COVE R S TORY
Environmental cleaning in the COVID-19 era
Thomas OH, Ph.D, Medical & Scientific Affairs for Asia Pacific (Schülke & Mayr), discusses effective cleaning strategies in healthcare environments, to prevent transmission of COVID-19 infection.
The number of COVID-19 cases in the United Kingdom continue to rise on a daily basis, with a consequent growth in the numbers of hospitalised patients infected with the virus. The current pandemic situation may soon be compounded by the annual peak season of influenza. Hospitals are at the forefront of COVID-19 care and will need an array of infection prevention and control measures to help stem a likely rise in nosocomial infections. The nosocomial infection rate in a major London teaching hospital was around 15% during the peak of the COVID-19 outbreak, with a case fatality rate of 36% for this cohort.1 Infection prevention measures include meticulous hand hygiene, effective use of personal protective equipment (PPE) and scrupulous environmental cleaning. This article examines some of the currently understood characteristics of SARS-CoV-2, the virus that causes COVID-19, and focuses on the relevance that environmental cleaning can play in virus containment. SARS-CoV-2 is highly contagious. Recent studies show that virus shedding from the upper respiratory tract of infected patients is extremely high particularly in the early stages of disease progression.2
The transmission
of SARS-CoV-2 mainly occurs through close contact with an infected person, by direct exposure to infectious viral particles from coughing, sneezing, breathing in droplets, or airborne particles, or indirectly from touching
contaminated surfaces.3 If viral particles are aerosolised during care, they can potentially travel from an infected person and lead to viral contamination elsewhere in the environment, potentially travelling up to ten metres indoors.4 Moreover, SARS-CoV-2 can remain viable in suspended aerosols for up to three hours.5 The virus has been detected in blood, cerebrospinal fluid, pericardial fluid, pleural fluid, placental tissue, urine, semen, saliva, tears, and conjunctival secretions.6 Viral shedding in stool samples has also been confirmed.7
Advice from Public
Health England is that apart from sweat, all secretions from people with known or suspected COVID-19, should be regarded as potentially infectious.8
An additional complication in the management of COVID-19 is that not all those who are infected with the virus display symptoms. Some patients are pre-symptomatic for a period of time and others remain asymptomatic throughout the course of the infection. Data obtained from the COVID microcosm provided by the Diamond Princess cruise ship, has helped build an understanding of asymptomatic viral transmission.
The ship was quarantined in Japan with 3711 people on board, when a high number of cases of COVID-19 were recorded. 712 of the crew and passengers (19.2%) had positive test results for SARS-CoV-2 and of
What have we learnt
from the pandemic? Blood clot prevention in COVID patients Plasma viscosity: a vital monitoring role
W W W. C L I N I C A LS E R VI C E S JO U R N A L . C O M
these, 331 (46.5%) were asymptomatic at the time of testing. Available statistical models of the Diamond Princess outbreak suggest that 17.9% of infected people never developed any COVID-19 symptoms.9 Viruses can survive on environmental
surfaces for an extended period of time and transmission via an individual touching a contaminated surface has been shown to be possible, based on the understanding of other highly transmissible respiratory diseases, such as influenza.10
This means
the risk of contracting the virus and becoming infected through touching contaminated surfaces is high. This is supported by a recent report on the persistence of various coronaviruses on different surfaces ranging from 2 hours to 9 days.11 The SARS-CoV-2 virus has been found to be more stable on plastic and stainless steel (up to 72 hours) compared with copper (up to 4 hours) and cardboard (up to 24 hours).5 In healthcare settings, the virus has been detected in the air and on surfaces including floors, rubbish bins, handrails and
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WWW.CLINICALSERVICESJOURNAL.COM OCTOBER 2020 OCTOBER 2020 THE CLINICAL SERVICES JOURNAL
COVID-19 REPORT
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