Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England

Ginny Moore; H. Rickard; D. Stevenson; P. Aranega-Bou; J. Pitman; A. Crook; K. Davies; A. Spencer; C. Burton; L. Easterbrook; H. E. Love; S. Summers; S. R. Welch; N. Wand; K. A. Thompson; T. Pottage; K. S. Richards; J. Dunning; Allan Bennett

doi:10.1016/j.jhin.2020.11.024

Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England

Ginny Moore^*, H. Rickard, D. Stevenson, P. Aranega-Bou, J. Pitman, A. Crook, K. Davies, A. Spencer, C. Burton, L. Easterbrook, H. E. Love, S. Summers, S. R. Welch, N. Wand, K. A. Thompson, T. Pottage, K. S. Richards, J. Dunning, Allan Bennett

^*Corresponding author for this work

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Abstract

Background: Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission.

Methods: The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays.

Findings: SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 10⁵ to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m³ air. Infectious virus was not recovered from any of the PCR-positive samples analysed.

Conclusions: Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.

Original language	English
Pages (from-to)	189-196
Number of pages	8
Journal	Journal of Hospital Infection
Volume	108
Early online date	28 Nov 2020
DOIs	https://doi.org/10.1016/j.jhin.2020.11.024
Publication status	Published - Feb 2021

Bibliographical note

Funding Information: This multi-centre study was funded by PHE. Validation of the sampling techniques and protocol(s) was funded by the Medical Research Council as part of a larger laboratory-based study investigating environmental and airborne routes of transmission.

Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Publisher Copyright: Crown Copyright © 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

Citation: G. Moore, H. Rickard, D. Stevenson, P. Aranega-Bou, J. Pitman, A. Crook, K. Davies, A. Spencer, C. Burton, L. Easterbrook, H.E. Love, S. Summers, S.R. Welch, N. Wand, K-A. Thompson, T. Pottage, K.S. Richards, J. Dunning, A. Bennett,
Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England, Journal of Hospital Infection, Volume 108, 2021, Pages 189-196, ISSN 0195-6701,
https://doi.org/10.1016/j.jhin.2020.11.024.(https://www.sciencedirect.com/science/article/pii/S019567012030548X)

DOI: https://doi.org/10.1016/j.jhin.2020.11.024

Keywords

Air
Environmental contamination
Environmental surfaces
Hospital
Infection control
SARS-CoV-2

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Moore2021DetectionOfSARS-CoV-2WithinTheHealthcareEnvironmentAMulti-CentreStudyJHospInfectFinal published version, 315 KBLicence: CC BY-NC-ND

Cite this

Moore, G., Rickard, H., Stevenson, D., Aranega-Bou, P., Pitman, J., Crook, A., Davies, K., Spencer, A., Burton, C., Easterbrook, L., Love, H. E., Summers, S., Welch, S. R., Wand, N., Thompson, K. A., Pottage, T., Richards, K. S., Dunning, J., & Bennett, A. (2021). Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England. Journal of Hospital Infection, 108, 189-196. https://doi.org/10.1016/j.jhin.2020.11.024

@article{ef5bcfa0729947248551076609fc5384,

title = "Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England",

abstract = "Background: Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. Methods: The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. Findings: SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. Conclusions: Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.",

keywords = "Air, Environmental contamination, Environmental surfaces, Hospital, Infection control, SARS-CoV-2",

author = "Ginny Moore and H. Rickard and D. Stevenson and P. Aranega-Bou and J. Pitman and A. Crook and K. Davies and A. Spencer and C. Burton and L. Easterbrook and Love, {H. E.} and S. Summers and Welch, {S. R.} and N. Wand and Thompson, {K. A.} and T. Pottage and Richards, {K. S.} and J. Dunning and Allan Bennett",

note = "Funding Information: This multi-centre study was funded by PHE. Validation of the sampling techniques and protocol(s) was funded by the Medical Research Council as part of a larger laboratory-based study investigating environmental and airborne routes of transmission. Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Publisher Copyright: Crown Copyright {\textcopyright} 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society. Citation: G. Moore, H. Rickard, D. Stevenson, P. Aranega-Bou, J. Pitman, A. Crook, K. Davies, A. Spencer, C. Burton, L. Easterbrook, H.E. Love, S. Summers, S.R. Welch, N. Wand, K-A. Thompson, T. Pottage, K.S. Richards, J. Dunning, A. Bennett, Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England, Journal of Hospital Infection, Volume 108, 2021, Pages 189-196, ISSN 0195-6701, https://doi.org/10.1016/j.jhin.2020.11.024.(https://www.sciencedirect.com/science/article/pii/S019567012030548X) DOI: https://doi.org/10.1016/j.jhin.2020.11.024",

year = "2021",

month = feb,

doi = "10.1016/j.jhin.2020.11.024",

language = "English",

volume = "108",

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journal = "Journal of Hospital Infection",

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Moore, G, Rickard, H, Stevenson, D, Aranega-Bou, P , Pitman, J, Crook, A, Davies, K, Spencer, A, Burton, C, Easterbrook, L, Love, HE, Summers, S, Welch, SR, Wand, N, Thompson, KA, Pottage, T , Richards, KS, Dunning, J & Bennett, A 2021, 'Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England', Journal of Hospital Infection, vol. 108, pp. 189-196. https://doi.org/10.1016/j.jhin.2020.11.024

TY - JOUR

T1 - Detection of SARS-CoV-2 within the healthcare environment

T2 - a multi-centre study conducted during the first wave of the COVID-19 outbreak in England

AU - Moore, Ginny

AU - Rickard, H.

AU - Stevenson, D.

AU - Aranega-Bou, P.

AU - Pitman, J.

AU - Crook, A.

AU - Davies, K.

AU - Spencer, A.

AU - Burton, C.

AU - Easterbrook, L.

AU - Love, H. E.

AU - Summers, S.

AU - Welch, S. R.

AU - Wand, N.

AU - Thompson, K. A.

AU - Pottage, T.

AU - Richards, K. S.

AU - Dunning, J.

AU - Bennett, Allan

N1 - Funding Information: This multi-centre study was funded by PHE. Validation of the sampling techniques and protocol(s) was funded by the Medical Research Council as part of a larger laboratory-based study investigating environmental and airborne routes of transmission. Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Publisher Copyright: Crown Copyright © 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society. Citation: G. Moore, H. Rickard, D. Stevenson, P. Aranega-Bou, J. Pitman, A. Crook, K. Davies, A. Spencer, C. Burton, L. Easterbrook, H.E. Love, S. Summers, S.R. Welch, N. Wand, K-A. Thompson, T. Pottage, K.S. Richards, J. Dunning, A. Bennett, Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England, Journal of Hospital Infection, Volume 108, 2021, Pages 189-196, ISSN 0195-6701, https://doi.org/10.1016/j.jhin.2020.11.024.(https://www.sciencedirect.com/science/article/pii/S019567012030548X) DOI: https://doi.org/10.1016/j.jhin.2020.11.024

PY - 2021/2

Y1 - 2021/2

N2 - Background: Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. Methods: The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. Findings: SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. Conclusions: Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.

AB - Background: Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. Methods: The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. Findings: SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. Conclusions: Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.

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KW - Environmental contamination

KW - Environmental surfaces

KW - Hospital

KW - Infection control

KW - SARS-CoV-2

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JF - Journal of Hospital Infection

ER -

Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England

Abstract

Bibliographical note

Keywords

UN SDGs

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