SARS-CoV-2 presented in the air of an intensive care unit (ICU)

Jin, Tingxu; Li, Jun; Yang, Jun; Li, Jiawei; Hong, Feng; Long, Hai; Deng, Qihong; Qin, Y.; Jiang, Jiajun; Zhou, Xuan; Song, Qian; Pan, Chunliu; Luo, Peng

doi:10.1016/j.scs.2020.102446

Cited by 61 publications

(59 citation statements)

References 21 publications

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“…After further screening and supplementary searching of articles published or posted between January 1 and October 27, 2020, we identified an additional article, and a total of 24 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 , 24 , 25 , 26 , 27 , 28 , 29 , 30 …”

Section: Resultsmentioning

confidence: 99%

“…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 (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: Resultsmentioning

confidence: 99%

“…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%

“…(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%

“…(50.0%) 3,[9][10][11][12][17][18][19][20]23,24,28 in clinical areas away from patients, 8 (33.3%) [9][10][11][12][13]19,23,29 in staff areas, 6 (25.0%) 3,9,[17][18][19]22 in toilets and/or bathrooms, and 6 (33.3%) 9,10,12,17,20,28 in public areas ( Table 1). The clinical context of patients hospitalized in the targeted areas was detailed in 18 studies, of which 10 (50.0%) [8][9][10][11]22,23,25,[27][28][29] were performed in units hospitalizing patients with severe or critical illness, 11 (61.1%) 3,11,12,[14][15][16]…”

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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%

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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Measuring SARS‐CoV‐2 aerosolization in rooms of hospitalized patients

Yan

Lin

Albaugh

et al. 2022

Laryngoscope Investig Oto

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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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