Evaluating fomite risk of brown paper bags storing personal protective equipment exposed to SARS-CoV-2: A quasi-experimental study
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Abstract
Literature is lacking on the safety of storing contaminated PPE in paper bags for reuse, potentially increasing exposure to frontline healthcare workers (HCW) and patients. The aim of this study is to evaluate the effectiveness of paper bags as a barrier for fomite transmission of SARS-CoV-2 by storing face masks, respirators, and face shields.
Methods
This quasi-experimental study evaluated the presence of SARS-CoV-2 on the interior and exterior surfaces of paper bags containing PPE that had aerosolized exposures in clinical and simulated settings. Between May and October 2020, 30 unique PPE items were collected from COVID-19 units at two urban hospitals. Exposed PPE, worn by either an infected patient or HCW during a SARS-CoV-2 aerosolizing event, were placed into an unused paper bag. Samples were tested at 30-minute and 12-hour intervals.
Results
A total of 177 swabs were processed from 30 PPE samples. We found a 6.8% positivity rate among all samples across both collection sites. Highest positivity rates were associated with ventilator disconnection and exposure to respiratory droplets from coughing. Positivity rates differed between hospital units. Total positivity rates were similar between 30-minute (6.7%) and 12-hour (6.9%) sample testing time intervals. Control samples exposed to inactivated SARS-CoV-2 droplets had higher total viral counts than samples exposed to nebulized aerosols.
Conclusions
Data suggests paper bags are not a significant fomite risk for SARS-CoV-2 transmission. However, controls demonstrated a risk with droplet exposure. Data can inform guidelines for storing and re-using PPE in situations of limited supplies during future pandemics.
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SciScore for 10.1101/2022.02.07.22270332: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: For HCWs workflow convenience, samples were collected by screening all staff in the designated department at shift change times (0700 and 1900) by four trained researchers and followed sampling methods and criteria described.
IRB: The OHSU Institutional Review Board (IRB) determined this study to be exempt for both hospital locations.
Consent: Protected patient data was not recorded, and a waiver of consent was obtained.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analysis was performed in Stata 16 (College Station, TX; StataCorp LLC). StataCorps…SciScore for 10.1101/2022.02.07.22270332: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: For HCWs workflow convenience, samples were collected by screening all staff in the designated department at shift change times (0700 and 1900) by four trained researchers and followed sampling methods and criteria described.
IRB: The OHSU Institutional Review Board (IRB) determined this study to be exempt for both hospital locations.
Consent: Protected patient data was not recorded, and a waiver of consent was obtained.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analysis was performed in Stata 16 (College Station, TX; StataCorp LLC). StataCorpsuggested: (Stata, RRID:SCR_012763)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:As the pandemic continues, and future PPE supply limitations remain precarious, the investigation on storage receptacles for the reuse of PPE is critical for protecting frontline HCWs. This is one of the first studies to examine the potential for fomite transfer of SARS-CoV-2 viral particles from PPE to storage receptacles, paper bags, for the reuse of HCW PPE. Even after high-risk exposure to AGPs, most of the samples we collected (93.2%) did not test positive for SARS-CoV-2 after either time interval. Although both community and tertiary care centers had patients with SARS-CoV-2, positive swabs were found only at the tertiary care center (paper bags and PPE). Specifically, they were found more often in locations in the COVID-19 step-down unit, 16.7% compared to 8.8% in the ICU, and 4.8% in the emergency department. Potential causes for site differences could be due to protocols on how to correctly re-use PPE, deviation from those protocols, or poor staff-to-patient ratios (in step down unit compared to ICU) whereby there is overall protocol fatigue and non-intentional relaxing of safety measures. While the abundance of virus found on tested PPE samples was low, some were positive, and such significant site differences needs further investigation as protocols could be improved to replicate optimal environments where there is low or no positivity samples. Our results demonstrate that recoverable SARS-CoV-2 RNA on exposed PPE items collected varied by procedure. The highest po...
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.
Results from scite Reference Check: We found no unreliable references.
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