Journal of Hospital Infection

ObjectivesThe aim of this observational study was to demonstrate the behaviour and trajectory of exhaled material from an individual wearing an FFP3 mask. Valves allow material release, but we theorised that valve design may direct material downwards towards patient and surrounding environment. Limiting transmission of diseases with aerosolised spread is a current and serious concern within healthcare worldwide. Filtering face piece masks (FFP) are an essential piece of protective equipment when treating patients with ongoing infection. However, valved masks in other settings such as elective theatre and by the general public may have unforeseen negative effects. DesignA heating coil-based vaporiser was used to produce visible water vapour. A healthy test subject was filmed wearing a variety of different masks and exhaling the water vapour. ResultsFlexible pleated and solid-shell FFP masks direct exhaled material downwards in plumes exceeding 25 cm. Duckbill-shaped masks appear to direct exhaled vapour laterally, with a smaller plume. The effect is influenced by mask design and type of valve. Fluid repellent surgical masks reduce material directed downwards, and when used in conjunction with an FFP3 mask, appear to reduce the size and density of the exhaled vapour plume. The use of a visor was ineffective in reducing plume expulsion. InterpretationA properly fit-tested FFP3-rated protective mask may only moderately limit expulsion of aerosolised particles from asymptomatic healthcare workers to patients, particularly in cases where procedures are being performed in close proximity to patients or in cases where mucosal surfaces are exposed. Further research in this area is needed.

IntroductionA controversy remains worldwide regarding the transmission routes of SARS-CoV-2 in hospital settings. We reviewed the current evidence on the air contamination with SARS-CoV-2 in hospital settings, and the factors associated to the contamination including the viral load and the particles size. MethodsThe MEDLINE, Embase, Web of Science databases were systematically interrogated for original English-language articles detailing COVID-19 air contamination in hospital settings between 1 December 2019 and 21 July 2020. This study was conducted in accordance with the PRISMA-ScR guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patient. The SARS-CoV-2 RNA concentrations in copies per m3 of air were pooled and their distribution were described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or TCID50 per m3 were analysed after categorization of sizes in < 1 {micro}m, 1-4 {micro}m, and > 4 {micro}m. ResultsAmong 2,034 records identified, 17 articles were included in the review. Overall, 27.5% (68/247) of air sampled from close patients environment were positive for SARS-CoV-2 RNA, without difference according to the setting (ICU: 27/97, 27.8%; non-ICU: 41/150, 27.3%; p = 0.93), the distance from patients (< 1 meter: 1/64, 1.5%; 1-5 meters: 4/67, 6%; p = 0.4). In other areas, the positivity rate was 23.8% (5/21) in toilets, 9.5% (20/221) in clinical areas, 12.4% (15/121) in staff areas, and 34.1% (14/41) in public areas. A total of 78 viral cultures were performed in three studies, and 3 (4%) were positive, all from close patients environment. The median SARS-CoV-2 RNA concentrations varied from 1.103 copies per m3 (IQR: 0.4.103-9.103) in clinical areas to 9.7.103 (5.1.103-14.3.103) in the air of toilets or bathrooms. The protective equipment removal and patients rooms had high concentrations/titre of SARS-CoV-2 with aerosol size distributions that showed peaks in the < 1 {micro}m region, and staff offices in the > 4{micro}m region. ConclusionIn hospital, the air near and away from COVID-19 patients is frequently contaminated with SARSCoV-2 RNA, with however, rare proofs of their viability. High viral loads found in toilet/bathrooms, staff and public hallways suggests to carefully consider these areas.

SummaryThe replacement frequency of mechanical ventilators breathing systems used in operating rooms (ORs) currently varies between hospitals. In light of evidence-based decision-making and sustainability efforts, we aim to determine whether 7-day use of breathing systems instead of 24 hours is microbial safe. In this prospective single-centre explorative study, 30mm UniflowTM breathing systems used in eight ORs were included. In four ORs, breathing systems were replaced daily following standard practice. In the remaining four ORs, they were intended for a 7-day use. Breathing systems were sampled daily on three locations of the exterior surface and cultured for the presence of microorganisms. A total of 128 breathing systems were included, 99 from an OR with daily replacement and 29 from an OR with weekly replacement. A total of 604 samples were cultured, of which the majority, 549 (90.9%) cultures were negative. From the 55 (9.1%) positive cultures, the majority (n=49, 70%) were coagulase-negative staphylococci. None of the identified microorganisms were found in consecutive cultures. Cultures from day 2 to 7 did not show a statistically significant increased positivity rate compared to cultures from day 1, respectively 22.9% vs. 24.1%. The weekly replacement regimen, furthermore, decreased the number of breathing systems used with 71%. Our data indicates that use of breathing systems up to seven days remains microbial safe. Additionally, only a minimal number of pathogenic microorganisms were detected, and these were not persistent on the breathing systems. Transitioning from 24-hours to intended 7-day use could significantly reduce costs and CO2 emissions.

BackgroundHealthcare workers treating patients with SARS-CoV-2 are at risk of infection from patient-emitted virus-laden aerosols. We quantified the reduction of airborne infectious virus in a simulated hospital room when a ventilated patient isolation (McMonty) hood was in use. MethodsWe nebulised 109 plaque forming units (PFU) of bacteriophage PhiX174 virus into a 35.1m3 room with a hood active or inactive. The airborne concentration of infectious virus was measured by BioSpot-VIVAS and settle plates using plaque assay quantification on the bacterial host Escherichia coli C. The particle number concentration (PNC) was monitored continuously using an optical particle sizer. ResultsMedian airborne viral concentration in the room reached 1.41 x 105 PFU.m-3 with the hood inactive. Using the active hood as source containment reduced infectious virus concentration by 374-fold in air samples. This was associated with a 109-fold reduction in total airborne particle number escape rate. The deposition of infectious virus on the surface of settle plates was reduced by 87-fold. ConclusionsThe isolation hood significantly reduced airborne infectious virus exposure in a simulated hospital room. Our findings support the use of the hood to limit exposure of healthcare workers to airborne virus in clinical environments. Lay summaryCOVID-19 patients exhale aerosol particles which can potentially carry infectious viruses into the hospital environment, putting healthcare workers at risk of infection. This risk can be reduced by proper use of personal protective equipment (PPE) to protect workers from virus exposure. More effective strategies, however, aim to provide source control, reducing the amount of virus-contaminated air that is exhaled into the hospital room. The McMonty isolation hood has been developed to trap and decontaminate the air around an infected patient. We tested the efficacy of the hood using a live virus model to mimic a COVID-19 patient in a hospital room. Using the McMonty hood reduced the amount of exhaled air particles in the room by over 109-times. In our tests, people working in the room were exposed to 374-times less infectious virus in the air, and room surfaces were 87-times less contaminated. Our study supports using devices like the McMonty hood in combination with PPE to keep healthcare workers safe from virus exposure at work.

The use of personal protective equipment (PPE) is a cornerstone of infection prevention and control guidelines and was of increased importance during the COVID-19 pandemic. Adherence with prescribed guidelines for the use of PPE and their applicability to the working practices of staff in general practitioner (GP) and ambulance settings have been a growing concern. The aim of this rapid review was to assess the barriers, facilitators, and potential adverse outcomes of the use of PPE in these specific settings. Included studies were published from 2020 to November 2022. We identified four systematic reviews, a rapid review, a retrospective chart review, and a prospective quantitative survey study. Outcome measures were broadly focused on physical adverse outcomes from the use of PPE, but also included barriers and facilitators to the use of PPE in varied healthcare settings. The five reviews covered a broad range of health and care settings, which included GP and ambulance settings, but not as a specific focus. Both the retrospective chart review and the prospective survey study took place in an ambulance or emergency response setting. Overall confidence in the body of evidence is low. Extended use of PPE is associated with an increased occurrence of adverse physiological events, such as pressure ulcers and de novo headaches. Evidence indicates that adherence with PPE guidance is primarily influenced by organisational communication and workplace cultures. In ambulance settings, adherence may also be affected by dispatch codes and indicative symptoms reported during the initial call. Policy implications: As there is evidence to suggest that usage of PPE increases risk of adverse effects in healthcare workers, this should be at the forefront of considerations when developing or reviewing new and existing infection prevention and control measures. If new policy regarding the use and implementation of PPE is to be developed, effective communication and dissemination should be a priority, as this was identified as a barrier to adherence. This review has identified a significant paucity of evidence in the settings of interest and is reliant on examining evidence that represents a large variety of health and care settings. It is important to acknowledge there may be some issues specific to Ambulance and GP settings that are not covered by this review. This does impact the validity of this reviews conclusions. Further high-quality research must be undertaken in the settings of interest to inform and guide policy. Funding statementHealth Technology Wales was funded for this work by the Wales Covid-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government. Rapid Review DetailsO_ST_ABSReview conducted byC_ST_ABSHealth Technology Wales (HTW) Review TeamO_LIAntonia Needham, Health Technology Wales, antonia.needham@wales.nhs.uk C_LIO_LITom Winfield, Health Technology Wales, tom.winfield@wales.nhs.uk C_LIO_LILauren Elston, Health Technology Wales, lauren.elston@wales.nhs.uk C_LIO_LIJenni Washington, Health Technology Wales, jenni.washington@wales.nhs.uk C_LI Review submitted to the WCEC on10th February 2023 Stakeholder consultation meeting23rd January 2023 [day, month, year] Rapid Review report issued by the WCECFebruary 2023 WCEC TeamAdrian Edwards, Ruth Lewis, Alison Cooper and Micaela Gal were involved in drafting the Topline summary, review of the report and editing This review should be cited asRR00046. Wales COVID-19 Evidence Centre. Use of Personal Protective Equipment (PPE) in General Practice and Ambulance settings: a rapid review. February 2023. DisclaimerThe views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest. TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews (RR) use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis. Who is this summary for?Wales Ambulance Service NHS Trust and the Royal College of General Practitioners Wales Background / Aim of Rapid ReviewThe use of personal protective equipment (PPE) is a cornerstone of infection prevention and control guidelines and was of increased importance during the COVID-19 pandemic. Adherence with prescribed guidelines for the use of PPE and their applicability to the working practices of staff in general practitioner (GP) and ambulance settings have been a growing concern. This rapid review aims to assess the barriers, facilitators, and potential adverse outcomes of the use of PPE in these specific settings. Key FindingsO_ST_ABSExtent of the evidence baseC_ST_ABSO_LIWe identified four systematic reviews (Galanis et al, 2021; Keng et al, 2021; Kunstler et al, 2022), one rapid review (Houghton et al, 2020), a retrospective chart review (McCann-Pineo et al 2022) and a prospective quantitative survey study (Gangaram et al 2022). C_LIO_LIOutcome measures were broadly focused on physical adverse outcomes from the use of PPE, but also included barriers and facilitators to the use of PPE in varied healthcare settings. C_LIO_LIIn terms of setting, all five systematic and rapid reviews covered a broad range of health and care settings, all of which included GP and ambulance settings, but not as a specific focus - it was deemed that as these settings were included as part of data collection and analysis that the findings would be generalisable. C_LIO_LIBoth the retrospective chart review (McCann-Pineo et al 2022) and the prospective survey study (Gangaram et al 2022) took place in an ambulance or emergency response setting. C_LI Recency of the evidence baseO_LIStudies included were published from 2020 up until November 2022. C_LI Key FindingsO_LIThere is a significant lack of evidence in the settings of interest. C_LIO_LIExtended use of PPE is associated with an increased occurrence of adverse physiological events, such as pressure ulcers and de novo headaches. C_LIO_LIEvidence indicates that adherence with PPE guidance is primarily influenced by organisational communication and workplace cultures. In ambulance settings, adherence may also be affected by dispatch codes and indicative symptoms reported during the initial call. C_LI Quality of the evidenceO_LIOf the systematic reviews identified (Galanis et al, 2021; Keng at al, 2021; Kunstler et al, 2022) all are of poor quality, and were determined to have high risk of bias following formal assessment. C_LIO_LIThe rapid review identified (Houghton et al, 2020) is of good quality, with a low risk of bias. C_LIO_LIOf the primary studies (McCann-Pineo et al, 2022; Gangaram et al, 2022) the retrospective chart review was deemed poor quality with high risk of bias, and the prospective quantitative survey study deemed fair quality, with undetermined risk of bias. C_LIO_LIPrimary concerns around the evidence base relate to evidence identification, applicability of evidence and methodological limitations. C_LI Policy ImplicationsO_LIThere is evidence to suggest that usage of PPE increases risk of adverse effects in healthcare workers, and this should be at the forefront of considerations when developing or reviewing new and existing infection prevention and control measures. C_LIO_LIIf new policy regarding the use and implementation of PPE is to be developed, effective communication and dissemination should be a priority, as this was identified as a barrier to adherence. C_LIO_LIThis review has identified a significant paucity of evidence in the settings of interest and is reliant on examining evidence that represents a large variety of health and care settings. It is important to acknowledge there may be some issues specific to Ambulance and GP settings that are not covered by this review. This does impact the validity of this reviews conclusions. C_LIO_LIFurther high-quality research must be undertaken in the settings of interest to inform and guide policy. C_LI Strength of EvidenceOverall confidence in the body of evidence is low, and caution should be exercised when drawing conclusions based on this evidence.

BackgroundWhile possibility of airborne transmission in the spread of common respiratory infections, there is no consensus on the relative importance of airborne infection route in real-life. This study aimed to investigate the significance of the airborne transmissions and the effectiveness of air cleaning in reducing infections among children in daycare. MethodsA cross-over study was conducted in four daycare centers in Helsinki. All children attending the daycare were invited to participate (n = 262) and the sole inclusion criterion was that the children were expected to stay in the same day care center for the two-year duration of the study. 51 subjects were included in the final analysis. Clean air flow rate was increased by 2.1-2.9 times compared to baseline mechanical ventilation of the premises. The effect of intervention was assessed using negative binomial regression. ResultsThe intervention reduced incident infections from 0.95 to 0.78 infections per child per month among the children (primary outcome) in daycare. The reduction attributed to intervention in the statistical model was 18.0 % (95% CI 2.1-31.3 %, p = 0.028). ConclusionsWe observed a significant decrease in incident infections without implementing any other infection mitigation strategies but air cleaning. Our results challenge the current paradigm which emphasizes fomite and contact transmission and infection control measures that target these pathways. As ventilation and air cleaning can only affect particles able to float in the air stream, our results support the significance of airborne transmission among common respiratory pathogens as well as air cleaning as an infection control measure.

1ObjectivesTo review the literature from 2011 until March 31st, 2020 to identify the risk of transmission of ARIs to healthcare workers caring for patients undergoing AGMPs compared with the risk of transmission when caring for patients not undergoing AGMPs. ResultsOnly two prospective cohort studies were identified meeting inclusion criteria. One found that performance or assistance with AGMP during the previous week was significantly associated with symptomatic influenza (adjusted OR: 2.29, 95% CI: 1.3 to 4.2). The second study found that performance of AGMP was significantly associated with clinical respiratory infections (RR 2.9, 95% CI 1.42-5.87, p<0.01), laboratory-confirmed virus or bacteria (RR 2.9, 95% CI 1.37-6.22, p=0.01), and laboratory-confirmed virus (RR 3.3, 95% CI 1.01-11.02, p=0.05). Further evidence is needed regarding what constitutes an AGMP and the risk of ARI transmission during presumed AGMPs. Organizations need to interpret these findings with caution when establishing AGMP lists requiring airborne precautions.

Structured summaryO_ST_ABSBackgroundC_ST_ABSWhole genome sequencing (WGS) for managing healthcare associated infections (HCAIs) has developed considerably through experiences with SARS-CoV-2. We interviewed various healthcare professionals (HCPs) with direct experience of using WGS in hospitals (within the COG-UK Hospital Onset COVID-19 Infection (HOCI) study) to explore its acceptability and future use. MethodAn exploratory, cross-sectional, qualitative design employed semi-structured interviews with 39 diverse HCPs between December 2020 and June 2021. Participants were recruited from five sites within the larger clinical study of a novel genome sequencing reporting tool for SARS-CoV-2 (the HOCI study). All had experience, in their diverse roles, of using sequencing data to manage nosocomial SARS-CoV-2 infection. Deductive and inductive thematic analysis identified themes exploring aspects of the acceptability of sequencing. FindingsThe analysis highlighted the overall acceptability of rapid WGS for infectious disease using SARS-CoV-2 as a case study. Diverse professionals were largely very positive about its future use and believed that it could become a valuable and routine tool for managing HCAIs. We identified three key themes 1) Proof of concept achieved; 2) Novel insights and implications; and 3) Challenges and demands. ConclusionOur qualitative analysis, drawn from five diverse hospitals, shows the broad acceptability of rapid sequencing and its potential. Participants believed it could and should become an everyday technology capable of being embedded within typical hospital processes and systems. However, its future integration into existing healthcare systems will not be without challenges (e.g., resource, multi-level change) warranting further mixed methods research.

The disinfection of high-contact surfaces is seen as an infection control practice to prevent the spread of pathogens by fomites. Unfortunately, recontamination of these surfaces can occur any time after the use of common disinfectants. We recently reported on a novel continuously active antimicrobial coating which was shown to reduce the spread of healthcare acquired infections in hospitals. We evaluated a modified coating that demonstrated a residual efficacy against viruses. The coated surfaces were found to be effective against human coronavirus (HCoV) 229E, reducing the concentration of these viruses by greater than 90% in 10 minutes and by greater than 99.9% after two hours of contact. The coating formulation when tested in suspension yielded a greater than 99.99% reduction of HCoV 229E within ten minutes of contact. This outcome presents an opportunity for controlling the transmission of COVID-19 from contaminated fomites.

The aerosol spread of SARS-CoV-2 has been a major challenge for healthcare facilities and there has been increased use of supplementary air filtration to mitigate SARS-CoV-2 transmission. Appropriately sized supplementary room air filtration systems could greatly reduce aerosol levels throughout ward spaces. Portable air filtration systems, such as those combining high efficiency particulate air (HEPA) filters and ultraviolet (UVC) light sterilisation, may be a scalable solution for removing respiratory viruses such as SARS-CoV-2. This rapid review aimed to assess the effectiveness of supplementary air cleaning devices in health service settings such as hospitals and dental clinics (including, but not limited to HEPA filtration, UVC light and mobile UVC light devices) to reduce the transmission of SARS-CoV-2. One systematic review (Daga et al. 2021), three observational studies (Conway Morris et al. 2022, Thuresson et al. 2022, Sloof et al. 2022), one modelling study, (Buchan et al. 2020) and two experimental studies (Barnewall & Bischoff 2021, Snelling et al. 2022) were found. Outcome measures included symptom scores, presence of SARS-CoV-2 RNA in sample counts, general particulate matter counts, viral counts, and relative risk of SARS-CoV-2 exposure. From real world settings, the systematic review assessed the effectiveness of HEPA filtration in dental clinics (Daga et al. 2021), two additional observational studies assessed HEPA and UV light in UK hospital settings (Conway Morris et al. 2022, Sloof et al. 2022) and one observational study included mobile HEPA-filtration units in Swedish hospitals (Thuresson et al. 2022). Studies were published from 2020 onwards. Real world evidence suggests supplementary air systems have the potential to reduce SARS-CoV-2 in the air and subsequently reduce transmission or infection rates but further research, with study designs having lower risk of bias, is required. HEPA filters alongside UVC light could provide the most notable reductions in SARS-CoV-2 counts, although the supporting evidence relates to HEPA/UVC filtration, and this review does not provide evidence on the effectiveness of other potential supplementary air filtration systems that could be used. Evidence is limited on the optimum air changes per hour needed and the positioning of air filtration units in rooms. Funding statementThe Wales Centre for Evidence Based Care was funded for this work by the Wales COVID-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government.

Between August-September 2021, an outbreak of SARS-CoV-2, with an attack rate of 55% (22/40 workers), occurred in a public-facing office in England. To identify workplace and worker-related risk factors, a comprehensive investigation involving surface sampling, environmental assessment, molecular and serological testing, and worker questionnaires was performed in September - October 2021. The results affirm the utility of surface sampling to identify SARS-CoV-2 control deficiencies and the importance of evolving, site-specific risk assessments with layered COVID-19 mitigation strategies.

During the Covid-19 pandemic, pristine and reprocessed N95 respirators are crucial equipment towards limiting nosocomial infections. The NIOSH test certifying the N95 rating, however, poorly simulates aerosols in healthcare settings, limiting our understanding of the exposure risk for healthcare workers wearing these masks, especially reprocessed ones. We used experimental conditions that simulated the sizes, densities and airflow properties of infectious aerosols in healthcare settings. We analyzed the penetration and leakage of aerosols through pristine and reprocessed N95 respirators. Seven reprocessing methods were investigated. Our findings suggest that pristine and properly reprocessed N95 respirators effectively limit exposure to infectious aerosols, but that care must be taken to avoid the elucidated degradation mechanisms and limit noncompliant wear.

ImportanceInfants in neonatal intensive care units are at risk of transmission events by bacteria with multidrug-resistance and/or epidemic potential ("multidrug-resistant organisms plus", MDRO+), which may precede invasive infections. Prospective high-level resolution of MDRO+ transmission clusters may alleviate high risk situations through targeted infection prevention control measures. Objectives1) Exploration of whole-genome sequencing in resolving putative MDRO+ transmission chains. 2) Analysis of risk factors for becoming part of a transmission cluster. Design, Setting, ParticipantsProspective monocentric cohort study at a level III neonatal intensive care unit at the Medical Center - University of Freiburg, Germany. Inclusion of 434 of 551 preterm and term infants admitted for at least 48h and screened at least once between February 15 2019 and November 16 2020. ExposuresIntegration of (1) culture-based screening, (2) genetic typing with amplified fragment length polymorphism and whole-genome sequencing and (3) granular clinical and staffing data. Statistical analysis of time-dependent risk factors based on advanced multivariate model analysis. Main OutcomesPrimary: Identification of MDRO+ transmission events, indistinguishable by amplified fragment length polymorphism or whole-genome sequencing. Secondary: MDRO+ colonization rates; identification of factors influencing transmission events; MDRO+ blood stream infection rates. ResultsAmong 434 participants 51.8 % (95% CI, 47.1%-56.5%) were colonized with at least one MDRO+; 32.5% (95% CI, 28.3%-37.0%) were colonized by transmission. Among 38 unique transmission clusters, E. coli was the most common cluster-forming MDRO+. Four of ten MDRO+ blood stream infections originated from transmission events. Multivariate analysis revealed three factors influencing the risk of becoming part of a transmission cluster: Increased nurse staffing levels and antibiotic administration lowered the risk of becoming part of a bacterial transmission cluster, while vascular catheter usage increased it. Conclusions and RelevanceProspective whole-genome sequencing of routine screening isolates from neonatal intensive care unit infants is powerful for detecting MDRO+ transmission chains, exceeding amplified fragment length polymorphism in precision and seems justified in high-risk neonates to uncover specific risk factors for MDRO+ transmission. Delayed and "false" identification of transmission events, which inevitably occur in conventional microbiological screening, have grave organizational consequences.

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has played havoc on the healthcare system and society. Many international guidelines have put forward various measures to control the spread and, using various quality masks seems to be the most important amongst them. This was a cross-sectional pilot study to see any alterations in the bacterial flora of the nasal and the oropharyngeal (OP) microbiota with the use of medical masks over prolonged periods during this COVID-19 outbreak. MethodsNasal and oropharyngeal swabs were collected using proper international guidelines from 30 healthy healthcare workers matching pre-set inclusion criteria, who gave written informed consent. The swabs were used for gram stain as well as culture and sensitivity analysis using standard methods. ResultsIn general, we found that the oropharyngeal microflora harboured a more diverse population of bacteria (n=13) than the nasal microflora (n=5). The predominant bacterial flora was found to Staphylococcus epidermidis in the nasal cavity and Streptococcus viridans in the oropharyngeal cavity. There was no growth in 8 (26.68%) samples of oropharynx and 3 (10%) of nasal samples, with one patient having no growth in both the samples. The commonest resistant antibiotic from both the cavity cultures was benzylpenicillin (nasal flora 80% and OP flora 47.37%). ConclusionThis small pilot study has shown a reassuring aspect of no change in the typical bacterial microflora species of the nasal and OP cavity with prolonged use of medical masks. This is the first study to show this convincing evidence during the COVID-19 outbreak and also in healthy healthcare workers who have to wear masks over long durations.

BackgroundThe high exposure risk to COVID among frontline heathcare workers was a major challenge to healthcare systems across the globe that warranted close monitoring through risk assessment and contact tracing strategies. The objective of our study was to characterize exposure risk factors for transmission and subsequent COVID positivity among the frontlinehealthcare workers in our institution during the pandemic period. MethodsThe retrospective observational study conducted over a period of 6 months from June 2020 to November 2020 at a 1300-bedded South Indian tertiary care centre included frontline healthcare workers who were assessed for their identified encounter with COVID positive individual using a modified WHO COVID risk assessment tool. Additional risk attributes of exposure characterized among COVID positive healthcare workers comprised of shared space, cluster related transmissions and multiple instances of exposure to COVID. ResultsAmong a total of 4744 contacts with COVID positive individuals assessed for risk stratification during the study period, 942 (19.8%) were high risk and 3802 (80.2%) were low risk exposures respectively. 106 (2.2%) turned COVID positive during the surveillance period of 14 days. Frontline workers working in COVID areas had significant low COVID rates as compared to other areas (N=1, 0.9%). The average monthly COVID positivity rates being 1.66%, the attack rates among high risk and low risk contacts among the total HCWs screened were 5% (46/942) and 1.57% (60/3802) respectively. Shared space (70%) and IPC breaches (66%) were found to be highly prevalent in the COVID positive cohort, along with maskless encounters (43%) and multiple exposure (39%). The attack rate among the 6 identified COVID cluster groups (5.5%) were found to be higher than the attack rate (2.2%) noted among the total contacts screened and no significant association was observed between risk categories in the clusters. DiscussionOur study highlights higher risk of COVID positivity among high risk contacts as compared to low risk contacts. However, the high COVID positivity rate in low risk group among cluster transmissions and its lack of association with risk assessment highlight the suboptimal utility of the risk assessment strategy among cluster groups.

BackgroundInfectious aerosols and droplets generated by SARS-CoV-2-positive patient aerosol generating procedures (AGPs), coughing, or exhalation could potentially contaminate surfaces, leading to indirect SARS-CoV-2 spread via fomites. Our objective was to determine SARS-CoV-2 surface contamination frequency in Emergency Department (ED) patient rooms with respect to patient SARS-CoV-2 status and AGP receipt. MethodsSwabs were collected from fixed surfaces or equipment in the rooms of patients under investigation for COVID-19 or known to be SARS-CoV-2-positive. Environmental swabs were tested for SARS-CoV-2 RNA by RT-qPCR; RNA-positive samples were cultured in Vero E6 cells. Room contamination was also evaluated by clinical severity of COVID-19 and time since symptom onset. ResultsIn total, 202 rooms were sampled: 42 SARS-CoV-2-positive AGP patient rooms, 45 non-AGP SARS-CoV-2-positive patient rooms, and 115 SARS-CoV-2-negative AGP patient rooms. SARS-CoV-2 RNA was detected on 36 (3.6%) surfaces from 29 (14.4%) rooms. RNA contamination was detected more frequently in rooms occupied by non-AGP SARS-CoV-2- positive patients than SARS-CoV-2-positive AGP patients (28.9% vs 14.3%, p=0.078). Infectious virus was cultured from one non-AGP SARS-CoV-2-positive patient room. There was no significant difference in room positivity according to COVID-19 severity or time since symptom onset. ConclusionSARS-CoV-2 RNA contamination of ED room surfaces was highest and most frequent in rooms occupied by SARS-CoV-2-positive patients who did not undergo an AGP, which may be attributable to disease stage and viral shedding; however, there was no difference in room contamination according to COVID-19 severity or time since symptom onset.

Healthcare workers are at increased risk of exposure to COVID-19. The majority of cases are acquired through inhalation of infected respiratory particles, contamination with infected surfaces or whilst performing aerosol-generating procedures. Basic infection prevention measures are essential to protect healthcare workers from contracting the disease when managing patients; consequently global demand for personal protective equipment (PPE) has exceeded supply in many regions. We present a novel, innovative polycarbonate shield designed for ENT clinicians performing tracheostomies. Clinical investigations using the shield demonstrated a sixteen-fold decrease in the number of particles detected at the position of the operating surgeon when the shield was used (particle size 0.3m; with shield 27,000 versus 439,000 without shield). The shield, used with appropriate PPE, could therefore help to minimise exposure to aerosol generated particles such as during tracheostomies on patients with COVID-19.

BackgroundThere is a significant transmission of contaminants in the healthcare setting. Daily disinfection utilizing ammonium and chlorine-based products can lead to adverse health effects such as asthma, cancer, and other serious health issues. MethodsThis study evaluated the effectiveness of eraDOCator-60 in a health care facility. This randomized trial took place at Copley Hospital in Morristown, Vermont. Separate areas of the hospital were cleaned and disinfected in one step with eraDOCator-60. A Charm analyzer was utilized to evaluate the efficacy of disinfection before and after 1 minute application of eraDOCator-60. The Charm analyzer detects Adenosine Triphosphate (ATP) presence measured in Relative Light Units (RLUs). ResultsThe median number of RLUs decreased from 52,874 s to 0 RLUs after one-minute eraDOCator-60 dwell time in the emergency room; 18.611 RLUs to 0 RLUs in the medical-surgical unit, 41,507 RLUs to 0 RLUs in the cafeteria; 24,932 RLUs to 0 RLUs in the birthing center. ConclusionsEraDOCator-60 reduced contamination levels on all surfaces in the acute care setting down to a value of zero following a 1-minute dwell time in less than 5% soil load.

Healthcare linens act as a vector of microbial transmission through use, storage and handling. In this retrospective multi-year, multi-site study, the impact of an infection prevention program, that included an automated silver ion-based antimicrobial laundry treatment, was studied. A composite reduction of 42% in healthcare associated infection (HAI) rates was observed, with the biggest reductions associated with CAUTI and CDI rates. Although further study is needed to better understand the exact contribution of such an intervention towards prevention of HAIs, ionic silver treatment of healthcare textiles may prove to be a useful tool in HAI reduction strategies.

BACKGROUNDWhether and to what degree SARS-CoV-2 is spread via the airborne route is unknown. Using data collected from health care worker interactions with hospitalized patients with COVID-19 illness, we calculated the transmissibility of SARS-CoV-2 via the airborne route. OBJECTIVES/METHODSHealthcare worker interaction with SARS-CoV-2 infected patients were tracked using a real time location system between March 18 and March 31. A value for q, the transmissibility expressed as quanta per hour, was estimated using a well-established model for airborne transmission. RESULTSSARS-CoV-2 infection prevalence among tracked HCWs was 2.21% (0.07-4.35). Transmissibility was estimated to be 0.225 quanta per hour, well below other well-characterized airborne pathogens. Simulations demonstrated that risk of infection is substantially reduced with increased ventilation of rooms. CONCLUSIONSOverall, our findings suggest that SARS-CoV-2 is not well transmitted via the airborne route in controlled conditions. We speculate that SARS-CoV-2 may be only opportunistically airborne, with most transmission occurring via droplet methods. One Sentence SummaryWe calculated the airborne transmissibility (q) of SARS-CoV-2 and the impact of masks and ventilation in a hospital setting.