Detection of Coronavirus Disease 2019 Viral Material on Environmental Surfaces of an Ophthalmology Examination Room

Abstract

evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, single-stranded RNA v i r u s t h a t c a u s e s c o r o n a v i r u s d i s e a s e 2 0 1 9 (COVID-19). 1 Person-to-person contact through droplets is believed to be the primary route of virus transmission. However, it has also been suggested that virus can be spread via contaminated surfaces. The survival of enveloped viruses, such as influenza, Middle Eastern respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus (SARS-CoV), on dry surfaces is generally believed to be limited. 2,3 In contrast, a few studies have suggested that those viruses can remain viable on dry surfaces for a suffic ient time to fac ilitate for ward transmission. 4-6 The presence of SARS-CoV-2 has also been reported 7 to have been spread by asymptomatic transmis-IMPORTANCE The new coronavirus disease 2019 (COVID-19) pandemic poses a particular threat to health care professionals; however, there appear to be no objective data that demonstrate the risks of encountering individuals carrying the virus asymptomatically in the case of maintained elective examinations. OBJECTIVE To investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the environmental surfaces of an ophthalmology examination room after visits by patients who were asymptomatic and had passed COVID-19 triage. DESIGN, SETTING, AND PARTICIPANTS This is a quality improvement study conducted 1 week after the first officially confirmed COVID-19 case in İzmir Tepecik Training and Research Hospital, İzmir, Turkey, on March 20, 2020. A triage system was used to determine the risk of COVID-19 from patients who were asymptomatic and presented for examination in an ophthalmology clinic. Real-time polymerase chain reaction testing was used to detect the presence of viral RNA material in samples from the biomicroscope stage, slitlamp breath shield, phoropter, tonometer, and door handles. The first group of samples was taken before the beginning of the examinations, and the second group of the samples was taken after the last patient had left the room. MAIN OUTCOMES AND MEASURES The main outcome was the presence of viral material on surfaces in 5 circular zones with a diameter of 1 m each around where the patients sat. RESULTS Thirty-one persons visited the room, of whom 22 underwent ophthalmic examination and 9 were companions. The mean (SD) examination time was 9 (4) minutes (range, 5-13 minutes). Seven samples were taken before examinations and 7 after examinations. Two samples that were taken after examinations were found to be positive for COVID-19, 1 from the slitlamp breath shield and 1 from the phoropter. CONCLUSIONS AND RELEVANCE This study showed the presence of COVID-19 viral material in a circle 1 m in diameter around where the patients sat. However, real-time polymerase chain reaction could only detect viral material, not the infectivity of these virus samples.

Investigation of SARS CoV-2 virus in environmental surface

“…A laboratory study ( Van Doremalen et al, 2020 ) has explicated that viability of SARS-CoV-2 can last in aerosols for about 3 hr. In addition, this virus can be observed on dry surfaces for 8 to 72 hr, depending on the surface material ( Aytoğan et al, 2020 ; Carraturo et al, 2020 ; Van Doremalen et al, 2020 ). It is also reported that human coronaviruses SARS-CoV-2 remains on inanimate surfaces infectious for up to 9 days at room temperature ( Kampf et al, 2020 ).…”

“…Concerning their ability in adsorption, several results were positive for samples taken with these swaps. In addition to the surface materials, it can also be affected by other conditions, such as temperature and humidity, as well as existence of the condition for generating droplet or aerosol ( Aytoğan et al, 2020 ). It appears that the viability of SARS-CoV-2 on dry surfaces is identical to that of SARS-CoV-1 and MERS-CoV ( Chan et al, 2011 ; Rabenau et al, 2005 ; Van Doremalen et al, 2013 ).…”

SARS‐CoV‐2 and COVID‐19 for the ophthalmologist

“…Because of the significant occupational risk associated with close exposure to potentially contaminated liquid droplets and particles, recommendations have been proposed and publicized so as to warrant professional and patient safety during ophthalmic examinations 86,120‐124 . These recommendations are continuously evolving, and should be adjusted according to the local context.…”

Phacoemulsification and COVID‐19 risk

“…Evidence exists of the ocular manifestations of coronavirus disease 2019 (COVID-19) and the presence of virus particles in ophthalmology examination rooms. [2][3][4][5] However, the risk of infection to health workers of caring for patients in such environments is yet to be established.…”

“…There has been speculation about the risk to surgeons and others in the operating theatre during cataract surgery should the patient be harbouring the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Evidence exists of the ocular manifestations of coronavirus disease 2019 (COVID‐19) and the presence of virus particles in ophthalmology examination rooms 2‐5 . However, the risk of infection to health workers of caring for patients in such environments is yet to be established.…”