An overview of automated room disinfection systems: When to use them and how to choose them

Keep It Clean: The Current State of Hygiene and Disinfection Research and Practices for Immersive Virtual Reality Experiences

The interest and dissemination of Virtual Reality (VR) is still expanding across multiple domains. While VR has the capacity to revolutionize many different industries and fields, the recent Covid-19 pandemic has also increased awareness of hygiene and safety associated with VR usage. Despite the growing commercial availability of both VR headsets and preventive and disinfection solutions, confirmatory studies required to validate both the efficacy and safety of the different solutions are severely lacking. This paper presents the findings of a survey aimed at gathering information about current hygiene practices in various domains, along with the perception of research availability. Cleaning methods varied among respondents (n=42), but most popular methods consisted of several consecutive solutions. Respondents primarily used anti-bacterial or alcohol disinfection wipes (81%), permanent face covers (leather/silicone) (43%), disposable cover/mask (26%), and UVC light disinfection (26%). 65% of the respondents stated that the Covid-19 pandemic made them change their practices. A majority of respondents remarked that there was a scarcity of research, yet, most respondents were fairly or completely confident that their cleaning protocols were sufficient, despite remarking that it was sometimes not adhered to. The efficacy of VR hygiene solutions and practices remains largely understudied despite the urgent need to establish validated and efficacious cleaning protocols and practices. Current solutions and practices primarily focuses on the inside of the headset, although the outside of the headset may be far more exposed to contaminants through e.g. hand-contact. Further research is needed to define and evaluate context-dependent risk-assessments as well as suitable cleaning protocols for VR-headsets.

Use of automated room disinfection systems in the health care environment: A national survey

BACKGROUND

Automated room disinfection systems (ARDSs) have been increasingly adopted worldwide to address emerging infectious diseases and antibiotic-resistant bacteria. This study aims to assess the current use of ARDSs in acute health care settings across South Korea.

METHODS

A nationwide online survey was conducted in 150 tertiary general hospitals and identified the experiences of ARDS use.

RESULTS

Among the hospitals surveyed, 32.7% used ultraviolet C (UV-C), 26.0% used aerosolized hydrogen peroxide (aHP), and 15.3% used vaporized hydrogen peroxide (vHP). Most systems were adopted after the Middle East Respiratory Syndrome outbreak. UV-C was mainly used in examination and isolation rooms, while aHP and vHP were used in isolation rooms. Satisfaction rates were 81.6% for UV-C, 76.9% for aHP, and 78.3% for vHP, with 91.3% to 94.9% of respondents intending to continue use. Barriers to adoption included high maintenance costs, uncertainty about UV-C efficacy, challenges with aHP systems, and high costs for vHP systems.

CONCLUSIONS

To increase the adoption of ARDSs, addressing high maintenance costs and confirming the disinfection efficacy of these systems is crucial. Enhancing convenience, cost-effectiveness, operational efficiency, and developing user guidelines and educational programs will be essential for the effective utilization of ARDSs.

Ultraviolet C Decontamination Devices in a Hospital Pharmacy: An Evaluation of Their Contribution

PURPOSE

The COVID-19 pandemic led to a major interest in ultraviolet C (UVC) disinfection devices and accelerated the implementation of UVC devices in healthcare facilities due to their proven efficacy in the inactivation of various pathogens. While UVC technology offers several advantages, some drawbacks remain. This report, drawing on studies, guidelines, and practical experiences related to the use of UVC technology in healthcare settings, examines the efficacy, advantages, and drawbacks of UVC devices, and their applications in aseptic drug-compounding pharmaceutical units.

SUMMARY

Studies, guidelines, and practical experiences were selected. UVC technology offers advantages such as rapid disinfection, reduced reliance on chemical agents, minimal waste, and freedom from manual disinfection variability, making it particularly valuable for maintaining aseptic conditions in compounding environments. However, some drawbacks persist, as it is a germ-dependent method and there is currently no standardized method for ensuring effectiveness.

CONCLUSIONS

This opinion paper highlights the effectiveness of UCV technology in pharmaceutical compounding units, proving that it is a viable alternative to the traditionally used manual and operator-dependent methods. However, there is a need for standardized methods to evaluate UVC devices.

Why do some metal ions spontaneously form nanoparticles in water microdroplets? Disentangling the contributions of the air-water interface and bulk redox chemistry

Water microdroplets containing 100 μM HAuCl4 have been shown to reduce gold ions into gold nanoparticles spontaneously. It has been suggested that this chemical transformation takes place exclusively at the air-water interface of microdroplets, albeit without mechanistic insights. We compared the fate of several metallic salts in water, methanol, ethanol, and acetonitrile in the bulk phase and microdroplet geometry (sprays). Experiments revealed that when HAuCl4 (or PtCl4) is added to bulk water (or methanol or ethanol), metal NPs appear spontaneously. Over time, the nanoparticles grow, evidenced by the bulk solutions' changing colors. If the bulk solution is sprayed pneumatically and microdroplets are collected, the NP size distribution is not significantly enhanced. We find that the reduction of metal ions is accompanied by the oxidation of water (or alcohols); however, these redox reactions are minimal in acetonitrile. This establishes that the spontaneous reduction of metal ions is (i) a bulk phase phenomenon in water and several non-aqueous solutions, (ii) minimally affected by the air-water interface or the microdroplet geometry, and (iii) is not limited to Au3+ ions and can be explained via the electrochemical series. These results advance our understanding of aquatic chemistry and liquids in general and should be relevant in soil chemistry, biogeochemistry, electrochemistry, and green chemistry.

Optimizing Ultrasound Probe Disinfection for Healthcare-Associated Infection Control: A Comparative Analysis of Disinfectant Efficacy

Background/Aims: Ultrasound is a key diagnostic tool in modern medicine due to its ability to provide real-time, high-resolution images of the internal structures of the human body. Despite its undeniable advantages, there are challenges related to the contamination of ultrasound probes, with the risk of healthcare-associated infections. The aim of this review was to identify the most effective disinfectants for disinfecting ultrasound probes to prevent the transmission of pathogens between patients. Methods: A narrative review was conducted using the PubMed, CINAHL, Embase, and Cochrane Library databases, resulting in the inclusion of 16 studies from an initial 1202 records. Results: Hydrogen peroxide (H2O2) was the most effective disinfectant, especially in automated systems, achieving a >5-log10 reduction in viral load, including that of resistant pathogens like Human Papillomavirus. Chlorhexidine gluconate (4%) demonstrated strong antibacterial efficacy, eliminating 84.62% of bacterial contamination, but was less effective against viral pathogens. Glutaraldehyde was effective in some cases, though its use carried a higher risk of probe damage. The use of sodium hypochlorite varied across guidelines; some endorsed it for COVID-19 prevention, while others cautioned against its application due to potential probe damage. Conclusions: This study highlights the importance of advanced disinfection technologies and strict adherence to protocols in improving infection control. Automated systems utilizing H2O2 strike an ideal balance between antimicrobial efficacy and equipment preservation. Future research should focus on developing disinfection methods that prioritize safety, cost-effectiveness, and environmental sustainability in various clinical environments.

Physicochemical methods for disinfection of contaminated surfaces - a way to control infectious diseases

This paper represents the reviews of recent advancements in different physicochemical methods for disinfecting contaminated surfaces, which are considered to be responsible for transmitting different bacterial, viral, and fungal infectious diseases. Surface disinfection can be achieved by applying chemicals, UV-based processes, ionization radiation (gamma-ray, X-ray and electron beam), application of self-disinfecting surfaces, no-touch room disinfection methods, and robotic disinfection methods for built-in settings. Application of different chemicals, such as alcohols, hydrogen peroxide, peracetic acid, quaternary ammonium salts, phenol, and iodine solution, are common and economical. However, the process is time-consuming and less efficient. The use of UVC light (wavelength: 200-280 nm, generated by low vapor mercury lamps or pulse xenon light) has gained much attention for disinfecting fomites worldwide. In recent times, the combination of UV and H2O2, based on the principle of the advanced oxidation process, has been applied for disinfecting inanimate surfaces. The process is very efficient and faster than chemical and UV processes. Heavy metals like copper, silver, zinc, and other metals can inactivate microbes and are used for surface modification to produce self-disinfecting surfaces and used in healthcare facilities. In combination with UVB (280-315 nm) and UVA (315-400 nm), titanium oxide has been utilized for disinfecting contaminated surfaces. Ionization radiation, one of the advanced methods, can be used in disinfecting medical devices and drugs. Post-COVID-19 pandemic, the no-touch and robotic disinfection methods utilizing chemicals or UVC lights have received much importance in built-in settings. Among these methods, surface disinfection by applying chemicals by fogging/vaporization and UV radiation methods has been widely reported in the literature compared to other methods.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-024-00893-2.

Busting the myth of spontaneous formation of H2O2 at the air-water interface: contributions of the liquid-solid interface and dissolved oxygen exposed

Recent reports on the spontaneous formation of hydrogen peroxide (H2O2) at the air-water and solid-water interfaces challenge our current understanding of aquatic chemistry and have ramifications on atmosphere chemistry models, surface science, and green chemistry. Suggested mechanisms underlying this chemical transformation include ultrahigh instantaneous electric fields at the air-water interface and the oxidation of water and reduction of the solid at the solid-water interface. Here, we revisit this curious problem with NMR spectroscopy (with an H2O2 detection limit ≥50 nM) and pay special attention to the effects of nebulizing gas, dissolved oxygen content, and the solid-water interface on this chemical transformation in condensed and sprayed water microdroplets. Experiments reveal that the reduction of dissolved oxygen at the solid-water interface predominantly contributes to the H2O2 formation (not the oxidation of hydroxyl ions at the air-water interface or the oxidation of water at the solid-water interface). We find that the H2O2 formation is accompanied by the consumption (i.e., reduction) of dissolved oxygen and the oxidation of the solid surface, i.e., in the absence of dissolved oxygen, the formation of H2O2(aq) is not observed within the detection limit of ≥50 nM. Remarkably, the tendency of the solids investigated in this work towards forming H2O2 in water followed the same order as their positions in the classic Galvanic series. These findings bust the prevailing myths surrounding H2O2 formation due to the air-water interface, the ultrahigh electric fields therein, or the micro-scale of droplets. The hitherto unrealized role of the oxidation of the solid surface due to dissolved oxygen in the formation of H2O2 is exposed. These findings are especially relevant to corrosion science, surface science, and electrochemistry, among others.

Inactivation of human coronaviruses using an automated room disinfection device

The emergence of more virulent and epidemic strains of viruses, especially in the context of COVID-19, makes it more important than ever to improve methods of decontamination. The objective of this study was to evaluate the potential of on-demand production of chlorine species to inactivate human coronaviruses. The commercial prototype disinfection unit was provided by Unipolar Water Technologies. The Unipolar device generates active chlorine species using an electrochemical reaction and dispenses the disinfectant vapour onto surfaces with an aspirator. The minimum effective concentration and exposure time of disinfectant were evaluated on human hepatoma (Huh7) cells using 50% tissue culture infectious dose (TCID50) assay and human coronavirus 229E (HCoV-229E), a surrogate for pathogenic human coronaviruses. We showed that chlorine species generated in the Unipolar device inactivate HCoV-229E on glass surfaces at ≥ 400 parts per million active chlorine concentration with a 5 min exposure time. Here, inactivation refers to the inability of the virus to infect the Huh7 cells. Importantly, no toxic effect was observed on Huh7 cells for any of the active chlorine concentrations and contact times tested.

Superiority of manual disinfection using pre-soaked wipes over automatic UV-C radiation without prior cleaning

BACKGROUND

The efficacy of ultraviolet C (UV-C) radiation against a broad spectrum of micro-organisms has been demonstrated in several studies, but differences in the specific doses and the extent of microbial reduction were found. Furthermore, the conditions of laboratory tests differ greatly from reality, such that efficacy achieved in tests may not necessarily be assumed in reality. Consequently, it is important to investigate the effectiveness of UV-C in representative field trials. The aim was therefore to develop and establish a field test to evaluate automatic UV-C in comparison to manual disinfection.

METHODS

Before and after disinfection, samples were repeatedly collected from naturally highly contaminated surfaces using the swab technique to obtain representative data sets for disinfected and non-disinfected surfaces. Subsequently, the log reduction values (LRV) and the disinfection success were evaluated for UV-C radiation and full compliant manual disinfection using alcohol-based wipes.

RESULTS

Surfaces that are naturally contaminated with bacteria on a regular and nearly uniform basis have been identified as particularly suitable for field testing. Mean contamination was reduced from 23.3 to 1.98 cfu/cm2 (LRV 0.9) and 29.7 to 0.26 cfu/cm2 (LRV 1.2) for UV-C and manual disinfection, respectively. UV-C disinfection achieved 75.5% successful disinfected surfaces, whereas manual disinfection showed 98.1%.

CONCLUSIONS

Full compliant manual disinfection showed slightly higher LRVs and disinfection success than automatic UV-C disinfection. Successful, operator-independent UV-C disinfection still has the potential to improve disinfection performance in addition to manual disinfection.

Tolerance of clinical vancomycin-resistant Enterococcus faecium isolates against UV-C light from a mobile source

BACKGROUND

Admission to a room previously occupied by patients carrying environmentally robust pathogens implies an increased risk of acquiring those pathogens. Therefore, 'No-touch' automated room disinfection systems, including devices based on UV-C irradiation, are discussed to improve terminal cleaning. It is still unclear if clinical isolates of relevant pathogens behave differently under UV-C irradiation compared to laboratory strains used in the approval process of disinfection procedures. In this study we analysed the susceptibility of well characterized clonally divergent vancomycin-resistant enterococci (VRE) strains, including a linezolid-resistant isolate, against UV-C radiation.

METHODS

Susceptibility against UV-C of ten clonally divergent clinical isolates of VRE was determined in comparison to the commonly used test organism Enterococcus hirae ATCC 10541. Ceramic tiles contaminated with 105 to 106 colony forming units/25 cm² of the different enterococci were positioned at a distance of 1.0 and 1.5 m and irradiated for 20 s, resulting in a UV-C dose of 50 and 22 mJ/cm², respectively. Reduction factors were calculated after quantitative culture of the bacteria recovered from treated and untreated surfaces.

RESULTS

Susceptibility to UV-C varied considerably among the strains studied, with the mean value of the most robust strain being up to a power of ten lower compared to the most sensitive strain at both UV-C doses. The two most tolerant strains belonged to MLST sequence types ST80 and ST1283. The susceptibility of the laboratory strain E. hirae ATCC 10541 ranged between the most sensitive and most tolerant isolates for both irradiation doses. However, for UV-C dose of 22 mJ/cm², the reduction of the most tolerant isolate of ST1283 was statistically significantly lower compared to E. hirae ATCC 10541. The most susceptible strains belonged to the MLST sequence types ST117 and ST203.

CONCLUSIONS

These results indicate that UV-C doses reported in the literature are sufficient for the reduction of commonly used reference strains of enterococci but could be insufficient for the reduction of tolerant patient VRE-isolates in a hospital setting. Therefore, for future studies, the most tolerant clinical isolates should be used to validate automated UV-C devices or longer exposure times should be expected to ensure efficacy in the real world.

Evaluation of Single-Pass Disinfection Performance of Far-UVC Light on Airborne Microorganisms in Duct Flows

Far-UVC irradiation (222 nm) is considered an emerging and sustainable solution for future infection and pandemic challenges. We examined the disinfection performance of a krypton-chloride lamp, with a quasi-monochromatic UVC peak at 222 nm, for inactivating airborne microorganisms in a full-scale ventilation duct system. Single-pass disinfection efficacy of far-UVC was determined and compared with that of a conventional mercury-type UVC (254 nm) lamp. Four bacteria, Escherichia coli (E. coli), Pseudomonas alcaligenes (P. alcaligenes), Serratia marcescens (S. marcescens), and Staphylococcus epidermidis (S. epidermidis), as well as bacteriophage P22, were tested under UV exposure with different velocities of duct flows. The data revealed that as the air velocity increased from 0.7 to 4 m/s, the far-UVC disinfection efficacies would decrease by 42, 47, 35, 39, and 33% for these five microorganisms, respectively. The inactivation rate constants to far-UVC light were 4.9, 7.5, 3.3, 6.3, and 3.0 cm²/mJ for aerosolized E. coli, P. alcaligenes, S. marcescens, S. epidermidis, and bacteriophage P22, respectively. Far-UVC irradiation showed a comparable disinfection ability on airborne microorganisms compared with the 254 nm UV irradiation. This first study of far-UVC in real duct applications provides a better understanding of the disinfection performance of this solution in bioaerosol inactivation. It offers a valuable database in the sizing and design of excimer lamps for novel portable air purifiers or in-duct disinfection units.

The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation

BACKGROUND

Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices.

METHODS

The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H₂O₂ vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy.

RESULTS

In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes.

CONCLUSION

Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.

Use of a Hydrogen Peroxide Nebulizer for Viral Disinfection of Emergency Ambulance and Hospital Waiting Room

Disinfection of hospital facilities and ambulances is an important issue for breaking the chain of transmission of viral pathogens. Hydrogen peroxide has provided promising results in laboratory assays. Here, we evaluate the efficacy of a hydrogen peroxide nebulizer for the inactivation of surrogate MS2 bacteriophage and murine norovirus (MNV) in a patient waiting room and the fully equipped cabin of a medical ambulance. We observed an average 3 log₁₀ titer reduction in both settings, which represents the destruction of over 10⁶ and 10⁹ infectious particles of MNV and MS2 per cm², respectively. The potential for viral exposure is high for health workers when disinfecting confined and cluttered spaces, so the use of a hydrogen peroxide mist might offer an affordable and efficient solution to minimize the risk of viral contaminations.

Disinfection of an ambulance using a compact atmospheric plasma device

AIMS

The worldwide spread of the coronavirus SARS-CoV-2 has highlighted the need for fast and simple disinfection processes, amongst others for ambulance cars on site. To overcome current drawbacks regarding room disinfection, the use of cold atmospheric plasma in remote operation represents a promising alternative for the disinfection of larger volumes. In this study, a compact plasma system was evaluated regarding its disinfection efficiency inside an ambulance car.

METHODS AND RESULTS

The developed plasma device is based on a dielectric barrier discharge (DBD) and operates with ambient air as process gas. The humidified afterglow from the plasma nozzle was introduced into an ambulance car with a volume of approximately 10 m³ while B. atrophaeus endospores, S. aureus or Phi 6 bacteriophages dried on different surfaces (PET-films, glass slides or aluminum foil) were exposed to the reactive gas inside the ambulance vehicle at eight different positions. Reductions of spores by more than 4 orders of magnitude were found on all surfaces and positions within 2 hours. Due to their higher susceptibility, Phi 6 bacteriophages and S. aureus counts were reduced by at least 4 orders of magnitude within 30 min on all surfaces.

CONCLUSION

The results show that different microorganisms dried on variable surfaces can be inactivated by several orders of magnitude inside an ambulance by plasma gas from of a compact DBD plasma nozzle.

SIGNIFICANCE AND IMPACT OF STUDY

Plasma gas generated on site by a DBD plasma nozzle proved to be highly efficient for the disinfection of the interior of an ambulance car. Compact plasma systems could be a viable alternative for the disinfection of vehicles or rooms.

On the formation of hydrogen peroxide in water microdroplets

Recent reports on the formation of hydrogen peroxide (H2O2) in water microdroplets produced via pneumatic spraying or capillary condensation have garnered significant attention. How covalent bonds in water could break under such mild conditions challenges our textbook understanding of physical chemistry and water. While there is no definitive answer, it has been speculated that ultrahigh electric fields at the air-water interface are responsible for this chemical transformation. Here, we report on our comprehensive experimental investigation of H2O2 formation in (i) water microdroplets sprayed over a range of liquid flow-rates, (shearing) air flow rates, and air composition, and (ii) water microdroplets condensed on hydrophobic substrates formed via hot water or humidifier under controlled air composition. Specifically, we assessed the contributions of the evaporative concentration and shock waves in sprays and the effects of trace O3(g) on the H2O2 formation. Glovebox experiments revealed that the H2O2 formation in water microdroplets was most sensitive to the air-borne ozone (O3) concentration. In the absence of O3(g), we could not detect H2O2(aq) in sprays or condensates (detection limit ≥250 nM). In contrast, microdroplets exposed to atmospherically relevant O3(g) concentration (10-100 ppb) formed 2-30 µM H2O2(aq), increasing with the gas-liquid surface area, mixing, and contact duration. Thus, the water surface area facilitates the O3(g) mass transfer, which is followed by the chemical transformation of O3(aq) into H2O2(aq). These findings should also help us understand the implications of this chemistry in natural and applied contexts.

Designing Post COVID-19 Buildings: Approaches for Achieving Healthy Buildings

The COVID-19 pandemic forced the accessibility, social gathering, lifestyle, and working environment to be changed to reduce the infection. Coronavirus spreads between people in several different ways. Small liquid particles (aerosols, respiratory droplets) from an infected person are transmitted through air and surfaces that are in contact with humans. Reducing transmission through modified heating, ventilation, and air conditioning (HVAC) systems and building design are potential solutions. A comprehensive review of the engineering control preventive measures to mitigate COVID-19 spread, healthy building design, and material was carried out. The current state-of-the-art engineering control preventive measures presented include ultraviolet germicidal irradiation (UVGI), bipolar ionization, vertical gardening, and indoor plants. They have potential to improve the indoor air quality. In addition, this article presents building design with materials (e.g., copper alloys, anti-microbial paintings) and smart technologies (e.g., automation, voice control, and artificial intelligence-based facial recognition) to mitigate the infections of communicable diseases.

The Air-Water Interface of Water Microdroplets Formed by Ultrasonication or Condensation Does Not Produce H2O2

Recent reports on the production of hydrogen peroxide (H₂O₂) on the surface of condensed water microdroplets without the addition of catalysts or additives have sparked significant interest. The underlying mechanism is thought to be ultrahigh electric fields at the air-water interface; smaller droplets present larger interfacial areas and produce higher (detectable) H₂O₂ yields. To gain insights into this phenomenon, we performed condensation experiments and quantified H₂O₂ formation as a function of the vapor source. Specifically, we compared the H₂O₂ concentration in water microdroplets condensed from the vapor realized via (i) heating water in the range of 50-70 °C and (ii) ultrasonic humidification (as exploited in the original report). Experimental results revealed that the H₂O₂ level inside water microdroplets condensed via heating water was below our detection limit (≥0.25 μM), regardless of the droplet size or the substrate wettability. In contrast, water droplets condensed via ultrasonic humidification contained significantly higher (∼1 μM) H₂O₂ concentrations. We conclude that the ultrasonic humidifiers contribute to H₂O₂ production, not droplet interfacial effects.

Public Buses Decontamination by Automated Hydrogen Peroxide Aerosolization System

BACKGROUND: Public transportation has been linked to an increase in the risk of coronavirus disease 2019 transmission. The effective decontamination system using aerosolized hydrogen peroxide can mitigate the transmission risk from using public transportation. AIM: The aim of this study was to develop and validate an effective decontamination system for public transport. METHODS: The experimental research was performed in 13 inter-city public buses. The aerosol generator with ultrasonic atomizer was used in the experiment. The validation process for disinfection was conducted using both a chemical indicator (CI) and spore discs biological indicator (inoculated with 106 Geobacillus stearothermophilus enclosed in glassine envelopes). The CIs and biological indicators were marked by number and placed in nine locations on each bus. The decontamination cycle was developed by analyzed of various aerosolized and decomposition period. Both concentrations of hydrogen peroxide, 5% and 7%, were used for comparison. RESULTS: In an aerosolized period, both concentrations of hydrogen peroxide at 30 min were effective for sporicidal 6-log reductions. The decontamination cycle totaled 100 min, based on a 70 min average decomposition time. CONCLUSIONS: The automated hydrogen peroxide aerosolized system is a highly effective and safe method of decontaminating public buses.

Conducting a VR Clinical Trial in the Era of COVID-19

The outbreak of severe acute respiratory syndrome coronavirus 2, also known as Coronavirus Disease 2019 (COVID-19) sparked a global public health pandemic that has impacted every aspect of daily life. Medical research was affected, and many clinical trials were halted to minimize COVID-19 transmission risk and spread while the world navigated this novel virus. Here we describe the relaunch of our virtual reality (VR) pilot clinical trial that uses an in-lab brain and body training program to promote brain health in mid-to-late life older adults, in the era of COVID-19. This case series includes five healthy female participants between 51 and 76 years of age, a subset of a larger VR pilot clinical trial that started pre-pandemic. We developed a revised study protocol based on the Center for Disease Control and World Health Organization guidelines to help manage the spread of COVID-19. Since the limited resumption of clinical trials at our institution in August 2020, we successfully completed over 200 in-lab virtual reality training sessions using our revised protocol. During this time, none of the five participants or three study staff reported any COVID-19 symptoms or reported a positive COVID-19 test. More than 40 voluntary COVID-19 tests were completed by our study staff over the last 6 months. All participants rated our safety protocol as very satisfied or extremely satisfied and that they would be very likely or extremely likely to participate in a VR clinical trial during the pandemic. Based on these findings, we suggest that continued VR clinical trial research during the COVID-19 pandemic is achievable and can be safely resumed if specific safety protocols are in place to mitigate the risk of exposure and spread of COVID-19.

Evaluation of the Effectiveness of Two Automated Room Decontamination Devices Under Real-Life Conditions

To evaluate the effectiveness of automated room decontamination devices, a common aerosolized hydrogen peroxide (aHP) as well as a recent gaseous ozone-based device, which produces the disinfectant reagent without the need of consumables, were tested under real-life conditions. Twenty-two contaminated surfaces were positioned in different areas in a patient room with adjacent bathroom and anteroom. Following the decontamination process bacteria were recovered and reduction factors were calculated after performing quantitative culture. Following the manufactures instructions, the ozone-based device displayed a bactericidal effect (log10 > 5), whereas the aHP system failed for a high bacterial burden and achieves only a complete elimination of a realistic bioburden (log10 2). After increasing the exposure time to 30 min, the aHP device also reached a bactericidal effect. Nevertheless, our results indicate, that further research and development is necessary, to get knowledge about toxicity, efficacy and safety by using in complex hospital conditions and achieve meaningful integration in cleaning procedures, to reach positive effects on disinfection performance.

Transmission routes, preventive measures and control strategies of SARS-CoV-2 in the food factory

SARS-CoV-2 virus represents a health threat in food factories. This infectious virus is transmitted by direct contact and indirectly via airborne route, whereas contamination through inanimate objects/surfaces/equipment is uncertain. To limit the potential spread of the pathogen in the food industry, close working between individuals should be avoided and both personal and respiratory hygiene activities should be enforced. Despite the high infectivity, SARS-CoV-2, being an enveloped virus with a fragile lipid envelop, is sensitive to biocidal products and sanitizers commonly used in the food factory. In the context of the building design, interventions that promote healthy air quality should be adopted, especially in food areas with high-occupancy rates for prolonged times, to help minimize the potential exposure to airborne SARS-CoV-2. Air ventilation and filtration provided by heating, ventilation and air conditioning systems, are effective and easy-to-organize tools to reduce the risk of transmission through the air. In addition to conventional sanitation protocols, aerosolization of hydrogen peroxide, UV-C irradiation or in-situ ozone generation are complementary techniques for an effective virucidal treatment of the air.

Infection Control Practices Among Private Practicing Dentists in Nairobi During the Pre-coronavirus Disease 2019 Period

Background: Cross-infection control is a dynamic field that requires frequent updates due to emerging diseases, advancement in technology, and scientific knowledge. Despite wide publication of guidelines, a laxity in compliance to the standard precautions for infection control by dental health-care personnel (DHCP) has been reported globally. Therefore, there is need to review previous shortcomings in order to adequately secure dental practices during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to determine knowledge and infection control practices by dentists in private practices. The study was done a few months before the first COVID-19 case was confirmed in Kenya. Materials and Methods: The study design was a descriptive cross-sectional study that was carried out in selected private dental clinics located in Nairobi. Data were collected using an interviewer-administered questionnaire. Convenience sampling method was utilized, while data were analyzed using SPSS 20.0.0.0. Results: A total of 71 private dentists participated in the study. Their mean age was 38 years with an age range of 27-55 years. Almost all (70, 98.6%) the dentists were able to define cross infection correctly. Majority (62, 87.3%) correctly differentiated between sterilization and disinfection, while 9 (12.7%) had difficulties. Most (68, 95.8%) of the respondents were aware of the standard precautions for cross-infection control. All participants used face masks and gloves. About half of them (38, 54%) practiced hand washing after removal of gloves and 31 (43.7%) before and after wearing of gloves, while 2 (2.8%) washed hands only before wearing gloves. Only 31 (42.3%) and 26 (36.6%) participants reported use of rubber dam isolation and impervious barrier, respectively. All the dentists reported disposal of sharps into especially labeled containers, while about half reported use of disposable suction traps and amalgam separators. Conclusion: The dentists had a good knowledge on various aspects of infection control measures that were studied. Use of basic personal protective equipment was widely practiced. There were irregularities in hand hygiene, use of rubber dam, surface barriers, and waste management. The work highlights that many dentists were unprepared to manage infectious risk during the COVID-19 outbreak, which justified the closure of the dental facilities. Development of strategies to promote adequate and safe practice is highly recommended.