Spread of SARS-CoV-2 in hospital areas

Distribution characteristics of aerosol microorganisms in bronchoscopy room and the risk assessment of nosocomial infection

Objective

A large number of aerosols containing pathogenic microorganisms can be produced during bronchoscopy. The aim of the study is to evaluate the risk of nosocomial infection by pathogenic microorganisms after bronchoscopy. The distribution characteristics of aerosol microorganisms were detected before and after bronchoscopy, and then compared with the distribution characteristics of the patients' respiratory pathogens.

Methods

A total of 152 patients underwent bronchoscopy in the bronchoscopy room from May 06, 2024 to June 30, 2024. Airborne microorganisms were collected in the bronchoscopy room before and after the bronchoscopy, then cultured, counted and identified, to analyze the species, numbers and changes of microorganisms. At the same time, the data of respiratory pathogens and nosocomial infection of all patients were collected to evaluate the correlation between air microorganisms and respiratory pathogens, and the risk of nosocomial infection.

Results

(1) The concentration of air microorganisms after bronchoscopy was 89.60 ± 63.52 CFU/m3, significantly higher than 43.80 ± 26.70 CFU/m3 before bronchoscopy (p < 0.001). The increase in air microorganism concentration was in accordance with the total number of patients and the number of patients with respiratory infectious diseases on the same day (p < 0.001). After bronchoscopy for patients with infectious diseases, the concentration was significantly higher than that for patients with non-infectious diseases (p < 0.05). (2) The bacteria accounted for 75.34, 70.35% of the total aerosol microorganisms, fungi 22.17, 26.80% before and after bronchoscopy. The bacteria mainly included Micrococcus luteus, Staphylococcus epidermidis, Staphylococcus hominis, Haemophilus influenzae, Neisseria faunalis, Staphylococcus capitis, etc. The fungi mainly included Aspergillus flavus, Aspergillus niger, Saccharomyces albicans, Penicillium spp., etc. (3) The increase in air microorganisms after bronchoscopy was consistent with the distribution of pathogens causing respiratory infections in patients (p < 0.001). The increased pathogens were mainly composed of common respiratory pathogens, but it did not increase the risk of nosocomial respiratory infections in patients (p = 0.735).

Conclusion

Bronchoscopy can increase the concentration of aerosol microorganisms. The increased microorganisms are related to the respiratory pathogens of patients, which are mainly the common pathogens of pulmonary infection. This, however, does not increase the risk of nosocomial respiratory infection.

The impact of exclusion due to COVID-19 restrictions on partners' satisfaction with Swedish hospital postnatal ward care: A multi-methods approach

BACKGROUND

To prevent the spread of SARS-CoV-2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care.

METHODS

An online survey (the Swedish Pregnancy Panel) including free-text comments was conducted before and during the first wave of the COVID-19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register.

RESULTS

The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (-0.94 OLS, 95% CI = -1.17 to -0.72). The drop was largest for partners of first-time mothers (-1.40 OLS, 95% CI = -1.69 to -1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical.

CONCLUSIONS

The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first-time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences.

Viral infection transmission and indoor air quality: A systematic review

Respiratory disease transmission in indoor environments presents persistent challenges for health authorities, as exemplified by the recent COVID-19 pandemic. This underscores the urgent necessity to investigate the dynamics of viral infection transmission within indoor environments. This systematic review delves into the methodologies of respiratory infection transmission in indoor settings and explores how the quality of indoor air (IAQ) can be controlled to alleviate this risk while considering the imperative of sustainability. Among the 2722 articles reviewed, 178 were retained based on their focus on respiratory viral infection transmission and IAQ. Fifty eight articles delved into SARS-CoV-2 transmission, 21 papers evaluated IAQ in contexts of other pandemics, 53 papers assessed IAQ during the SARS-CoV-2 pandemic, and 46 papers examined control strategies to mitigate infectious transmission. Furthermore, of the 46 papers investigating control strategies, only nine considered energy consumption. These findings highlight clear gaps in current research, such as analyzing indoor air and surface samples for specific indoor environments, oversight of indoor and outdoor parameters (e.g., temperature, relative humidity (RH), and building orientation), neglect of occupancy schedules, and the absence of considerations for energy consumption while enhancing IAQ. This study distinctly identifies the indoor environmental conditions conducive to the thriving of each respiratory virus, offering IAQ trade-offs to mitigate the risk of dominant viruses at any given time. This study argues that future research should involve digital twins in conjunction with machine learning (ML) techniques. This approach aims to enhance IAQ by analyzing the transmission patterns of various respiratory viruses while considering energy consumption.

Air Change Rate and SARS-CoV-2 Exposure in Hospitals and Residences: A Meta-Analysis

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.

Nosocomial Coronavirus Disease 2019 during 2020-2021: Role of Architecture and Ventilation

Nosocomial coronavirus disease 2019 (COVID-19) is a major airborne health threat for inpatients. Architecture and ventilation are key elements to prevent nosocomial COVID-19 (NC), but real-life data are challenging to collect. We aimed to retrospectively assess the impact of the type of ventilation and the ratio of single/double rooms on the risk of NC (acquisition of COVID-19 at least 48 h after admission). This study was conducted in a tertiary hospital composed of two main structures (one historical and one modern), which were the sites of acquisition of NC: historical (H) (natural ventilation, 53% single rooms) or modern (M) hospital (double-flow mechanical ventilation, 91% single rooms). During the study period (1 October 2020 to 31 May 2021), 1020 patients presented with COVID-19, with 150 (14.7%) of them being NC (median delay of acquisition, 12 days). As compared with non-nosocomial cases, the patients with NC were older (79 years vs. 72 years; p < 0.001) and exhibited higher mortality risk (32.7% vs. 14.1%; p < 0.001). Among the 150 NC cases, 99.3% were diagnosed in H, mainly in four medical departments. A total of 73 cases were diagnosed in single rooms versus 77 in double rooms, including 26 secondary cases. Measured air changes per hour were lower in H than in M. We hypothesized that in H, SARS-CoV-2 transmission was favored by short-range transmission within a high ratio of double rooms, but also during clusters, via far-afield transmission through virus-laden aerosols favored by low air changes per hour. A better knowledge of the mechanism of airborne risk in healthcare establishments should lead to the implementation of corrective measures when necessary. People's health is improved using not only personal but also collective protective equipment, i.e., ventilation and architecture, thereby reinforcing the need to change institutional and professional practices.

Dispersion of sneeze droplets in a meat facility indoor environment - Without partitions

Spreading patterns of the coronavirus disease (COVID-19) showed that infected and asymptotic carriers both played critical role in escalating transmission of virus leading to global pandemic. Indoor environments of restaurants, classrooms, hospitals, offices, large assemblies, and industrial installations are susceptible to virus outbreak. Industrial facilities such as fabrication rooms of meat processing plants, which are laden with moisture and fat in indoor air are the most sensitive spaces. Fabrication room workers standing next to each other are exposed to the risk of long-range viral droplets transmission within the facility. An asymptomatic carrier may transmit the virus unintentionally to fellow workers through sporadic sneezing leading to community spread. A novel Computational Fluid Dynamics (CFD) model of a fabrication room with typical interior (stationary objects) was prepared and investigated. Study was conducted to identify indoor airflow patterns, droplets spreading patterns, leading droplets removal mechanism, locations causing maximum spread of droplets, and infection index for workers along with stationary objects in reference to seven sneeze locations covering the entire room. The role of condensers, exhaust fans and leakage of indoor air through large and small openings to other rooms was investigated. This comprehensive study presents flow scenarios in the facility and helps identify locations that are potentially at lower or higher risk for exposure to COVID-19. The results presented in this study are suitable for future engineering analyses aimed at redesigning public spaces and common areas to minimize the spread of aerosols and droplets that may contain pathogens.

Risk of Testing Positive for COVID-19 among Healthcare and Healthcare-Related Workers

Understanding the risk factors associated with COVID-19 infection among healthcare workers is crucial for infection prevention and control. The aim of this study was to examine the risk of testing positive for COVID-19 among a multicenter cohort of workers, taking into account their occupational roles (medical professionals, staff in operational and administrative roles, or laboratory personnel) in healthcare settings. The data analyzed in this study included 2163 individuals with suggestive COVID-19 symptoms who underwent laboratory testing. The incidence rate in the study sample was calculated to be 15.3 cases per 10,000 person-days. The results from the multiple regression model indicated that job roles were not significantly associated with the risk of testing positive. However, age and the duration of the pandemic were identified as significant risk factors, with increasing age and longer pandemic duration being associated with a higher risk of testing positive. Additionally, vaccination was found to reduce the risk of testing positive. These findings provide valuable insights into COVID-19 transmission among indoor healthcare workers, highlighting the influence of age, pandemic duration, and vaccination on infection risk. Further research is needed to develop evidence-based strategies aimed at protecting healthcare workers and preventing virus spread in healthcare settings.

Numerical simulation of social distancing of preventing airborne transmission in open space with lateral wind direction, taking into account temperature of human body and floor surface

This paper presents the numerical results of particle propagation in open space, taking into account the temperature of the human body and the surface of the ground. And also, the settling of particles or droplets under the action of gravitational force and transport in the open air is taken into account, taking into account the temperature during the process of breathing and sneezing or coughing. The temperature of the body and the surface of the ground, different rates of particle emission from the mouth, such as breathing and coughing or sneezing, are numerically investigated. The effect of temperature, cross-inlet wind, and the velocity of particle ejection from a person's mouth on social distancing is being investigated using a numerical calculation. The variable temperature of the human body forms a thermal plume, which affects the increase in the trajectory of the particle propagation, taking into account the lateral air flow. The thermal plume affects the particles in the breathing zone and spreads the particles over long distances in the direction of the airflow. The result of this work shows that in open space, taking into account the temperature of the body and the surface of the ground, a 2-m social distance may be insufficient for the process of sneezing and social distance must be observed depending on the breathing mode.

A prevalence study of COVID-19 among healthcare workers in a pandemic hospital in the Samsun province of Turkey

Among populations globally, many healthcare workers have been disproportionally impacted by the COVID-19 pandemic because of their above average exposure to people infected with SARS-CoV-2. Exposure to asymptomatic or pre-symptomatic individuals is particularly challenging, if those individuals continue to work, not knowing that they are potentially infectious. This study aimed to measure the level of asymptomatic infection in a cohort of workers in a healthcare setting in Turkey during the second major wave of infection in late 2020. Blood samples were collected and tested by electrochemiluminescence immunoassay for SARS-CoV-2 IgM and IgG antibodies. Nasal and throat swabs were performed in a subset of this cohort and RT-qPCR was used to search for the presence of SARS-CoV-2 RNA. The results showed that approximately 23% of the cohort were positive for anti-SARS-CoV-2 IgM antibodies and approximately 22% were positive for anti-SARS-CoV-2 IgG antibodies despite no reported history of COVID-19 symptoms. Just less than 30% of a subset of the group were positive for the presence of SARS-CoV-2 RNA indicating the likelihood of a current or recent infection, again despite a lack of typical COVID-19 associated symptoms. This study indicates a high rate of asymptomatic infection and highlights the need for regular testing of groups such as healthcare workers when community prevalence of disease is high and there is a desire to limit entry of virus into settings where vulnerable people may be present, because symptoms cannot be relied on as indicators of infection or infectiousness.

Genetic Load of SARS-CoV-2 in Aerosols Collected in Operating Theaters

After the outbreak of COVID-19, additional protocols have been established to prevent the transmission of the SARS-CoV-2 from the patient to the health personnel and vice versa in health care settings. However, in the case of emergency surgeries, it is not always possible to ensure that the patient is not infected with SARS-CoV-2, assuming a potential source of transmission of the virus to health personnel. This work aimed to evaluate the presence of the SARS-CoV-2 and quantify the viral load in indoor air samples collected inside operating rooms, where emergency and scheduled operations take place. Samples were collected for 3 weeks inside two operating rooms for 24 h at 38 L/min in quartz filters. RNA was extracted from the filters and analyzed using RT-qPCR targeting SARS-CoV-2 genes E, N1 and N2 regions. SARS-CoV-2 RNA was detected in 11.3% of aerosol samples collected in operating rooms, despite with low concentrations (not detected at 13.5 cg/m3 and 10.5 cg/m3 in the scheduled and emergency operating rooms, respectively). Potential sources of airborne SARS-CoV-2 could be aerosolization of the virus during aerosol-generating procedures and in open surgery from patients that might have been recently infected with the virus, despite presenting a negative COVID-19 test. Another source could be related to health care workers unknowingly infected with the virus and exhaling SARS-CoV-2 virions into the air. These results highlight the importance of reinforcing preventive measures against COVID-19 in operating rooms, such as the correct use of protective equipment, screening programs for health care workers, and information campaigns. IMPORTANCE Operating rooms are critical environments in which asepsis must be ensured. The COVID-19 pandemic entailed the implementation of additional preventative measures in health care settings, including operating theaters. Although one of the measures is to operate only COVID-19 free patients, this measure cannot be always implemented, especially in emergency interventions. Therefore, a surveillance campaign was conducted during 3 weeks in two operating rooms to assess the level of SARS-CoV-2 genetic material detected in operating theaters with the aim to assess the risk of COVID-19 transmission during operating procedures. SARS-CoV-2 genetic material was detected in 11% of aerosol samples collected in operating rooms, despite with low concentrations. Plausible SARS-CoV-2 sources have been discussed, including patients and health care personnel infected with the virus. These results highlight the importance of reinforcing preventive measures against COVID-19 in operating rooms, such as the correct use of protective equipment, screening programs for health care workers and information campaigns.

Numerical investigation on indoor environment decontamination after sneezing

More than 320 million people worldwide were affected by SARS-CoV-2 or COVID-19, which already caused more than 5.5 million deaths. COVID-19 spreads through air when an infected person breathes, coughs, or sneezes out droplets containing virus. Emerging variants like Omicron with positivity rate of 16 (highest among others) present a greater risk of virus spread, so all types of indoor environments become critically important. Strategically adopted Heating Ventilation and Air Conditioning (HVAC) approach can significantly reduce the virus spread by early removal of contaminated aerosolized droplets. We modeled different HVAC configurations to characterize the diffusion of contaminated droplets cloud through Computational Fluid Dynamics (CFD) simulations of sneeze in standard hospital room as indoor scenario. Injection of saliva droplets with characteristics of exhaled air from lungs was applied to mimic real sneeze. CFD simulations have been performed for three HVAC configurations at two Air Change per Hour (ACH) rates; 6 and 15 ACH. For the first time, use of air curtain at low flow rate has been examined. Simulations provide high fidelity spatial and temporal droplets cloud diffusion under different HVAC configurations, showing spread in room indoor environment up to 360 s. Over 92% of ejected sneeze mass is removed from room air within seconds while the remaining 8% or less becomes airborne with droplets (<50 μm size) and tends to spread uniformly with regular HVAC configuration. Low-speed air curtain accelerates decontamination by efficiently removing aerosolized 1-50 μm size droplets. Study investigates role of droplets removal mechanisms such as escape, evaporation, and deposition on surfaces. Interestingly, results show presence of contaminated droplets even after 5 min of sneeze, which can be effectively removed using low-speed air curtain. Study finds that high ventilation rate requirements can be optimized to modify earlier and new hospital designs to reduce the spread of airborne disease.

SARS-CoV-2 surveillance in indoor and outdoor size-segregated aerosol samples

We aimed to determine the presence of SARS-CoV-2 RNA in indoor and outdoor size-segregated aerosol samples (PM_10-2.5, PM_2.5). Five outdoor daily samples were collected between November and December 2020 in an urban/industrial area with relatively high PM₁₀ levels (Maliaño, Santander, Spain) by using a PM impactor (air flowrate of 30 L/min). In a non-hospital indoor sampling surveillance context, 8 samples in classrooms and 6 samples in the central library-Paraninfo of the University of Cantabria (UC) were collected between April and June 2021 by using personal PM samplers (air flowrate of 3 L/min). Lastly, 8 samples in the pediatric nasopharyngeal testing room at Liencres Hospital, 6 samples from different single occupancy rooms of positive patients, and 2 samples in clinical areas of the COVID plant of the University Hospital Marqués de Valdecilla (HUMV) were collected between January and May 2021. N1, N2 genes were used to test the presence of SARS-CoV-2 RNA by RT-qPCR. SARS-CoV-2 positive detection was only obtained from one fine fraction (PM_2.5) sample, corresponding to one occupancy room, where a patient with positive PCR and cough was present. Negative results found in other sampling areas such as the pediatric nasopharyngeal testing rooms should be interpreted in terms of air sampling volume limitation and good ventilation.

The role of outdoor and indoor air quality in the spread of SARS-CoV-2: Overview and recommendations by the research group on COVID-19 and particulate matter (RESCOP commission)

There are important questions surrounding the potential contribution of outdoor and indoor air quality in the transmission of SARS-CoV-2 and perpetuation of COVID-19 epidemic waves. Environmental health may be a critical component of COVID-19 prevention. The public health community and health agencies should consider the evolving evidence in their recommendations and statements, and work to issue occupational guidelines. Evidence coming from the current epidemiological and experimental research is expected to add knowledge about virus diffusion, COVID-19 severity in most polluted areas, inter-personal distance requirements and need for wearing face masks in indoor or outdoor environments. The COVID-19 pandemic has highlighted the need for maintaining particulate matter concentrations at low levels for multiple health-related reasons, which may also include the spread of SARS-CoV-2. Indoor environments represent even a more crucial challenge to cope with, as it is easier for the SARS-COV2 to spread, remain vital and infect other subjects in closed spaces in the presence of already infected asymptomatic or mildly symptomatic people. The potential merits of preventive measures, such as CO₂ monitoring associated with natural or controlled mechanical ventilation and air purification, for schools, indoor public places (restaurants, offices, hotels, museums, theatres/cinemas etc.) and transportations need to be carefully considered. Hospital settings and nursing/retirement homes as well as emergency rooms, infectious diseases divisions and ambulances represent higher risk indoor environments and may require additional monitoring and specific decontamination strategies based on mechanical ventilation or air purification.

SARS-CoV-2 detection in hospital indoor environments, NW Iran

This study aimed to investigate the potential contamination of SARS-CoV-2 in indoor settled dust and surfaces of Amir Al-Muminin hospital in Maragheh, Iran. Samples were taken from surfaces and settled dust using a passive approach and particulate matter (PM) using an active approach from different hospital wards. SARS-CoV-2 was detected in 15% of settled dust samples (N = 4/26) and 10% of surface samples (3/30). SARS-CoV-2 has been detected in 13.8% and 9.1% of the dust samples collected at a distance of fewer than 1 m and more than 3 m from the patient bed, respectively. SARS-CoV-2 was found in 11% of surface samples from low-touch surfaces and 8% from high touch surfaces. The relationship between PM_2.5, PM₁₀, humidity, temperature, and positive samples of SARS-CoV-2 was investigated. A positive correlation was observed between relative humidity, PM_2.5, and positive SARS-CoV-2 samples. Principal component analysis (PCA) suggested positive correlation between positive SARS-CoV-2 samples, relative humidity, and PM_2.5. Risk assessment results indicated that the annual mean infection risk of SARS-CoV-2 for hospital staff with illness and death was 2.6 × 10^-2 and 7.7 × 10^-4 per person per year. Current findings will help reduce the permanence of viral particles in the COVID 19 tragedy and future similar pandemics e.g., novel influenza viruses.

Evaluation of SARS-CoV-2 in Indoor Air of Sina and Shahid Beheshti Hospitals and Patients' Houses

Side by side air sampling was conducted using a PTFE filter membrane as dry sampler and an impinger containing a suitable culture medium as a wet sampler. Most of the samples were collected from two hospitals and few air samples were collected from private houses of non-hospitalized confirmed COVID-19 patients. The collected air samples were analyzed using RT-PCR. The results indicated that all air samples collected from the hospitals were PCR negative for SARS-CoV-2. While two of four air samples collected from the house of non-hospitalized patients were PCR positive. In this study, most of the hospitalized patients had oxygen mask and face mask, and hence this may be a reason for our negative results regarding the presence of SARS-CoV-2 in indoor air of the hospitals, while non-hospitalized patients did not wear oxygen and protective face masks in their houses. Moreover, a very high concentration of particles in the size range of droplet nuclei (< 5 µm) was identified compared to particles in the size range of respiratory droplets (> 5-10 µm) in the areas where patients were hospitalized. It can be concluded that using face mask by patients can prevent the release of viruses into the indoor air, even in hospitals with a high density of patients.

SARS-CoV-2 RNA Recovery from Air Sampled on Quartz Fiber Filters: A Matter of Sample Preservation?

The airborne route of transmission of SARS-CoV-2 was confirmed by the World Health Organization in April 2021. There is an urge to establish standardized protocols for assessing the concentration of SARS-CoV-2 RNA in air samples to support risk assessment, especially in indoor environments. Debates on the airborne transmission route of SARS-CoV-2 have been complicated because, among the studies testing the presence of the virus in the air, the percentage of positive samples has often been very low. In the present study, we report preliminary results on a study for the evaluation of parameters that can influence SARS-CoV-2 RNA recovery from quartz fiber filters spotted either by standard single-stranded SARS-CoV-2 RNA or by inactivated SARS-CoV-2 virions. The analytes were spiked on filters and underwent an active or passive sampling; then, they were preserved at −80 °C for different numbers of days (0 to 54) before extraction and analysis. We found a mean recovery of 2.43%, except for the sample not preserved (0 days) that showed a recovery of 13.51%. We found a relationship between the number of days and the recovery percentage. The results presented show a possible issue that relates to the quartz matrix and SARS-CoV-2 RNA recovery. The results are in accordance with the already published studies that described similar methods for SARS-CoV-2 RNA field sampling and that reported non-detectable concentrations of RNA. These outcomes could be false negatives due to sample preservation conditions. Thus, until further investigation, we suggest, as possible alternatives, to keep the filters: (i) in a sealed container for preservation at 4 °C; and (ii) in a viral transport medium for preservation at a temperature below 0 °C.

[Low risk of environmental contagion by SARS-CoV-2 in non-sanitary spaces]

Objetivo

Estudiar la presencia de SARS-CoV-2 en superficies (alto, medio y bajo contacto) y aires de espacios no sanitarios pero de elevada afluencia de público para evaluar el riesgo de contagio ambiental.

Método

Se ha realizado el análisis de las superficies y de los aires por RT-qPCR para detectar la presencia de SARS-CoV-2.

Resultados

Se obtuvieron 394 superficies y 23 muestras de aire de espacios de alta afluencia de personas, como oficinas, centros comerciales y residencias de ancianos. El virus no fue detectado en ninguna de las muestras analizadas.

Conclusión

Aunque no podemos concluir rotundamente que no existe un riesgo de infección ambiental por SARS-CoV-2 en espacios no sanitarios, sí podemos afirmar que el riesgo es casi nulo.