface testing should include virus delivered in a physiologically relevant carrier solution (saliva or nasal secretions when testing respiratory viruses) to accurately predict real-life surface anti-viral performance when deployed in public spaces.IMPORTANCEThe purpose of evaluating the anti-viral activity of test surfaces in the laboratory is to identify surfaces that will perform efficiently in preventing fomite transmission when deployed on high-traffic touch surfaces in public spaces. The conventional method in laboratory testing is to use tissue culture-derived virus inoculum; however, this study demonstrates that anti-viral performance of test copper-containing surfaces is dependent on the composition of the carrier solution in which the virus inoculum is delivered to test surfaces. Therefore, we recommend that laboratory surface testing should include virus delivered in a physiologically relevant carrier solution to accurately predict real-life test surface performance in public spaces. Understanding the mechanism of virus inactivation is key to future rational design of improved anti-viral surfaces. Here, we demonstrate that release of copper ions from copper surfaces into small liquid droplets containing SARS-CoV-2 is a mechanism by which the virus that causes COVID-19 can be inactivated.
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Affiliation(s)
- Jane Hilton
- Biomedical Sciences Research Complex, School of Biology, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Yoshiko Nanao
- SUPA, School of Physics and Astronomy, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Machiel Flokstra
- SUPA, School of Physics and Astronomy, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Meisam Askari
- SUPA, School of Physics and Astronomy, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Terry K. Smith
- Biomedical Sciences Research Complex, School of Biology, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Andrea Di Falco
- SUPA, School of Physics and Astronomy, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Phil D. C. King
- SUPA, School of Physics and Astronomy, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Peter Wahl
- SUPA, School of Physics and Astronomy, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Catherine S. Adamson
- Biomedical Sciences Research Complex, School of Biology, University of St Andrews, St Andrews, Fife, United Kingdom
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Sousan S, Boatman M, Johansen L, Fan M, Roper RL. Comparing and validating air sampling methods for SARS-CoV-2 detection in HVAC ducts of student dorms. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123164. [PMID: 38103710 DOI: 10.1016/j.envpol.2023.123164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic demonstrated the threat of airborne pathogenic respiratory viruses such as the airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The ability to detect circulating viruses in a workplace or dormitory setting allows an early warning system that can alert occupants to implement precautions (e.g. masking) and/or trigger individual testing to allow isolation and quarantine measures to halt contagion. This work extends and validates the first successful detection of SARS-CoV-2 virus in dormitory Heating, Ventilation, and Air Conditioning (HVAC) systems and compares different air sampling methods and media types combined with optimized quantitative Reverse-Transcription PCR (qRT-PCR) analysis. The study was performed in two environments; large dormitories of students who underwent periodic testing for COVID-19 (unknown environment) and the HVAC air from a suite with a student who had tested positive for COVID-19 (known dorm). The air sampling methods were performed using Filter Cassettes, BioSampler, AerosolSense Sampler and Button Sampler (with four media types with different pore sizes of 5 μm, 3 μm, 3 μm (gelatin), and 1.2 μm). The SARS-CoV-2 positive air samples were compared with the positive samples collected by individual student campus track tracing methods using PCR testing on saliva and nasopharyngeal samples. The results show a detection rate of 73% in the unknown environment and a 78% detection rate in the known dorm. Our data show that the virus was detectable with all the sampling methods we employed. However, the AerosolSense sampler and BioSampler performed the best at 63% and 61% detection rates, compared to 25% for the Filter Cassettes and 23% for the Button Sampler. Despite the success rate, it is not possible to definitively conclude which method is most sensitive due to the limited number of samples. These results show that with careful sampling and optimized PCR methods, pathogenic respiratory viruses can be detected in large buildings using HVAC return air.
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Affiliation(s)
- Sinan Sousan
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA; North Carolina Agromedicine Institute, Greenville, NC, 27834, USA.
| | - Marina Boatman
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA; Department of Health Services and Information Management, College of Allied Health, East Carolina University, Greenville, NC, 27834, USA; Department of Microbiology & Immunology, Brody School of Medicine, 5E-106A, East Carolina University, Greenville, NC, 27834, USA
| | - Lauren Johansen
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA; Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, 27834, USA; Department of Microbiology & Immunology, Brody School of Medicine, 5E-106A, East Carolina University, Greenville, NC, 27834, USA
| | - Ming Fan
- Department of Microbiology & Immunology, Brody School of Medicine, 5E-106A, East Carolina University, Greenville, NC, 27834, USA
| | - Rachel L Roper
- Department of Microbiology & Immunology, Brody School of Medicine, 5E-106A, East Carolina University, Greenville, NC, 27834, USA
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Arienzo A, Gallo V, Tomassetti F, Pitaro N, Pitaro M, Antonini G. A narrative review of alternative transmission routes of COVID 19: what we know so far. Pathog Glob Health 2023; 117:681-695. [PMID: 37350182 PMCID: PMC10614718 DOI: 10.1080/20477724.2023.2228048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
The Coronavirus disease 19 (COVID-19) pandemics, caused by severe acute respiratory syndrome coronaviruses, SARS-CoV-2, represent an unprecedented public health challenge. Beside person-to-person contagion via airborne droplets and aerosol, which is the main SARS-CoV-2's route of transmission, alternative modes, including transmission via fomites, food and food packaging, have been investigated for their potential impact on SARS-CoV-2 diffusion. In this context, several studies have demonstrated the persistence of SARS-CoV-2 RNA and, in some cases, of infectious particles on exposed fomites, food and water samples, confirming their possible role as sources of contamination and transmission. Indeed, fomite-to-human transmission has been demonstrated in a few cases where person-to-person transmission had been excluded. In addition, recent studies supported the possibility of acquiring COVID-19 through the fecal-oro route; the occurrence of COVID-19 gastrointestinal infections, in the absence of respiratory symptoms, also opens the intriguing possibility that these cases could be directly related to the ingestion of contaminated food and water. Overall, most of the studies considered these alternative routes of transmission of low epidemiological relevance; however, it should be considered that they could play an important role, or even be prevalent, in settings characterized by different environmental and socio-economic conditions. In this review, we discuss the most recent findings regarding SARS-CoV-2 alternative transmission routes, with the aim to disclose what is known about their impact on COVID-19 spread and to stimulate research in this field, which could potentially have a great impact, especially in low-resource contexts.
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Affiliation(s)
| | | | | | | | - Michele Pitaro
- National Institute of Biostructures and Biosystems (INBB), Rome, Italy
| | - Giovanni Antonini
- National Institute of Biostructures and Biosystems (INBB), Rome, Italy
- Department of Science, Roma Tre University, Rome, Italy
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Zambrana W, Boehm AB. Occurrence of Human Viruses on Fomites in the Environment: A Systematic Review and Meta-analysis. ACS ENVIRONMENTAL AU 2023; 3:277-294. [PMID: 37743950 PMCID: PMC10515712 DOI: 10.1021/acsenvironau.3c00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 09/26/2023]
Abstract
Documenting the occurrence of viruses on fomites is crucial in determining the significance of fomite-mediated transmission and the potential use of fomites for environmental disease surveillance. We conducted a systematic review and meta-analysis to compile information on the occurrence of human viruses on fomites in the environment; we identified 134 peer-reviewed papers. We compiled sampling and measurement methods, results, quality control information, and whether virus data were compared with community health data from the papers. We conducted univariate and multivariate analyses to investigate if presence of virus on fomites was associated with virus type (enveloped, nonenveloped), sampling location (healthcare setting, nonhealthcare temporary setting, nonhealthcare nontemporary setting), and area of fomite swabbed (<50, 50-100, >100 cm2). Across 275 data sets from the 134 papers, there was the most data available for Coronaviridae and from fomites at hospitals. Positivity rates, defined as the percent positive fomite samples, were low (median = 6%). Data were available on viruses from 16 different viral families, but data on viruses from 9 families had few (n < 5) data sets. Many human virus families were not identified in this review (11 families). Less than 15% of the data sets reported virus concentrations in externally valid units (viruses per area of surface), and 16% provided a quantitative comparison between virus and health data. Virus type and area swabbed were significant predictors of virus presence on fomites, and the positivity rate of data sets collected from healthcare settings and nonhealthcare nontemporary settings (e.g., individual housing) were significantly higher than those collected in nonhealthcare temporary settings (e.g., restaurants). Data from this review indicates that viruses may be present on fomites, that fomite-mediated virus transmission may occur, and that fomites may provide information on circulation of infectious diseases in the community. However, more quantitative data on diverse viruses are needed, and method reporting needs significant improvements.
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Affiliation(s)
- Winnie Zambrana
- Department
of Civil & Environmental Engineering, Stanford University, 473 Via Ortega, Stanford, California 94305, United States
| | - Alexandria B. Boehm
- Department
of Civil & Environmental Engineering, Stanford University, 473 Via Ortega, Stanford, California 94305, United States
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Yung L, Leung LY, Lee KH, Morrell S, Fong MW, Yan Fung NH, Cheng KL, Kaewpreedee P, Li Y, Cowling BJ, Lau EH, Hui DS, Graham CA, Yen HL. A longitudinal environmental surveillance study for SARS-CoV-2 from the emergency department of a teaching hospital in Hong Kong. J Hosp Infect 2023:S0195-6701(23)00181-0. [PMID: 37315806 PMCID: PMC10259104 DOI: 10.1016/j.jhin.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Understanding factors associated with SARS-CoV-2 exposure risk in the hospital setting may help improve infection control measures for prevention. AIM To monitor SARS-CoV-2 exposure risk among healthcare workers and to identify risk factors associated with SARS-CoV-2 detection. METHODS Surface and air samples were collected longitudinally over 14 months spanning 2020-2022 at the Emergency Department (ED) of a teaching hospital in Hong Kong. SARS-CoV-2 viral RNA was detected by real-time reverse-transcription polymerase chain reaction. Ecological factors associated with SARS-CoV-2 detection were analysed by logistic regression. A sero-epidemiological study was conducted in January to April 2021 to monitor SARS-CoV-2 seroprevalence. A questionnaire was used to collect information on job nature and use of personal protective equipment (PPE) of the participants. FINDINGS SARS-CoV-2 RNA was detected at low frequencies from surfaces (0.7%, n=2562) and air samples (1.6%, n=128). Crowding was identified as the main risk factor, as weekly ED attendance (OR=1.002, p=0.04) and sampling after peak-hours of ED attendance (OR=5.216, p=0.03) were associated with the detection of SARS-CoV-2 viral RNA from surfaces. The low exposure risk was corroborated by the zero seropositive rate among 281 participants by April 2021. CONCLUSION Crowding may introduce SARS-CoV-2 into ED through increased attendances. Multiple factors may have contributed to the low contamination of SARS-CoV-2 at the ED, including hospital infection control measures for screening ED attendees, high PPE compliance among healthcare workers, and various public health and social measures implemented to reduce community transmission in Hong Kong where a dynamic zero COVID-19 policy was adopted.
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Affiliation(s)
- Louise Yung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Kwok Hung Lee
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
| | - Steven Morrell
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Min Whui Fong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Nikki Ho Yan Fung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kit Ling Cheng
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Prathanporn Kaewpreedee
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric Hy Lau
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - David Sc Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong Special Administrative Region, China.
| | - Hui-Ling Yen
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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9
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Liao Y, Guo S, Mao N, Li Y, Li J, Long E. Animal experiments on respiratory viruses and analogous studies of infection factors for interpersonal transmission. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:66209-66227. [PMID: 37097557 PMCID: PMC10125856 DOI: 10.1007/s11356-023-26738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/15/2023]
Abstract
Air pollution caused by SARS-CoV-2 and other viruses in human settlements will have a great impact on human health, but also a great risk of transmission. The transmission power of the virus can be represented by quanta number in the Wells-Riley model. In order to solve the problem of different dynamic transmission scenarios, only a single influencing factor is considered when predicting the infection rate, which leads to large differences in quanta calculated in the same space. In this paper, an analog model is established to define the indoor air cleaning index RL and the space ratio parameter. Based on infection data analysis and rule summary in animal experiments, factors affecting quanta in interpersonal communication were explored. Finally, by analogy, the factors affecting person-to-person transmission mainly include viral load of infected person, distance between individuals, etc., the more severe the symptoms, the closer the number of days of illness to the peak, and the closer the distance to the quanta. In summary, there are many factors that affect the infection rate of susceptible people in the human settlement environment. This study provides reference indicators for environmental governance under the COVID-19 epidemic, provides reference opinions for healthy interpersonal communication and human behavior, and provides some reference for accurately judging the trend of epidemic spread and responding to the epidemic.
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Affiliation(s)
- Yuxuan Liao
- MOE Key Laboratory of Deep Earth Science and Engineering, Room 112, College of Architecture and Environment, Administration Building, Sichuan University, No. 24, First Loop South First Section, Chengdu, 610065, China
| | - Shurui Guo
- MOE Key Laboratory of Deep Earth Science and Engineering, Room 112, College of Architecture and Environment, Administration Building, Sichuan University, No. 24, First Loop South First Section, Chengdu, 610065, China
| | - Ning Mao
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Ying Li
- MOE Key Laboratory of Deep Earth Science and Engineering, Room 112, College of Architecture and Environment, Administration Building, Sichuan University, No. 24, First Loop South First Section, Chengdu, 610065, China
| | - Jin Li
- MOE Key Laboratory of Deep Earth Science and Engineering, Room 112, College of Architecture and Environment, Administration Building, Sichuan University, No. 24, First Loop South First Section, Chengdu, 610065, China
| | - Enshen Long
- MOE Key Laboratory of Deep Earth Science and Engineering, Room 112, College of Architecture and Environment, Administration Building, Sichuan University, No. 24, First Loop South First Section, Chengdu, 610065, China.
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China.
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10
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Sammartino JC, Colaneri M, Bassoli C, Ceresini M, Piralla A, Ferrari A, Percivalle E, Baldanti F, Bruno R, Mondelli MU. Real-life lack of evidence of viable SARS-CoV-2 transmission via inanimate surfaces: The SURFACE study. J Infect Public Health 2023; 16:736-740. [PMID: 36958168 PMCID: PMC10027289 DOI: 10.1016/j.jiph.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Although the potential role of inanimate surfaces in SARS-CoV-2 transmission has yet to be adequately assessed, it is still routine practice to apply deep and expensive environmental disinfection protocols. The aim of this study was to verify the presence of viable virus on different surfaces exposed to droplets released by coughing in SARS-CoV-2 RNA positive patients. METHODS Patients admitted to hospital with a positive SARS-CoV-2 real-time (RT)-PCR swab were asked to cough on steel, cardboard, plastic and their hands. Surfaces were tested at baseline (T0) and at different timepoints thereafter using swabs dipped in medium, and quickly seeded on VERO E6 cells that were checked every other day for cytopathic effect (CPE). Laboratory-propagated SARS-CoV-2 strains were examined at the same time points and on identical materials. RESULTS Ten RNA-positive patients were enrolled into the study. The median cycle threshold value was 20.7 (range 13-28.3). Nasopharyngeal swabs from 3 of the patients yielded viable virus 2-10 days post-inoculation. However, in none of the patients was it possible to isolate viable SARS-CoV-2 from sputum under identical experimental conditions. A CPE was instead already visible using laboratory-propagated SARS-CoV-2 strains at 20', 60', 180' while an effect at 24 h required a 6-day incubation. CONCLUSION The evidence emerging from this real-life study suggests that droplets delivered by SARS-CoV-2 infected patients on common inanimate surfaces did not contain viable virus. In contrast, and in line with several laboratory-based experiments, in vitro adapted viruses could survive and grow on the same fomites.
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Affiliation(s)
- José Camilla Sammartino
- Division of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Colaneri
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Bassoli
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariaelena Ceresini
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Piralla
- Division of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Ferrari
- Division of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Percivalle
- Division of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Division of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Diagnostic & Pediatric Sciences, University of Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Diagnostic & Pediatric Sciences, University of Pavia, Italy
| | - Mario U Mondelli
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Division of Clinical Immunology and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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11
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Cox J, Christensen B, Burton N, Dunn KH, Finnegan M, Ruess A, Estill C. Transmission of SARS-CoV-2 in the workplace: Key findings from a rapid review of the literature. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2023; 57:233-254. [PMID: 37213938 PMCID: PMC10193509 DOI: 10.1080/02786826.2023.2166394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/27/2022] [Indexed: 05/23/2023]
Abstract
At the beginning of the COVID-19 pandemic, the primary route of transmission of the SARS-CoV-2 virus was not well understood. Research gathered from other respiratory infectious diseases, including other coronaviruses, was the basis for the initial perceptions for transmission of SARS-CoV-2. To better understand transmission of SARS-CoV-2, a rapid literature review was conducted from literature generated March 19, 2020, through September 23, 2021. 18,616 unique results were identified from literature databases and screened. Of these, 279 key articles were reviewed and abstracted covering critical topics such as environmental/workplace monitoring, sampling and analytical method evaluation, and the ability of the virus to remain intact and infectious during sampling. This paper describes the results of the rapid literature review, which evaluated pathways that contribute to transmission as well as the strengths and limitations of current sampling approaches. This review also evaluates how different factors, including environmental conditions and surface characteristics, could impact the transmission potential of SARS-CoV-2. A continual rapid review in the midst of a pandemic proved particularly useful for quickly understanding the transmission parameters of the virus and enabled us to comprehensively assess literature, respond to workplace questions, and evaluate our understanding as the science evolved. Air and surface sampling with the accompanying analytical methods were not generally effective in recovering SARS-CoV-2 viable virus or RNA in many likely contaminated environments. In light of these findings, the development of validated sampling and analysis methods is critical for determining worker exposure to SARS-CoV-2 and to assess the impact of mitigation efforts.
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Affiliation(s)
- Jennie Cox
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Brian Christensen
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Nancy Burton
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Kevin H. Dunn
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | | | - Ana Ruess
- Gryphon Scientific, Takoma Park, MD, USA
| | - Cherie Estill
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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12
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Ramírez-Torres CA, Rivera-Sanz F, Sufrate-Sorzano T, Pedraz-Marcos A, Santolalla-Arnedo I. Closed Endotracheal Suction Systems for COVID-19: Rapid Review. Interact J Med Res 2023; 12:e42549. [PMID: 36548950 PMCID: PMC9874988 DOI: 10.2196/42549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. OBJECTIVE This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. METHODS A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." RESULTS A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. CONCLUSIONS Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.
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Affiliation(s)
- Carmen Amaia Ramírez-Torres
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| | | | - Teresa Sufrate-Sorzano
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| | | | - Ivan Santolalla-Arnedo
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
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13
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Muacevic A, Adler JR, Afzal Z, Tucker S, Lucas-Evans R, Dayala A, Mlangeni D. Environmental Contamination With SARS-CoV-2 in a Hospital Setting. Cureus 2023; 15:e34136. [PMID: 36843686 PMCID: PMC9948512 DOI: 10.7759/cureus.34136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is a global concern and has changed the way we practice medicine in acute hospital settings. This is particularly true with regard to patient triage, patient risk assessment, use of personal protective equipment, and environmental disinfection. Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily through inhalation of respiratory droplets generated through talking, coughing, or sneezing. There is, however, a potential risk that respiratory droplets settling on inanimate surfaces and objects in the hospital environment could provide a reservoir for nosocomial infections in patients and pose a healthcare risk to medical staff. Indeed, there have been previous reports of healthcare-associated outbreaks in hospitals. Several authors have argued that the risk of transmission via fomites may be insignificant. It is, however, not clear what proportion of SARS-CoV-2 infections are attributable to direct contact with fomites; a few reports have indicated possible transmission via this route. Environmental contamination with SARS-CoV-2 in healthcare institutions has been shown to vary according to the function or service provided by a unit or department. Information that identifies hospital areas that have a propensity for higher environmental burden may improve the practice of infection control and environmental cleaning and decontamination in healthcare institutions. This study aimed to investigate environmental SARS-CoV-2 contamination in the clinical areas of patients with COVID-19 infection. Methodology We conducted a cross-sectional study performing swabbing of frequently touched surfaces, equipment, and ventilation ducts in five specific clinical areas of Peterborough City Hospital which is part of the North West Anglia NHS Foundation Trust. The five clinical areas that were chosen for swabbing were the Emergency Department (ED), Intensive Care Unit (ICU), Isolation Ward, Respiratory Ward, and a Gastroenterology Ward that was serving as a receiving ward at the height of the second COVID-19 infection wave in the United Kingdom. Surfaces to be swabbed were divided into the patient zone, doctor zone, and nursing zone. Swabs from the chosen surfaces were collected on two consecutive days. A total of 158 surface swabs were collected during the second wave of the COVID-19 pandemic. SARS-CoV-2 RNA was detected by reverse transcription polymerase chain reaction. Results The most contaminated clinical areas were the three receiving wards where 12% (11/96) of the swabs were positive. Inside the patient rooms, these surfaces included bed rails and controls, bedside tables, television screens, remote control units, and the room ventilation system. Outside the patient room, these surfaces included mobile computers and computer desk surfaces in the doctors' offices. All swabs taken from the ED and ICU were found to be negative. Conclusions Our study confirms the potential infection risks posed by environmental contamination with the SARS-CoV-2 virus. This highlights the importance of adequate environmental cleaning for proper infection control and prevention in healthcare settings.
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14
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Response to "Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) surface contamination in staff common areas and impact on healthcare worker infection: Prospective surveillance during the coronavirus disease 2019 (COVID-19) pandemic". Infect Control Hosp Epidemiol 2023; 44:161-162. [PMID: 35383551 PMCID: PMC9043627 DOI: 10.1017/ice.2022.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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15
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The Management of Infectious Pulmonary Processes in the Emergency Department: Pneumonia. PHYSICIAN ASSISTANT CLINICS 2023; 8:123-137. [PMID: 36448036 PMCID: PMC9688359 DOI: 10.1016/j.cpha.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pneumonia is a common diagnosis encountered by emergency medicine providers. It is crucial that an accurate and timely diagnosis is established in order to appropriately manage each patient. Following the outbreak of SARS-CoV-2 in 2019, the frequency of patient visits to the emergency department for symptoms consistent with pneumonia have increased and overwhelmed virtually all hospital systems. The rapid identification of COVID-19 patients is imperative for patient care and to these hospital systems experiencing the pandemic. Community-acquired bacterial pneumonia continues to be prevalent and clinical decision-making tools are useful aids to assist the appropriate disposition of patients.
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16
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Siewiera J, Brodaczewska K, Jermakow N, Lubas A, Kłos K, Majewska A, Kot J. Effectiveness of Hyperbaric Oxygen Therapy in SARS-CoV-2 Pneumonia: The Primary Results of a Randomised Clinical Trial. J Clin Med 2022; 12:jcm12010008. [PMID: 36614808 PMCID: PMC9820955 DOI: 10.3390/jcm12010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Mortality in COVID-19 is mainly associated with respiratory failure, cytokine storm, and macrophage activation. Oxygenation and anti-inflammatory effects of Hyperbaric Oxygen Therapy (HBOT) suggest that it is a promising adjunct treatment for COVID-19. Repeated sessions of HBO with standard COVID-19 therapy were used to reduce the inflammation and increase oxygenation. We evaluated the safety and efficacy of HBOT in avoiding the replacement ventilation and/or ECMO and its effect on the inflammatory process. Twenty-eight moderate-to-severe COVID-19 patients were randomized into control or HBOT group. HBOT patients participated in 5 hyperbaric sessions (60 min). Before and after each session blood gas levels and vital parameters were monitored. Blood samples were collected for extended biochemical tests, blood morphology and immunological assays. There were 3 deaths in the control, no deaths in the HBOT group. No adverse events leading to discontinuation of HBOT were observed and patients receiving HBOT required lower oxygen delivery. We observed decrease in CRP, ferritin and LDH and increase in CD3 in HBOT group compared to control. This study confirmed the feasibility and safety of HBOT in patients with COVID-19 and indicated HBOT can lead to alleviation of inflammation and partial restoration of T cell responses.
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Affiliation(s)
- Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Klaudia Brodaczewska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Natalia Jermakow
- Department of Hyperbaric Medicine, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Arkadiusz Lubas
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Aleksandra Majewska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
- Postgraduate School of Molecular Medicine (SMM), Warsaw Medical University, 02-091 Warsaw, Poland
- Correspondence:
| | - Jacek Kot
- National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 81-519 Gdynia, Poland
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Sato M, Fukaya T, Ogawa T, Nunose N, Hosaka S. The role of clinical engineers in the coronavirus disease 2019 pandemic. Glob Health Med 2022; 4:294-295. [PMID: 36381567 PMCID: PMC9619116 DOI: 10.35772/ghm.2022.01012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
The duties of a clinical engineer (CE) during the coronavirus infection 2019 (COVID-19) pandemic were diverse. The original duties of a CE included operation and maintenance of life support equipment used for respiratory therapy, hemodialysis, and extracorporeal membrane oxygenation. The management of life support equipment is critical. The PB-840 ventilator is equipped with a heat sink system that dissipates internal heat through thermal conduction. Therefore, internal contamination is less likely to occur. The exhalation filter used in the PB- 840 can be used for up to 15 days. It can be used for long periods of time without maintenance, reducing the risk of infection. The PB-840 is a suitable device for patients with COVID-19. Its use in critically ill patients was determined to be a priority. Thus, use of an appropriate device for infection control requires a proper understanding of and familiarity with the device in question.
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Affiliation(s)
- Motohiko Sato
- Address correspondence to:Motohiko Sato, Medical Equipment Management Office, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
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18
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Correia G, Rodrigues L, Afonso M, Mota M, Oliveira J, Soares R, Tomás AL, Reichel A, Silva PM, Costa JJ, da Silva MG, Santos NC, Gonçalves T. SARS-CoV-2 air and surface contamination in residential settings. Sci Rep 2022; 12:18058. [PMID: 36302823 PMCID: PMC9610309 DOI: 10.1038/s41598-022-22679-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
SARS-CoV-2 transmission occurs mainly indoors, through virus-laden airborne particles. Although the presence and infectivity of SARS-CoV-2 in aerosol are now acknowledged, the underlying circumstances for its occurrence are still under investigation. The contamination of domiciliary environments during the isolation of SARS-CoV-2-infected patients in their respective rooms in individual houses and in a nursing home was investigated by collecting surface and air samples in these environments. Surface contamination was detected in different contexts, both on high and low-touch surfaces. To determine the presence of virus particles in the air, two sampling methodologies were used: air and deposition sampling. Positive deposition samples were found in sampling locations above the patient's height, and SARS-CoV-2 RNA was detected in impactation air samples within a size fraction below 2.5 μm. Surface samples rendered the highest positivity rate and persistence for a longer period. The presence of aerosolized SARS-CoV-2 RNA occurred mainly in deposition samples and closer to symptom onset. To evaluate the infectivity of selected positive samples, SARS-CoV-2 viability assays were performed, but our study was not able to validate the virus viability. The presented results confirm the presence of aerosolized SARS-CoV-2 RNA in indoor compartments occupied by COVID-19 patients with mild symptoms, in the absence of aerosol-generating clinical procedures.
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Affiliation(s)
- Gil Correia
- FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.
- Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504, Coimbra, Portugal.
- ARS Centro, IP, Alameda Júlio Henriques, 3000-457, Coimbra, Portugal.
| | - Luís Rodrigues
- Universitary Clinic of Nephrology, Faculty of Medicine University of Coimbra Nephrology Service, Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Mariana Afonso
- FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504, Coimbra, Portugal
| | - Marta Mota
- FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504, Coimbra, Portugal
| | - Joana Oliveira
- FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504, Coimbra, Portugal
| | - Rui Soares
- FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504, Coimbra, Portugal
- Department of Clinical Pathology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, 3000-075, Coimbra, Portugal
| | - Ana Luísa Tomás
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Anna Reichel
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Patrícia M Silva
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - José J Costa
- ADAI, Department of Mechanical Engineering, Univ Coimbra, Rua Luís Reis Santos, Pólo II, 3030-788, Coimbra, Portugal
| | - Manuel Gameiro da Silva
- ADAI, Department of Mechanical Engineering, Univ Coimbra, Rua Luís Reis Santos, Pólo II, 3030-788, Coimbra, Portugal
| | - Nuno C Santos
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Teresa Gonçalves
- FMUC, Faculty of Medicine, Univ Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.
- Medical Microbiology Research Group, CNC-Center for Neurosciences and Cell Biology, 3004-504, Coimbra, Portugal.
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Photocatalytic Inactivation of Viruses and Prions: Multilevel Approach with Other Disinfectants. Appl Microbiol 2022. [DOI: 10.3390/applmicrobiol2040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ag, Cu, Zn, Ti, and Au nanoparticles show enhanced photocatalytic properties. Efficient indoor disinfection strategies are imperative to manage the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Virucidal agents, such as ethanol, sodium hypochlorite, 222-nm UV light, and electrolyzed water inactivate SARS-CoV-2 in indoor environments. Tungsten trioxide (WO3) photocatalyst and visible light disinfect abiotic surfaces against SARS-CoV-2. The titanium dioxide (TiO2)/UV system inactivates SARS-CoV-2 in aerosols and on deliberately contaminated TiO2-coated glass slide surfaces in photocatalytic chambers, wherein 405-nm UV light treatment for 20 min sterilizes the environment and generates reactive oxygen species (ROS) that inactivate the virus by targeting S and envelope proteins and viral RNA. Mesoscopic calcium bicarbonate solution (CAC-717) inactivates pathogens, such as prions, influenza virus, SARS-CoV-2, and noroviruses, in fluids; it presumably acts similarly on human and animal skin. The molecular complexity of cementitious materials promotes the photocatalysis of microorganisms. In combination, the two methods can reduce the pathogen load in the environment. As photocatalysts and CAC-717 are potent disinfectants for prions, disinfectants against prionoids could be developed by combining photocatalysis, gas plasma methodology, and CAC-717 treatment, especially for surgical devices and instruments.
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Viral Cultures for Assessing Fomite Transmission of SARS-CoV-2: a Systematic Review and Meta-Analysis. J Hosp Infect 2022; 130:63-94. [PMID: 36115620 PMCID: PMC9473144 DOI: 10.1016/j.jhin.2022.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/01/2023]
Abstract
Background The role of fomites in the transmission of SARS-CoV-2 is unclear. Aim To assess whether SARS-CoV-2 can be transmitted through fomites, using evidence from viral culture studies. Methods Searches were conducted in the World Health Organization COVID-19 Database, PubMed, LitCovid, medRxiv, and Google Scholar to December 31st, 2021. Studies that investigated fomite transmission and performed viral culture to assess the cytopathic effect (CPE) of positive fomite samples and confirmation of SARS-CoV-2 as the cause of the CPE were included. The risk of bias using a checklist modified from the modified Quality Assessment of Diagnostic Accuracy Studies – 2 (QUADAS-2) criteria was assessed. Findings Twenty-three studies were included. The overall risk of bias was moderate. Five studies demonstrated replication-competent virus from fomite cultures and three used genome sequencing to match fomite samples with human clinical specimens. The mean cycle threshold (CT) of samples with positive viral culture was significantly lower compared with cultured samples that returned negative results (standardized mean difference: –1.45; 95% confidence interval (CI): –2.00 to –0.90; I2 = 0%; P < 0.00001). The likelihood of isolating replication-competent virus was significantly greater when CT was <30 (relative risk: 3.10; 95% CI: 1.32 to 7.31; I2 = 71%; P = 0.01). Infectious specimens were mostly detected within seven days of symptom onset. One study showed possible transmission of SARS-CoV-2 from fomites to humans. Conclusion The evidence from published studies suggests that replication-competent SARS-CoV-2 is present on fomites. Replication-competent SARS-CoV-2 is significantly more likely when the PCR CT for clinical specimens and fomite samples is <30. Further studies should investigate the duration of infectiousness of SARS-CoV-2 and the frequency of transmission from fomites.
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21
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Joan TV, Kristiyan SA, Ernest SL, Nuria TP, Herme GB, Josep MB. Efficiency and sensitivity optimization of a protocol to quantify indoor airborne SARS-CoV-2 levels. J Hosp Infect 2022; 130:44-51. [PMID: 36100140 PMCID: PMC9465472 DOI: 10.1016/j.jhin.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Background Development of methodologies to quantify airborne micro-organisms is needed for the prevention and control of infections. It is difficult to conclude which is the most efficient and sensitive strategy to assess airborne SARS-CoV-2 RNA levels due to the disparity of results reported in clinical settings. Aim To improve our previously reported protocol of measuring SARS-CoV-2 RNA levels, which was based on bioaerosol collection with a liquid impinger and RNA quantification with droplet digital polymerase chain reaction (ddPCR). Methods Air samples were collected in COVID-19 patient rooms to assess efficiency and/or sensitivity of different air samplers, liquid collection media, and reverse transcriptases (RT). Findings Mineral oil retains airborne RNA better than does hydrophilic media without impairing integrity. SARS-CoV-2 ORF1ab target was detected in 80% of the air samples using BioSampler with mineral oil. No significant differences in effectiveness were obtained with MD8 sampler equipped with gelatine membrane filters, but the SARS-CoV-2 copies/m3 air obtained with the latter were lower (28.4 ± 6.1 vs 9 ± 1.7). SuperScript II RT allows the detection of a single SARS-CoV-2 genome RNA molecule by ddPCR with high efficiency. This was the only RT that allowed the detection of SARS-CoV-2 N1 target in air samples. Conclusion The collection efficiency and detection sensivity of a protocol to quantify SARS-CoV-2 RNA levels in indoor air has been improved in the present study. Such optimization is important to improve our understanding of the microbiological safety of indoor air.
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Affiliation(s)
- Truyols-Vives Joan
- Molecular Biology and One Health Research Group (MolONE), Universitat de Les Illes Balears (UIB), Palma, Spain
| | | | - Sala-Llinàs Ernest
- Molecular Biology and One Health Research Group (MolONE), Universitat de Les Illes Balears (UIB), Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain; Department of Pulmonary Medicine, Hospital Universitari Son Espases (HUSE), Balearic Islands, Spain; Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Toledo-Pons Nuria
- Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain; Department of Pulmonary Medicine, Hospital Universitari Son Espases (HUSE), Balearic Islands, Spain
| | - G Baldoví Herme
- Department of Chemistry, Universitat Politècnica de València (UPV)
| | - Mercader-Barceló Josep
- Molecular Biology and One Health Research Group (MolONE), Universitat de Les Illes Balears (UIB), Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain.
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22
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Geng Y, Wang Y. Stability and transmissibility of SARS-CoV-2 in the environment. J Med Virol 2022; 95:e28103. [PMID: 36039831 PMCID: PMC9537778 DOI: 10.1002/jmv.28103] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the ongoing global coronavirus disease 2019 (COVID-19) pandemic, is believed to be transmitted primarily through respiratory droplets and aerosols. However, reports are increasing regarding the contamination of environmental surfaces, shared objects, and cold-chain foods with SARS-CoV-2 RNA and the possibility of environmental fomite transmission of the virus raises much concern and debate. This study summarizes the current knowledge regarding potential mechanisms of environmental transmission of SARS-CoV-2, including the prevalence of surface contamination in various settings, the viability and stability of the virus on surfaces or fomites, as well as environmental factors affecting virus viability and survival such as temperature and relative humidity. Instances of fomite transmission, including cold-chain food transmission, and the importance of fomite transmission in epidemics, are discussed. The knowledge gaps regarding fomite transmission of SARS-CoV-2 are also briefly analyzed.
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Affiliation(s)
- Yansheng Geng
- Key Laboratory of Public Health Safety of Hebei Province, School of Public HealthHebei UniversityBaodingChina
| | - Youchun Wang
- Division of HIV/AIDS and Sex‐Transmitted Virus VaccinesNational Institutes for Food and Drug ControlBeijingChina
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23
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Yan K, Lin J, Albaugh S, Yang M, Wang E, Cyberski T, Abasiyanik MF, Wroblewski KE, O'Connor M, Klock A, Tung A, Shahul S, Kurian D, Tay S, Pinto JM. Measuring SARS-CoV-2 aerosolization in rooms of hospitalized patients. Laryngoscope Investig Otolaryngol 2022; 7:1033-1041. [PMID: 35942422 PMCID: PMC9350181 DOI: 10.1002/lio2.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Airborne spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a significant risk for healthcare workers. Understanding transmission of SARS-CoV-2 in the hospital could help minimize nosocomial infection. The objective of this pilot study was to measure aerosolization of SARS-CoV-2 in the hospital rooms of COVID-19 patients. Methods Two air samplers (Inspirotec) were placed 1 and 4 m away from adults with SARS-CoV-2 infection hospitalized at an urban, academic tertiary care center from June to October 2020. Airborne SARS-CoV-2 concentration was measured by quantitative reverse transcription polymerase chain reaction and analyzed by clinical parameters and patient demographics. Results Thirteen patients with COVID-19 (eight females [61.5%], median age: 57 years old, range 25-82) presented with shortness of breath (100%), cough (38.5%) and fever (15.4%). Respiratory therapy during air sampling varied: mechanical ventilation via endotracheal tube (n = 3), high flow nasal cannula (n = 4), nasal cannula (n = 4), respiratory helmet (n = 1), and room air (n = 1). SARS-CoV-2 RNA was identified in rooms of three out of three intubated patients compared with one out of 10 of the non-intubated patients (p = .014). Airborne SARS-CoV-2 tended to decrease with distance (1 vs. 4 m) in rooms of intubated patients. Conclusions Hospital rooms of intubated patients had higher levels of aerosolized SARS-CoV-2, consistent with increased aerosolization of virus in patients with severe disease or treatment with positive pressure ventilation through an endotracheal tube. While preliminary, these data have safety implications for health care workers and design of protective measures in the hospital. Level of Evidence 2.
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Affiliation(s)
- Kenneth Yan
- Department of Head and Neck SurgeryUniversity of California Los AngelesCaliforniaLos AngelesUSA
| | - Jing Lin
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Shaley Albaugh
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Meredith Yang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Esther Wang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Thomas Cyberski
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Mustafa Fatih Abasiyanik
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | | | - Michael O'Connor
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Allan Klock
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Avery Tung
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Sajid Shahul
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Dinesh Kurian
- Department of Anesthesiology & Critical CareThe University of ChicagoChicagoIllinoisUSA
| | - Savaş Tay
- Pritzker School of Molecular EngineeringThe University of ChicagoChicagoIllinoisUSA
- Institute for Genomics and Systems BiologyThe University of ChicagoChicagoIllinoisUSA
| | - Jayant M. Pinto
- Section of Otolaryngology‐Head and Neck Surgery, Department of SurgeryThe University of ChicagoChicagoIllinoisUSA
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24
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Borgese L, Tomasoni G, Marciano F, Zacco A, Bilo F, Stefana E, Cocca P, Rossi D, Cirelli P, Ciribini ALC, Comai S, Mastrolembo Ventura S, Savoldi Boles M, Micheletti D, Cattivelli D, Galletti S, Dubacq S, Perrone MG, Depero LE. Definition of an Indoor Air Sampling Strategy for SARS-CoV-2 Detection and Risk Management: Case Study in Kindergartens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7406. [PMID: 35742654 PMCID: PMC9224333 DOI: 10.3390/ijerph19127406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
In the last two years, the world has been overwhelmed by SARS-CoV-2. One of the most important ways to prevent the spread of the virus is the control of indoor conditions: from surface hygiene to ventilation. Regarding the indoor environments, monitoring the presence of the virus in the indoor air seems to be promising, since there is strong evidence that airborne transmission through infected droplets and aerosols is its dominant transmission route. So far, few studies report the successful detection of SARS-CoV-2 in the air; moreover, the lack of a standard guideline for air monitoring reduces the uniformity of the results and their usefulness in the management of the risk of virus transmission. In this work, starting from a critical analysis of the existing standards and guidelines for indoor air quality, we define a strategy to set-up indoor air sampling plans for the detection of SARS-CoV-2. The strategy is then tested through a case study conducted in two kindergartens in the metropolitan city of Milan, in Italy, involving a total of 290 children and 47 teachers from 19 classrooms. The results proved its completeness, effectiveness, and suitability as a key tool in the airborne SARS-CoV-2 infection risk management process. Future research directions are then identified and discussed.
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Affiliation(s)
- Laura Borgese
- INSTM and Chemistry for Technologies Laboratory, Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (A.Z.); (F.B.); (L.E.D.)
- Smart Solutions S.r.l., Via Corfù, 106, 25124 Brescia, Italy
| | - Giuseppe Tomasoni
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.T.); (E.S.); (P.C.); (D.R.)
| | - Filippo Marciano
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.T.); (E.S.); (P.C.); (D.R.)
| | - Annalisa Zacco
- INSTM and Chemistry for Technologies Laboratory, Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (A.Z.); (F.B.); (L.E.D.)
- Smart Solutions S.r.l., Via Corfù, 106, 25124 Brescia, Italy
| | - Fabjola Bilo
- INSTM and Chemistry for Technologies Laboratory, Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (A.Z.); (F.B.); (L.E.D.)
- Smart Solutions S.r.l., Via Corfù, 106, 25124 Brescia, Italy
| | - Elena Stefana
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.T.); (E.S.); (P.C.); (D.R.)
| | - Paola Cocca
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.T.); (E.S.); (P.C.); (D.R.)
| | - Diana Rossi
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.T.); (E.S.); (P.C.); (D.R.)
| | - Paola Cirelli
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy;
| | - Angelo Luigi Camillo Ciribini
- Department of Civil and Environmental Engineering, Architecture and Mathematics, University of Brescia, Via Branze 43, 25123 Brescia, Italy; (A.L.C.C.); (S.C.); (S.M.V.)
| | - Sara Comai
- Department of Civil and Environmental Engineering, Architecture and Mathematics, University of Brescia, Via Branze 43, 25123 Brescia, Italy; (A.L.C.C.); (S.C.); (S.M.V.)
| | - Silvia Mastrolembo Ventura
- Department of Civil and Environmental Engineering, Architecture and Mathematics, University of Brescia, Via Branze 43, 25123 Brescia, Italy; (A.L.C.C.); (S.C.); (S.M.V.)
| | | | | | - Daniela Cattivelli
- AAT-Advanced Analytical Technologies S.r.l., Via P. Majavacca 12, 29017 Fiorenzuola d’Arda, Italy; (D.C.); (S.G.)
| | - Serena Galletti
- AAT-Advanced Analytical Technologies S.r.l., Via P. Majavacca 12, 29017 Fiorenzuola d’Arda, Italy; (D.C.); (S.G.)
| | - Sophie Dubacq
- Bertin Instruments, Brand of Bertin Technologies S.A.S., 10 Bis Avenue Ampère, 78180 Montigny-le-Bretonneux, France;
| | - Maria Grazia Perrone
- TCR Tecora S.r.l., Via delle Primule, 16, 20815 Cogliate, Italy;
- XearPro S.r.l., Via delle Primule, 16, 20815 Cogliate, Italy
| | - Laura Eleonora Depero
- INSTM and Chemistry for Technologies Laboratory, Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (A.Z.); (F.B.); (L.E.D.)
- Smart Solutions S.r.l., Via Corfù, 106, 25124 Brescia, Italy
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25
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Cosentini R, Groff P, Brambilla AM, Camajori Todeschini R, Gangitano G, Ingrassia S, Marino R, Nori F, Pagnozzi F, Panero F, Ferrari R. SIMEU position paper on non-invasive respiratory support in COVID-19 pneumonia. Intern Emerg Med 2022; 17:1175-1189. [PMID: 35103926 PMCID: PMC8803573 DOI: 10.1007/s11739-021-02906-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
The rapid worldwide spread of the Coronavirus disease (COVID-19) crisis has put health systems under pressure to a level never experienced before, putting intensive care units in a position to fail to meet an exponentially growing demand. The main clinical feature of the disease is a progressive arterial hypoxemia which rapidly leads to ARDS which makes the use of intensive care and mechanical ventilation almost inevitable. The difficulty of health systems to guarantee a corresponding supply of resources in intensive care, together with the uncertain results reported in the literature with respect to patients who undergo early conventional ventilation, make the search for alternative methods of oxygenation and ventilation and potentially preventive of the need for tracheal intubation, such as non-invasive respiratory support techniques particularly valuable. In this context, the Emergency Department, located between the area outside the hospital and hospital ward and ICU, assumes the role of a crucial junction, due to the possibility of applying these techniques at a sufficiently early stage and being able to rapidly evaluate their effectiveness. This position paper describes the indications for the use of non-invasive respiratory support techniques in respiratory failure secondary to COVID-19-related pneumonia, formulated by the Non-invasive Ventilation Faculty of the Italian Society of Emergency Medicine (SIMEU) on the base of what is available in the literature and on the authors' direct experience. Rationale, literature, tips & tricks, resources, risks and expected results, and patient interaction will be discussed for each one of the escalating non-invasive respiratory techniques: standard oxygen, HFNCO, CPAP, NIPPV, and awake self-repositioning. The final chapter describes our suggested approach to the failing patient.
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Affiliation(s)
| | - Paolo Groff
- Pronto Soccorso e Osservazione Breve, Perugia, AO, Italy
| | | | | | | | - Stella Ingrassia
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | - Roberta Marino
- Emergency Medicine, Sant'Andrea Hospital, Vercelli, Italy
| | - Francesca Nori
- Emergency Room, Emergency Care Unit, Santa Maria Della Scaletta Hospital, Imola, Italy
| | | | - Francesco Panero
- MECAU 2, Pronto Soccorso e Area Critica, ASL Città di Torino, Turin, Italy
| | - Rodolfo Ferrari
- Emergency Room, Emergency Care Unit, Santa Maria Della Scaletta Hospital, Imola, Italy
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26
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Sobolik JS, Sajewski ET, Jaykus LA, Cooper DK, Lopman BA, Kraay AN, Ryan PB, Guest JL, Webb-Girard A, Leon JS. Decontamination of SARS-CoV-2 from cold-chain food packaging provides no marginal benefit in risk reduction to food workers. Food Control 2022; 136:108845. [PMID: 35075333 PMCID: PMC8770992 DOI: 10.1016/j.foodcont.2022.108845] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 01/20/2023]
Abstract
Countries continue to debate the need for decontamination of cold-chain food packaging to reduce possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fomite transmission among frontline workers. While laboratory-based studies demonstrate persistence of SARS-CoV-2 on surfaces, the likelihood of fomite-mediated transmission under real-life conditions is uncertain. Using a quantitative microbial risk assessment model of a frozen food packaging facility, we simulated 1) SARS-CoV-2 fomite-mediated infection risks following worker exposure to contaminated plastic packaging; and 2) reductions in these risks from masking, handwashing, and vaccination. In a frozen food facility without interventions, SARS-CoV-2 infection risk to a susceptible worker from contact with contaminated packaging was 1.5 × 10-3 per 1h-period (5th - 95th percentile: 9.2 × 10-6, 1.2 × 10-2). Standard food industry infection control interventions, handwashing and masking, reduced risk (99.4%) to 8.5 × 10-6 risk per 1h-period (5th - 95th percentile: 2.8 × 10-8, 6.6 × 10-5). Vaccination of the susceptible worker (two doses Pfizer/Moderna, vaccine effectiveness: 86-99%) with handwashing and masking reduced risk to 5.2 × 10-7 risk per 1h-period (5th - 95th percentile: 1.8 × 10-9, 5.4 × 10-6). Simulating increased transmissibility of current and future variants (Delta, Omicron), (2-, 10-fold viral shedding) among a fully vaccinated workforce, handwashing and masking continued to mitigate risk (1.4 × 10-6 - 8.8 × 10-6 risk per 1h-period). Additional decontamination of frozen food plastic packaging reduced infection risks to 1.2 × 10-8 risk per 1h-period (5th - 95th percentile: 1.9 × 10-11, 9.5 × 10-8). Given that standard infection control interventions reduced risks well below 1 × 10-4 (World Health Organization water quality risk thresholds), additional packaging decontamination suggest no marginal benefit in risk reduction. Consequences of this decontamination may include increased chemical exposures to workers, food quality and hazard risks to consumers, and unnecessary added costs to governments and the global food industry.
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Affiliation(s)
- Julia S. Sobolik
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA,Corresponding author. 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | | | - Lee-Ann Jaykus
- Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, 27695, USA
| | - D. Kane Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Ben A. Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Alicia N.M. Kraay
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - P. Barry Ryan
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Amy Webb-Girard
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Juan S. Leon
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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27
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Brown E, Nelson N, Gubbins S, Colenutt C. Airborne Transmission of Foot-and-Mouth Disease Virus: A Review of Past and Present Perspectives. Viruses 2022; 14:1009. [PMID: 35632750 PMCID: PMC9145556 DOI: 10.3390/v14051009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/25/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
The primary transmission route for foot-and-mouth disease (FMD), a contagious viral disease of cloven-hoofed animals, is by direct contact with infected animals. Yet indirect methods of transmission, such as via the airborne route, have been shown to play an important role in the spread of the disease. Airborne transmission of FMD is referred to as a low probability- high consequence event as a specific set of factors need to coincide to facilitate airborne spread. When conditions are favourable, airborne virus may spread rapidly and cause disease beyond the imposed quarantine zones, thus complicating control measures. Therefore, it is important to understand the nature of foot-and-mouth disease virus (FMDV) within aerosols; how aerosols are generated, viral load, how far aerosols could travel and survive under different conditions. Various studies have investigated emissions from infected animals under laboratory conditions, while others have incorporated experimental data in mathematical models to predict and trace outbreaks of FMD. However, much of the existing literature focussing on FMDV in aerosols describe work which was undertaken over 40 years ago. The aim of this review is to revisit existing knowledge and investigate how modern instrumentation and modelling approaches can improve our understanding of airborne transmission of FMD.
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Affiliation(s)
- Emma Brown
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK; (S.G.); (C.C.)
| | - Noel Nelson
- The Met Office, FitzRoy Road, Exeter, Devon EX1 3PB, UK;
| | - Simon Gubbins
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK; (S.G.); (C.C.)
| | - Claire Colenutt
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK; (S.G.); (C.C.)
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28
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Baselga M, Güemes A, Alba JJ, Schuhmacher AJ. SARS-CoV-2 Droplet and Airborne Transmission Heterogeneity. J Clin Med 2022; 11:2607. [PMID: 35566733 PMCID: PMC9099777 DOI: 10.3390/jcm11092607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022] Open
Abstract
The spread dynamics of the SARS-CoV-2 virus have not yet been fully understood after two years of the pandemic. The virus's global spread represented a unique scenario for advancing infectious disease research. Consequently, mechanistic epidemiological theories were quickly dismissed, and more attention was paid to other approaches that considered heterogeneity in the spread. One of the most critical advances in aerial pathogens transmission was the global acceptance of the airborne model, where the airway is presented as the epicenter of the spread of the disease. Although the aerodynamics and persistence of the SARS-CoV-2 virus in the air have been extensively studied, the actual probability of contagion is still unknown. In this work, the individual heterogeneity in the transmission of 22 patients infected with COVID-19 was analyzed by close contact (cough samples) and air (environmental samples). Viral RNA was detected in 2/19 cough samples from patient subgroups, with a mean Ct (Cycle Threshold in Quantitative Polymerase Chain Reaction analysis) of 25.7 ± 7.0. Nevertheless, viral RNA was only detected in air samples from 1/8 patients, with an average Ct of 25.0 ± 4.0. Viral load in cough samples ranged from 7.3 × 105 to 8.7 × 108 copies/mL among patients, while concentrations between 1.1-4.8 copies/m3 were found in air, consistent with other reports in the literature. In patients undergoing follow-up, no viral load was found (neither in coughs nor in the air) after the third day of symptoms, which could help define quarantine periods in infected individuals. In addition, it was found that the patient's Ct should not be considered an indicator of infectiousness, since it could not be correlated with the viral load disseminated. The results of this work are in line with proposed hypotheses of superspreaders, which can attribute part of the heterogeneity of the spread to the oversized emission of a small percentage of infected people.
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Affiliation(s)
- Marta Baselga
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
| | - Antonio Güemes
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
| | - Juan J. Alba
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
| | - Alberto J. Schuhmacher
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
- Fundación Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), 50018 Zaragoza, Spain
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29
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Horve PF, Dietz LG, Bowles G, MacCrone G, Olsen-Martinez A, Northcutt D, Moore V, Barnatan L, Parhizkar H, Van Den Wymelenberg KG. Longitudinal analysis of built environment and aerosol contamination associated with isolated COVID-19 positive individuals. Sci Rep 2022; 12:7395. [PMID: 35513399 PMCID: PMC9070971 DOI: 10.1038/s41598-022-11303-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/12/2022] [Indexed: 12/13/2022] Open
Abstract
The indoor environment is the primary location for the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), largely driven by respiratory particle accumulation in the air and increased connectivity between the individuals occupying indoor spaces. In this study, we aimed to track a cohort of subjects as they occupied a COVID-19 isolation dormitory to better understand the impact of subject and environmental viral load over time, symptoms, and room ventilation on the detectable viral load within a single room. We find that subject samples demonstrate a decrease in overall viral load over time, symptoms significantly impact environmental viral load, and we provide the first real-world evidence for decreased aerosol SARS-CoV-2 load with increasing ventilation, both from mechanical and window sources. These results may guide environmental viral surveillance strategies and be used to better control the spread of SARS-CoV-2 within built environments and better protect those caring for individuals with COVID-19.
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Affiliation(s)
- Patrick F Horve
- Institute of Molecular Biology, University of Oregon, Eugene, OR, 97403, USA
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Leslie G Dietz
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Garis Bowles
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Georgia MacCrone
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | | | - Dale Northcutt
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
- Energy Studies in Buildings Laboratory, University of Oregon, Eugene, OR, 97403, USA
| | - Vincent Moore
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Liliana Barnatan
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA
| | - Hooman Parhizkar
- Energy Studies in Buildings Laboratory, University of Oregon, Eugene, OR, 97403, USA
- Institute for Health and the Built Environment, University of Oregon, Portland, OR, 97209, USA
| | - Kevin G Van Den Wymelenberg
- Biology and the Built Environment Center, University of Oregon, Eugene, OR, 97403, USA.
- Energy Studies in Buildings Laboratory, University of Oregon, Eugene, OR, 97403, USA.
- Institute for Health and the Built Environment, University of Oregon, Portland, OR, 97209, USA.
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30
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Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA environmental contamination in rooms of patients with coronavirus disease 2019 (COVID-19). Infect Control Hosp Epidemiol 2022; 44:827-829. [PMID: 35225184 PMCID: PMC8914131 DOI: 10.1017/ice.2022.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The risk factors of environmental contamination by SARS-CoV-2 are largely unknown. We analyzed 1,320 environmental samples obtained from COVID-19 patients over 1 year. The risk factors for contamination of COVID-19 patients’ surrounding environment were higher viral load in the respiratory tract and shorter duration from symptom onset to sample collection.
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31
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Katona P, Kullar R, Zhang K. Bringing Transmission of SARS-CoV-2 to the Surface: Is there a Role for Fomites? Clin Infect Dis 2022; 75:910-916. [PMID: 35218181 PMCID: PMC8903442 DOI: 10.1093/cid/ciac157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 01/22/2023] Open
Abstract
Understanding the contribution of routes of transmission, particularly the role of fomites in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) transmission is important in developing and implementing successful public health infection prevention and control measures.This article will look at case reports, laboratory findings, animal studies, environmental factors, the need for disinfection, and differences in settings, as they relate to SARS-CoV-2 transmission.
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Affiliation(s)
- Peter Katona
- UCLA School of Medicine Dept. of Infectious Diseases and UCLA School of Public Health
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32
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Dinoi A, Feltracco M, Chirizzi D, Trabucco S, Conte M, Gregoris E, Barbaro E, La Bella G, Ciccarese G, Belosi F, La Salandra G, Gambaro A, Contini D. A review on measurements of SARS-CoV-2 genetic material in air in outdoor and indoor environments: Implication for airborne transmission. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 809:151137. [PMID: 34699823 PMCID: PMC8539199 DOI: 10.1016/j.scitotenv.2021.151137] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 05/03/2023]
Abstract
Airborne transmission of SARS-CoV-2 has been object of debate in the scientific community since the beginning of COVID-19 pandemic. This mechanism of transmission could arise from virus-laden aerosol released by infected individuals and it is influenced by several factors. Among these, the concentration and size distribution of virus-laden particles play an important role. The knowledge regarding aerosol transmission increases as new evidence is collected in different studies, even if it is not yet available a standard protocol regarding air sampling and analysis, which can create difficulties in the interpretation and application of results. This work reports a systematic review of current knowledge gained by 73 published papers on experimental determination of SARS-CoV-2 RNA in air comparing different environments: outdoors, indoor hospitals and healthcare settings, and public community indoors. Selected papers furnished 77 datasets: outdoor studies (9/77, 11.7%) and indoor studies (68/77. 88.3%). The indoor datasets in hospitals were the vast majority (58/68, 85.3%), and the remaining (10/68, 14.7%) were classified as community indoors. The fraction of studies having positive samples, as well as positivity rates (i.e. ratios between positive and total samples) are significantly larger in hospitals compared to the other typologies of sites. Contamination of surfaces was more frequent (in indoor datasets) compared to contamination of air samples; however, the average positivity rate was lower compared to that of air. Concentrations of SARS-CoV-2 RNA in air were highly variables and, on average, lower in outdoors compared to indoors. Among indoors, concentrations in community indoors appear to be lower than those in hospitals and healthcare settings.
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Affiliation(s)
- Adelaide Dinoi
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Str. Prv. Lecce-Monteroni km 1.2, Lecce, Italy
| | - Matteo Feltracco
- Istituto di Scienze Polari (ISP-CNR), Via Torino 155, Venice, Mestre, Italy; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Daniela Chirizzi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Sara Trabucco
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Via Gobetti 101, Bologna, Italy
| | - Marianna Conte
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Str. Prv. Lecce-Monteroni km 1.2, Lecce, Italy; Laboratory for Observations and Analyses of Earth and Climate, Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), 00123 Rome, Italy
| | - Elena Gregoris
- Istituto di Scienze Polari (ISP-CNR), Via Torino 155, Venice, Mestre, Italy; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Elena Barbaro
- Istituto di Scienze Polari (ISP-CNR), Via Torino 155, Venice, Mestre, Italy; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Gianfranco La Bella
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Giuseppina Ciccarese
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Franco Belosi
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Via Gobetti 101, Bologna, Italy
| | - Giovanna La Salandra
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Andrea Gambaro
- Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Daniele Contini
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Str. Prv. Lecce-Monteroni km 1.2, Lecce, Italy.
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33
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Haddadin Z, Halasa N, McHenry R, Varjabedian R, Lynch TL, Chen H, Abdul Ghani MO, Schmitz JE, Sucre J, Isenberg K, Zamora I, Danko M, Blakely M, Olson J, Jackson GP, Lovvorn HN. SARS-CoV-2 Testing of Aerosols Emitted During Pediatric Minimally Invasive Surgery: A Prospective, Case-Controlled Study. Am Surg 2022; 88:2710-2718. [PMID: 35148619 DOI: 10.1177/00031348211067707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic has presented significant safety concerns for healthcare providers, especially those performing aerosol-generating procedures. Several surgical societies issued early warnings that aerosols generated during minimally invasive surgery (MIS) could harbor infectious quantities of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study tested the hypothesis that MIS-aerosols contain SARS-CoV-2. METHODS To evaluate SARS-CoV-2 presence in aerosols emitted during intracavitary MIS, children <18 years who required emergent MIS and were discovered to be SARS-CoV-2-positive were enrolled. Swabs were obtained from the port in-line with a filtered smoke evacuation system, the tubing adjacent to this port, the fluid collection chamber and filter, and the distal endotracheal tube (ETT). All swabs were analyzed for SARS-CoV-2 using quantitative reverse-transcription polymerase chain reaction. To evaluate viral distribution in tissues, fluorescence in situ hybridization for SARS-CoV-2 was performed on resected specimens. Outcomes were recorded, and participating healthcare workers were tracked for SARS-CoV-2 conversion. RESULTS From July 1, 2020, to June 30, 2021, 11 children requiring emergent MIS were discovered preoperatively to be SARS-CoV-2 positive (median age: 14 years [5-17]). SARS-CoV-2 was detected only in ETT swabs and not in surgical aerosols or specimens. Median operative time was 56.5 minutes (IQR: 46-66), and postoperative stay was 21.2 hours (IQR: 1.97-57.57). No complications or viral eruption were recorded, and none of 63 healthcare workers tested positive for SARS-CoV-2 within 6 weeks. DISCUSSION SARS-CoV-2 was detected only in ETT secretions and not in surgical aerosols or specimens among a pediatric cohort of asymptomatic patients having emergent MIS.
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Affiliation(s)
- Zaid Haddadin
- Department of General Surgery, 6566Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Rendie McHenry
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Rebekkah Varjabedian
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Tricia L Lynch
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical CenterRINGGOLD, Nashville, TN, USA
| | - Heidi Chen
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jonathan E Schmitz
- Department of Pathology, Microbiology and Immunology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Sucre
- Division of Neonatology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Isenberg
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Irving Zamora
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Danko
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin Blakely
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob Olson
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gretchen P Jackson
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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34
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Owen L, Shivkumar M, Cross RBM, Laird K. Porous surfaces: stability and recovery of coronaviruses. Interface Focus 2022; 12:20210039. [PMID: 34956608 PMCID: PMC8662390 DOI: 10.1098/rsfs.2021.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
The role of indirect contact in the transmission of SARS-CoV-2 is not clear. SARS-CoV-2 persists on dry surfaces for hours to days; published studies have largely focused on hard surfaces with less research being conducted on different porous surfaces, such as textiles. Understanding the potential risks of indirect transmission of COVID-19 is useful for settings where there is close contact with textiles, including healthcare, manufacturing and retail environments. This article aims to review current research on porous surfaces in relation to their potential as fomites of coronaviruses compared to non-porous surfaces. Current methodologies for assessing the stability and recovery of coronaviruses from surfaces are also explored. Coronaviruses are often less stable on porous surfaces than non-porous surfaces, for example, SARS-CoV-2 persists for 0.5 h-5 days on paper and 3-21 days on plastic; however, stability is dependent on the type of surface. In particular, the surface properties of textiles differ widely depending on their construction, leading to variation in the stability of coronaviruses, with longer persistence on more hydrophobic materials such as polyester (1-3 days) compared to highly absorbent cotton (2 h-4 days). These findings should be considered where there is close contact with potentially contaminated textiles.
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Affiliation(s)
- Lucy Owen
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
| | - Maitreyi Shivkumar
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
| | - Richard B. M. Cross
- Emerging Technologies Research Centre, School of Engineering and Sustainable Development, De Montfort University, Leicester LE1 9BH, UK
| | - Katie Laird
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK
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35
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Truyols Vives J, Muncunill J, Toledo Pons N, Baldoví HG, Sala Llinàs E, Mercader Barceló J. SARS-CoV-2 detection in bioaerosols using a liquid impinger collector and ddPCR. INDOOR AIR 2022; 32:e13002. [PMID: 35225399 PMCID: PMC9111801 DOI: 10.1111/ina.13002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
The airborne route is the dominant form of COVID-19 transmission, and therefore, the development of methodologies to quantify SARS-CoV-2 in bioaerosols is needed. We aimed to identify SARS-CoV-2 in bioaerosols by using a highly efficient sampler for the collection of 1-3 µm particles, followed by a highly sensitive detection method. 65 bioaerosol samples were collected in hospital rooms in the presence of a COVID-19 patient using a liquid impinger sampler. The SARS-CoV-2 genome was detected by ddPCR using different primer/probe sets. 44.6% of the samples resulted positive for SARS-CoV-2 following this protocol. By increasing the sampled air volume from 339 to 650 L, the percentage of positive samples went from 41% to 50%. We detected five times less positives with a commercial one-step RT-PCR assay. However, the selection of primer/probe sets might be one of the most determining factor for bioaerosol SARS-CoV-2 detection since with the ORF1ab set more than 40% of the samples were positive, compared to <10% with other sets. In conclusion, the use of a liquid impinger collector and ddPCR is an adequate strategy to detect SARS-CoV-2 in bioaerosols. However, there are still some methodological aspects that must be adjusted to optimize and standardize a definitive protocol.
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Affiliation(s)
- Joan Truyols Vives
- Molecular Biology and One Health research group (MolONE)Universitat de les Illes Balears (UIB)PalmaSpain
| | - Josep Muncunill
- Health Research Institute of the Balearic Islands (IdISBa)Balearic IslandsSpain
| | - Núria Toledo Pons
- Health Research Institute of the Balearic Islands (IdISBa)Balearic IslandsSpain
- Department of Pulmonary MedicineHospital Universitari Son Espases (HUSE)Balearic IslandsSpain
| | - Herme G. Baldoví
- Department of ChemistryUniversitat Politècnica de València (UPV)ValenciaSpain
| | - Ernest Sala Llinàs
- Molecular Biology and One Health research group (MolONE)Universitat de les Illes Balears (UIB)PalmaSpain
- Health Research Institute of the Balearic Islands (IdISBa)Balearic IslandsSpain
- Department of Pulmonary MedicineHospital Universitari Son Espases (HUSE)Balearic IslandsSpain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES)MadridSpain
| | - Josep Mercader Barceló
- Molecular Biology and One Health research group (MolONE)Universitat de les Illes Balears (UIB)PalmaSpain
- Health Research Institute of the Balearic Islands (IdISBa)Balearic IslandsSpain
- Foners Medicina Veterinària i Innovació SLPPalmaSpain
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36
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Reynolds KA, Verhougstraete MP, Mena KD, Sattar SA, Scott EA, Gerba CP. Quantifying pathogen infection risks from household laundry practices. J Appl Microbiol 2022; 132:1435-1448. [PMID: 34465009 PMCID: PMC9290578 DOI: 10.1111/jam.15273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022]
Abstract
AIMS Contaminated laundry can spread infections. However, current directives for safe laundering are limited to healthcare settings and not reflective of domestic conditions. We aimed to use quantitative microbial risk assessment to evaluate household laundering practices (e.g., detergent selection, washing and drying temperatures, and sanitizer use) relative to log10 reductions in pathogens and infection risks during the clothes sorting, washer/dryer loading, folding and storing steps. METHODS AND RESULTS Using published data, we characterized laundry infection risks for respiratory and enteric pathogens relative to a single user contact scenario and a 1.0 × 10-6 acceptable risk threshold. For respiratory pathogens, risks following cold water wash temperatures (e.g. median 14.4℃) and standard detergents ranged from 2.2 × 10-5 to 2.2 × 10-7 . Use of advanced, enzymatic detergents reduced risks to 8.6 × 10-8 and 2.2 × 10-11 respectively. For enteric pathogens, however, hot water, advanced detergents, sanitizing agents and drying are needed to reach risk targets. SIGNIFICANCE AND IMPACT OF THE STUDY Conclusions provide guidance for household laundry practices to achieve targeted risk reductions, given a single user contact scenario. A key finding was that hand hygiene implemented at critical control points in the laundering process was the most significant driver of infection prevention, additionally reducing infection risks by up to 6 log10 .
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Affiliation(s)
- Kelly A. Reynolds
- The Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonAZUSA
| | | | - Kristina D. Mena
- School of Public HealthThe University of Texas Health Science Center at HoustonEl PasoTXUSA
| | | | - Elizabeth A. Scott
- Center for Hygiene and Health, Department of BiologySimmons UniversityBostonMAUSA
| | - Charles P. Gerba
- Department of Environmental SciencesUniversity of ArizonaTucsonAZUSA
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges in critical care medicine, including extreme demand for intensive care unit (ICU) resources and rapidly evolving understanding of a novel disease. Up to one-third of hospitalized patients with COVID-19 experience critical illness. The most common form of organ failure in COVID-19 critical illness is acute hypoxemic respiratory failure, which clinically presents as acute respiratory distress syndrome (ARDS) in three-quarters of ICU patients. Noninvasive respiratory support modalities are being used with increasing frequency given their potential to reduce the need for intubation. Determining optimal patient selection for and timing of intubation remains a challenge. Management of mechanically ventilated patients with COVID-19 largely mirrors that of non-COVID-19 ARDS. Organ failure is common and portends a poor prognosis. Mortality rates have improved over the course of the pandemic, likely owing to increasing disease familiarity, data-driven pharmacologics, and improved adherence to evidence-based critical care.
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Affiliation(s)
- Jennifer C Ginestra
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA; , , ,
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | - Oscar J L Mitchell
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA; , , ,
- Center for Resuscitation Science, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - George L Anesi
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA; , , ,
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA; , , ,
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38
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Schumacher YO, Tabben M, Chamari K, Dzendrowskyj P, Bahr R, Hassoun K, Abbassi AK, Bensaad M, Al Barghouthi B, Alishaq M, Fadel RAA, Jeremijenko AM. Environmental surface contamination with SARS-CoV-2 in professional football clubs. SCI MED FOOTBALL 2022; 5:8-12. [PMID: 35077321 DOI: 10.1080/24733938.2021.1941227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: We assessed SARS-CoV-2 contamination of random surfaces in football training facilities in an environment with a high prevalence of infections.Methods: In six clubs of the Qatar Stars League, surfaces of random locations (high-touch areas, ventilation systems, toilets, cleaning tools, freezers, pantries) in routinely cleaned training facilities, locker rooms, medical and administrative areas were swabbed for SARS-CoV-2. The swabs were screened for the presence of viral RNA using a SARS-CoV-2 qPCR Probe Assay.Results: None of the 103 swabs reached a cycle threshold (cT) value ≤30 (strong viral presence, suggestive of potential surface transmission). Four samples showed cT values >30 and <35 (low quantity of virus) and 16 swabs returned a cT value ≥35 and <40 (inactive virus remnants). The remaining 83 samples were negative (cT value ≥40). Most samples with viral or viral remnant presence originated from high-touch areas.Conclusion: We did not find evidence for potential surface transmission in football club facilities when routine cleaning procedures are in place despite the presence of infected subjects.
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Affiliation(s)
| | | | - Karim Chamari
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Roald Bahr
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Khalid Hassoun
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Meryem Bensaad
- Genomics Laboratory, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Bayan Al Barghouthi
- Genomics Laboratory, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Moza Alishaq
- Department of Medicine, Staff Medical Services & Occupational Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Andrew M Jeremijenko
- Department of Medicine, Staff Medical Services & Occupational Medicine, Hamad Medical Corporation, Doha, Qatar
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39
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Wilson AM, Sleeth DK, Schaefer C, Jones RM. Transmission of Respiratory Viral Diseases to Health Care Workers: COVID-19 as an Example. Annu Rev Public Health 2022; 43:311-330. [DOI: 10.1146/annurev-publhealth-052120-110009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health care workers (HCWs) can acquire infectious diseases, including coronavirus disease 2019 (COVID-19), from patients. Herein, COVID-19 is used with the source–pathway–receptor framework as an example to assess evidence for the role of aerosol transmission and indirect contact transmission of viral respiratory infectious diseases. Evidence for both routes is strong for COVID-19 and other respiratory viruses, but aerosol transmission is likely dominant for COVID-19. Key knowledge gaps about transmission processes and control strategies include the distribution of viable virus among respiratory aerosols of different sizes, the mechanisms and efficiency by which virus deposited on the facial mucous membrane moves to infection sites inside the body, and the performance of source controls such as face coverings and aerosol containment devices. To ensure that HCWs are adequately protected from infection, guidelines and regulations must be updated to reflect the evidence that respiratory viruses are transmitted via aerosols. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Amanda M. Wilson
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Darrah K. Sleeth
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
| | - Camie Schaefer
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
| | - Rachael M. Jones
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA;, ,
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40
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da Silva PG, Gonçalves J, Lopes AIB, Esteves NA, Bamba GEE, Nascimento MSJ, Branco PTBS, Soares RRG, Sousa SIV, Mesquita JR. Evidence of Air and Surface Contamination with SARS-CoV-2 in a Major Hospital in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010525. [PMID: 35010785 PMCID: PMC8744945 DOI: 10.3390/ijerph19010525] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
As the third wave of the COVID-19 pandemic hit Portugal, it forced the country to reintroduce lockdown measures due to hospitals reaching their full capacities. Under these circumstances, environmental contamination by SARS-CoV-2 in different areas of one of Portugal's major Hospitals was assessed between 21 January and 11 February 2021. Air samples (n = 44) were collected from eleven different areas of the Hospital (four COVID-19 and seven non-COVID-19 areas) using Coriolis® μ and Coriolis® Compact cyclone air sampling devices. Surface sampling was also performed (n = 17) on four areas (one COVID-19 and three non-COVID-19 areas). RNA extraction followed by a one-step RT-qPCR adapted for quantitative purposes were performed. Of the 44 air samples, two were positive for SARS-CoV-2 RNA (6575 copies/m3 and 6662.5 copies/m3, respectively). Of the 17 surface samples, three were positive for SARS-CoV-2 RNA (200.6 copies/cm2, 179.2 copies/cm2, and 201.7 copies/cm2, respectively). SARS-CoV-2 environmental contamination was found both in air and on surfaces in both COVID-19 and non-COVID-19 areas. Moreover, our results suggest that longer collection sessions are needed to detect point contaminations. This reinforces the need to remain cautious at all times, not only when in close contact with infected individuals. Hand hygiene and other standard transmission-prevention guidelines should be continuously followed to avoid nosocomial COVID-19.
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Affiliation(s)
- Priscilla Gomes da Silva
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal;
- Epidemiology Research Unit (EPIunit), Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- LEPABE–Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.T.B.S.B.); (S.I.V.S.)
| | - José Gonçalves
- Institute of Sustainable Processes, University of Valladolid, 47011 Valladolid, Spain;
- Department of Chemical Engineering, University of Valladolid, 47011 Valladolid, Spain
| | - Ariana Isabel Brito Lopes
- Unidade Local de Saúde do Alto Minho E.P.E., 4904-858 Viana do Castelo, Portugal; (A.I.B.L.); (N.A.E.); (G.E.E.B.)
| | - Nury Alves Esteves
- Unidade Local de Saúde do Alto Minho E.P.E., 4904-858 Viana do Castelo, Portugal; (A.I.B.L.); (N.A.E.); (G.E.E.B.)
| | - Gustavo Emanuel Enes Bamba
- Unidade Local de Saúde do Alto Minho E.P.E., 4904-858 Viana do Castelo, Portugal; (A.I.B.L.); (N.A.E.); (G.E.E.B.)
| | | | - Pedro T. B. S. Branco
- LEPABE–Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.T.B.S.B.); (S.I.V.S.)
| | - Ruben R. G. Soares
- Department of Biochemistry and Biophysics, Science for Life Laboratory, Stockholm University, SE-106 91 Stockholm, Sweden;
| | - Sofia I. V. Sousa
- LEPABE–Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (P.T.B.S.B.); (S.I.V.S.)
| | - João R. Mesquita
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal;
- Epidemiology Research Unit (EPIunit), Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Correspondence:
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Modes de transmission du SARS-CoV-2 : que sait-on actuellement ? M�DECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC8815781 DOI: 10.1016/j.mmifmc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Des progrès remarquables ont été obtenus dans notre compréhension de la transmission du SARS-CoV-2 et la réduction de sa propagation. La prise en compte du risque majeur des formes asymptomatiques par le port universel du masque est une de ces avancées. Les données épidémiologiques (taux d'attaque et R0) ainsi que l'accumulation de données en contexte clinique suggèrent une similitude de transmission du SARS-CoV-2 avec celle des autres virus respiratoires comme la grippe ou le SARS-CoV-1, un mode de transmission principal direct de personne à personne, à courte distance par les gouttelettes. La transmission aéroportée est possible mais rare, et ne semble se produire que dans des circonstances opportunistes, notamment lors de procédures médicales sur la sphère respiratoire de patients infectés, ou dans des conditions d'excrétion virale élevée en zone confinée mal ventilée. L'hygiène des mains et le port du masque sont les deux armes essentielles de prévention dans le contexte de la COVID-19.
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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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Cuevas-Ferrando E, Girón-Guzmán I, Falcó I, Pérez-Cataluña A, Díaz-Reolid A, Aznar R, Randazzo W, Sánchez G. Discrimination of non-infectious SARS-CoV-2 particles from fomites by viability RT-qPCR. ENVIRONMENTAL RESEARCH 2022; 203:111831. [PMID: 34352235 PMCID: PMC8327643 DOI: 10.1016/j.envres.2021.111831] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 05/05/2023]
Abstract
The ongoing coronavirus 2019 (COVID-19) pandemic constitutes a concerning global threat to public health and economy. In the midst of this pandemic scenario, the role of environment-to-human COVID-19 spread is still a matter of debate because mixed results have been reported concerning SARS-CoV-2 stability on high-touch surfaces in real-life scenarios. Up to now, no alternative and accessible procedures for cell culture have been applied to evaluate SARS-CoV-2 infectivity on fomites. Several strategies based on viral capsid integrity have latterly been developed using viability markers to selectively remove false-positive qPCR signals resulting from free nucleic acids and damaged viruses. These have finally allowed an estimation of viral infectivity. The present study aims to provide a rapid molecular-based protocol for detection and quantification of viable SARS-CoV-2 from fomites based on the discrimination of non-infectious SARS-CoV-2 particles by platinum chloride (IV) (PtCl4) viability RT-qPCR. An initial assessment compared two different swabbing procedures to recover inactivated SARS-CoV-2 particles from fomites coupled with two RNA extraction methods. Procedures were validated with human (E229) and porcine (PEDV) coronavirus surrogates, and compared with inactivated SARS-CoV-2 suspensions on glass, steel and plastic surfaces. The viability RT-qPCR efficiently removed the PCR amplification signals from heat and gamma-irradiated inactivated SARS-CoV-2 suspensions that had been collected from specified surfaces. This study proposes a rapid viability RT-qPCR that discriminates non-infectious SARS-CoV-2 particles on surfaces thus helping researchers to better understand the risk of contracting COVID-19 through contact with fomites and to develop more efficient epidemiological measures.
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Affiliation(s)
- Enric Cuevas-Ferrando
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain
| | - Inés Girón-Guzmán
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain; Department of Microbiology and Ecology, University of Valencia, Valencia, Spain
| | - Irene Falcó
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain
| | - Alba Pérez-Cataluña
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain
| | - Azahara Díaz-Reolid
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain
| | - Rosa Aznar
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain; Department of Microbiology and Ecology, University of Valencia, Valencia, Spain
| | - Walter Randazzo
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain
| | - Gloria Sánchez
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Av. Agustín Escardino 7, Paterna, 46980, Valencia, Spain.
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Nannu Shankar S, Witanachchi CT, Morea AF, Lednicky JA, Loeb JC, Alam MM, Fan ZH, Eiguren-Fernandez A, Wu CY. SARS-CoV-2 in residential rooms of two self-isolating persons with COVID-19. JOURNAL OF AEROSOL SCIENCE 2022; 159:105870. [PMID: 34483358 PMCID: PMC8401278 DOI: 10.1016/j.jaerosci.2021.105870] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 05/16/2023]
Abstract
Individuals with COVID-19 are advised to self-isolate at their residences unless they require hospitalization. Persons sharing a dwelling with someone who has COVID-19 have a substantial risk of being exposed to the virus. However, environmental monitoring for the detection of virus in such settings is limited. We present a pilot study on environmental sampling for SARS-CoV-2 virions in the residential rooms of two volunteers with COVID-19 who self-quarantined. Apart from standard surface swab sampling, based on availability, four air samplers positioned 0.3-2.2 m from the volunteers were used: a VIable Virus Aerosol Sampler (VIVAS), an inline air sampler that traps particles on polytetrafluoroethylene (PTFE) filters, a NIOSH 2-stage cyclone sampler (BC-251), and a Sioutas personal cascade impactor sampler (PCIS). The latter two selectively collect particles of specific size ranges. SARS-CoV-2 RNA was detected by real-time Reverse-Transcription quantitative Polymerase Chain Reaction (rRT-qPCR) analyses of particles in one air sample from the room of volunteer A and in various air and surface samples from that of volunteer B. The one positive sample collected by the NIOSH sampler from volunteer A's room had a quantitation cycle (Cq) of 38.21 for the N-gene, indicating a low amount of airborne virus [5.69E-02 SARS-CoV-2 genome equivalents (GE)/cm3 of air]. In contrast, air samples and surface samples collected off the mobile phone in volunteer B's room yielded Cq values ranging from 14.58 to 24.73 and 21.01 to 24.74, respectively, on the first day of sampling, indicating that this volunteer was actively shedding relatively high amounts of SARS-CoV-2 at that time. The SARS-CoV-2 GE/cm3 of air for the air samples collected by the PCIS was in the range 6.84E+04 to 3.04E+05 using the LED-N primer system, the highest being from the stage 4 filter, and similarly, ranged from 2.54E+03 to 1.68E+05 GE/cm3 in air collected by the NIOSH sampler. Attempts to isolate the virus in cell culture from the samples from volunteer B's room with the aforementioned Cq values were unsuccessful due to out-competition by a co-infecting Human adenovirus B3 (HAdVB3) that killed the Vero E6 cell cultures within 4 days of their inoculation, although Cq values of 34.56-37.32 were measured upon rRT-qPCR analyses of vRNA purified from the cell culture medium. The size distribution of SARS-CoV-2-laden aerosol particles collected from the air of volunteer B's room was >0.25 μm and >0.1 μm as recorded by the PCIS and the NIOSH sampler, respectively, suggesting a risk of aerosol transmission since these particles can remain suspended in air for an extended time and travel over long distances. The detection of virus in surface samples also underscores the potential for fomite transmission of SARS-CoV-2 in indoor settings.
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Affiliation(s)
- Sripriya Nannu Shankar
- Department of Environmental Engineering Sciences, College of Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Chiran T Witanachchi
- Department of Environmental Engineering Sciences, College of Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - Alyssa F Morea
- Department of Environmental Engineering Sciences, College of Engineering, University of Florida, Gainesville, FL, 32611, USA
| | - John A Lednicky
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 32610, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32610, USA
| | - Julia C Loeb
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 32610, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32610, USA
| | - Md Mahbubul Alam
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 32610, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32610, USA
| | - Z Hugh Fan
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, 32611, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA
| | | | - Chang-Yu Wu
- Department of Environmental Engineering Sciences, College of Engineering, University of Florida, Gainesville, FL, 32611, USA
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45
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Ikner LA, Torrey JR, Gundy PM, Gerba CP. Efficacy of an antimicrobial surface coating against human coronavirus 229E and SARS-CoV-2. Am J Infect Control 2021; 49:1569-1571. [PMID: 34499978 PMCID: PMC8420084 DOI: 10.1016/j.ajic.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
The COVID-19 pandemic has accelerated the demand for alternatives to standard cleaning and disinfection practices. Antiviral coatingsmay provide an alternative to common surface treatments. A newly developed quaternary ammonium polymer coating was applied to stainless steel coupons and evaluated for efficacy against human coronavirus 229E and SARS-CoV-2. The polymer coating reduced levels of both test viruses by greater than 99.9% relative to non-coated stainless steel coupons during a 2-hour contact time.
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46
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Alnimr A, Alamri A, Salama KF, Radi M, Bukharie H, Alshehri B, Rabaan AA, Alshahrani M. The Environmental Deposition of Severe Acute Respiratory Syndrome Coronavirus 2 in Nosocomial Settings: Role of the Aerosolized Hydrogen Peroxide. Risk Manag Healthc Policy 2021; 14:4469-4475. [PMID: 34754253 PMCID: PMC8570375 DOI: 10.2147/rmhp.s336085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Data on the role of aerosolized hydrogen peroxide (AHP) systems in the control of the COVID-19 pandemic are still emerging. This study provides evidence of the environmental shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the hospital environment, and the efficacy of AHP to eliminate it. Methods A total of 324 environmental sites (224 surfaces and 100 air samples) belonging to 54 patient rooms were contextually collected and tested for genes of SARS-CoV-2 using RT-PCR assays and Xpert® Xpress SARS-CoV-2. Results The SARS-CoV-2 viral genome was detected in seven sites (2.5%) of three patients’ rooms, including six highly touched surfaces and one air sample. Viral shedding was directly related to the distance from the patient, with 1, 1.9, and 3.5% of samples testing positive at 3, 2, and 1 meter, respectively (P-value=0.02). None of the sites showed the viral genome following application of 6% AHP. Of note, the viral genome was detected at 2 meters of a mildly symptomatic case on a face mask in the absence of aerosol generating procedures. Conclusion Our data support the possible role of the hospital environment as a source of infection, and the efficacy of AHP to eliminate the virus. Further studies are needed to address the viability of the pathogen in these nosocomial sites and the cost-effectiveness of routine hospital disinfection procedures using AHP for SARS-CoV-2.
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Affiliation(s)
- Amani Alnimr
- Department of Microbiology, College of Medicine & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aisha Alamri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khaled F Salama
- Department of Environmental Health, College of Public Health & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mahmoud Radi
- Department of Infection Control, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Huda Bukharie
- Department of Infection Control, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Bashayer Alshehri
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Mohammed Alshahrani
- Emergency and Critical Care Department, College of Medicine & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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47
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Winslow RL, Zhou J, Windle EF, Nur I, Lall R, Ji C, Millar JE, Dark PM, Naisbitt J, Simonds A, Dunning J, Barclay W, Baillie JK, Perkins GD, Semple MG, McAuley DF, Green CA. SARS-CoV-2 environmental contamination from hospitalised patients with COVID-19 receiving aerosol-generating procedures. Thorax 2021; 77:259-267. [PMID: 34737194 PMCID: PMC8646974 DOI: 10.1136/thoraxjnl-2021-218035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered 'aerosol-generating procedures' in the treatment of COVID-19. OBJECTIVE To measure air and surface environmental contamination with SARS-CoV-2 virus when CPAP and HFNO are used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients. METHODS 30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturation ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. Real-time quantitative polymerase chain reaction analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus. RESULTS Overall 21/30 (70%) participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination than supplemental oxygen use. Only one nasopharyngeal sample was culture positive. CONCLUSIONS The use of CPAP and HFNO to treat moderate/severe COVID-19 did not appear to be associated with substantially higher levels of air or surface viral contamination in the immediate care environment, compared with the use of supplemental oxygen.
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Affiliation(s)
- Rebecca L Winslow
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Epidemiology and Public Health Group (EPHG), Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jie Zhou
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Ella F Windle
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Intesar Nur
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Paul M Dark
- NIHR Manchester Biomedical Research Centre, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Critical Care Unit, Northern Care Alliance NHS Group, Salford Royal Hospital, Greater Manchester, UK
| | - Jay Naisbitt
- Critical Care Unit, Northern Care Alliance NHS Group, Salford Royal Hospital, Greater Manchester, UK
| | - Anita Simonds
- Lung Division, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jake Dunning
- Faculty of Medicine, Imperial College London, London, UK
| | - Wendy Barclay
- Department of Infectious Diseases, Imperial College London, London, UK
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Malcolm Gracie Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel Francis McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland .,Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Christopher A Green
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
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48
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Lu Y, Li Y, Zhou H, Lin J, Zheng Z, Xu H, Lin B, Lin M, Liu L. Affordable measures to monitor and alarm nosocomial SARS-CoV-2 infection due to poor ventilation. INDOOR AIR 2021; 31:1833-1842. [PMID: 34181766 PMCID: PMC8447035 DOI: 10.1111/ina.12899] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/20/2021] [Accepted: 06/12/2021] [Indexed: 05/09/2023]
Abstract
Since the coronavirus disease 2019 (COVID-19) outbreak, the nosocomial infection rate worldwide has been reported high. It is urgent to figure out an affordable way to monitor and alarm nosocomial infection. Carbon dioxide (CO2 ) concentration can reflect the ventilation performance and crowdedness, so CO2 sensors were placed in Beijing Tsinghua Changgung Hospital's fever clinic and emergency department where the nosocomial infection risk was high. Patients' medical records were extracted to figure out their timelines and whereabouts. Based on these, site-specific CO2 concentration thresholds were calculated by the dilution equation and sites' risk ratios were determined to evaluate ventilation performance. CO2 concentration successfully revealed that the expiratory tracer was poorly diluted in the mechanically ventilated inner spaces, compared to naturally ventilated outer spaces, among all of the monitoring sites that COVID-19 patients visited. Sufficient ventilation, personal protection, and disinfection measures led to no nosocomial infection in this hospital. The actual outdoor airflow rate per person (Qc ) during the COVID-19 patients' presence was estimated for reference using equilibrium analysis. During the stay of single COVID-19 patient wearing a mask, the minimum Qc value was 15-18 L/(s·person). When the patient was given throat swab sampling, the minimum Qc value was 21 L/(s·person). The Qc value reached 36-42 L/(s·person) thanks to window-inducted natural ventilation, when two COVID-19 patients wearing masks shared the same space with other patients or healthcare workers. The CO2 concentration monitoring system proved to be effective in assessing nosocomial infection risk by reflecting real-time dilution of patients' exhalation.
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Affiliation(s)
- Yiran Lu
- Department of Building ScienceTsinghua UniversityBeijingChina
- Key Laboratory of Eco‐Planning & Green BuildingMinistry of EducationTsinghua UniversityBeijingChina
| | - Yifan Li
- Department of Building ScienceTsinghua UniversityBeijingChina
- Key Laboratory of Eco‐Planning & Green BuildingMinistry of EducationTsinghua UniversityBeijingChina
| | - Hao Zhou
- Department of Building ScienceTsinghua UniversityBeijingChina
- Key Laboratory of Eco‐Planning & Green BuildingMinistry of EducationTsinghua UniversityBeijingChina
| | - Jinlan Lin
- Department of Disease & Nosocomial infection controlBeijing Tsinghua Changgung HospitalBeijingChina
- School of Clinical MedicineTsinghua UniversityBeijingChina
| | - Zhuozhao Zheng
- School of Clinical MedicineTsinghua UniversityBeijingChina
- Department of radiologyBeijing Tsinghua Changgung HospitalBeijingChina
| | - Huji Xu
- School of Clinical MedicineTsinghua UniversityBeijingChina
- Peking‐Tsinghua Center for Life SciencesTsinghua UniversityBeijingChina
| | - Borong Lin
- Department of Building ScienceTsinghua UniversityBeijingChina
- Key Laboratory of Eco‐Planning & Green BuildingMinistry of EducationTsinghua UniversityBeijingChina
| | - Minggui Lin
- School of Clinical MedicineTsinghua UniversityBeijingChina
- Department of InfectionBeijing Tsinghua Changgung HospitalBeijingChina
| | - Li Liu
- Department of Building ScienceTsinghua UniversityBeijingChina
- Key Laboratory of Eco‐Planning & Green BuildingMinistry of EducationTsinghua UniversityBeijingChina
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Akoumianaki E, Ischaki E, Karagiannis K, Sigala I, Zakyn-thinos S. The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia. J Pers Med 2021; 11:jpm11090884. [PMID: 34575661 PMCID: PMC8469068 DOI: 10.3390/jpm11090884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation.
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Affiliation(s)
- Evangelia Akoumianaki
- Department of Intensive Care Unit, University Hospital of Heraklion, 71500 Crete, Greece
- Correspondence:
| | - Eleni Ischaki
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 10676 Athens, Greece; (E.I.); (I.S.); (S.Z.-t.)
| | | | - Ioanna Sigala
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 10676 Athens, Greece; (E.I.); (I.S.); (S.Z.-t.)
| | - Spyros Zakyn-thinos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 10676 Athens, Greece; (E.I.); (I.S.); (S.Z.-t.)
- School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece
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50
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Sobolik JS, Sajewski ET, Jaykus LA, Cooper DK, Lopman BA, Kraay ANM, Ryan PB, Guest JL, Webb-Girard A, Leon JS. Low risk of SARS-CoV-2 transmission via fomite, even in cold-chain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.08.23.21262477. [PMID: 34462753 PMCID: PMC8404890 DOI: 10.1101/2021.08.23.21262477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Countries continue to debate the need for decontamination of cold-chain food packaging to reduce possible SARS-CoV-2 fomite transmission among workers. While laboratory-based studies demonstrate persistence of SARS-CoV-2 on surfaces, the likelihood of fomite-mediated transmission under real-life conditions is uncertain. METHODS Using a quantitative risk assessment model, we simulated in a frozen food packaging facility 1) SARS-CoV-2 fomite-mediated infection risks following worker exposure to contaminated plastic packaging; and 2) reductions in these risks attributed to masking, handwashing, and vaccination. FINDINGS In a representative facility with no specific interventions, SARS-CoV-2 infection risk to a susceptible worker from contact with contaminated packaging was 2·8 × 10 -3 per 1h-period (95%CI: 6·9 × 10 -6 , 2·4 × 10 -2 ). Implementation of standard infection control measures, handwashing and masks (9·4 × 10 -6 risk per 1h-period, 95%CI: 2·3 × 10 -8 , 8·1 × 10 -5 ), substantially reduced risk (99·7%). Vaccination of the susceptible worker (two doses Pfizer/Moderna, vaccine effectiveness: 86-99%) combined with handwashing and masking reduced risk to less than 1·0 × 10 -6 . Simulating increased infectiousness/transmissibility of new variants (2-, 10-fold viral shedding) among a fully vaccinated workforce, handwashing and masks continued to mitigate risk (2·0 × 10 -6 -1·1 × 10 -5 risk per 1h-period). Decontamination of packaging in addition to these interventions reduced infection risks to below the 1·0 × 10 -6 risk threshold. INTERPRETATION Fomite-mediated SARS-CoV-2 infection risks were very low under cold-chain conditions. Handwashing and masking provide significant protection to workers, especially when paired with vaccination. FUNDING U.S. Department of Agriculture.
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Affiliation(s)
- Julia S. Sobolik
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | | | - Lee-Ann Jaykus
- Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, USA, 27695
| | - D. Kane Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | - Ben A. Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | - Alicia NM. Kraay
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | - P. Barry Ryan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | - Amy Webb-Girard
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
| | - Juan S. Leon
- Rollins School of Public Health, Emory University, Atlanta, GA, USA, 30322
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