Clearing the air about airborne transmission of SARS-CoV-2.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has created the current pandemic, has caused a worldwide worry. Different countries have since enforced varying levels of lockdowns and guidelines for their populations to follow in a serious effort to mitigate the spread. Up until recently, the majority of these regulations and policies were established on the assumption that the dominant routes of transmission of this virus are through droplets and fomite contact. However, there is now a substantial amount of research pointing towards the strong possibility that SARS-CoV-2 can spread through airborne means. The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have recently recognized this, which poses the question of whether our collective methods of lessening transmission risk and keeping people safe have been sufficient. This paper is a comprehensive review of the evidence on SARS-CoV-2 being an airborne disease, through different epidemiological, experimental, and animal-model based published research. Studies opposing this evidence have also been discussed. The majority of these studies are favoring the high plausibility of SARS-CoV-2 aerosol transmission, and therefore the many implications of aerosol transmission have been discussed in this paper to suggest effective mitigation and control strategies.

SARS-CoV-2 aerosol generation during respiratory equipment reprocessing.

Aerosolization may occur during reprocessing of medical devices. With the current coronavirus disease 2019 pandemic, it is important to understand the necessity of using respirators in the cleaning area of the sterile processing department. To evaluate the presence of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the air of the sterile processing department during the reprocessing of contaminated medical devices. Air and surface samples were collected from the sterile processing department of two teaching tertiary hospitals during the reprocessing of respiratory equipment used in patients diagnosed with coronavirus disease 2019 and from intensive care units during treatment of these patients. SARS-CoV-2 was detected only in 1 air sample before the beginning of decontamination process. Viable severe acute respiratory syndrome coronavirus 2 RNA was not detected in any sample collected from around symptomatic patients or in sterile processing department samples. The cleaning of respiratory equipment does not cause aerosolization of SARS-CoV-2. We believe that the use of medical masks is sufficient while reprocessing medical devices during the coronavirus disease 2019 pandemic.

An automated room disinfection system using ozone is highly active against surrogates for SARS-CoV-2.

BACKGROUND: The presence of coronaviruses on surfaces in the patient environment is a potential source of indirect transmission. Manual cleaning and disinfection measures do not always achieve sufficient removal of surface contamination. This increases the importance of automated solutions in the context of final disinfection of rooms in the hospital setting. Ozone is a highly effective disinfectant which, combined with high humidity, is an effective agent against respiratory viruses. Current devices allow continuous nebulization for high room humidity as well as ozone production without any consumables. AIM: In the following study, the effectiveness of a fully automatic room decontamination system based on ozone was tested against bacteriophage Φ6 (phi 6) and bovine coronavirus L9, as surrogate viruses for the pandemic coronavirus SARS-CoV-2. METHODS: For this purpose, various surfaces (ceramic tile, stainless steel surface and furniture board) were soiled with the surrogate viruses and placed at two different levels in a gas-tight test room. After using the automatic decontamination device according to the manufacturer's instructions, the surrogate viruses were recovered from the surfaces and examined by quantitative cultures. Then, reduction factors were calculated. FINDINGS: The ozone-based room decontamination device achieved virucidal efficacy (reduction factor >4 log10) against both surrogate organisms regardless of the different surfaces and positions confirming a high activity under the used conditions. CONCLUSION: Ozone is highly active against SARS-CoV-2 surrogate organisms. Further investigations are necessary for a safe application and efficacy in practice as well as integration into routine processes.

Decontaminating N95 Respirators for Reuse in a Hospital Setting.

With the global outbreak of the COVID-19 pandemic, hospitals in Canada and around the world have been forced to consider conservation strategies to ensure continued availability of personal protective equipment (PPE) for healthcare providers. To mitigate critical PPE shortages, Sinai Health System (Sinai Health), a large academic healthcare institution in Canada, has developed and operationalized a standard operating procedure for the collection, decontamination and reuse of N95 respirators and other single-use PPE using a vaporized hydrogen peroxide decontamination method. Sinai Health has incorporated stringent quality assurance steps to ensure that the N95 respirators are successfully decontaminated without deformation and are safe to use.

Elementos de protección y nivel de contagio de Covid 19 en el personal sanitario que labora en un hospital ecuatoriano / Elements of protection and level of Covid 19 in the sanitary personnel working in an Ecuadorian hospital

INTRODUCCIÓN: el COVID-19 es una afección ocasionada por el SARS COV2 que ha tenido grandes repercusiones en la salud de la población a nivel mundial, principalmente en la población vulnerable, entre los cuales se encuentra el personal de salud, ya que están en la primera línea de atención en las unidades de salud, es por ello que se ven en la necesidad del uso del equipo de protección personal para disminuir el nivel de riesgo de contagio. OBJETIVO: identificar los elementos de protección y el nivel de contagio de COVID-19 en el personal de Salud que labor en los Hospitales Ecuatorianos. MATERIAL Y MÉTODOS: el actual estudio es de alcance descriptivo, enfoque cuantitativo, en un periodo de tiempo determinado, con una muestra del estudio de 218 trabajadores entre médicos, enfermeros y auxiliares a los cuales se les aplico la encuesta virtual. RESULTADOS: el 95.9% recibió mascarilla N95,76.6 % overol, 87.2%zapatones, 86.2 % las gafas, 91.7 % gorro, 93,1% guantes y 56,9% protector facial, el 96.3 % menciona que ha recibido capacitación sobre el uso de Equipo de Protección Personal (EPP) por parte de la institución, el 76.6 %del personal refieren haber presentado signos y síntomas de COVID-19, el 63.1 % de los resultados de prueba rápida fue positivos y la prueba de hisopado nasofaríngeo el 32,7 % tuvieron un resultaron positivo y 45,7% aún se encuentran en espera de los resultados. CONCLUSIONES: los elementos de protección que recibieron por parte de la Institución, en la pandemia de COVID-19 fueron: mascarilla N95, overol, zapatones, gafas, protector facial, gorro y guantes para la atención de los pacientes en el área hospitalaria, además de obtener capacitaciones acerca del uso correcto del EPP. Sin embargo, el nivel de contagio es elevado según las pruebas positivas rápidas e hisopado nasofaríngeo.

INTRODUCTION: COVID-19 is a condition caused by SARS COV2 that has had great repercussions on the health of the population worldwide, mainly on the vulnerable population, among which are health personnel, since they are on the front line. Care in health units, that is why they are in need of the use of personal protective equipment to reduce the level of risk of infection. OBJECTIVE: to identify the protection elements and the level of contagion of COVID-19 in the Health personnel who work at the Ecuadorians Hospitals. MATERIAL AND METHODS: the current study is descriptive in scope, quantitative approach, in a given period of time, with a sample of the study of 218 workers including doctors, nurses and assistants to whom the virtual survey was applied. RESULTS: 95.9% received N95 mask, 76.6% overalls, 87.2% sneakers, 86.2% glasses, 91.7% hat, 93.1% gloves and 56.9% face protector, 96.3% mention that they have received training on the use of Personal Protective Equipment (PPE) by the institution, 76.6% of the staff report having presented signs and symptoms of COVID-19, 63.1% of the rapid test results were positive and the nasopharyngeal swab test was 32, 7% had a positive result and 45.7% are still awaiting the results. CONCLUSIONS: the protection elements received by the Institution in the COVID-19 pandemic were: N95 mask, overalls, shoes, glasses, face shield, hat and gloves for patient care in the hospital area, in addition to obtain training on the correct use o PPE. However, the level of infection is high according to rapid positive tests and nasopharyngeal swab.

Protective hybrid coating containing silver, copper and zinc cations effective against human immunodeficiency virus and other enveloped viruses.

BACKGROUND: Healthcare-acquired infections by pathogenic microorganisms including viruses represent significant health concern worldwide. Next to direct transmission from person-to-person also indirect transmission from contaminated surfaces is well documented and important route of infections. Here, we tested antiviral properties of hybrid coating containing silver, copper and zinc cations that was previously shown to be effective against pathogenic bacteria including methicillin-resistant Staphylococcus aureus. Hybrid coatings containing silver, copper and zinc cations were prepared through radical polymerization via sol-gel method and applied on glass slides or into the wells of polymethylmethacrylate plates. A 10 µl droplet of several viruses such as human immunodeficiency virus type 1 (HIV-1), influenza, dengue virus, herpes simplex virus, and coxsackievirus was added to coated and uncoated slides or plates, incubated usually from 5 to 240 min and followed by titer determination of recovered virus. RESULTS: Scanning electron microscopy analysis showed better adhesion of coatings on glass surfaces, which resulted in 99.5-100 % HIV-1 titer reduction (3.1 ± 0.8 log10TCID50, n = 3) already after 20 min of exposure to coatings, than on coated polymethylmethacrylate plates with 75-100 % (1.7 ± 1.1 log10TCID50, n = 3) and 98-100 % (2.3 ± 0.5 log10TCID50, n = 3) HIV-1 titer reduction after 20 and 120 min of exposure, respectively. Slower virucidal kinetics was observed with other enveloped viruses, where 240 min exposure to coated slides lead to 97 % (dengue), 100 % (herpes simplex) and 77 % (influenza) reduction in virus titers. Interestingly, only marginal reduction in viral titer after 240 min of exposure was noticed for non-enveloped coxsackie B3 virus. CONCLUSIONS: Our hybrid coatings showed virucidal activity against HIV and other enveloped viruses thus providing further findings towards development of broad-spectrum antimicrobial coating suitable for surfaces in healthcare settings.

Environmental Contamination and Viral Shedding in MERS Patients During MERS-CoV Outbreak in South Korea.

BACKGROUND: Although Middle East Respiratory Syndrome coronavirus (MERS-CoV) is characterized by a risk of nosocomial transmission, the detailed mode of transmission and period of virus shedding from infected patients are poorly understood. The aims of this study were to investigate the potential role of environmental contamination by MERS-CoV in healthcare settings and to define the period of viable virus shedding from MERS patients. METHODS: We investigated environmental contamination from 4 patients in MERS-CoV units of 2 hospitals. MERS-CoV was detected by reverse transcription polymerase chain reaction (PCR) and viable virus was isolated by cultures. RESULTS: Many environmental surfaces of MERS patient rooms, including points frequently touched by patients or healthcare workers, were contaminated by MERS-CoV. Viral RNA was detected up to five days from environmental surfaces following the last positive PCR from patients' respiratory specimens. MERS-CoV RNA was detected in samples from anterooms, medical devices, and air-ventilating equipment. In addition, MERS-CoV was isolated from environmental objects such as bed sheets, bedrails, IV fluid hangers, and X-ray devices. During the late clinical phase of MERS, viable virus could be isolated in 3 of the 4 enrolled patients on day 18 to day 25 after symptom onset. CONCLUSIONS: Most of touchable surfaces in MERS units were contaminated by patients and health care workers and the viable virus could shed through respiratory secretion from clinically fully recovered patients. These results emphasize the need for strict environmental surface hygiene practices, and sufficient isolation period based on laboratory results rather than solely on clinical symptoms.

Rotaviral RNA found on various surfaces in a hospital laundry.

The aim of this investigative study was to determine the presence of rotaviral RNA at various control points (CP) of a hospital laundry. One of the possible sources of hospital infections is inappropriately laundered and disinfected hospital textiles. RT-PCR and nested PCR for gene amplification using specific primers following RNA isolation were used to determine the presence of rotaviral RNA on swabs. In addition, rotavirus suspensions were inoculated on marked surfaces as positive controls for different surfaces (cotton textiles, folding table and industrial dryer). Rotaviral RNA was found on various laundry surfaces: technical equipment, storage shelves, transport vehicles, personnel's hands, damp textiles, and folded laundry. Rotaviral RNA was also detected at all positive controls on tested surfaces after 24h. Based on the results, it is very important to take into consideration the proper handling of textiles after washing as one of the precautions against hospital-acquired infections. This paper reports the presence of rotaviral RNA for the first time on surfaces in laundries and equipment, as well as textiles.

Severe acute respiratory syndrome coronavirus on hospital surfaces.

BACKGROUND: Health care workers continued to contract severe acute respiratory syndrome (SARS), even after barrier precautions were widely implemented. METHODS: We explored the possible contribution of contaminated hospital surfaces to SARS transmission by swabbing surfaces in 2 hospitals and testing the swab samples by reverse-transcriptase polymerase chain reaction (RT-PCR) and viral culture. RESULTS: Twenty-six of 94 swab samples tested positive for viral RNA. Swab samples of respiratory secretions from each of the 4 patients examined tested positive by RT-PCR, as were 12 of 43 swabs from patient rooms and 10 of 47 swabs from other parts of the hospital, including the computer mouses at 2 nursing stations and the handrail of the public elevator. Specimens from areas with patients with SARS in the most infectious phase of illness (days 5-15 after onset) were more likely to be RNA positive than were swab specimens from elsewhere (24 of 63 samples vs. 2 of 31 samples; P=.001). All cultures showed no growth. CONCLUSIONS: Although the viruses identified may have been noninfectious, health care workers should be aware that SARS coronavirus can contaminate environmental surfaces in the hospital, and fomites should be considered to be a possible mode of transmission of SARS.