Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

• Published in: Infection control and hospital epidemiology Vol. 42; no. 6; pp. 669 - 677
• Main Authors: Ong, Sean Wei Xiang, Lee, Pei Hua, Tan, Yian Kim, Ling, Li Min, Ho, Benjamin Choon Heng, Ng, Ching Ging, Wang, Dong Ling, Tan, Boon Huan, Leo, Yee-Sin, Ng, Oon-Tek, Wong, Michelle Su Yen, Marimuthu, Kalisvar
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.06.2021
• Subjects: Aerosols; Cell culture; Contamination; Coronaviruses; COVID-19; Disease transmission; Environmental risk; Epidemics; Hospitals; Illnesses; Infections; Infectious diseases; Intensive care; Intubation; Literature reviews; Observational studies; Original; Patients; Polymerase chain reaction; Severe acute respiratory syndrome coronavirus 2; Thermal cycling; Ventilators; Singapore
• DOI: 10.1017/ice.2020.1278
• ISSN: 0899-823X; 1559-6834

The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities. In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards. In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture. Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.