RESUMEN
When transferring highly infective patients to specialist hospitals, safe systems of work minimise the risk to healthcare staff. The EpiShuttle is a patient transport system that was developed to fit into an air ambulance. A validated decontamination procedure is required before the system can be adopted in the UK. Hydrogen peroxide (H2O2) vapour fumigation may offer better penetration of the inaccessible parts than the liquid disinfectant wiping that is currently suggested. To validate this, an EpiShuttle was fumigated in a sealed test chamber. Commercial bacterial spore indicators (BIs), alongside organic liquid suspensions and dried surface samples of MS2 bacteriophage (a safe virus surrogate), were placed in and around the EpiShuttle, for the purpose of evaluation. The complete kill of all of the BIs in the five test runs demonstrated the efficacy of the fumigation cycle. The log reduction of the MS2 that was dried on the coupons ranged from 2.66 to 4.50, but the log reduction of the MS2 that was in the organic liquids only ranged from 0.07 to 1.90, confirming the results of previous work. Fumigation with H2O2 alone may offer insufficient inactivation of viruses in liquid droplets, therefore a combination of fumigation and disinfectant surface wiping was proposed. Initial fumigation reducing contamination with minimal intervention allows disinfectant wipe cleaning to be completed more safely, with a second fumigation step inactivating the residual pathogens.
RESUMEN
BACKGROUND: Norovirus (NoV) can survive in buffer at a range of pH values. However, when variations to pH are combined with the enzymatic conditions typical in gastric fluid, NoV survival is less predictable. Added to this, the material on which expelled vomitus fluid lands e.g. safety vinyl or carpet, might also affect the level of NoV survival in the environment. AIM: This study assessed survival of the NoV surrogate Feline calicivirus (FCV) after application onto four material types in the presence of synthetic gastric fluid of varying pH values. METHODS: Synthetic gastric fluid of varying pH values (1.5, 2.5, 3.5 and 4.5) containing FCV (1×106 PFU/100 µL of gastric fluid) was seeded (100 µL) onto four material types: Formica, safety vinyl, cotton sheet and carpet tiles (2 cm × 2 cm) and left for 0, 30 and 60 minutes before recovering and identifying any viable viruses via plaque assay. FINDINGS: FCV survived in synthetic gastric fluid at pH values as low as 2.5 and in some cases as low as 1.5 for at least 30 min when associated with certain materials. Greater average numbers of viable virus were recovered from the more absorbent materials of cotton (1900 PFU/sample) and carpet (1600 PFU/sample) compared with Formica (360 PFU/sample) and safety vinyl (380 PFU/sample). CONCLUSION: This study showed that FCV can survive in synthetic gastric fluids of low pH values for significant time periods especially on absorbent materials. This emphasises the importance of ensuring effective cleaning and decontamination procedures, particularly of soft furnishings and laundry, for infection prevention and control of NoV outbreaks.
RESUMEN
Infectious diseases such as norovirus can induce emesis (vomiting), which can be of a projectile nature. Although studies have been carried out on transmission, prevalence and decontamination of such micro-organisms within various environments, little is known about the extent to which the surrounding environment is contaminated when an individual vomits. This is an important consideration for infection control purposes. The aim of this study was to develop a simulated vomiting system (Vomiting Larry) to be used for assessing the extent to which projected fluid can contaminate the environment. Vomiting Larry was set up within a Controlled Atmosphere Chamber (CAC) facility at the Health and Safety Laboratory (HSL). Simulated vomiting was undertaken using water as a vomitus substitute containing a fluorescent marker enabling small splashes, ordinarily missed, to be visualised using UV lighting. Experiments revealed that splashes and droplets produced during an episode of projectile vomiting can travel great distances (>3 m forward spread and 2.6 m lateral spread). The research highlighted that small droplets can be hard to see and therefore cleaning all contaminated surfaces is difficult to achieve. Evidence from this study suggests that areas of at least 7.8 m2 should be decontaminated following an episode of projectile vomiting.