Exploring Integrated Environmental Viral Surveillance of Indoor Environments: A comparison of surface and bioaerosol environmental sampling in hospital rooms with COVID-19 patients

  1. Leslie Dietz
  2. David A. Constant
  3. Mark Fretz
  4. Patrick F. Horve
  5. Andreas Olsen-Martinez
  6. Jason Stenson
  7. Andrew Wilkes
  8. Robert G. Martindale
  9. William B. Messer
  10. Kevin G. Van Den Wymelenberg

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Abstract

The outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has dramatically transformed policies and practices surrounding public health. One such shift is the expanded emphasis on environmental surveillance for pathogens. Environmental surveillance methods have primarily relied upon wastewater and indoor surface testing, and despite substantial evidence that SARS-CoV-2 commonly travels through space in aerosols, there has been limited indoor air surveillance. This study investigated the effectiveness of integrated surveillance including an active air sampler, surface swabs and passive settling plates to detect SARS-CoV-2 in hospital rooms with COVID-19 patients and compared detection efficacy among sampling methods. The AerosolSense active air sampler was found to detect SARS-CoV-2 in 53.8% of all samples collected compared to 12.1% detection by passive air sampling and 14.8% detection by surface swabs. Approximately 69% of sampled rooms (22/32) returned a positive environmental sample of any type. Among positive rooms, ~32% had only active air samples that returned positive, while ~27% and ~9% had only one or more surface swabs or passive settling plates that returned a positive respectively, and ~32% had more than one sample type that returned a positive result. This study demonstrates the potential for the AerosolSense to detect SARS-CoV-2 RNA in real-world healthcare environments and suggests that integrated sampling that includes active air sampling is an important addition to environmental pathogen surveillance in support of public health.

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    SciScore for 10.1101/2021.03.26.21254416: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: This work was reviewed by the OHSU Institutional Biosafety Committee and approved under PROTO202000016.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study contains a few important limitations. Aerosol sampling durations were variable (1-12.75 hours) in order to prioritize the schedule and activities of the care team providing patient care. Approximately 81% of study rooms (26/32) had one air sampler while approximately 19% of the rooms (6/32) had two air samplers during the sampling period. All rooms with two air samplers returned the same result for both samplers. Verified hospital room air exchange rate was not available for every patient room studied. The analysis methods cannot ensure that RNA detected in any room came solely from the patient occupying the room. Finally, our results report the presence of SARS-CoV-2 RNA, and do not address viability, since qRT-PCR does not distinguish viable virions from RNA from non-viable cells. Overall, we sought to identify the potential utility of the AerosolSense device for active air environmental surveillance and used a healthcare setting as the testbed. The active air samples recovered were compared to the current standard for indoor environmental surveillance, flocked environmental swabs and passive air settling plates64–67. We confirmed the results of previous studies that demonstrated significant environmental contamination by SARS-CoV-2 in rooms occupied by COVID-19 positive patients14,50,54,64,68. While one may expect more consistent detection of SARS-CoV-2 RNA in rooms occupied by COVID-19 positive patients, shedding has been shown to vary by individual and decreas...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.03.26.21254416v1 on medRxiv