J Hosp Infect . Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy

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J Hosp Infect


. 2020 Aug 20;S0195-6701(20)30401-1.
doi: 10.1016/j.jhin.2020.08.014. Online ahead of print.
Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy


Jin Young Ahn ¹ , Sanggwon An ² , Yujin Sohn ¹ , Yunsuk Cho ¹ , Jong Hoon Hyun ¹ , Yae Jee Baek ¹ , Moo Hyun Kim ¹ , Su Jin Jeong ¹ , Jung Ho Kim ¹ , Nam Su Ku ¹ , Joon-Sup Yeom ¹ , Davey M Smith ³ , Hyukmin Lee ⁴ , Dongeun Yong ⁴ , Youn-Jung Lee ¹ , Ji Won Kim ¹ , Hyeong Rae Kim ² , Jung Ho Hwang ² , Jun Yong Choi ⁵



Affiliations

• PMID: 32828864
• DOI: 10.1016/j.jhin.2020.08.014

Abstract

Background: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients.
Aim: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy.
Methods: We collected environmental swab samples and air samples from the isolation rooms of three COVID-19 patients with severe pneumonia. Patient 1 and Patient 2 received mechanical ventilation with a closed suction system, while Patient 3 received high-flow oxygen therapy and noninvasive ventilation. Real-time reverse transcription polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR.
Findings: Of the 48 swab samples collected in the rooms of Patient 1 and Patient 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in Patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of Patient 1 and seven sites in Patient 3's room.
Conclusion: Environmental contamination of SARS-CoV-2 can be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.

Keywords: COVID-19; SARS-CoV-2; environmental contamination; severe pneumonia.