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Zhang Y, Shankar SN, Vass WB, Lednicky JA, Fan ZH, Agdas D, Makuch R, Wu CY. Air Change Rate and SARS-CoV-2 Exposure in Hospitals and Residences: A Meta-Analysis. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2024; 58:217-243. [PMID: 38764553 PMCID: PMC11101186 DOI: 10.1080/02786826.2024.2312178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/16/2024] [Indexed: 05/21/2024]
Abstract
As SARS-CoV-2 swept across the globe, increased ventilation and implementation of air cleaning were emphasized by the US CDC and WHO as important strategies to reduce the risk of inhalation exposure to the virus. To assess whether higher ventilation and air cleaning rates lead to lower exposure risk to SARS-CoV-2, 1274 manuscripts published between April 2020 and September 2022 were screened using key words "airborne SARS-CoV-2 or "SARS-CoV-2 aerosol". Ninety-three studies involved air sampling at locations with known sources (hospitals and residences) were selected and associated data were compiled. Two metrics were used to assess exposure risk: SARS-CoV-2 concentration and SARS-CoV-2 detection rate in air samples. Locations were categorized by type (hospital or residence) and proximity to the sampling location housing the isolated/quarantined patient (primary or secondary). The results showed that hospital wards had lower airborne virus concentrations than residential isolation rooms. A negative correlation was found between airborne virus concentrations in primary-occupancy areas and air changes per hour (ACH). In hospital settings, sample positivity rates were significantly reduced in secondary-occupancy areas compared to primary-occupancy areas, but they were similar across sampling locations in residential settings. ACH and sample positivity rates were negatively correlated, though the effect was diminished when ACH values exceeded 8. While limitations associated with diverse sampling protocols exist, data considered by this meta-analysis support the notion that higher ACH may reduce exposure risks to the virus in ambient air.
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Affiliation(s)
- Yuetong Zhang
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columnia, Canada
| | - Sripriya Nannu Shankar
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Environmental & Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - William B. Vass
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - John A. Lednicky
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Z. Hugh Fan
- Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Duzgun Agdas
- Engineering School of Sustainable Infrastructure & Environment, University of Florida, Gainesville, Florida, USA
| | - Robert Makuch
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Chang-Yu Wu
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, Florida, USA
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2
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Zhang X, Chen Y, Pan Y, Ma X, Hu G, Li S, Deng Y, Chen Z, Chen H, Wu Y, Jiang Z, Li Z. Research progress of severe acute respiratory syndrome coronavirus 2 on aerosol collection and detection. CHINESE CHEM LETT 2023:108378. [PMID: 37362323 PMCID: PMC10039702 DOI: 10.1016/j.cclet.2023.108378] [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: 12/14/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 06/28/2023]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 has negatively affected people's lives and productivity. Because the mode of transmission of SARS-CoV-2 is of great concern, this review discusses the sources of virus aerosols and possible transmission routes. First, we discuss virus aerosol collection methods, including natural sedimentation, solid impact, liquid impact, centrifugal, cyclone and electrostatic adsorption methods. Then, we review common virus aerosol detection methods, including virus culture, metabolic detection, nucleic acid-based detection and immunology-based detection methods. Finally, possible solutions for the detection of SARS-CoV-2 aerosols are introduced. Point-of-care testing has long been a focus of attention. In the near future, the development of an instrument that integrates sampling and output results will enable the real-time, automatic monitoring of patients.
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Affiliation(s)
- Xinyu Zhang
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yuting Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yueying Pan
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Xinye Ma
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Gui Hu
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Song Li
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yan Deng
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Zhu Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Hui Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, 412007, China
| | - Yanqi Wu
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
- Shenzhen Lemniscare Med Technol Co. Ltd., Shenzhen, 518000, China
| | - Zhihong Jiang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
| | - Zhiyang Li
- Department of Clinical Laboratory, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
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3
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Zorzi CGC, Neckel A, Maculan LS, Cardoso GT, Moro LD, Savio AAD, Carrasco LDZ, Oliveira MLS, Bodah ET, Bodah BW. Geo-environmental parametric 3D models of SARS-CoV-2 virus circulation in hospital ventilation systems. GEOSCIENCE FRONTIERS 2022; 13:101279. [PMID: 38620951 PMCID: PMC8349361 DOI: 10.1016/j.gsf.2021.101279] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 05/09/2023]
Abstract
The novel coronavirus, SARS-CoV-2, has the potential to cause natural ventilation systems in hospital environments to be rendered inadequate, not only for workers but also for people who transit through these environments even for a limited duration. Studies in of the fields of geosciences and engineering, when combined with appropriate technologies, allow for the possibility of reducing the impacts of the SARS-CoV-2 virus in the environment, including those of hospitals which are critical centers for healthcare. In this work, we build parametric 3D models to assess the possible circulation of the SARS-CoV-2 virus in the natural ventilation system of a hospital built to care infected patients during the COVID-19 pandemic. Building Information Modeling (BIM) was performed, generating 3D models of hospital environments utilizing Revit software for Autodesk CFD 2021. The evaluation considered dimensional analyses of 0°, 45°, 90° and 180°. The analysis of natural ventilation patterns on both internal and external surfaces and the distribution of windows in relation to the displacement dynamics of the SARS-CoV-2 virus through the air were considered. The results showed that in the external area of the hospital, the wind speed reached velocities up to 2.1 m/s when entering the building through open windows. In contact with the furniture, this value decreased to 0.78 m/s. In some internal isolation wards that house patients with COVID-19, areas that should be equipped with negative room pressure, air velocity was null. Our study provides insights into the possibility of SARS-CoV-2 contamination in internal hospital environments as well as external areas surrounding hospitals, both of which encounter high pedestrian traffic in cities worldwide.
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Affiliation(s)
| | - Alcindo Neckel
- Faculdade Meridional, IMED, 304- Passo Fundo - RS 99070-220, Brazil
| | | | | | - Leila Dal Moro
- Faculdade Meridional, IMED, 304- Passo Fundo - RS 99070-220, Brazil
| | | | | | - Marcos L S Oliveira
- Universidad de Lima, Avenida Javier Prado Este 4600 - Santiago de Surco 1503, Peru
- Department of Civil and Environmental. Universidad de la Costa, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia
| | - Eliane Thaines Bodah
- State University of New York, Onondaga Community College, 4585 West Seneca Turnpike, Syracuse, NY 13215, USA
- Thaines and Bodah Center for Education and Development, 840 South Meadowlark Lane, Othello, WA 99344, USA
| | - Brian William Bodah
- Faculdade Meridional, IMED, 304- Passo Fundo - RS 99070-220, Brazil
- Thaines and Bodah Center for Education and Development, 840 South Meadowlark Lane, Othello, WA 99344, USA
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4
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Silva PG, Branco PTBS, Soares RRG, Mesquita JR, Sousa SIV. SARS-CoV-2 air sampling: A systematic review on the methodologies for detection and infectivity. INDOOR AIR 2022; 32:e13083. [PMID: 36040285 PMCID: PMC9538005 DOI: 10.1111/ina.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
This systematic review aims to present an overview of the current aerosol sampling methods (and equipment) being used to investigate the presence of SARS-CoV-2 in the air, along with the main parameters reported in the studies that are essential to analyze the advantages and disadvantages of each method and perspectives for future research regarding this mode of transmission. A systematic literature review was performed on PubMed/MEDLINE, Web of Science, and Scopus to assess the current air sampling methodologies being applied to SARS-CoV-2. Most of the studies took place in indoor environments and healthcare settings and included air and environmental sampling. The collection mechanisms used were impinger, cyclone, impactor, filters, water-based condensation, and passive sampling. Most of the reviewed studies used RT-PCR to test the presence of SARS-CoV-2 RNA in the collected samples. SARS-CoV-2 RNA was detected with all collection mechanisms. From the studies detecting the presence of SARS-CoV-2 RNA, fourteen assessed infectivity. Five studies detected viable viruses using impactor, water-based condensation, and cyclone collection mechanisms. There is a need for a standardized protocol for sampling SARS-CoV-2 in air, which should also account for other influencing parameters, including air exchange ratio in the room sampled, relative humidity, temperature, and lighting conditions.
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Affiliation(s)
- Priscilla G Silva
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Pedro T B S Branco
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ruben R G Soares
- Department of Biochemistry and Biophysics, Science for Life Laboratory, Stockholm University, Solna, Sweden
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
| | - João R Mesquita
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Sofia I V Sousa
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
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5
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Baselga M, Güemes A, Alba JJ, Schuhmacher AJ. SARS-CoV-2 Droplet and Airborne Transmission Heterogeneity. J Clin Med 2022; 11:2607. [PMID: 35566733 PMCID: PMC9099777 DOI: 10.3390/jcm11092607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022] Open
Abstract
The spread dynamics of the SARS-CoV-2 virus have not yet been fully understood after two years of the pandemic. The virus's global spread represented a unique scenario for advancing infectious disease research. Consequently, mechanistic epidemiological theories were quickly dismissed, and more attention was paid to other approaches that considered heterogeneity in the spread. One of the most critical advances in aerial pathogens transmission was the global acceptance of the airborne model, where the airway is presented as the epicenter of the spread of the disease. Although the aerodynamics and persistence of the SARS-CoV-2 virus in the air have been extensively studied, the actual probability of contagion is still unknown. In this work, the individual heterogeneity in the transmission of 22 patients infected with COVID-19 was analyzed by close contact (cough samples) and air (environmental samples). Viral RNA was detected in 2/19 cough samples from patient subgroups, with a mean Ct (Cycle Threshold in Quantitative Polymerase Chain Reaction analysis) of 25.7 ± 7.0. Nevertheless, viral RNA was only detected in air samples from 1/8 patients, with an average Ct of 25.0 ± 4.0. Viral load in cough samples ranged from 7.3 × 105 to 8.7 × 108 copies/mL among patients, while concentrations between 1.1-4.8 copies/m3 were found in air, consistent with other reports in the literature. In patients undergoing follow-up, no viral load was found (neither in coughs nor in the air) after the third day of symptoms, which could help define quarantine periods in infected individuals. In addition, it was found that the patient's Ct should not be considered an indicator of infectiousness, since it could not be correlated with the viral load disseminated. The results of this work are in line with proposed hypotheses of superspreaders, which can attribute part of the heterogeneity of the spread to the oversized emission of a small percentage of infected people.
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Affiliation(s)
- Marta Baselga
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
| | - Antonio Güemes
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
- Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
| | - Juan J. Alba
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
| | - Alberto J. Schuhmacher
- Institute for Health Research Aragon (IIS Aragón), 50009 Zaragoza, Spain; (M.B.); (A.G.); (J.J.A.)
- Fundación Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), 50018 Zaragoza, Spain
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6
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Grein JD, Garland JA, Arguinchona C, Frank MG, Garibaldi BT, Grindle A, Hewlett A, Kline S, Levine CB, Mehta A, Mukherjee V, Sauer LM, Searle EF, Vanairsdale S, Vasa A. Contributions of the Regional Emerging Special Pathogen Treatment Centers to the US COVID-19 Pandemic Response. Health Secur 2022; 20:S4-S12. [PMID: 35483049 DOI: 10.1089/hs.2021.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Emerging Special Pathogens Training and Education Center (NETEC) was established in 2015 to improve the capabilities of healthcare facilities to provide safe and effective care to patients with Ebola and other special pathogens in the United States. Through NETEC, a collaborative network of 10 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) undertook readiness activities that included potential respiratory pathogens. These preparations, which took place before the COVID-19 pandemic, established a foundation of readiness that enabled RESPTCs to play a pivotal role in the US COVID-19 pandemic response. As initial COVID-19 cases were detected in the United States, RESPTCs provided essential isolation capacity, supplies, and subject matter expertise that allowed for additional time for healthcare systems to prepare. Through the Special Pathogen Research Network, RESPTCs rapidly enrolled patients into early clinical trials. During periods of high community transmission, RESPTCs provided educational, clinical, and logistical support to a wide range of healthcare and nonhealthcare settings. In this article, we describe how NETEC and the RESPTC network leveraged this foundation of special pathogen readiness to strengthen the national healthcare system's response to the COVID-19 pandemic. NETEC and the RESPTC network have proven to be an effective model that can support the national response to future emerging special pathogens.
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Affiliation(s)
- Jonathan D Grein
- Jonathan D. Grein, MD, is Director, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer A Garland
- Jennifer A. Garland, RN-BC, PhD, CIC, is Special Pathogens Clinical Program Manager, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Christa Arguinchona
- Christa Arguinchona, MSN, RN, CCRN, is Manager, Special Pathogens/Infection Prevention, Providence Sacred Heart Medical Center, Spokane, WA
| | - Maria G Frank
- Maria G. Frank, MD, is a Hospitalist, Division of Hospital Medicine, Denver Health and Hospital Authority, and an Associate Professor of Medicine, School of Medicine, University of Colorado; both in Denver, CO
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Grindle
- Amanda Grindle, RN, MSN, CNL, CPN, CCRN, is Clinical Program Manager, Special Care Unit, Children's Healthcare of Atlanta, Atlanta, GA
| | - Angela Hewlett
- Angela Hewlett, MD, MS, is an Associate Professor, Division of Infectious Diseases, Department of Internal Medicine; the George W. Orr MD and Linda Orr Chair in Health Security; and Medical Director, Nebraska Biocontainment Unit; all at the University of Nebraska Medical Center, Omaha, NE
| | - Susan Kline
- Susan Kline, MD, MPH, is Executive Medical Director for Infection Prevention, University of Minnesota Medical Center, and a Professor of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School; both in Minneapolis, MN
| | - Corri B Levine
- Corri B. Levine, PhD, MS, MPH, is Program Manager for Emerging and Special Pathogens Program, University of Texas Medical Branch, Galveston, TX
| | - Aneesh Mehta
- Aneesh Mehta, MD, is an Associate Professor of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP(Edin), is an Assistant Professor, NYU School of Medicine; and is Director, Medical Intensive Care Unit, and Director, Special Pathogens Program, Bellevue Hospital Center; all in New York, NY
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, and is an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, Global Center for Health Security; both at the University of Nebraska Medical Center, Omaha, NE
| | - Eileen F Searle
- Eileen F. Searle, PhD, RN, CCRN, is Biothreats Program Director, Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA
| | - Sharon Vanairsdale
- Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, is an Associate Professor, Clinical Track, Nell Hodgson Woodruff School of Nursing, Emory University; Program Director for Serious Communicable Diseases, Emory University Hospital; and Director of Education and Resources, National Emerging Special Pathogens Training and Education Center, Emory University; all in Atlanta, GA
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director of Isolation and Quarantine Services and Director, Readiness Consultations and Metrics Development, National Emerging Special Pathogens Training and Education Center; both at Nebraska Medicine, Omaha, NE
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7
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Styczynski A, Hemlock C, Hoque KI, Verma R, LeBoa C, Bhuiyan MOF, Nag A, Harun MGD, Amin MB, Andrews JR. Assessing impact of ventilation on airborne transmission of SARS-CoV-2: a cross-sectional analysis of naturally ventilated healthcare settings in Bangladesh. BMJ Open 2022; 12:e055206. [PMID: 35428628 PMCID: PMC9013789 DOI: 10.1136/bmjopen-2021-055206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/18/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the risk of exposure to SARS-CoV-2 in naturally ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling. STUDY DESIGN Cross-sectional study. STUDY SETTING AND STUDY SAMPLE The study sample included nine hospitals in Dhaka, Bangladesh. Ventilation characteristics and air samples were collected from 86 healthcare spaces during October 2020 to February 2021. PRIMARY OUTCOME Risk of cumulative SARS-CoV-2 infection by type of healthcare area. SECONDARY OUTCOMES Ventilation rates by healthcare space; risk of airborne detection of SARS-CoV-2 across healthcare spaces; impact of room characteristics on absolute ventilation; SARS-CoV-2 detection by naturally ventilated versus mechanically ventilated spaces. RESULTS The majority (78.7%) of naturally ventilated patient care rooms had ventilation rates that fell short of the recommended ventilation rate of 60 L/s/p. Using a modified Wells-Riley equation and local COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (7.7%). SARS-CoV-2 RNA was most frequently detected in air samples from non-COVID wards (50.0%) followed by outpatient departments (42.9%). Naturally ventilated spaces (22.6%) had higher rates of SARS-CoV-2 detection compared with mechanically ventilated spaces (8.3%), though the difference was not statistically significant (p=0.128). In multivariable linear regression with calculated elasticity, open door area and cross-ventilation were found to have a significant impact on ventilation. CONCLUSION Our findings provide evidence that naturally ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID-designated spaces, but improving parameters of ventilation can mitigate this risk.
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Affiliation(s)
- Ashley Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Kazi Injamamul Hoque
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Renu Verma
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Chris LeBoa
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Md Omar Faruk Bhuiyan
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Auddithio Nag
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Md Golam Dostogir Harun
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Badrul Amin
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
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8
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Thomas A, Suresh M. Assessment of COVID-19 prevention and protection measures in hospitals. CLEANER ENGINEERING AND TECHNOLOGY 2022; 7:100440. [PMID: 35156071 PMCID: PMC8820025 DOI: 10.1016/j.clet.2022.100440] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
This paper aims to develop an assessment framework for the Covid-19 prevention and protection measures in hospitals. The conceptual model is developed by using fifty-four attributes, fifteen criteria, and three enablers. The multi-grade fuzzy approach is used to develop the assessment framework, and Importance Performance Analysis (IPA) identifies the weaker attributes in the case organization. The case hospital's preventive and safety measures assessment level is 8.05, which is 'very highly focused on protection measures,' and fourteen weaker attributes were identified. The case hospital management should focus on the guidelines of Covid-19 preventive and protection measures, strict protocols, regular audits, education and training of the staff, and active surveillance. Case hospital managers should also focus on staffing and timings, the formulation of policies, and abiding by those policies without any fail. This proposed assessment model is a new initiative in-hospital assessment in preventive and safety measures in the healthcare sector during the Covid-19 era. This framework will enable hospital managers as a continuous assessment tool to improve their Covid-19 prevention operations.
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Affiliation(s)
- Albi Thomas
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, 641 112, India
| | - M Suresh
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, 641 112, India
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9
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Dinoi A, Feltracco M, Chirizzi D, Trabucco S, Conte M, Gregoris E, Barbaro E, La Bella G, Ciccarese G, Belosi F, La Salandra G, Gambaro A, Contini D. A review on measurements of SARS-CoV-2 genetic material in air in outdoor and indoor environments: Implication for airborne transmission. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 809:151137. [PMID: 34699823 PMCID: PMC8539199 DOI: 10.1016/j.scitotenv.2021.151137] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 05/03/2023]
Abstract
Airborne transmission of SARS-CoV-2 has been object of debate in the scientific community since the beginning of COVID-19 pandemic. This mechanism of transmission could arise from virus-laden aerosol released by infected individuals and it is influenced by several factors. Among these, the concentration and size distribution of virus-laden particles play an important role. The knowledge regarding aerosol transmission increases as new evidence is collected in different studies, even if it is not yet available a standard protocol regarding air sampling and analysis, which can create difficulties in the interpretation and application of results. This work reports a systematic review of current knowledge gained by 73 published papers on experimental determination of SARS-CoV-2 RNA in air comparing different environments: outdoors, indoor hospitals and healthcare settings, and public community indoors. Selected papers furnished 77 datasets: outdoor studies (9/77, 11.7%) and indoor studies (68/77. 88.3%). The indoor datasets in hospitals were the vast majority (58/68, 85.3%), and the remaining (10/68, 14.7%) were classified as community indoors. The fraction of studies having positive samples, as well as positivity rates (i.e. ratios between positive and total samples) are significantly larger in hospitals compared to the other typologies of sites. Contamination of surfaces was more frequent (in indoor datasets) compared to contamination of air samples; however, the average positivity rate was lower compared to that of air. Concentrations of SARS-CoV-2 RNA in air were highly variables and, on average, lower in outdoors compared to indoors. Among indoors, concentrations in community indoors appear to be lower than those in hospitals and healthcare settings.
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Affiliation(s)
- Adelaide Dinoi
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Str. Prv. Lecce-Monteroni km 1.2, Lecce, Italy
| | - Matteo Feltracco
- Istituto di Scienze Polari (ISP-CNR), Via Torino 155, Venice, Mestre, Italy; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Daniela Chirizzi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Sara Trabucco
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Via Gobetti 101, Bologna, Italy
| | - Marianna Conte
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Str. Prv. Lecce-Monteroni km 1.2, Lecce, Italy; Laboratory for Observations and Analyses of Earth and Climate, Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), 00123 Rome, Italy
| | - Elena Gregoris
- Istituto di Scienze Polari (ISP-CNR), Via Torino 155, Venice, Mestre, Italy; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Elena Barbaro
- Istituto di Scienze Polari (ISP-CNR), Via Torino 155, Venice, Mestre, Italy; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Gianfranco La Bella
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Giuseppina Ciccarese
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Franco Belosi
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Via Gobetti 101, Bologna, Italy
| | - Giovanna La Salandra
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZSPB), Via Manfredonia 20, Foggia, Italy
| | - Andrea Gambaro
- Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari di Venezia, Via Torino 155, Venezia, Mestre, Italy
| | - Daniele Contini
- Istituto di Scienze dell'Atmosfera e del Clima (ISAC-CNR), Str. Prv. Lecce-Monteroni km 1.2, Lecce, Italy.
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10
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Vardoulakis S, Espinoza Oyarce DA, Donner E. Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 803:149932. [PMID: 34525681 PMCID: PMC8390098 DOI: 10.1016/j.scitotenv.2021.149932] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments. METHODS We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms. RESULTS Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings. CONCLUSION Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.
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Affiliation(s)
- Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia.
| | - Daniela A Espinoza Oyarce
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Erica Donner
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
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11
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Lee G, Yoo K. A review of the emergence of antibiotic resistance in bioaerosols and its monitoring methods. RE/VIEWS IN ENVIRONMENTAL SCIENCE AND BIO/TECHNOLOGY 2022; 21:799-827. [PMID: 35694630 PMCID: PMC9169023 DOI: 10.1007/s11157-022-09622-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/30/2022] [Indexed: 04/18/2023]
Abstract
Despite significant public health concerns regarding infectious diseases in air environments, potentially harmful microbiological indicators, such as antibiotic resistance genes (ARGs) in bioaerosols, have not received significant attention. Traditionally, bioaerosol studies have focused on the characterization of microbial communities; however, a more serious problem has recently arisen due to the presence of ARGs in bioaerosols, leading to an increased prevalence of horizontal gene transfer (HGT). This constitutes a process by which bacteria transfer genes to other environmental media and consequently cause infectious disease. Antibiotic resistance in water and soil environments has been extensively investigated in the past few years by applying advanced molecular and biotechnological methods. However, ARGs in bioaerosols have not received much attention. In addition, ARG and HGT profiling in air environments is greatly limited in field studies due to the absence of suitable methodological approaches. Therefore, this study comprehensively describes recent findings from published studies and some of the appropriate molecular and biotechnological methods for monitoring antibiotic resistance in bioaerosols. In addition, this review discusses the main knowledge gaps regarding current methodological issues and future research directions.
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Affiliation(s)
- Gihan Lee
- Department of Environmental Engineering, Korea Maritime and Ocean University, Busan, 49112 South Korea
- Interdisciplinary Major of Ocean Renewable Energy Engineering, Korea Maritime and Ocean University, Busan, 49112 South Korea
| | - Keunje Yoo
- Department of Environmental Engineering, Korea Maritime and Ocean University, Busan, 49112 South Korea
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12
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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: 6.5] [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.
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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
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13
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Lane MA, Walawender M, Webster AS, Brownsword EA, Ingersoll JM, Miller C, Waggoner J, Uyeki TM, Lindsley WG, Kraft CS. Sampling for SARS-CoV-2 Aerosols in Hospital Patient Rooms. Viruses 2021; 13:2347. [PMID: 34960615 PMCID: PMC8703426 DOI: 10.3390/v13122347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Evidence varies as to how far aerosols spread from individuals infected with SARS-CoV-2 in hospital rooms. We investigated the presence of aerosols containing SARS-CoV-2 inside of dedicated COVID-19 patient rooms. Three National Institute for Occupational Safety and Health BC 251 two-stage cyclone samplers were set up in each patient room for a six-hour sampling period. Samplers were place on tripods, which each held two samplers at various heights above the floor. Extracted samples underwent reverse transcription polymerase chain reaction for selected gene regions of the SARS-CoV-2 virus nucleocapsid. Patient medical data were compared between participants in rooms where virus-containing aerosols were detected and those where they were not. Of 576 aerosols samples collected from 19 different rooms across 32 participants, 3% (19) were positive for SARS-CoV-2, the majority from near the head and foot of the bed. Seven of the positive samples were collected inside a single patient room. No significant differences in participant clinical characteristics were found between patients in rooms with positive and negative aerosol samples. SARS-CoV-2 viral aerosols were detected from the patient rooms of nine participants (28%). These findings provide reassurance that personal protective equipment that was recommended for this virus is appropriate given its spread in hospital rooms.
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Affiliation(s)
- Morgan A. Lane
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
| | - Maria Walawender
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Andrew S. Webster
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
- Department of Infectious Diseases, Atlanta VA Health Care System, Decatur, GA 30033, USA
| | - Erik A. Brownsword
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
| | - Jessica M. Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (J.M.I.); (C.M.)
| | - Candace Miller
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (J.M.I.); (C.M.)
| | - Jesse Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
- Emory Healthcare, Atlanta, GA 30322, USA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA;
| | - William G. Lindsley
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26508, USA;
| | - Colleen S. Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (J.M.I.); (C.M.)
- Emory Healthcare, Atlanta, GA 30322, USA
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14
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Alnimr A, Alamri A, Salama KF, Radi M, Bukharie H, Alshehri B, Rabaan AA, Alshahrani M. The Environmental Deposition of Severe Acute Respiratory Syndrome Coronavirus 2 in Nosocomial Settings: Role of the Aerosolized Hydrogen Peroxide. Risk Manag Healthc Policy 2021; 14:4469-4475. [PMID: 34754253 PMCID: PMC8570375 DOI: 10.2147/rmhp.s336085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Data on the role of aerosolized hydrogen peroxide (AHP) systems in the control of the COVID-19 pandemic are still emerging. This study provides evidence of the environmental shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the hospital environment, and the efficacy of AHP to eliminate it. Methods A total of 324 environmental sites (224 surfaces and 100 air samples) belonging to 54 patient rooms were contextually collected and tested for genes of SARS-CoV-2 using RT-PCR assays and Xpert® Xpress SARS-CoV-2. Results The SARS-CoV-2 viral genome was detected in seven sites (2.5%) of three patients’ rooms, including six highly touched surfaces and one air sample. Viral shedding was directly related to the distance from the patient, with 1, 1.9, and 3.5% of samples testing positive at 3, 2, and 1 meter, respectively (P-value=0.02). None of the sites showed the viral genome following application of 6% AHP. Of note, the viral genome was detected at 2 meters of a mildly symptomatic case on a face mask in the absence of aerosol generating procedures. Conclusion Our data support the possible role of the hospital environment as a source of infection, and the efficacy of AHP to eliminate the virus. Further studies are needed to address the viability of the pathogen in these nosocomial sites and the cost-effectiveness of routine hospital disinfection procedures using AHP for SARS-CoV-2.
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Affiliation(s)
- Amani Alnimr
- Department of Microbiology, College of Medicine & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aisha Alamri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khaled F Salama
- Department of Environmental Health, College of Public Health & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mahmoud Radi
- Department of Infection Control, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Huda Bukharie
- Department of Infection Control, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Bashayer Alshehri
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Mohammed Alshahrani
- Emergency and Critical Care Department, College of Medicine & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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15
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Habibi N, Uddin S, Al‐Salameen F, Al‐Amad S, Kumar V, Al‐Otaibi M, Razzack NA, Shajan A, Shirshikar F. SARS-CoV-2, other respiratory viruses and bacteria in aerosols: Report from Kuwait's hospitals. INDOOR AIR 2021; 31:1815-1825. [PMID: 34121237 PMCID: PMC8447393 DOI: 10.1111/ina.12871] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 05/08/2023]
Abstract
The role of airborne particles in the spread of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is well explored. The novel coronavirus can survive in aerosol for extended periods, and its interaction with other viral communities can cause additional virulence and infectivity. This baseline study reports concentrations of SARS-CoV-2, other respiratory viruses, and pathogenic bacteria in the indoor air from three major hospitals (Sheikh Jaber, Mubarak Al-Kabeer, and Al-Amiri) in Kuwait dealing with coronavirus disease 2019 (COVID-19) patients. The indoor aerosol samples showed 12-99 copies of SARS-CoV-2 per m3 of air. Two non-SARS-coronavirus (strain HKU1 and NL63), respiratory syncytial virus (RSV), and human bocavirus, human rhinoviruses, Influenza B (FluB), and human enteroviruses were also detected in COVID-positive areas of Mubarak Al Kabeer hospital (MKH). Pathogenic bacteria such as Mycoplasma pneumonia, Streptococcus pneumonia and, Haemophilus influenza were also found in the hospital aerosols. Our results suggest that the existing interventions such as social distancing, use of masks, hand hygiene, surface sanitization, and avoidance of crowded indoor spaces are adequate to prevent the spread of SARS-CoV-2 in enclosed areas. However, increased ventilation can significantly reduce the concentration of SARS-CoV-2 in indoor aerosols. The synergistic or inhibitory effects of other respiratory pathogens in the spread, severity, and complexity of SARS-CoV-2 need further investigation.
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Affiliation(s)
- N. Habibi
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - S. Uddin
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - F. Al‐Salameen
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - S. Al‐Amad
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - V. Kumar
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - M. Al‐Otaibi
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - N. Abdul Razzack
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - A. Shajan
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
| | - F. Shirshikar
- Environment and Life Sciences Research CenterKuwait Institute for Scientific ResearchSafatKuwait
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16
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Krokhine S, Torabi H, Doostmohammadi A, Rezai P. Conventional and microfluidic methods for airborne virus isolation and detection. Colloids Surf B Biointerfaces 2021; 206:111962. [PMID: 34352699 PMCID: PMC8249716 DOI: 10.1016/j.colsurfb.2021.111962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022]
Abstract
With the COVID-19 pandemic, the threat of infectious diseases to public health and safety has become much more apparent. Viral, bacterial and fungal diseases have led to the loss of millions of lives, especially in the developing world. Diseases caused by airborne viruses like SARS-CoV-2 are difficult to control, as these viruses are easily transmissible and can circulate in the air for hours. To contain outbreaks of viruses such as SARS-CoV-2 and institute targeted precautions, it is important to detect them in air and understand how they infect their targets. Point-of-care (PoC) diagnostics and point-of-need (PoN) detection methods are necessary to rapidly test patient and environmental samples, so precautions can immediately be applied. Traditional benchtop detection methods such as ELISA, PCR and culture are not suitable for PoC and PoN monitoring, because they can take hours to days and require specialized equipment. Microfluidic devices can be made at low cost to perform such assays rapidly and at the PoN. They can also be integrated with air- and liquid-based sampling technologies to capture and analyze viruses from air and body fluids. Here, conventional and microfluidic virus detection methods are reviewed and compared. The use of air sampling devices to capture and concentrate viruses is discussed first, followed by a review of analysis methods such as immunoassays, RT-PCR and isothermal amplification in conventional and microfluidic platforms. This review provides an overview of the capabilities of microfluidics in virus handling and detection, which will be useful to infectious disease researchers, biomedical engineers, and public health agencies.
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Affiliation(s)
- Sophie Krokhine
- Faculty of Science, McMaster University, Burke Science Building, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Hadis Torabi
- Department of Biomedical Engineering, University of Isfahan, Iran.
| | | | - Pouya Rezai
- Department of Mechanical Engineering, York University, ON, Canada.
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17
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Borges JT, Nakada LYK, Maniero MG, Guimarães JR. SARS-CoV-2: a systematic review of indoor air sampling for virus detection. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:40460-40473. [PMID: 33630259 PMCID: PMC7905194 DOI: 10.1007/s11356-021-13001-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/12/2021] [Indexed: 05/03/2023]
Abstract
In a post-pandemic scenario, indoor air monitoring may be required seeking to safeguard public health, and therefore well-defined methods, protocols, and equipment play an important role. Considering the COVID-19 pandemic, this manuscript presents a literature review on indoor air sampling methods to detect viruses, especially SARS-CoV-2. The review was conducted using the following online databases: Web of Science, Science Direct, and PubMed, and the Boolean operators "AND" and "OR" to combine the following keywords: air sampler, coronavirus, COVID-19, indoor, and SARS-CoV-2. This review included 25 published papers reporting sampling and detection methods for SARS-CoV-2 in indoor environments. Most of the papers focused on sampling and analysis of viruses in aerosols present in contaminated areas and potential transmission to adjacent areas. Negative results were found in 10 studies, while 15 papers showed positive results in at least one sample. Overall, papers report several sampling devices and methods for SARS-CoV-2 detection, using different approaches for distance, height from the floor, flow rates, and sampled air volumes. Regarding the efficacy of each mechanism as measured by the percentage of investigations with positive samples, the literature review indicates that solid impactors are more effective than liquid impactors, or filters, and the combination of various methods may be recommended. As a final remark, determining the sampling method is not a trivial task, as the samplers and the environment influence the presence and viability of viruses in the samples, and thus a case-by-case assessment is required for the selection of sampling systems.
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Affiliation(s)
- João Tito Borges
- Department of Infrastructure and Environment, School of Civil Engineering, Architecture and Urban Design, University of Campinas (InfrA, FEC, UNICAMP), Rua Saturnino de Brito, 224, Cidade Universitária, Campinas, SP, 13083889, Brazil
| | - Liane Yuri Kondo Nakada
- Department of Infrastructure and Environment, School of Civil Engineering, Architecture and Urban Design, University of Campinas (InfrA, FEC, UNICAMP), Rua Saturnino de Brito, 224, Cidade Universitária, Campinas, SP, 13083889, Brazil
| | - Milena Guedes Maniero
- Department of Infrastructure and Environment, School of Civil Engineering, Architecture and Urban Design, University of Campinas (InfrA, FEC, UNICAMP), Rua Saturnino de Brito, 224, Cidade Universitária, Campinas, SP, 13083889, Brazil
| | - José Roberto Guimarães
- Department of Infrastructure and Environment, School of Civil Engineering, Architecture and Urban Design, University of Campinas (InfrA, FEC, UNICAMP), Rua Saturnino de Brito, 224, Cidade Universitária, Campinas, SP, 13083889, Brazil.
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18
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Li M, Wang L, Qi W, Liu Y, Lin J. Challenges and Perspectives for Biosensing of Bioaerosol Containing Pathogenic Microorganisms. MICROMACHINES 2021; 12:798. [PMID: 34357208 PMCID: PMC8307108 DOI: 10.3390/mi12070798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/20/2022]
Abstract
As an important route for disease transmission, bioaerosols have received increasing attention. In the past decades, many efforts were made to facilitate the development of bioaerosol monitoring; however, there are still some important challenges in bioaerosol collection and detection. Thus, recent advances in bioaerosol collection (such as sedimentation, filtration, centrifugation, impaction, impingement, and microfluidics) and detection methods (such as culture, molecular biological assay, and immunological assay) were summarized in this review. Besides, the important challenges and perspectives for bioaerosol biosensing were also discussed.
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Affiliation(s)
| | | | | | | | - Jianhan Lin
- Key Laboratory of Agricultural Information Acquisition Technology, Ministry of Agriculture and Rural Affairs, China Agricultural University, Beijing 100083, China; (M.L.); (L.W.); (W.Q.); (Y.L.)
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19
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Sampling methods and assays applied in SARS-CoV-2 exposure assessment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021. [PMCID: PMC7886636 DOI: 10.1016/j.scitotenv.2021.145903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The SARS-CoV-2 exposure assessment is critical to implement control measures and guarantee safety of patients and workers from different occupational environments. The aim of this review article was to identify methodologies applied for SARS-CoV-2 sampling and analyses in environmental samples in different occupational and indoor environments. This study reports the search of available data published between May 29th 2020 and November 1st 2020. The search strategy used allowed the identification of 48 papers that comply with selected inclusion and exclusion criteria. The most described indoor environment consisted of health care facilities. From all the analyzed studies, 34 sampled surfaces, 27 sampled air (impactors and impingers being the most used), and 9 sampled water. All studies were based on molecular detection by qPCR of viral RNA extracted from collected samples. SARS-CoV-2 was detected in 44 out of the 48 studies. The results suggest that the sampling approach should include both active and passive sampling methods in order to overcome each method limitations. Concerning the assays used, although most studies were based on qPCR detection, the fact that the digital PCR technique allows SARS-CoV-2 detection at lower concentrations, indicates that this should be the chosen method for future detection studies.
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20
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Lane MA, Brownsword EA, Babiker A, Ingersoll JM, Waggoner J, Ayers M, Klopman M, Uyeki TM, Lindsley WG, Kraft CS. Bioaerosol sampling for SARS-CoV-2 in a referral center with critically ill COVID-19 patients March-May 2020. Clin Infect Dis 2021; 73:e1790-e1794. [PMID: 33506256 PMCID: PMC7953966 DOI: 10.1093/cid/ciaa1880] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Previous research has shown that rooms of patients with coronavirus disease 2019 (COVID-19) present the potential for healthcare-associated transmission through aerosols containing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, data on the presence of these aerosols outside of patient rooms are limited. We investigated whether virus-containing aerosols were present in nursing stations and patient room hallways in a referral center with critically ill COVID-19 patients. Methods Eight National Institute for Occupational Safety and Health BC 251 2-stage cyclone samplers were set up throughout 6 units, including nursing stations and visitor corridors in intensive care units and general medical units, for 6 h each sampling period. Samplers were placed on tripods which held 2 samplers positioned 102 cm and 152 cm above the floor. Units were sampled for 3 days. Extracted samples underwent reverse transcription polymerase chain reaction for selected gene regions of the SARS-CoV-2 virus nucleocapsid and the housekeeping gene human RNase P as an internal control. Results The units sampled varied in the number of laboratory-confirmed COVID-19 patients present on the days of sampling. Some of the units included patient rooms under negative pressure, while most were maintained at a neutral pressure. Of 528 aerosol samples collected, none were positive for SARS-CoV-2 RNA by the estimated limit of detection of 8 viral copies/m3 of air. Conclusions Aerosolized SARS-CoV-2 outside of patient rooms was undetectable. While healthcare personnel should avoid unmasked close contact with each other, these findings may provide reassurance for the use of alternatives to tight-fitting respirators in areas outside of patient rooms during the current pandemic.
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Affiliation(s)
- Morgan A Lane
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA
| | - Erik A Brownsword
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA
| | - Ahmed Babiker
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Jessica M Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Jesse Waggoner
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA.,Emory Healthcare, Atlanta, GA
| | | | - Matthew Klopman
- Emory Healthcare, Atlanta, GA.,Department of Anesthesiology, Emory University, Atlanta, GA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA.,Emory Healthcare, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
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A safe and effective sample collection method for assessment of SARS-CoV-2 in aerosol samples. ENVIRONMENTAL RESILIENCE AND TRANSFORMATION IN TIMES OF COVID-19 2021. [PMCID: PMC8137555 DOI: 10.1016/b978-0-323-85512-9.00016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The role of airborne particles in spread of remains largely unexplored. It has been speculated that the novel corona virus can survive for extended periods in aerosols and its interaction with other viral communities is responsible for additional virulence and infectivity. Therefore, investigations on adsorption, survival, and behavior of the COVID-19 virus within the aerosol community are needed to help understand its spread. In order to explore its spread via aerosols an immediate need is to develop efficient cost-effective sampling methodology for viral aerosols. In view of this we performed the aerosol sample collection through a simplified protocol adapted for its use in laboratory research with minimal biosafety regulations level 1 biosafety level precautions and facilities. In this setup, the air was passed through three gas glass bottles filled with TRIzol @ 30 L−1. The latter served the purpose of collecting and lysing the viral particles trapped in the air. The collected lysate can be transported safely to biosafety regulations level 1 class biosafety level laboratories for downstream processing of ribonucleic acid purification and further analysis such as quantitative polymerase chain reaction or next generation sequencing-based applications. We tested the viability status of the collected aerosols in TRIzol and discovered 90%–100% of the microbial load to be lysed. We expect to recover approximately 1 µg of total ribonucleic acid from 3.6 m3 of aerosols that was successfully amplified using bacterial, fungal, and viral primers. Hence, this technique is safe for use in laboratories that are not complying with the stringent requirements of a virology laboratory.
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