key: cord-282272-wy8do2z6
authors: Nelson, Atiba; Kassimatis, Jennifer; Estoque, Jay; Yang, Cicely; McKee, Geoff; Bryce, Elizabeth; Hoang, Linda; Daly, Patricia; Lysyshyn, Mark; Hayden, Althea S.; Harding, John; Boraston, Suni; Dawar, Meena; Schwandt, Michael
title: Environmental Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from Medical Equipment in Long-Term Care Facilities undergoing COVID-19 Outbreaks
date: 2020-07-06
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2020.07.001
sha: 
doc_id: 282272
cord_uid: wy8do2z6

We conducted environmental sampling at long-term care facilities to determine the extent of surface contamination with SARS-CoV-2 virus. Medical equipment used throughout the facility was determined to be contaminated.

Outbreaks Abstract:

We conducted environmental sampling at long-term care facilities to determine the extent of surface contamination with SARS-CoV-2 virus. Medical equipment used throughout the facility was determined to be contaminated.

Keywords: SARS-CoV-2, COVID-19, Long-term Care, Infection Control, Environmental sampling Background:

SARS-CoV-2 outbreaks in community long-term care facilities have primarily been linked to person-to-person transmission; however, despite implementation of enhanced infection control measures limiting person-to-person transmission potential, many long-term care facilities continue to report new cases and outbreaks. 1 Environmental contamination with SARS-CoV-2 virus has been hypothesized to propagate spread; however, the extent to which environmental contamination occurs in long-term care settings has yet to be fully understood. 2, 3 We conducted environmental sampling to assess the extent of surface contamination with SARS-CoV-2 virus within long-term care facilities with declared COVID-19 outbreaks.

We assessed surface SARS-CoV-2 contamination at three licensed long-term care facilities with declared COVID-19 outbreaks within a Canadian metropolitan city. Each longterm care facility services over 150 residents and provides room and board, management of medical conditions and assistance with activities of daily living. 4 Environmental samples were collected from high-touch surfaces, communal sites, and mobile medical equipment at various sites in each of the three facilities. Sampling sites were selected based on the distribution of COVID-19 cases within the facility, areas common to case clusters, and the advice of an infection prevention and control specialist. Patient rooms and patient bathrooms were excluded from sampling, as the presence of SARS-CoV-2 in the personal areas of patients diagnosed with COVID-19 was expected. 

Overall 89 sites were sampled. Table 1 details the sites sampled at each facility. Sampled sites included 20 (22·5%) sites in staff communal areas, and 60 (67·4%) sites in care provision areas; for example, nursing stations, and related medical equipment. Seven sites (7·9%) in an institutional kitchen were also sampled, as well as 2 sites (2·2%) at a main entrance of a facility.

Eighty-four (94·3%) of the 89 sites were negative for both SARS-CoV-2 virus targets.

Six (6·7%) sites tested positive or indeterminate for the SARS-CoV-2 virus: two from each of the three facilities. The six sites with detected SARS-CoV-2 included the bladder of a normal adult size, reusable blood pressure cuff (E gene cycle threshold: 39·18) (Image 1) and the bladder of the large adult size, reusable blood pressure cuff (38·6) (Image 2) in facility one (Table 1) ; the touch fastening strap of a reusable blood pressure cuff (38·65) (Image 3) and the handle of a mobile linen cart (38·54) (Image 4) in facility two (Table 1) ; the bladder of a reusable blood pressure cuff (37·38) (Image 5) and the touch display of an electronic medication administration record (MAR) tablet (38·48) (Image 6) in facility three ( Table 1) .

The lowest cycle time for a sample with SARS-CoV-2 detected was from the bladder of the blood pressure cuff in facility three (37·38).

Four (44%) of 9 environmental samples taken from blood pressure cuffs contained detectable levels of SARS-CoV-2 viral RNA.

Environmental contamination with SARS-CoV-2 virus was detected at each of three COVID-19 outbreak facilities sampled in this study, including surfaces of five frequently used medical devices transferred between patient rooms, and one high-touch surface used by care staff This study contains limitations. The swabs used were not validated for environmental sampling, and the sensitivity of their use for the novel virus SARS-CoV-2 is not known.

Additionally, all samples with viral RNA detected recorded a CT value greater than 24, a level at which the detected virus may not be infectious in the context of a human nasopharyngeal sample infecting Vero cell lines. 7 However, although the cycle threshold values for these six samples were above an observed threshold for SARS-CoV-2 Vero cell infectivity, infectious levels of the virus may have been present before an environmental sample was taken.

Future studies focusing on environmental contamination with SARS-CoV-2 are required to confirm these results and explore other mechanisms of environmental transmission in the long-term care environment. Given the ubiquity of blood pressure cuffs throughout acute and community healthcare settings, further research should also explore their role as fomites for SARS-CoV-2 transmission.

Our findings suggest medical equipment is a potential environmental route for transmission of SARS-CoV-2 virus in long-term care facilities. As such, enhanced environmental cleaning for all medical equipment or prohibiting communal use is recommended. 

Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility

Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient

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