新冠肺炎可能因環境汙染的傳播途徑導致院內感染,新加坡Marimuthu博士團隊研究結果指出,新冠肺炎病例顯著藉由飛沫或糞便的傳播途徑,導致院內環境汙染而傳播COVID-19病毒。因此在照護新冠肺炎病例時,要格外注意手部清潔與環境衛生的必要性。

(財團法人國家衛生研究院 蔡慧如博士摘要整理)

Coronaviruses have been implicated in nosocomial outbreaks1 with environmental contamination as a route of transmission.2 Similarly, nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported.3 However, the mode of transmission and extent of environmental contamination are unknown.

 
Methods

From January 24 to February 4, 2020, 3 patients at the dedicated SARS-CoV-2 outbreak center in Singapore in airborne infection isolation rooms (12 air exchanges per hour) with anterooms and bathrooms had surface environmental samples taken at 26 sites. Personal protective equipment (PPE) samples from study physicians exiting the patient rooms also were collected. Sterile premoistened swabs were used.

Air sampling was done on 2 days using SKC Universal pumps (with 37-mm filter cassettes and 0.3-μm polytetrafluoroethylene filters for 4 hours at 5 L/min) in the room and anteroom and a Sartorius MD8 microbiological sampler (with gelatin membrane filter for 15 minutes at 6 m3/h) outside the room (eFigure in the Supplement).

Specific real-time reverse transcriptase–polymerase chain reaction (RT-PCR) targeting RNA-dependent RNA polymerase and E genes4 was used to detect the presence of SARS-CoV-2 (see detailed methods in the eAppendix in the Supplement). Cycle threshold values, ie, number of cycles required for the fluorescent signal to cross the threshold in RT-PCR, quantified viral load, with lower values indicating higher viral load.

Samples were collected on 5 days over a 2-week period. One patient’s room was sampled before routine cleaning and 2 patients’ rooms after routine cleaning. Twice-daily cleaning of high-touch areas was done using 5000 ppm of sodium dichloroisocyanurate. The floor was cleaned daily using 1000 ppm of sodium dichloroisocyanurate.

Clinical data (symptoms, day of illness, and RT-PCR results) and timing of cleaning were collected and correlated with sampling results. Percentage positivity was calculated for rooms with positive environmental swabs. Institutional review board approval and written informed consent were obtained as part of a larger multicenter study.

Author:Sean Wei Xiang Ong, Yian Kim Tan, Po Ying Chia, et al.
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2762692