SARS-CoV-2 RNA detection of hospital isolation wards hygiene monitoring during the coronavirus disease 2019 outbreak in a Chinese hospital

Objectives: The aim of this paper was to monitor the presence of SARS-Cov-2 among hospital environment surfaces, sewage, and personal protective equipment (PPE) of staffs in isolation wards in the First Affiliated Hospital of Zhejiang University, China. Methods Surfaces of objects were routinely wiped with 1000 mg/L chlorine containing disinfectant . Air and sewage disinfection was proceeded routinely and strictly. Hospital environmental surfaces and PPE of staffs in isolation wards were sampled using swabs. The sewage from various inlet and outlets were sampled. The respiratory and stool specimens of patients were collected. The respiratory specimens of staffs in the isolation wards were also sampled once a week. Quantitative real-time reverse transcription PCR (qRT-PCR) methods were used to confirm the existence of SARS-Cov-2 RNA. Viral culture was done for the samples positive for SARS-Cov-2 RNA. Results During the study period, 33 laboratory-confirmed patients were hospitalized in isolation wards in the hospital. None of SARS-Cov-2 RNA was detected among the 36 objects surface samples and 9 staffs PPE samples in isolation wards. Though the 3 sewage samples from the inlet of preprocessing disinfection pool were positive for SARS-CoV-2 RNA and the sample from the outlet of preprocessing disinfection pool was weakly positive, the sewage sample from the outlet of the last disinfection pool was negative. All of the 5 sewage samples from various points were negative by viral culture of SARS-Cov-2. None of the respiratory specimens of staffs in the isolation wards were positive. Conclusions Though SARS-Cov-2 RNA of the sewage samples were positive from inlets of the sewage disinfection pool and negative from the outlet of the last sewage disinfection pool, no viable virus was detected by culture. The monitoring data in this study suggested that the strict disinfection and hand hygiene could decrease the hospital-associated COVID-19 infection risk of the staffs in isolation wards.

The emergency surgical infection management checklist of hospitalized patients with coronavirus disease 2019 (COVID-19) in Zhejiang, China.

The novel coronavirus disease 2019 (COVID-19) epidemic broke out in 2019, it is highly contagious, and the infection rate among medical staff is high. The management of infection prevention and control during emergency surgery of COVID-19 patients has been outlined and the perioperative infection management checklist for emergency surgery of COVID-19 patients has been summarized and validated. There have been 13 emergency surgeries performed on COVID-19 patients at our hospital during this time. Two cases were cured and discharged, and the others were discharged after improvement and transferred to further rehabilitation, 30-day mortality of the emergency surgical is 0%. Once the emergency surgery protocol in the hospital is successfully established, emergency surgery can be performed as soon as the surgical planning decision is made, and the operating room can be prepared for use at any time. The incidence of surgical site infection (SSI) was largely higher than that of ordinary patients in the same time; however, the successful implementation of emergency surgery for COVID-19 had positive significance in reducing the incidence of death, risk of bleeding, and hypoxia. The current cumulative cure rate of COVID-19 in our hospital is 98%, patient mortality rate is 0%, and the incidence of COVID-19 infection in medical staff is 0%. The emergency surgical infection management checklist is feasible and effective in guiding the preoperative and intraoperative surgical procedures.

Coronavirus disease 2019: MRI examination procedures and infection prevention and protection.

BACKGROUND: Though chest computed tomography (CT) and digital radiography (DR) is important in the diagnosis and treatment of COVID-19, for patients with COVID-19 who may need magnetic resonance imaging (MRI) due to other complications, we proposed the MRI procedures for patients and medical staff to reduce the risk of infection between them. METHODS: Combining two cases in our hospital and other literature, a solution about the procedure and necessary preventive and protective measures for MRI examination of COVID-19 patients is proposed for peer reference with the help of experts from our hospital infection-control department. The solution that meets the hospital infection-control regulations covers five aspects including the layout requirements for the MRI room in the radiology department, preparation before admission, preparation of medical staff, preparation of patients, and terminal disinfection after MRI examination. Radiology personnel should strictly abide by the regulations on infection prevention and control. MRI technicians who have been in close contact with COVID-19 patients should receive strict medical observation for two weeks. Each step should be performed carefully to minimize the risk of hospital infection. RESULTS: A solution that includes five aspects was formulated to prevent the potential contamination during the MRI scan for COVID-19 patients. These five aspects are layout requirements in the MRI room, preparation before admission, preparation of medical staff, preparation of patients, and terminal disinfection after an examination. MRI technicians who have been in close contact with COVID-19 patients should receive strict medical observation for two weeks. CONCLUSIONS: To prevent and control the potential hospital infection during the MRI examination for COVID-19 patients, a solution including five aspects was initially proposed.

Multi-route transmission potential of SARS-CoV-2 in healthcare facilities.

Understanding the transmission mechanism of SARS-CoV-2 is a prerequisite to effective control measures. To investigate the potential modes of SARS-CoV-2 transmission, 21 COVID-19 patients from 12-47 days after symptom onset were recruited. We monitored the release of SARS-CoV-2 from the patients' exhaled breath and systematically investigated environmental contamination of air, public surfaces, personal necessities, and the drainage system. SARS-CoV-2 RNA was detected in 0 of 9 exhaled breath samples, 2 of 8 exhaled breath condensate samples, 1 of 12 bedside air samples, 4 of 132 samples from private surfaces, 0 of 70 samples from frequently touched public surfaces in isolation rooms, and 7 of 23 feces-related air/surface/water samples. The maximum viral RNA concentrations were 1857 copies/m3 in the air, 38 copies/cm2 in sampled surfaces and 3092 copies/mL in sewage/wastewater samples. Our results suggest that nosocomial transmission of SARS-CoV-2 can occur via multiple routes. However, the low detection frequency and limited quantity of viral RNA from the breath and environmental specimens may be related to the reduced viral load of the COVID-19 patients on later days after symptom onset. These findings suggest that the transmission dynamics of SARS-CoV-2 differ from those of SARS-CoV in healthcare settings.

Evaluation of disinfection procedures in a designated hospital for COVID-19.

BACKGROUND: Coronavirus disease 2019 has spread globally and been a public health emergency worldwide. It is important to reduce the risk of healthcare associated infections among the healthcare workers and patients. This study aimed to investigate the contamination of environment in isolation wards and sewage, and assess the quality of routine disinfection procedures in our hospital. METHODS: Routine disinfection procedures were performed 3-times a day in general isolation wards and 6-times a day in isolated ICU wards in our hospital. Environmental surface samples and sewage samples were collected for viral RNA detection. Severe acute respiratory syndrome coronavirus 2 RNA detection was performed with quantitative reverse transcription polymerase chain reaction. RESULTS: A total of 163 samples were collected from February 6 to April 4. Among 122 surface samples, 2 were positive for severe acute respiratory syndrome coronavirus 2 RNA detection. One was collected from the flush button of the toilet bowl, and the other was collected from a hand-basin. Although 10 of the sewage samples were positive for viral RNA detection, all positive samples were negative for viral culture. CONCLUSION: These results revealed the routine disinfection procedures in our hospital were effective in reducing the potential risk of healthcare associated infection. Two surface samples were positive for viral detection, suggesting that more attention should be paid when disinfecting places easy to be ignored.