Cleaning COVID-Tainted Hospital Rooms: Proceed With Contact Precaution

August 11, 2020

Investigators found SARS-CoV-2 "on various hospital objects, and these surfaces can be sources of nosocomial transmission via direct contact. Therefore, our findings provide an important basis for justification of strict contact precaution.”

Hospital rooms treating patients with, or suspected of having, coronavirus disease 2019 (COVID-19), need to be handled with special care when it comes to cleaning and disinfecting. That’s not much debated these days, and a recent study in the American Journal of Infection Control reinforces the importance of strict contact precaution, routine cleaning, and disinfection when it comes to surfaces in those rooms.

Education about infection prevention and maintaining adequate supplies of personal protective equipment (PPE)—two areas of focus for infection preventionists—also plays a part, according to investigators with the Gyeongsang National University Changwon Hospital, Changwon, in South Korea, who conducted the study.

For instance, they note that the standard cleaning procedures include using solutions made up of 0.1% hypochlorite. “However, due to the shortage of personal protective equipment (PPE) and vague fears of cleaners, room cleaning, and disinfection were not performed every day,” the study states.

The data come from 13 patients with COVID-19 who were admitted to two hospitals in South Korea in March. The hospitals are identified as Hospital A and B. Hospital A had 5 patients, 2 of whom with severe pneumonia and who needed oxygen, were sent to negative pressure rooms off of the intensive care unit (ICU). The other 3 patients were admitted to negative pressure rooms in the isolation ward.

Meanwhile, in Hospital B, 8 asymptomatic patients were admitted to 2 common 4-bed rooms without negative pressure or ventilation systems. The beds were placed in the four corners of the room and divided by curtains.

“Environmental samples were collected from each patient’s room and ancillary spaces, such as the anteroom, adjacent common corridor, and nursing station,” the study states. “Dacron swabs premoistened with viral transport medium … were used to swab environmental surfaces aseptically.”

The surfaces tested included: patient monitor, ventilator monitor, blood pressure cuff, pillow, suction bottle and line, infusion pump, fluid stand, door button or knob, bedside rail, head and foot of the bed, nurse call controller, lower part of the window frame, top of the television, air exhaust damper, wall and floor of the room, toilet paper holder, and inside and seat of the toilet. Surfaces in anterooms were also tested, such as door buttons, computer keyboard and mouse, and the floor. The nurse station surfaces were tested as well (counter, interphone, keyboard, computer mouse, chair, and floor).

“In Hospital A, SARS-CoV-2 was detected in 10 of 57 (17.5%) samples from inside the rooms including the Ambu bag and infusion pump,” the study states. “Two samples obtained at more than 2 m from the patients showed positive results. In Hospital B, 3 of 22 (13.6%) samples from inside the rooms were positive. Areas outside the rooms, such as the anteroom, corridor, and nursing station, were all negative in both hospitals.”

The investigators conclude: “Our results clearly show environmental contamination of the COVID-19 patients’ surroundings by SARS-CoV-2. Indeed, viruses have been found on various hospital objects, and these surfaces can be sources of nosocomial transmission via direct contact. Therefore, our findings provide an important basis for justification of strict contact precaution.”