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Understanding how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is spread within the hospital setting is essential if staff are to be adequately protected, effective infection control measures are to be implemented and nosocomial transmission is to be prevented.
The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalised patients, with and without respiratory symptoms, was investigated. Environmental sampling was carried out within eight hospitals in England during the first wave of the COVID-19 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (RT-PCR) and virus isolation assays.
SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Ct values ranged from 28.8 to 39.1 equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken < 1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from < 10 to 460 genomic copies per m3 of air. Infectious virus was not recovered from any of the PCR positive samples analysed.
Effective cleaning can reduce the risk of fomite (contact) transmission but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific PPE ensembles for aerosol and non-aerosol generating procedures.
The ability to model the dispersion of pathogens in exhaled breath is important for characterizing transmission of the SARS‐CoV‐2 virus and other respiratory pathogens. A Computational Fluid Dynamics (CFD) model of droplet and aerosol emission during exhalations has been developed and for the first time compared directly with experimental data for the dispersion of respiratory and oral bacteria from ten subjects coughing, speaking, and singing in a small unventilated room. The modeled exhalations consist of a warm, humid, gaseous carrier flow and droplets represented by a discrete Lagrangian particle phase which incorporates saliva composition. The simulations and experiments both showed greater deposition of bacteria within 1 m of the subject, and the potential for a substantial number of bacteria to remain airborne, with no clear difference in airborne concentration of small bioaerosols (<10 μm diameter) between 1 and 2 m. The agreement between the model and the experimental data for bacterial deposition directly in front of the subjects was encouraging given the uncertainties in model input parameters and the inherent variability within and between subjects. The ability to predict airborne microbial dispersion and deposition gives confidence in the ability to model the consequences of an exhalation and hence the airborne transmission of respiratory pathogens such as SARS‐CoV‐2.
Colorectal is the third most common cancer in the UK and even when successfully treated, its effects on the patient can be complex and life-changing. Claire Taylor and Helen Rickard discuss how to manage them All patients face consequences as a result of being diagnosed and treated for cancer. These can include physical, emotional, social and/or financial factors which can occur both acutely and in the longer-term. This article focuses on the common consequences of being treated for colorectal cancer and suggests some ways these concerns can be managed holistically and effectively in general practice. In doing so, nursing can play an important role in helping individuals to live well with, and beyond, cancer.
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