Healthcare-acquired clusters of COVID-19 across multiple wards in a Scottish health board

Dancer, Stephanie J.; Cormack, Kylie; Loh, Miranda; Coulombe, C.; Thomas, Linda; Pravinkumar, S. J.; Kasengele, K.; King, Marco‐Felipe; Keaney, John F.

doi:10.1016/j.jhin.2021.11.019

Cited by 8 publications

(10 citation statements)

References 30 publications

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“…Current hospital architectural standards stipulate a minimum of 6 air changes per hour in clinical spaces, more in procedural and operative areas. This is considerably more air changes compared to the estimates associated with well-documented superspreading events in hospitals, nursing homes, hospices, restaurants, and churches [14,15,61–65]. Higher air changes are associated with less recovery of SARS-CoV-2 from the air in hospitalized patients’ rooms, faster clearance of respiratory aerosols, and less viral exposure for healthcare personnel [66 ▪▪ ,67,68].…”

Section: Structural Approaches To Preventionmentioning

confidence: 97%

Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts

Rhee

Baker

2022

Current Opinion in Infectious Diseases

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Purpose of review COVID-19 has catalyzed a wealth of new data on the science of respiratory pathogen transmission and revealed opportunities to enhance infection prevention practices in healthcare settings. Recent findingsNew data refute the traditional division between droplet vs airborne transmission and clarify the central role of aerosols in spreading all respiratory viruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), even in the absence of so-called 'aerosol-generating procedures' (AGPs). Indeed, most AGPs generate fewer aerosols than talking, labored breathing, or coughing. Risk factors for transmission include high viral loads, symptoms, proximity, prolonged exposure, lack of masking, and poor ventilation. Testing all patients on admission and thereafter can identify early occult infections and prevent hospital-based clusters. Additional prevention strategies include universal masking, encouraging universal vaccination, preferential use of N95 respirators when community rates are high, improving native ventilation, utilizing portable high-efficiency particulate air filters when ventilation is limited, and minimizing room sharing when possible. SummaryMultifaceted infection prevention programs that include universal testing, masking, vaccination, and enhanced ventilation can minimize nosocomial SARS-CoV-2 infections in patients and workplace infections in healthcare personnel. Extending these insights to other respiratory viruses may further increase the safety of healthcare and ready hospitals for novel respiratory viruses that may emerge in the future.

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Section: Structural Approaches To Preventionmentioning

confidence: 97%

Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts

Rhee

Baker

2022

Current Opinion in Infectious Diseases

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“…For a detailed description of the number of references at each stage, see the Prisma flowchart in figure 1. Overall, the 19 studies included here provide evidence for the effectiveness (or ineffectiveness) of the following NPIs: ventilation (n = 12) [10][11][12][13][14][15][16][17][18][19][20][21]; air filtration/air cleaning devices (n = 4) [17,[26][27][28]; surface disinfection (n = 5) [20][21][22][23][24]; room occupancy (n = 6) [11,12,16,[24][25][26]; and screens/barriers (n = 1) [17]. No evidence was found on the use of CO 2 monitoring or one-way systems in reducing transmission.…”

Section: Resultsmentioning

confidence: 99%

“…Unclear association : Three (of 12) studies considered ventilation in combination with a range of other NPIs (Li et al [10] Dancer et al [19] and Feathers et al [18]) and do not enable one to determine the effect of ventilation alone, although they provide an understanding of how different NPIs can work together to affect transmission. Li et al [10] found that in a residential setting increased ventilation (measured using normalCO2 tracer decay) in combination with lower adherence to masking (adherence qualitatively assessed) was associated with increased transmission.…”

Section: Resultsmentioning

confidence: 99%

Non-pharmaceutical interventions for COVID-19: a systematic review on environmental control measures

Madhusudanan,

Iddon,

Cevik

et al. 2023

Phil. Trans. R. Soc. A.

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The purpose of this review was to identify the effectiveness of environmental control (EC) non-pharmaceutical interventions (NPIs) in reducing transmission of SARS-CoV-2 through conducting a systematic review. EC NPIs considered in this review are room ventilation, air filtration/cleaning, room occupancy, surface disinfection, barrier devices, CO 2 monitoring and one-way-systems. Systematic searches of databases from Web of Science, Medline, EMBASE, preprint servers MedRxiv and BioRxiv were conducted in order to identify studies reported between 1 January 2020 and 1 December 2022. All articles reporting on the effectiveness of ventilation, air filtration/cleaning, room occupancy, surface disinfection, barrier devices, CO 2 monitoring and one-way systems in reducing transmission of SARS-CoV-2 were retrieved and screened. In total, 13 971 articles were identified for screening. The initial title and abstract screening identified 1328 articles for full text review. Overall, 19 references provided evidence for the effectiveness of NPIs: 12 reported on ventilation, 4 on air cleaning devices, 5 on surface disinfection, 6 on room occupancy and 1 on screens/barriers. No studies were found that considered the effectiveness of CO 2 monitoring or the implementation of one-way systems. Many of these studies were assessed to have critical risk of bias in at least one domain, largely due to confounding factors that could have affected the measured outcomes. As a result, there is low confidence in the findings. Evidence suggests that EC NPIs of ventilation, air cleaning devices and reduction in room-occupancy may have a role in reducing transmission in certain settings. However, the evidence was usually of low or very low quality and certainty, and hence the level of confidence ascribed to this conclusion is low. Based on the evidence found, it was not possible to draw any specific conclusions regarding the effectiveness of surface disinfection and the use of barrier devices. From these results, we further conclude that community agreed standards for well-designed epidemiological studies with low risk of bias are needed. Implementation of such standards would enable more confident assessment in the future of the effectiveness of EC NPIs in reducing transmission of SARS-CoV-2 and other pathogens in real-world settings. This article is part of the theme issue ‘The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence’.

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“… 8 Regular opening of windows was instituted as an intervention in January 2021, given that most of the ward bedrooms relied on natural ventilation, but compliance was not formally audited. 10 Air extract for most rooms occurred through the ensuite toilet rather than within the room itself, which was often the only area where there was mechanical ventilation. The corridors have supplied filtered air resulting in positive pressure with respect to the wards.…”

Section: Discussionmentioning

confidence: 99%

Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals

Loh

Yaxley²,

Moore³

et al. 2023

Journal of Hospital Infection

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Healthcare-acquired clusters of COVID-19 across multiple wards in a Scottish health board

Cited by 8 publications

References 30 publications

Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts

Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts

Non-pharmaceutical interventions for COVID-19: a systematic review on environmental control measures

Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals

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