SARS-CoV-2 environmental contamination from hospitalised patients with COVID-19 receiving aerosol-generating procedures
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Abstract
Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered ‘aerosol-generating procedures’ in the treatment of COVID-19.
Objective
To measure air and surface environmental contamination with SARS-CoV-2 virus when CPAP and HFNO are used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients.
Methods
30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturation ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. Real-time quantitative polymerase chain reaction analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus.
Results
Overall 21/30 (70%) participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination than supplemental oxygen use. Only one nasopharyngeal sample was culture positive.
Conclusions
The use of CPAP and HFNO to treat moderate/severe COVID-19 did not appear to be associated with substantially higher levels of air or surface viral contamination in the immediate care environment, compared with the use of supplemental oxygen.
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SciScore for 10.1101/2021.07.04.21259945: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Recruitment was opportunistic and written informed consent was obtained before any study procedures were undertaken. Sex as a biological variable not detected. Randomization not detected. Blinding Detection and quantification of human and SARS-CoV-2 viral RNA by real-time polymerase chain reaction and viral cultures: Laboratory analyses were performed blinded to study group. Power Analysis not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources Vero E6 (African Green monkey kidney) cells were used to culture virus from any positive/suspected positive viral RNA sample. Vero E6suggested: RRID:CVCL_XD71)Software and Algorithms Sentenc… SciScore for 10.1101/2021.07.04.21259945: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Recruitment was opportunistic and written informed consent was obtained before any study procedures were undertaken. Sex as a biological variable not detected. Randomization not detected. Blinding Detection and quantification of human and SARS-CoV-2 viral RNA by real-time polymerase chain reaction and viral cultures: Laboratory analyses were performed blinded to study group. Power Analysis not detected. Cell Line Authentication not detected. Table 2: Resources
Experimental Models: Cell Lines Sentences Resources Vero E6 (African Green monkey kidney) cells were used to culture virus from any positive/suspected positive viral RNA sample. Vero E6suggested: RRID:CVCL_XD71)Software and Algorithms Sentences Resources The statistical models were fitted in SAS and Prism 7 (GraphPad Inc, USA). GraphPadsuggested: (GraphPad Prism, RRID:SCR_002798)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has some notable strengths and limitations. Strengths include the ‘real-world’ setting, a standardised sampling strategy, concurrent air and surface sampling, collection of patient data and nasopharyngeal samples to understand the clinical context, and the use of human genetic material as a control. Finally, embedding the evaluation within the RECOVERY-Recovery Support randomised controlled trial helped to minimise selection bias. Limitations include the lack of serial sampling with findings representing a ‘snap shot’ picture, potential cross-contamination by other infected patients in cohorted areas, no particle size fractionation or concentration measurement (hence not able to differentiate between droplets and aerosols), air volume sampled only a small fraction of the total room air, and challenges interpreting the significance of samples with low viral loads. The small group sizes risk the study being underpowered with confounding chance observations and larger studies are needed to develop the evidence-base needed to reliably inform pragmatic infection prevention control measures around the use of CPAP/HFNO.
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title ISRCTN66726260 NA NA 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.
Results from scite Reference Check: We found no unreliable references.
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