scholarly journals SARS-CoV-2 environmental contamination from hospitalised COVID-19 patients receiving aerosol generating procedures

Author(s):  
Rebecca Winslow ◽  
Jie Zhou ◽  
E F Windle ◽  
I X Nur ◽  
Ranjit Lall ◽  
...  

ABSTRACT Background. Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered "aerosol-generating procedures" (AGPs) in the treatment of COVID-19. We aimed to measure air and surface environmental contamination of SARS-CoV-2 virus when CPAP and HFNO were used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients. Methods. 30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturations ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. RT qPCR analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus. Results. Overall 21/30 (70%) of participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination. Only one nasopharyngeal sample was culture positive. Conclusions. The use of CPAP and HFNO to treat moderate/severe COVID-19 was not associated with significantly higher levels of air or surface viral contamination in the immediate care environment.

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-218035
Author(s):  
Rebecca L Winslow ◽  
Jie Zhou ◽  
Ella F Windle ◽  
Intesar Nur ◽  
Ranjit Lall ◽  
...  

BackgroundContinuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are considered ‘aerosol-generating procedures’ in the treatment of COVID-19.ObjectiveTo measure air and surface environmental contamination with SARS-CoV-2 virus when CPAP and HFNO are used, compared with supplemental oxygen, to investigate the potential risks of viral transmission to healthcare workers and patients.Methods30 hospitalised patients with COVID-19 requiring supplemental oxygen, with a fraction of inspired oxygen ≥0.4 to maintain oxygen saturation ≥94%, were prospectively enrolled into an observational environmental sampling study. Participants received either supplemental oxygen, CPAP or HFNO (n=10 in each group). A nasopharyngeal swab, three air and three surface samples were collected from each participant and the clinical environment. Real-time quantitative polymerase chain reaction analyses were performed for viral and human RNA, and positive/suspected-positive samples were cultured for the presence of biologically viable virus.ResultsOverall 21/30 (70%) participants tested positive for SARS-CoV-2 RNA in the nasopharynx. In contrast, only 4/90 (4%) and 6/90 (7%) of all air and surface samples tested positive (positive for E and ORF1a) for viral RNA respectively, although there were an additional 10 suspected-positive samples in both air and surfaces samples (positive for E or ORF1a). CPAP/HFNO use or coughing was not associated with significantly more environmental contamination than supplemental oxygen use. Only one nasopharyngeal sample was culture positive.ConclusionsThe use of CPAP and HFNO to treat moderate/severe COVID-19 did not appear to be associated with substantially higher levels of air or surface viral contamination in the immediate care environment, compared with the use of supplemental oxygen.


Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andreas Papoutsis ◽  
Thomas Borody ◽  
Siba Dolai ◽  
Jordan Daniels ◽  
Skylar Steinberg ◽  
...  

Abstract Background SARS-CoV-2 has been detected not only in respiratory secretions, but also in stool collections. Here were sought to identify SARS-CoV-2 by enrichment next-generation sequencing (NGS) from fecal samples, and to utilize whole genome analysis to characterize SARS-CoV-2 mutational variations in COVID-19 patients. Results Study participants underwent testing for SARS-CoV-2 from fecal samples by whole genome enrichment NGS (n = 14), and RT-PCR nasopharyngeal swab analysis (n = 12). The concordance of SARS-CoV-2 detection by enrichment NGS from stools with RT-PCR nasopharyngeal analysis was 100%. Unique variants were identified in four patients, with a total of 33 different mutations among those in which SARS-CoV-2 was detected by whole genome enrichment NGS. Conclusion These results highlight the potential viability of SARS-CoV-2 in feces, its ongoing mutational accumulation, and its possible role in fecal–oral transmission. This study also elucidates the advantages of SARS-CoV-2 enrichment NGS, which may be a key methodology to document complete viral eradication. Trial registration ClinicalTrials.gov, NCT04359836, Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359836?term=NCT04359836&draw=2&rank=1).


Author(s):  
Ibukun A. Sonaike ◽  
Tosin A. Bewaji ◽  
Paul Ritchey ◽  
S. Camille Peres

Background:Shape writing is relatively new technology for on-screen keyboards that enable users of mobile touch-screen devices to input text by drawing continuous lines. With growth of touch-screen device usage, there has risen the need to investigate potential risks that may occur during prolonged usage. Objective: The biomechanical strain on upper limb muscles were assessed while study-participants used Swype technology on a tablet touch screen device and compared with traditional/regular input methods. Methods: Study-participants performed typing tasks (email and text) using Swype and regular input methods under counterbalanced conditions with sEMG data collected to measure muscle activity during tasks. Results: Email & Text had the same exertion for all muscles except the Extensor. The interaction between task and muscle was significant, F (1.6, 27.5) = 15.39, p < .001, ηp2 = 0.48. The interaction between muscle, task and method was also significant, F (2.19, 37.19) = 3.6, p = 0.03, ηp2= 0.18. Exertion was lower for Swype but with marginal significance. Overall, Email resulted in less dynamic activity than Text with Main effects F(1, 17) = 10.07, p = 0.006, ηp2 = 0.37. Extensor has more dynamic activity than other muscles with main effect F(1.8, 29.9) = 16.51, p < 0.001, ηp2 = 0.49. Conclusion: Results indicate that Swype presents no more biomechanical strain than regular input for most muscles. Swype may result in less exertion for the Extensor muscles in the lower arm. This may be particularly true for tasks requiring interactions like those found in the email task.


2013 ◽  
Vol 12 (4) ◽  
pp. 224-232
Author(s):  
Gintaras Simutis ◽  
Mantas Drungilas ◽  
Pavel Petrik ◽  
Eglė Petrik ◽  
Virgilijus Beiša ◽  
...  

Background / objectiveThe study was carried out to evaluate the potential use of laparoscopic simulators to enhance basic laparoscopic skills until proficiency is reached.Materials and methodsThe study participants were divided into two groups according to their experience in laparoscopic procedures: no prior experience (group A; n = 16) and laparoscope navigation experience (group B; n = 16). All the participants performed nineattempts of three basic laparoscopic skill tasks (“Instrument navigation”, “Cutting”, “Clip applying”) on the LapSim® simulator during three sessions within one month. The distribution of practice sessions was standardized by performing three attemptsfor each task per session and no more than one session per week. The assessment of laparoscopic skills was based on the cumulative score for each task measured by the computer system.ResultsTrainees in the group A were younger (22.2 ± 1.3 vs. 26.1 ± 1.3 years, P < 0.001). There were statistically significant differences in cumulative scores for all three tasks after the first five attempts between the two groups (P < 0.001). Comparison of thecumulative scores for the task “Instrument navigation” after the sixth attempt (P = 0.073), for the task “Clip applying” after the seventh attempt (P = 0.287), and for the task “Cutting” after the eighth attempt (P = 0.080) showed no significant differences among the study groups.ConclusionsThe results indicated that a group of trainees with no prior laparoscopic experience acquired the basic laparoscopic skills significantly faster. Proficiency in the laparoscopic basic tasks was achieved within 6–8 repetitions in both groups. These findings suggest that training of practical skills in using laparoscopic simulators should be integrated into medical education much earlier.Key words: surgical education, simulation, laparoscopy, virtual reality simulator, LapSimBazinių laparoskopinių įgūdžių įgijimas studijuojant mediciną TikslasAtlikti tyrimą, siekiant įvertinti kompiuterinių laparoskopinių simuliatorių naudojimą medicinos studijoms mokant pagrindinių laparoskopinių operacijų įgūdžių, kol bus įgyta reikiama patirtis.MetodikaTyrimo dalyviai pagal patirtį buvo suskirstyti į dvi grupes: vienos grupės tiriamieji neturėjo jokios išankstinės laparoskopinių operacijų patirties (A grupė, n=16), o kitos grupės turėjo tik navigacijos laparoskopu patirties (B grupė, n=16). Visi dalyviai pertrejas pratybas su laparoskopiniu virtualiu simuliatoriumi LapSim® atliko trijų pagrindinių laparoskopinių užduočių („Instrumentų navigacija“, „Pjovimas“, „Kabučių uždėjimas“) devynis bandymus. Kiekvieną užsiėmimą atskira užduotis buvo kartojamatris kartus, o užsiėmimas vyko ne dažniau nei kartą per savaitę. Vertintas galutinis užduoties rezultatas. Laparoskopinių operacijų įgūdžiai vertinti kompiuterine sistema pagal išvestinį kaupiamąjį kiekvienos užduoties balą.RezultataiA grupės dalyviai buvo jaunesni (22,2±1,3 vs. 26,1±1,3 metų, p<0,001). Išanalizavus visų trijų užduočių kaupiamuosius balus po pirmųjų penkių bandymų, abi grupės skyrėsi statistiškai reikšmingai (p<0,001). Tyrimą tęsiant ir lyginant išvestinį kaupiamąjįbalą atliekant užduotį „Instrumentų navigacija“ po šešto bandymo (p=0,073), užduotį „Kabučių uždėjimas“ po septinto bandymo (p=0,287), užduotį „Pjovimas“ po aštunto bandymo (p = 0,080), jokių reikšmingų skirtumų tarp tiriamų grupių nerasta.IšvadosTyrimo rezultatai parodė, kad net be laparoskopinių operacijų patirties tokių operacijų pagrindinius įgūdžius laparoskopiniu simuliatoriumi įgyjama greičiau. Chirurginės simuliacijos užduočių kartojimas iki 6–8 bandymų leidžia įgyti gerus pagrindiniųlaparoskopinių operacijų įgūdžius. Šie rezultatai rodo, kad praktinių įgūdžių mokymas naudojant laparoskopinį simuliatorių turėtų būti įtrauktas į medicinos studijų programą.Reikšminiai žodžiai: chirurgijos studijos, simuliacija, laparoskopija, virtualios realybės simuliatorius, LapSim.


2016 ◽  
Vol 283 (1834) ◽  
pp. 20160390 ◽  
Author(s):  
T. Alex Perkins ◽  
Valerie A. Paz-Soldan ◽  
Steven T. Stoddard ◽  
Amy C. Morrison ◽  
Brett M. Forshey ◽  
...  

Pathogens inflict a wide variety of disease manifestations on their hosts, yet the impacts of disease on the behaviour of infected hosts are rarely studied empirically and are seldom accounted for in mathematical models of transmission dynamics. We explored the potential impacts of one of the most common disease manifestations, fever, on a key determinant of pathogen transmission, host mobility, in residents of the Amazonian city of Iquitos, Peru. We did so by comparing two groups of febrile individuals (dengue-positive and dengue-negative) with an afebrile control group. A retrospective, semi-structured interview allowed us to quantify multiple aspects of mobility during the two-week period preceding each interview. We fitted nested models of each aspect of mobility to data from interviews and compared models using likelihood ratio tests to determine whether there were statistically distinguishable differences in mobility attributable to fever or its aetiology. Compared with afebrile individuals, febrile study participants spent more time at home, visited fewer locations, and, in some cases, visited locations closer to home and spent less time at certain types of locations. These multifaceted impacts are consistent with the possibility that disease-mediated changes in host mobility generate dynamic and complex changes in host contact network structure.


Author(s):  
Erik A Jensen ◽  
Huayan Zhang ◽  
Rui Feng ◽  
Kevin Dysart ◽  
Kathleen Nilan ◽  
...  

ObjectiveCompare rates of hypoxaemia during transpyloric and gastric feedings in very preterm infants with severe bronchopulmonary dysplasia.DesignN-of-1 multiple crossover trials with individual patient and pooled data analyses.SettingLevel IV intensive care nursery.PatientsInfants receiving positive airway pressure between 36 and 55 weeks postmenstrual age were enrolled between December 2014–July 2016.InterventionN-of-1 trial consisting of two blocks, each with a 4-day gastric and 4-day transpyloric feeding period assigned in random order.Main outcome measuresThe primary outcome was the frequency of daily intermittent hypoxaemic events (SpO2 ≤80% lasting 10–180 s). Secondary outcomes included the daily proportion of time with an SpO2 ≤80% and mean daily fraction of inspired oxygen.ResultsOf 15 infants, 13 completed the trial and 2 stopped early for transient worsening in respiratory status during gastric feedings. In the intention-to-treat analyses, transpyloric feedings resulted in increased rates of intermittent hypoxaemia in five infants, greater time per day in hypoxaemia in three infants and more supplemental oxygen use in three infants. One infant received more supplemental oxygen during gastric feedings. The remaining study outcomes were similar between the feeding routes in all other infants. Pooling all data, transpyloric feedings resulted in a higher frequency of intermittent hypoxaemic events (median 7.5/day (IQR 1–23.5) vs 3/day (1–11); adjusted incidence rate ratio 1.8, 95% CI 1.3 to 2.5) and a greater proportion of daily hypoxaemia time (median 0.8% (IQR 0.1–2.3) vs 0.4% (0.07–1.8); adjusted mean difference 1.6, 95% CI 1.1 to 2.5).ConclusionsTranspyloric compared with gastric feedings modestly increased rates of hypoxaemia among study participants.Trial registration numberNCT02142621


2018 ◽  
Vol 20 (2) ◽  
pp. 66-74 ◽  
Author(s):  
John Gammon ◽  
Julian Hunt

Hand hygiene is a fundamental strategy for controlling the spread of infection. Careful hand drying is integral to the process of hand hygiene, which aims to optimise the removal of potentially pathogenic microorganisms. Ineffective hand drying results in wet hands that are an infection risk increasing the potential for cross-infection, occupational contact dermatitis for healthcare practitioners, harm to patients and environmental contamination. Evidence indicates that there has been limited research regarding the significance of hand drying and the efficacy and clinical impact of different drying methods. The purpose of this review paper was to scope and evaluate the existing literature pertaining to hand drying; to examine the clinical consequences associated with wet hands for patients, healthcare practitioners and the clinical environment; to assess the efficacy of different drying methods; to consider the impact on patient safety; and to progress the research, debate and practice relating to hand drying. The methodological framework applied in this review was that of Arksey and O’Malley (2007). Twenty-one papers identified from 112 abstracts screened were included in the review. Analysis identified three primary themes emerging from the literature: (1) efficacy of hand drying methods; (2) drying method and microbial translocation, dispersion and environmental contamination; and (3) drying methods and environmental sustainability. This review highlights the equal importance of hand drying in the process of hand hygiene and suggests that the efficacy of hand drying is a critical factor in the prevention of the transfer of microorganisms to the environment, and from person to person following hand washing. In conclusion, this paper argues that greater attention needs to be given to hand drying in terms of practice, policy and research and its importance in clinical settings given greater focus.


2018 ◽  
Vol 59 (3) ◽  
pp. 1-8
Author(s):  
Elly Morros González ◽  
Diana Estrada Cano ◽  
Marcela Murillo Galvis ◽  
Jos Carlos Montes Correa ◽  
Nelcy Rodríguez Malagón ◽  
...  

Introduction: Supplemental oxygen is considered a pharmaceutical drug; therefore, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and the peripheral oxygen saturation (SpO2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpO2 goals and reading of oxygen flowmeters among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied survey between December 2016 and January 2017. The poll evaluated topics on supplemental oxygen therapy fundamentals and adverse effects, SpO2 goals and flowmeter readings through flowmeters photographs indicating a specific fraction of inspired oxygen (FiO2). Results: The response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% of participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplemental oxygen concentration greater than required. In neonatal population, 10% considered oxygen saturation goals equal to or greater than 96%. In the flowmeter’s reading evaluation, incorrect answers ranged from 9 to 19%. Conclusion: It is imperative to reinforce updated concepts on oxygen therapy, with emphasis in SpO2 goals, adverse effects and appropriate flowmeter’s readings through periodic educational campaigns.


2019 ◽  
Vol 85 (2) ◽  
pp. 162-166
Author(s):  
Jessica Rabbany ◽  
Teresa Kim ◽  
Sharon Koh ◽  
Karen Zaghiyan ◽  
Phillip Fleshner

The ideal incision for specimen extraction during laparoscopic colorectal surgery is controversial. The objective of this study was to compare incision types (Pfannenstiel, periumbilical, lower midline, and right upper quadrant transverse) with regard to postoperative scar appearance, symptoms, preference, and satisfaction. This study is a retrospective survey review performed in an urban teaching hospital. The study participants were patients undergoing multiport laparoscopic colorectal surgery. Two web-based questionnaires, the Patient Scar Assessment Questionnaire and Photo-Series Questionnaire, were used to assess study parameters. The main outcome measures were incision symptoms and cosmetic satisfaction. The 112 study patients included 54 patients with a Pfannenstiel incision (Group P) and 58 patients with an alternate incision (Group A). Of the 58 patients in Group A, 19 (33%) had a periumbilical incision, 10 (17%) a lower midline incision, and 29 (50%) a right upper quadrant transverse incision. Although Groups P and Awere comparable in all five subscales of the Patient Scar Assessment Questionnaire, more Group P participants (n = 12; 22%) said their incision felt “fairly numb” than Group A participants (n = 2; 3%) (P = 0.008). There was no significant difference between study groups in all Photo-Series Questionnaire domains; however, after comparing patients’ own incisions with photographs of various alternative incisions, 36 (62%) Group A patients would choose an alternative incision compared with only 11 (19%) Group P patients (P = 0.001). Selection bias, recall bias, external validity, and variability of scar lengths were the limitations of the study. It was concluded that although a Pfannenstiel incision seems to be the optimal cosmetic choice, it is associated with a higher incidence of wound numbness than alternate extraction incisions.


Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 399-407 ◽  
Author(s):  
Jose Luis Rodriguez-Garcia ◽  
Gines Sanchez-Nievas ◽  
Juan Arevalo-Serrano ◽  
Cristina Garcia-Gomez ◽  
Jose Maria Jimenez-Vizuete ◽  
...  

Abstract Objectives The Janus kinase (JAK) inhibitor baricitinib may block viral entry into pneumocytes and prevent cytokine storm in patients with SARS-CoV-2 pneumonia. We aimed to assess whether baricitinib improved pulmonary function in patients treated with high-dose corticosteroids for moderate to severe SARS-CoV-2 pneumonia. Methods This observational study enrolled patients with moderate to severe SARS-CoV-2 pneumonia [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) &lt;200 mmHg] who received lopinavir/ritonavir and HCQ plus either corticosteroids (CS group, n = 50) or corticosteroids and baricitinib (BCT-CS group, n = 62). The primary end point was the change in oxygen saturation as measured by pulse oximetry (SpO2)/FiO2 from hospitalization to discharge. Secondary end points included the proportion of patients requiring supplemental oxygen at discharge and 1 month later. Statistics were adjusted by the inverse propensity score weighting (IPSW). Results A greater improvement in SpO2/FiO2 from hospitalization to discharge was observed in the BCT-CS vs CS group (mean differences adjusted for IPSW, 49; 95% CI: 22, 77; P &lt; 0.001). A higher proportion of patients required supplemental oxygen both at discharge (62.0% vs 25.8%; reduction of the risk by 82%, OR adjusted for IPSW, 0.18; 95% CI: 0.08, 0.43; P &lt; 0.001) and 1 month later (28.0% vs 12.9%, reduction of the risk by 69%, OR adjusted for IPSW, 0.31; 95% CI: 0.11, 0.86; P = 0.024) in the CS vs BCT-CS group. Conclusions . In patients with moderate to severe SARS-CoV-2 pneumonia a combination of baricitinib with corticosteroids was associated with greater improvement in pulmonary function when compared with corticosteroids alone. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance, ENCEPP (EUPAS34966, http://www.encepp.eu/encepp/viewResource.htm? id = 34967)


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