|
1
|
Konatzii R, Schmidt-Ott F, Palazis L, Stagianos P, Foka M, Richter J, Christodoulou C, Sciare J, Pikridas M. Exposure to airborne SARS-CoV-2 in four hospital wards and ICUs of Cyprus. A detailed study accounting for day-to-day operations and aerosol generating procedures. Heliyon 2023; 9:e13669. [PMID: 36819229 PMCID: PMC9918438 DOI: 10.1016/j.heliyon.2023.e13669] [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: 02/16/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
In any infectious disease, understanding the modes of transmission is key to selecting effective public health measures. In the case of COVID-19 spread, the strictness of the imposed measures outlined the lack of understanding on how SARS-CoV-2 transmits, particularly via airborne pathways. With the aim to characterize the transmission dynamics of airborne SARS-CoV-2, 165 and 62 air and environmental samples, respectively, were collected in four COVID-19 wards and ICUs in Cyprus and analyzed by RT-PCR. An alternative method for SARS-CoV-2 detection in air that provides comparable results but is less cumbersome and time demanding, is also proposed. Considering that all clinics employed 14 regenerations per hour of full fresh air inside patient rooms, it was hypothesized that the viral levels and the frequency of positive samples would be minimum outside of the rooms. However, it is shown that leaving the door opened in patient rooms hinders the efficiency of the ventilation system applied, allowing the virus to escape. As a result, the highest observed viral levels (135 copies m-3) were observed in the corridor of a ward and the frequency of positive samples in the same area was comparable to that inside a two-bed cohort. SARS-CoV-2 in that corridor was found primarily to lie in the coarse mode, at sizes between 1.8 and 10 μm. Similar to previous studies, the frequency of positive samples and viral levels were the lowest inside intensive care units. However, if a patient with sufficient viral load (Ct-value 31) underwent aerosol generating procedures, positive samples with viral levels below 45 copies m-3 were acquired within a 2 m distance of the patient. Our results suggest that a robust ventilation system can prevent unnecessary exposure to SARS-CoV-2 but with limitations related to foot traffic or the operations taking place at the time.
Collapse
Affiliation(s)
- Rafail Konatzii
- Climate and Atmosphere Research Centre, The Cyprus Institute, Nicosia, 2121, Cyprus
| | - Fabian Schmidt-Ott
- Climate and Atmosphere Research Centre, The Cyprus Institute, Nicosia, 2121, Cyprus,Department of Physics, University of Helsinki, Helsinki, 00014, Finland
| | - Lakis Palazis
- Department of Intensive Care Unit, Nicosia General Hospital, Ministry of Health, Nicosia, 2029, Cyprus
| | - Panagiotis Stagianos
- Climate and Atmosphere Research Centre, The Cyprus Institute, Nicosia, 2121, Cyprus
| | - Maria Foka
- Department of Intensive Care Unit, Nicosia General Hospital, Ministry of Health, Nicosia, 2029, Cyprus
| | - Jan Richter
- Department of Molecular Virology, The Cyprus Institute of Neurology and Genetics, Nicosia, 1683, Cyprus
| | - Christina Christodoulou
- Department of Molecular Virology, The Cyprus Institute of Neurology and Genetics, Nicosia, 1683, Cyprus
| | - Jean Sciare
- Climate and Atmosphere Research Centre, The Cyprus Institute, Nicosia, 2121, Cyprus
| | - Michael Pikridas
- Climate and Atmosphere Research Centre, The Cyprus Institute, Nicosia, 2121, Cyprus,Corresponding author
| |
Collapse
|
|
2
|
Jeong D, Eun Y. Factors Influencing SARS-CoV-2 Infection Control Practices of Nurses Caring for COVID-19 Patients in South Korea: Based on Health Belief Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3223. [PMID: 36833918 PMCID: PMC9966129 DOI: 10.3390/ijerph20043223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/28/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to verify the level of COVID-19 infection control practices and the factors affecting the COVID-19 infection control practices of Korean nurses based on the health belief model. The participants were 143 nurses experienced in caring for COVID-19 patients in South Korea. Questionnaires were used to measure health beliefs, confidence in practice, knowledge of COVID-19, infection protection environment, and COVID-19 infection control practices. Data were analyzed by performing descriptive statistics, an independent t-test, one-way analysis of variance, the Mann-Whitney test and multiple regression analysis. The mean score for infection control practices related to COVID-19 was 4.76 on a 5-point scale where a higher score indicates superior infection control performance. Multiple regression analysis revealed that the factors that influenced COVID-19 infection control practices were gender, marital status, perceived susceptibility, and confidence in practice related to COVID-19. With COVID-19 approaching endemic and to prevent infectious diseases, it is necessary to emphasize perceived sensitivity by providing accurate information on the risk of infection rather than simply inducing infection control to be divided into individual activities. In addition, nurses' infection control practices should be implemented with confidence with the nurses themselves feeling the need for infection control and not being forced by the social atmosphere or the hospital.
Collapse
Affiliation(s)
- Dain Jeong
- College of Nursing, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Young Eun
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Republic of Korea
| |
Collapse
|
|
3
|
Li Y, Lu Y, Wang Y, Liu L, Zhou H, Lin B, Peng Z, Yuan Y. Investigation on the effectiveness of ventilation dilution on mitigating COVID-19 patients' secondary airway damage due to exposure to disinfectants. BUILDING AND ENVIRONMENT 2023; 228:109787. [PMID: 36407877 PMCID: PMC9652096 DOI: 10.1016/j.buildenv.2022.109787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
Chlorine-containing disinfectants are widely used in hospitals to prevent hospital-acquired severe acute respiratory syndrome coronavirus 2 infection. Meanwhile, ventilation is a simple but effective means to maintain clean air. It is essential to explore the exposure level and health effects of coronavirus disease 2019 patients' inhalation exposure to by-products of chloride-containing disinfectants under frequent surface disinfection and understand the role of ventilation in mitigating subsequent airway damage. We determined ventilation dilution performance and indoor air quality of two intensive care unit wards of the largest temporary hospital constructed in China, Leishenshan Hospital. The chloride inhalation exposure levels, and health risks indicated by interleukin-6 and D-dimer test results of 32 patients were analysed. The mean ± standard deviation values of the outdoor air change rate in the two intensive care unit wards were 8.8 ± 1.5 h-1 (Intensive care unit 1) and 4.1 ± 1.4 h-1 (Intensive care unit 2). The median carbon dioxide and fine particulate matter concentrations were 480 ppm and 19 μg/m3 for intensive care unit 1, and 567 ppm and 21 μg/m3 for intensive care unit 2, all of which were around the average levels of those in permanent hospitals (579 ppm and 21 μg/m3). Of these patients, the median (lower quartile, upper quartile) chloride exposure time and calculated dose were 26.66 (2.89, 57.21) h and 0.357 (0.008, 1.317) mg, respectively. A statistically significant positive correlation was observed between interleukin-6 and D-dimer concentrations. To conclude, ventilation helped maintain ward air cleanliness and health risks were not observed.
Collapse
Affiliation(s)
- Yifan Li
- Department of Building Science, Tsinghua University, Beijing 100084, China
- Laboratory of Eco-Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Yiran Lu
- Department of Building Science, Tsinghua University, Beijing 100084, China
- Laboratory of Eco-Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Ying Wang
- Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, Hubei 430071, China
| | - Li Liu
- Department of Building Science, Tsinghua University, Beijing 100084, China
- Laboratory of Eco-Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, Hubei 430071, China
| | - Hao Zhou
- Laboratory of Eco-Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
- Institute for Urban Governance and Sustainable Development, Tsinghua University, Beijing 100084, China
| | - Borong Lin
- Department of Building Science, Tsinghua University, Beijing 100084, China
- Laboratory of Eco-Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Zhiyong Peng
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, Hubei 430071, China
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yufeng Yuan
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, Hubei 430071, China
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| |
Collapse
|
|
4
|
Habibi N, Uddin S, Behbehani M, Abdul Razzack N, Zakir F, Shajan A. SARS-CoV-2 in hospital air as revealed by comprehensive respiratory viral panel sequencing. Infect Prev Pract 2022; 4:100199. [PMID: 34977533 PMCID: PMC8711137 DOI: 10.1016/j.infpip.2021.100199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nosocomially acquired severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection has become the most significant pandemic of our lifetime. Though its transmission was essentially attributed to droplets from an infected person, with recent advancements in knowledge, aerosol transmission seems to be a viable pathway, as well. Because of the lower biological load in ambient aerosol, detection of SARS-CoV-2 is challenging. A few recent attempts of sampling large aerosol volumes and using next-generation sequencing (NGS) to detect the presence of SARS-CoV-2 in the air at very low levels gave positive results. These results suggest the potential of using this technique to detect the presence of SARS-CoV-2 and use it as an early warning signal for possible outbreak or recurrence of coronavirus disease 2019 (COVID-19). AIM To assess efficacy of comprehensive respiratory viral panel (CRVP) sequencing and RT-PCR for low-level identification of SARS-CoV-2 and other respiratory viruses in indoor air. METHODS A large volume of indoor aerosol samples from three major hospitals involved in COVID-19 care in Kuwait was collected. Viral RNA was isolated and subjected to comprehensive respiratory viral panel sequencing (CRVP) as per the standard protocol to detect the SARS-CoV-2 and other respiratory viruses in the hospital aerosol and monitor variations within the sequences. RT-PCR was also employed to estimate the viral load of SARS-CoV-2. FINDINGS 13 of 15 (86.7%) samples exhibited SARS-CoV-2 with a relative abundance of 0.2-33.3%. The co-occurrence of human adenoviruses (type C1, C2, C5, C4), respiratory syncytial virus (RSV), influenza B, and non-SARS-CoV-229E were also recorded. Alignment of SARS-CoV-2 sequences against the reference strain of Wuhan China revealed variations in the form of single nucleotide polymorphisms (SNPs-17), insertions and deletions (indels-1). These variations were predicted to create missense (16), synonymous (15), frameshift (1) and stop-gained (1) mutations with a high (2), low (15), and moderate (16) impact. CONCLUSIONS Our results suggest that using CRVP on a large volume aerosol sample was a valuable tool for detecting SARS-CoV-2 in indoor aerosols of health care settings. Owing to its higher sensitivity, it can be employed as a surveillance strategy in the post COVID times to act as an early warning system to possibly control future outbreaks.
Collapse
Affiliation(s)
- Nazima Habibi
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Saif Uddin
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Montaha Behbehani
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Nasreem Abdul Razzack
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Farhana Zakir
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Anisha Shajan
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| |
Collapse
|
|
5
|
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: 4.3] [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.
Collapse
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
| |
Collapse
|
|
6
|
Mody L, Gibson KE, Mantey J, Bautista L, Montoya A, Neeb K, Jenq G, Mills JP, Min L, Kabeto M, Galecki A, Cassone M, Martin ET. Environmental contamination with SARS-CoV-2 in nursing homes. J Am Geriatr Soc 2022; 70:29-39. [PMID: 34674220 PMCID: PMC8661527 DOI: 10.1111/jgs.17531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND SARS-CoV-2 outbreaks in nursing homes (NHs) have been devastating and have led to the creation of coronavirus disease 2019 (COVID-19) units within NHs to care for affected patients. Frequency and persistence of SARS-CoV-2 environmental contamination in these units have not been studied. METHODS A prospective cohort study was conducted between October 2020 and January 2021 in four Michigan NHs. Swabs from high-touch surfaces in COVID-19-infected patient rooms were obtained at enrollment and follow-up. Demographic and clinical data were collected from clinical records. Primary outcome of interest was the probability of SARS-CoV-2 RNA detection from specific environmental surfaces in COVID-19 patient rooms. We used multivariable logistic regression to assess patient risk factors for SARS-CoV-2 contamination. Pairwise Phi coefficients were calculated to measure correlation of site-specific environmental detection upon enrollment and during follow-up. RESULTS One hundred and four patients with COVID-19 were enrolled (61.5% >80 years; 67.3% female; 89.4% non-Hispanic White; 51% short stay) and followed up for 241 visits. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities, including dementia (55.8%), diabetes (40.4%), and heart failure (32.7%). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient rooms, 191 common areas). SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Nearly 90% (93/104) of patients had SARS-CoV-2 contamination in their room at least once. Environmental contamination upon enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination. CONCLUSIONS Environmental detection of viral RNA from surfaces in the rooms of COVID-19 patients is nearly universal and persistent; more investigation is needed to determine the implications of this for infectiousness. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.
Collapse
Affiliation(s)
- Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Geriatrics Research Education and Clinical Center (GRECC)Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Kristen E. Gibson
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Liza Bautista
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Ana Montoya
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Post‐Acute Care ServicesUniversity of Michigan Medical GroupAnn ArborMichiganUSA
| | - Karen Neeb
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Grace Jenq
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Post‐Acute Care ServicesUniversity of Michigan Medical GroupAnn ArborMichiganUSA
| | - John P. Mills
- Division of Infectious Diseases, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Lillian Min
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Geriatrics Research Education and Clinical Center (GRECC)Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Mohammed Kabeto
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Andrzej Galecki
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of BiostatisticsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Marco Cassone
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Emily T. Martin
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| |
Collapse
|
|
7
|
Veenendaal NR, Deierl A, Bacchini F, O’Brien K, Franck LS. Supporting parents as essential care partners in neonatal units during the SARS-CoV-2 pandemic. Acta Paediatr 2021; 110:2008-2022. [PMID: 33772861 PMCID: PMC8250667 DOI: 10.1111/apa.15857] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
AIM To review the evidence on safety of maintaining family integrated care practices and the effects of restricting parental participation in neonatal care during the SARS-CoV-2 pandemic. METHODS MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched from inception to the 14th of October 2020. Records were included if they reported scientific, empirical research (qualitative, quantitative or mixed methods) on the effects of restricting or promoting family integrated care practices for parents of hospitalised neonates during the SARS-CoV-2 pandemic. Two authors independently screened abstracts, appraised study quality and extracted study and outcome data. RESULTS We retrieved 803 publications and assessed 75 full-text articles. Seven studies were included, reporting data on 854 healthcare professionals, 442 parents, 364 neonates and 26 other family members, within 286 neonatal units globally. The pandemic response resulted in significant changes in neonatal unit policies and restricting parents' access and participation in neonatal care. Breastfeeding, parental bonding, participation in caregiving, parental mental health and staff stress were negatively impacted. CONCLUSION This review highlights that SARS-CoV-2 pandemic-related hospital restrictions had adverse effects on care delivery and outcomes for neonates, families and staff. Recommendations for restoring essential family integrated care practices are discussed.
Collapse
Affiliation(s)
- Nicole R. Veenendaal
- Department of Pediatrics/Neonatology OLVG Amsterdam The Netherlands
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC, Vrije Universiteit, University of Amsterdam Amsterdam The Netherlands
| | - Aniko Deierl
- Department of Neonatology Imperial College Healthcare NHS Trust London UK
| | | | - Karel O’Brien
- Department of Pediatrics Mount Sinai Hospital Toronto Ontario Canada
| | - Linda S. Franck
- School of Nursing University of California San Francisco San Francisco CA USA
| | | |
Collapse
|
|
8
|
Lee SAK, Laefer DF. Spring 2020 COVID-19 community transmission behaviours around New York City medical facilities. Infect Prev Pract 2021; 3:100158. [PMID: 34316553 PMCID: PMC8233409 DOI: 10.1016/j.infpip.2021.100158] [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: 02/05/2021] [Accepted: 06/16/2021] [Indexed: 11/08/2022] Open
Abstract
Background Epidemiological studies have long been used for infection transmission prevention, but exact patterns of touch behaviours and transportation choices [contributors to community spread of coronavirus disease 2019 (COVID-19)] were previously unknown. Aim To investigate individual risk behaviour levels with respect to local COVID-19 infection levels. Methods A longitudinal field study recorded behaviours of individuals leaving medical facilities following the New York State's PAUSE order. A subset of those data was analysed herein (4793 records, 16 facilities, 23rd March–17th May 2020). Touched objects and transportation choices were compared over time using Chi-squared tests (P<0.05 significance threshold). Findings In Week 1, 64.1% of subjects touched at least one environmental object [such as a building door handle (21.8%); traffic light, railing or parking meter (5.6%)]; shared object [such as a vehicle door handle (19.7%)]; personal object [such as a cell phone (4.2%)]; or themselves (0.4%). By Week 8, <35% of subjects touched at least one object, where the greatest reduction was in touching environmental objects. The frequency of touching increased slightly during the observation period for some personal objects such as cell phones. The use of public transportation remained steady (approximately 20%) throughout the study period; for-hire vehicle usage increased from 0% in Week 1 to 7% in Week 8, mirroring a 7% decrease in the use of personal vehicles (from 34% to 27%). Touching and transportation patterns varied significantly by facility. Conclusions While this study observed a decline in touch patterns and use of shared modes of transportation, the persistence of many risk-related behaviours suggests that more effective public health policies, including cleaning regimens for public environmental objects and the removal or relocation of frequently touched objects, could help limit the spread of COVID-19.
Collapse
Affiliation(s)
- S-A Kingsbury Lee
- Center for Urban Science + Progress, New York University, Brooklyn, NY, USA
| | - D F Laefer
- Center for Urban Science + Progress, New York University, Brooklyn, NY, USA
| |
Collapse
|
|
9
|
Wang MK, Yue HY, Cai J, Zhai YJ, Peng JH, Hui JF, Hou DY, Li WP, Yang JS. COVID-19 and the digestive system: A comprehensive review. World J Clin Cases 2021; 9:3796-3813. [PMID: 34141737 PMCID: PMC8180220 DOI: 10.12998/wjcc.v9.i16.3796] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/10/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.
Collapse
Affiliation(s)
- Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Hai-Yan Yue
- Department of Digestive Diseases, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jin Cai
- Department of Geriatrics, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
- Department of Infectious Diseases, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Yu-Jia Zhai
- Department of Outpatient Services, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jian-Hui Peng
- Department of Quality Management, Guangdong Second Provincial General Hospital (Pazhou Campus), Guangzhou 510317, Guangdong Province, China
| | - Ju-Fen Hui
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Deng-Yong Hou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Wei-Peng Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| |
Collapse
|
|
10
|
Kanamori H, Weber DJ, Rutala WA. Role of the Healthcare Surface Environment in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission and Potential Control Measures. Clin Infect Dis 2021; 72:2052-2061. [PMID: 32985671 PMCID: PMC7543309 DOI: 10.1093/cid/ciaa1467] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023] Open
Abstract
The healthcare environment serves as one of the possible routes of transmission of epidemiologically important pathogens, but the role of the contaminated environment on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission remains unclear. We reviewed survival, contamination, and transmission of SARS-CoV-2 via environmental surfaces and shared medical devices as well as environmental disinfection of SARS-CoV-2 in healthcare settings. Coronaviruses, including SARS-CoV-2, have been demonstrated to survive for hours to days on environmental surfaces depending on experimental conditions. The healthcare environment is frequently contaminated with SARS-CoV-2 RNA in most studies but without evidence of viable virus. Although direct exposure to respiratory droplets is the main transmission route of SARS-CoV-2, the contaminated healthcare environment can potentially result in transmission of SARS-CoV-2 as described with other coronaviruses such as SARS and Middle East respiratory syndrome coronaviruses. It is important to improve thoroughness of cleaning/disinfection practices in healthcare facilities and select effective disinfectants to decontaminate inanimate surfaces and shared patient care items.
Collapse
Affiliation(s)
- Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
|
11
|
Bedrosian N, Mitchell E, Rohm E, Rothe M, Kelly C, String G, Lantagne D. A Systematic Review of Surface Contamination, Stability, and Disinfection Data on SARS-CoV-2 (Through July 10, 2020). ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:4162-4173. [PMID: 33227206 DOI: 10.1021/acs.est.0c05651] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We conducted a systematic review of hygiene intervention effectiveness against SARS-CoV-2, including developing inclusion criteria, conducting the search, selecting articles for inclusion, and summarizing included articles. Overall, 96 268 articles were screened and 78 articles met inclusion criteria with outcomes in surface contamination, stability, and disinfection. Surface contamination was assessed on 3343 surfaces using presence/absence methods. Laboratories had the highest percent positive surfaces (21%, n = 83), followed by patient-room healthcare facility surfaces (17%, n = 1170), non-COVID-patient-room healthcare facility surfaces (12%, n = 1429), and household surfaces (3%, n = 161). Surface stability was assessed using infectivity, SARS-CoV-2 survived on stainless steel, plastic, and nitrile for half-life 2.3-17.9 h. Half-life decreased with temperature and humidity increases, and was unvaried by surface type. Ten surface disinfection tests with SARS-CoV-2, and 15 tests with surrogates, indicated sunlight, ultraviolet light, ethanol, hydrogen peroxide, and hypochlorite attain 99.9% reduction. Overall there was (1) an inability to align SARS-CoV-2 contaminated surfaces with survivability data and effective surface disinfection methods for these surfaces; (2) a knowledge gap on fomite contribution to SARS-COV-2 transmission; (3) a need for testing method standardization to ensure data comparability; and (4) a need for research on hygiene interventions besides surfaces, particularly handwashing, to continue developing recommendations for interrupting SARS-CoV-2 transmission.
Collapse
Affiliation(s)
- Noah Bedrosian
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| | - Elizabeth Mitchell
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| | - Elsa Rohm
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| | - Miguel Rothe
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| | - Christine Kelly
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| | - Gabrielle String
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| | - Daniele Lantagne
- Tufts University School of Engineering, Medford, Massachusetts, 02155, United States
| |
Collapse
|
|
12
|
Kampf G, Jatzwauk L. [Is Disinfection of Public Surfaces useful for the Prevention of SARS-CoV-2 Infections?]. DAS GESUNDHEITSWESEN 2021; 83:180-185. [PMID: 33540430 PMCID: PMC8043670 DOI: 10.1055/a-1335-4549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Measures to control SARS-CoV-2 often include the regular disinfection of public surfaces. The frequency of SARS-CoV-2 detection on surfaces in the surrounding of confirmed cases was evaluated in this systematic review. Overall, 26 studies showed 0 and 100% rates of contamination with SARS-CoV-2 RNA on surfaces in the surrounding of patients. Seven studies with at least 100 samples mostly showed detection rates between 1.4 and 19%. Two other studies did not detect infectious SARS-CoV-2 on any surface. Similar results were obtained from surfaces in the surrounding of confirmed SARS- and influenza-patients. A contamination of public surfaces with infectious virus is considerably less likely because there are much less potential viral spreaders around a surface, the contact time between a person and the surface is much shorter, and the asymptomatic carriers typically have no symptoms. In addition, a hand contact with a contaminated surface transfers only a small part of the viral load. A simple cleaning reduces the number of infectious viruses already by 2 log10-steps. That is why public surfaces should in general be cleaned because the wide use of biocidal agents for surface disinfection further increases the microbial selection pressure without an expectable health benefit.
Collapse
Affiliation(s)
- Günter Kampf
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Lutz Jatzwauk
- Krankenhaushygiene, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| |
Collapse
|
|
13
|
[Infection prevention and control for COVID-19 in healthcare settings]. Uirusu 2021; 71:151-162. [PMID: 37245977 DOI: 10.2222/jsv.71.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In healthcare facilities, the initial response to emerging and reemerging infectious diseases, including COVID-19, requires systematic management. The first step is to establish an initial risk assessment and subsequent response flow, using a combination of triage and clinical examination for patients. Screening tests are performed for the early diagnosis of asymptomatic patients who are judged to be at low risk in the initial assessment. However, regardless of the test results, subsequent patient care should be taken cautiously to avoid inadequate initial evaluation at the time of admission, follow-up of symptoms and infection control measures after admission. The basic principle is standard precautions, with particular emphasis on compliance with hand hygiene. Universal masking for preventing transmission from asymptomatic/pre-symptomatic patients and reducing droplet emission and inhalation become the new essential precaution. For suspected/confirmed patients with COVID-19, surgical mask or N95 mask, gloves, gown, eye protection, and cap are basically used. The policy for personal protective equipment is made based on the medical environment of each facility. A negative pressure room is not always required but should be considered in high-risk environments, if possible. While the risk of transmission from the surface environment in a standard healthcare delivery system is limited, a continuous review of the facility environment is expected, considering the importance of ventilation.
Collapse
|
|
14
|
Belluco S, Mancin M, Marzoli F, Bortolami A, Mazzetto E, Pezzuto A, Favretti M, Terregino C, Bonfante F, Piro R. Prevalence of SARS-CoV-2 RNA on inanimate surfaces: a systematic review and meta-analysis. Eur J Epidemiol 2021; 36:685-707. [PMID: 34313896 PMCID: PMC8313411 DOI: 10.1007/s10654-021-00784-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
Abstract
Coronavirus disease (COVID-19) is a respiratory disease affecting many people and able to be transmitted through direct and perhaps indirect contact. Direct contact transmission, mediated by aerosols or droplets, is widely demonstrated, whereas indirect transmission is only supported by collateral evidence such as virus persistence on inanimate surfaces and data from other similar viruses. The present systematic review aims to estimate SARS-CoV-2 prevalence on inanimate surfaces, identifying risk levels according to surface characteristics. Data were obtained from studies in published papers collected from two databases (PubMed and Embase) with the last search on 1 September 2020. Included studies had to be papers in English, had to deal with coronavirus and had to consider inanimate surfaces in real settings. Studies were coded according to our assessment of the risk that the investigated surfaces could be contaminated by SARS-CoV-2. A meta-analysis and a metaregression were carried out to quantify virus RNA prevalence and to identify important factors driving differences among studies. Thirty-nine out of forty retrieved paper reported studies carried out in healthcare settings on the prevalence of virus RNA, five studies carry out also analyses through cell culture and six tested the viability of isolated viruses. Overall prevalences of SARS-CoV-2 RNA on high-, medium- and low-risk surfaces were 0.22 (CI95 [0.152-0.296]), 0.04 (CI95 [0.007-0.090]), and 0.00 (CI95 [0.00-0.019]), respectively. The duration surfaces were exposed to virus sources (patients) was the main factor explaining differences in prevalence.
Collapse
Affiliation(s)
- Simone Belluco
- Department of Food Safety, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy.
| | - Marzia Mancin
- Department of Food Safety, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Filippo Marzoli
- Department of Food Safety, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Alessio Bortolami
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Eva Mazzetto
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Alessandra Pezzuto
- Department of Food Safety, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Michela Favretti
- Department of Food Safety, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Calogero Terregino
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Francesco Bonfante
- Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| | - Roberto Piro
- Department of Food Safety, Istituto Zooprofilattico Sperimentale Delle Venezie, Legnaro, Italy
| |
Collapse
|
|
15
|
An overview of research on air and environmental contamination with SARS-CoV-2 in healthcare settings. Infect Control Hosp Epidemiol 2020; 43:130-133. [PMID: 33298221 PMCID: PMC8485011 DOI: 10.1017/ice.2020.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
|
16
|
Kampf G, Brüggemann Y, Kaba H, Steinmann J, Pfaender S, Scheithauer S, Steinmann E. Potential sources, modes of transmission and effectiveness of prevention measures against SARS-CoV-2. J Hosp Infect 2020; 106:678-697. [PMID: 32956786 PMCID: PMC7500278 DOI: 10.1016/j.jhin.2020.09.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022]
Abstract
During the current SARS-CoV-2 pandemic new studies are emerging daily providing novel information about sources, transmission risks and possible prevention measures. In this review, we aimed to comprehensively summarize the current evidence on possible sources for SARS-CoV-2, including evaluation of transmission risks and effectiveness of applied prevention measures. Next to symptomatic patients, asymptomatic or pre-symptomatic carriers are a possible source with respiratory secretions as the most likely cause for viral transmission. Air and inanimate surfaces may be sources; however, viral RNA has been inconsistently detected. Similarly, even though SARS-CoV-2 RNA has been detected on or in personal protective equipment (PPE), blood, urine, eyes, the gastrointestinal tract and pets, these sources are currently thought to play a negligible role for transmission. Finally, various prevention measures such as handwashing, hand disinfection, face masks, gloves, surface disinfection or physical distancing for the healthcare setting and in public are analysed for their expected protective effect.
Collapse
Affiliation(s)
- G. Kampf
- University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Greifswald, Germany,Corresponding author. Address: University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Y. Brüggemann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - H.E.J. Kaba
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University, Göttingen, Germany
| | - J. Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, General Hospital Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - S. Pfaender
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - S. Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University, Göttingen, Germany
| | - E. Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
|
17
|
Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit-What is the risk? Infect Control Hosp Epidemiol 2020; 42:669-677. [PMID: 33081858 PMCID: PMC7653228 DOI: 10.1017/ice.2020.1278] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities. Methods: In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards. Results: In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture. Conclusion: Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.
Collapse
|