Aerosol and environmental surface monitoring for SARS-CoV-2 RNA in a designated hospital for severe COVID-19 patients

Li, Y. H.; Fan, Yebin; Jiang, Lili; Wang, H. B.

doi:10.1017/s0950268820001570

Cited by 82 publications

(99 citation statements)

References 23 publications

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“…Of the 24 included studies, all were cross-sectional observational studies. Ten studies (41.7%) were from China, [9][10][11]15,[18][19][20]22,25,29 and the remaining were from the United States (4 [16.7%]), 12,13,26,30 Hong Kong (2 [8.3%]), 14,21 Korea (2 [8.3%]), 24,27 Singapore (2 [8.3%]), 3,16 Iran (2 [8.3%]), 8,28 the United Kingdom (1 [4.2%]), 19 and Italy (1 [4.2%]). 23 Of all included articles and studies, 20…”

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

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Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

et al. 2020

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IMPORTANCE Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).OBJECTIVE To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. EVIDENCE REVIEWThe MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between January 1 and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patients. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose (TCID50) per meter cubed were analyzed after categorization as less than 1 μm, from 1 to 4 μm, and greater than 4 μm. FINDINGS Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples (17.4%) from close patient environments were positive for SARS-CoV-2 RNA, with a significantly higher positivity rate in intensive care unit settings (intensive care unit, 27 of 107 [25.2%] vs non-intensive care unit, 39 of 364 [10.7%]; P < .001). There was no difference according to the distance from patients (Յ1 m, 3 of 118 [2.5%] vs >1-5 m, 13 of 236 [5.5%]; P = .22). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) from 2 studies were positive, all from close patient environments. The median (interquartile range) SARS-CoV-2 RNA concentrations varied from 1.0 × 10 3 copies/m 3 (0.4 × 10 3 to 3.1 × 10 3 copies/m 3 ) in clinical areas to 9.7 × 10 3 copies/m 3 (5.1 × 10 3 to 14.3 × 10 3 copies/m 3 ) in the air of toilets or bathrooms. Protective equipment removal and patient rooms had high concentrations per titer of SARS-CoV-2 (varying from 0.9 × 10 3 to 40 × 10 3 copies/m 3 and 3.8 × 10 3 to 7.2 × 10 3 TCID50/m 3 ), with aerosol size distributions that showed peaks in the region of particle size less than 1 μm; staff offices had peaks in the region of particle size greater than 4 μm. CONCLUSIONS AND RELEVANCEIn this systematic review, the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads found in toilets and bathrooms, staff areas, and public hallways suggest that these areas should be carefully considered.

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Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

“…(83.3%) 3,[8][9][10][11][14][15][16][17][20][21][22][23][24][25][26][27][28][29][30] were published in peer-reviewed journals, and 4 (16.7%) 12,13,17,18 were posted on preprint servers.…”

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

et al. 2020

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“…For COVID-19 pneumonia patients, researchers have detected the pathogen in their ward environment, especially the toilet environment ( Ong et al, 2020 ). A study reported that SARS-CoV-2 was found in mask swabs ( Li et al, 2020b ) and the air ( Guo et al, 2020 ). Viruses were widely distributed on floors, computer mouses, trash cans, and sickbed handrails and were detected in air ≈4 m from patients ( Guo et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Environmental virus detection associated with asymptomatic SARS-CoV-2-infected individuals with positive anal swabs

Huang

Zhang

Chen

et al. 2021

Science of The Total Environment

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In the fight against the outbreak of COVID-19 in China, we treated some asymptomatic infected individuals. This study aimed to detect pathogens in biological and environmental samples of these asymptomatic infected individuals and analyse their association. Using a cross-sectional study design, we collected biological and environmental samples from 19 patients treated in the isolation ward of Nanjing No.2 Hospital. Biological samples included saliva, pharyngeal swabs, blood, anal swabs, and exhaled breath condensate. Swab samples from the ward environment included inside masks, outside masks, palm swabs, bedside handrails, bedside tables, cell phone screens, toilet cell phone shelves, toilet pads and toilet lids. We also obtained some samples from public areas. We used RT-PCR to detect pathogens and colloidal gold to detect antibodies. As results, 19 asymptomatic infected individuals participated in the survey, with 8 positives for pathogens and 11 positives only for antibodies. Three positive samples were detected from among 96 environmental samples, respectively, from a cell phone surface, a cell phone shelf and a bedside handrail. No positive samples were detected in the exhaled breath condensate in this work. All patients identified pathogens in the environment had positive anal swabs. There was a statistical association between positive anal swabs and positive environmental samples. The association of positive samples from the surrounding of asymptomatically infected patients with positive anal swabs suggested that patients might secrete the virus for a more extended period.

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“…After further screening, and supplementary searching of articles published or posted between 1 January 2020 and 21 July 2020, we identified an additional article and a total of 17 articles were included in the review (Figure 1). [3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]…”

Section: Search Resultsmentioning

confidence: 99%

Airborne contamination of COVID-19 in hospitals: a scoping review of the current evidence

Birgand

Peiffer-Smadja

Fournier

et al. 2020

Preprint

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Introduction A controversy remains worldwide regarding the transmission routes of SARS-CoV-2 in hospital settings. We reviewed the current evidence on the air contamination with SARS-CoV-2 in hospital settings, and the factors associated to the contamination including the viral load and the particles size. Methods The MEDLINE, Embase, Web of Science databases were systematically interrogated for original English-language articles detailing COVID-19 air contamination in hospital settings between 1 December 2019 and 21 July 2020. This study was conducted in accordance with the PRISMA-ScR guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patient. The SARS-CoV-2 RNA concentrations in copies per m3 of air were pooled and their distribution were described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or TCID50 per m3 were analysed after categorization of sizes in <1 micrometers, 1-4 micrometers, and >4 micrometers. Results Among 2,034 records identified, 17 articles were included in the review. Overall, 27.5% (68/247) of air sampled from close patients environment were positive for SARS-CoV-2 RNA, without difference according to the setting (ICU: 27/97, 27.8%; non-ICU: 41/150, 27.3%; p=0.93), the distance from patients (<1 meter: 1/64, 1.5%; 1-5 meters: 4/67, 6%; p=0.4). In other areas, the positivity rate was 23.8% (5/21) in toilets, 9.5% (20/221) in clinical areas, 12.4% (15/121) in staff areas, and 34.1% (14/41) in public areas. A total of 78 viral cultures were performed in three studies, and 3 (4%) were positive, all from close patients environment. The median SARS-CoV-2 RNA concentrations varied from 1.103 copies per m3 (IQR: 0.4.103-9.103) in clinical areas to 9.7.103 (5.1.103-14.3.103) in the air of toilets or bathrooms. The protective equipment removal and patients rooms had high concentrations/titre of SARS-CoV-2 with aerosol size distributions that showed peaks in the <1 micrometers region, and staff offices in the >4 micrometers region. Conclusion In hospital, the air near and away from COVID-19 patients is frequently contaminated with SARS-CoV-2 RNA, with however, rare proofs of their viability. High viral loads found in toilet/bathrooms, staff and public hallways suggests to carefully consider these areas.

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Aerosol and environmental surface monitoring for SARS-CoV-2 RNA in a designated hospital for severe COVID-19 patients

Cited by 82 publications

References 23 publications

Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

Environmental virus detection associated with asymptomatic SARS-CoV-2-infected individuals with positive anal swabs

Airborne contamination of COVID-19 in hospitals: a scoping review of the current evidence

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