Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Patient Transport Van

Jones, Lucas D.; Chan, E. Ricky; Zabarsky, Trina F.; Cadnum, Jennifer L.; Navas, Maria E.; Redmond, Sarah; Kovach, Jeffrey D.; Linger, Marlin; Rutala, William A.; Zimmerman, Peter A.; Donskey, Curtis J.

doi:10.1093/cid/ciab347

Cited by 23 publications

(26 citation statements)

References 9 publications

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“…Frequent hand hygiene should be emphasized for patients with suspected or confirmed COVID-19. Because pre-symptomatic patients contribute substantially to transmission of SARS-CoV-2, [6][7] hand hygiene is also essential in the absence of symptoms. Educational interventions can increase hand hygiene in hospitalized patients and long-term care facility residents.…”

mentioning

confidence: 99%

Frequent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on hands and skin of patients with coronavirus disease 2019 (COVID-19)

Redmond

Haq

et al. 2021

Infect. Control Hosp. Epidemiol.

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mentioning

confidence: 99%

Frequent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on hands and skin of patients with coronavirus disease 2019 (COVID-19)

Redmond

Haq

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…Whole-genome sequencing studies have confirmed transmission both to and from patients and healthcare workers despite one or both wearing surgical masks. 47 50 53 63 64…”

Section: Mechanisms Of Transmissionmentioning

confidence: 99%

“…57 62 In practice, this is sufficient to substantially lower infection rates, 105 106 but breakthrough transmissions despite medical or surgical masks have been well documented, in many instances using whole-genome sequencing to confirm transmission links. 47 50 53 63 90…”

Section: Maskingmentioning

confidence: 99%

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

Klompas

2022

Semin Respir Crit Care Med

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A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.

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“…Travel poses a substantial risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses because people are often required to be in close proximity for prolonged periods [1][2][3][4]. Transmission of SARS-CoV-2 has been reported on airplanes, with most secondary cases occurring in passengers sitting within a few rows of the source patient [5].…”

Section: Introductionmentioning

confidence: 99%

“…Other situations that might place travelers at risk include crowded settings inside airports, using public transportation, staying in hotels, and eating in restaurants. Inadequate ventilation in these indoor spaces increases the risk for airborne transmission of respiratory viruses [1][2][3]. However, limited information is available on the adequacy of ventilation in many areas encountered during travel.…”

Section: Introductionmentioning

confidence: 99%

Planes, Trains, and Automobiles: Use of Carbon Dioxide Monitoring to Assess Ventilation During Travel

Cadnum

Alhmidi

Donskey

2022

PAI

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Background: Travel poses a risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. Poorly ventilated indoor settings pose a particularly high risk for transmission. Methods: We used carbon dioxide measurements to assess adequacy of ventilation during 5 trips that included air travel. During selected parts of each trip that involved indoor settings, we monitored carbon dioxide levels every 1 minute and recorded peak levels and the number of people present. Carbon dioxide readings above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation. Results: Carbon dioxide levels remained below 800 ppm during train rides to and from the airport and inside airports except in a crowded boarding area with ~300 people present. Carbon dioxide levels exceeded 800 ppm inside the airplanes, but the air was filtered with high efficiency particulate air filters. Carbon dioxide levels remained below 800 ppm in common areas of a hotel but exceeded 800 ppm in a hotel room with 2 to 3 occupants and in a fitness center with 3 people exercising. In restaurants, carbon dioxide levels increased above 800 ppm during crowded conditions with 24 or more people present and 75% or more seat occupancy. Conclusion: Our results suggest that ventilation may be sufficient to minimize the risk for airborne transmission in many situations during travel. However, ventilation may be suboptimal in some areas or under certain conditions such as in hotel rooms or when restaurants, fitness centers, or airplane boarding areas are crowded. There is a need for larger scale studies to assess the quality of ventilation in a wide range of community settings.

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Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Patient Transport Van

Cited by 23 publications

References 9 publications

Frequent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on hands and skin of patients with coronavirus disease 2019 (COVID-19)

Frequent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on hands and skin of patients with coronavirus disease 2019 (COVID-19)

New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses

Planes, Trains, and Automobiles: Use of Carbon Dioxide Monitoring to Assess Ventilation During Travel

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