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INF ECTION P R EVENTION


Tackling COVID-19 risk via hospital beds


Silver Türk PhD discusses how hospital pillows can pose a potential risk of COVID-19 transmission and how to mitigate the risk.


Microorganisms can persist on common hospital surfaces for up to several weeks or months.1


In contrast to evidence regarding


hard surfaces, relatively few studies have focused on textiles. Pillow seams and care labels that are attached by stitching to the pillow form the most significant vector for pathogens.2


When the head is lifted from


the pillow, air flows into the pillow and can contaminate the interior; when the head is laid on the pillow or is moved, air escapes the pillow and can contaminate the exterior – in effect, an aerosol generating procedure. Pathogens can contaminate both the


surface and interior of traditional pillows and mattresses. Conversely, only the surface remains accessible to pathogens if a nanoporous filter is used as a barrier that blocks the viruses but lets the air pass. The filter is necessary on a sealed pillow, since it would otherwise be unable to deflate and conform to the patient. Infectious agents can enter the traditional pillows and mattresses via vents and sewing holes, while the pillows and mattresses with nanoporous filters block such mechanisms of contamination.


What is known about coronaviruses?


While it is known that bacteria can contaminate the interior of pillows and filters can prevent this3


, there is scant information


on viral contamination. COVID-19 has shown person-to-person transmission and has higher infectivity but lower mortality compared to its close relatives SARS and MERS. The route of transmission is mainly via airborne particles but transmission from surface contamination to mucous membranes of eyes, nose and mouth should not be disregarded. Twenty-two studies have


SEPTEMBER 2020


investigated persistence of these reasonably similar coronaviruses. The viral particles can retain their infectivity on hard surfaces like metal, glass or plastic for up to nine days but can be inactivated with 70% ethanol, 50% isopropanol, 0.5% hydrogen peroxide or 0.1% bleach within one minute, while common nonionic surfactants are less effective.4


biosafety measures, including a dedicated decontamination area, should be adopted. A visual technique that can also be used for investigating contamination risks is to use smoke as a substitute for viral particles.8


What can be generalised from other studies?


Importantly, for equipment, glutaraldehyde disinfection was also effective. In typical room temperature and relative humidity, COVID-19 seems to persist on hard surfaces for days.4,5


In hospitals, the known risk factors of transmission are low air exchange, small isolation room volume and aerosol generating procedures – such as resuscitation, tracheal intubation, non-invasive ventilation, tracheotomy, manual ventilation, bed distance <1m.6


Gowns, N95 respirators, face masks, gloves, eye protection, face shields, and head and shoe coverings can be used for protection with variable results. N95 masks are considered to be more effective barriers than the surgical masks with the caveat of sideways leakage that bypasses the filter.8 It is safe to assume that careful high-level


The differences between textiles matter a lot – it is known that polio virus (inoculated with direct contact, aerosol and contaminated dust) persists at 35% relative humidity for 20 weeks on wool fabrics but only one to four weeks on cotton fabrics.9


Disinfectants


are different – the persistence of poliovirus was recalcitrant to quaternary ammonium salts while some of these compounds killed vaccinia virus.10


This antiviral activity is


probably broad as it is oxidation-mediated, and it is shown that it can inactivate HIV as well.11 Antiviral plastics have been researched – a polyurethane that can neutralise the influenza virus (but not polio virus) has been described.12


Cotton treated with 3%


sodium pentaborate pentahydrate and 0.03% triclosan reduced the viral titers by a thousand times within 72 hours in comparison to no reduction on untreated cotton.13


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