Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY 11549, USA.
North Shore University Hospital/Long Island Jewish Emergency Medical Department, Northwell Health, Manhasset, NY 11030, USA.
Int J Environ Res Public Health. 2021 Mar 3;18(5):2479. doi: 10.3390/ijerph18052479.
Health care systems in the United States are continuously expanding and contracting spaces to treat patients with coronavirus disease 2019 (COVID-19) in intensive care units (ICUs). As a result, hospitals must effectively decontaminate and contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in constructed and deconstructed ICUs that care for patients with COVID-19. We assessed decontamination of a COVID-19 ICU and examined the containment efficacy of combined contact and droplet precautions in creating and maintaining a SARS-CoV-2-negative ICU "antechamber". To examine the efficacy of chemical decontamination, we used high-density, semi-quantitative environmental sampling to detect SARS-CoV-2 on surfaces in a COVID-19 ICU and COVID-19 ICU antechamber. Quantitative real-time polymerase chain reaction was used to measure viral RNA on surfaces. Viral location mapping revealed the distribution of viral RNA in the COVID-19 ICU and COVID-19 ICU antechamber. Results were further assessed using loop-mediated isothermal amplification. We collected 224 surface samples pre-decontamination and 193 samples post-decontamination from a COVID-19 ICU and adjoining COVID-19 ICU antechamber. We found that 46% of antechamber objects were positive for SARS-CoV-2 pre-decontamination despite the construction of a swinging door barrier system, implementation of contact precautions, and installation of high-efficiency particulate air filters. The object positivity rate reduced to 32.1% and viral particle rate reduced by 95.4% following decontamination. Matched items had an average of 432.2 ± 2729 viral copies/cm pre-decontamination and 19.2 ± 118 viral copies/cm post-decontamination, demonstrating significantly reduced viral surface distribution ( < 0.0001). Environmental sampling is an effective method for evaluating decontamination protocols and validating measures used to contain SARS-CoV-2 viral particles. While chemical decontamination effectively removes detectable viral RNA from surfaces, our approach to droplet/contact containment with an antechamber was not highly effective. These data suggest that hospitals should plan for the potential of aerosolized virions when creating strategies to contain SARS-CoV-2.
美国的医疗保健系统不断扩大和缩小空间，以便在重症监护病房（ICU）中治疗 2019 年冠状病毒病（COVID-19）患者。因此，医院必须在为 COVID-19 患者提供护理的建造和拆除的 ICU 中有效地对严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）进行去污和隔离。我们评估了 COVID-19 ICU 的去污情况，并研究了联合接触和飞沫预防措施在创建和维持 SARS-CoV-2 阴性 ICU“前室”方面的隔离效果。为了检查化学去污的效果，我们使用高密度，半定量环境采样来检测 COVID-19 ICU 和 COVID-19 ICU 前室中表面上的 SARS-CoV-2。定量实时聚合酶链反应用于测量表面上的病毒 RNA。病毒位置图揭示了 COVID-19 ICU 和 COVID-19 ICU 前室中病毒 RNA 的分布。使用环介导的等温扩增进一步评估了结果。我们从前 COVID-19 ICU 和相邻的 COVID-19 ICU 前室中采集了 224 个表面样本进行预去污和 193 个样本进行后去污。我们发现，尽管建造了摆动门屏障系统，实施了接触预防措施并安装了高效微粒空气过滤器，但前室中仍有 46％的物体对 SARS-CoV-2 呈阳性。去污后，物体阳性率降低至 32.1％，病毒颗粒率降低了 95.4％。经匹配的物品在前去污时的平均病毒拷贝数为每平方厘米 432.2±2729 拷贝，后去污时的平均病毒拷贝数为每平方厘米 19.2±118 拷贝，表明病毒表面分布明显减少（<0.0001）。环境采样是评估去污方案和验证用于包含 SARS-CoV-2 病毒颗粒的措施的有效方法。尽管化学去污可有效去除表面上可检测到的病毒 RNA，但我们使用前室进行飞沫/接触隔离的方法效果并不高。这些数据表明，当医院制定包含 SARS-CoV-2 的策略时，应考虑到病毒气溶胶化的可能性。
