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When a new virus is running rampant across the world, gaining a better understanding of its mechanisms of transmission is crucial for bolstering our prevention methods.
In a collaboration between The University of Hong Kong, Hunan Provincial Center for Disease Control and Prevention, and Sun Yat-sen University, researchers gained a greater understanding of the transmission method of the SARS-CoV-2 virus from a single pre-symptomatic case.
The subjects of the study come from a two-bus COVID-19 outbreak in China’s Hunan province. Using closed-circuit television images/clips and questionnaire surveys, the researchers were able to determine the participant’s seating position, boarding and alighting time, and whether they were wearing a mask.
The study revealed that the leading route of transmission for SARS-CoV-2 in a poorly ventilated indoor environment is through the air, and fomite transmission is negligible. The researchers highlighted a need for more targeted interventions in these poorly ventilated environments in order to stop the transmission of primarily airborne-spread viruses, SARS-CoV-2 included, and specifically found that a ventilation rate greater than 3.2 L/s per person is required for sufficient infection prevention.
These findings are a big discrepancy from the initial thoughts surrounding COVID-19, where the World Health Organization, in the pandemic’s initial phases, stated that SARS-CoV-2 could be transmitted through direct contact with a person or through droplets exhaled by an infected individual. Airborne transmission was initially considered unlikely, but in a 2020 update, the WHO recognized that airborne and fomite transmission may be possible.
Thanks to the Hunan province study, we now know that airborne transmission is the predominant transmission type, and fomite transmission has an insignificant impact in asymptomatic cases. Findings such as these can shape the methods of transmission reduction that we seek to implement in public settings, as well as guide our continual search to find the most efficient and effective methods of virus protection.
The impact of SARS-CoV-2 on our society is immense, with the virus’s rapid transmission highlighting areas of disease prevention in need of significant attention.
Perhaps one of the greatest challenges in halting a virus’s transmission lies in those who are asymptomatic—they feel perfectly healthy and so are unaware that they should distance themselves from others. Thus, those who are asymptomatic have a greater opportunity to spread the virus to those around them.
When infected individuals enter a poorly ventilated environment, they put those around them at risk, as evident in the Hunan province study, where just one pre-symptomatic individual initiated a COVID-19 outbreak. The implications of this emphasize the importance of proper ventilation since we cannot rely solely on complete adherence to self-imposed isolation, especially when taking into consideration asymptomatic individuals.
The truly groundbreaking nature of this study is that it utilizes data from day-to-day interactions, not situations overseen in a lab. The researchers were able to study transmission in real life, showcasing a need for additional studies of this same nature—those that observe viral transmission in everyday scenarios.
This study offers an unbiased look into how COVID-19 can spread from a single case to those around them, and we believe that this greater understanding of the virus’s mechanisms of transmission can be used to forge effective prevention initiatives—do you agree?
Share your thoughts on this unique study design and how we can better address the risk posed by asymptomatic individuals in the comments below. To further explore the Hunan province COVID-19 outbreak study, you can read the full article here.
Cheng, P., Luo, K., Xiao, S., Yang, H., Hang, J., Ou, C., Cowling, B. J., Yen, H. L., Hui, D. S., Hu, S., & Li, Y. (2022). Predominant airborne transmission and insignificant fomite transmission of SARS-CoV-2 in a two-bus COVID-19 outbreak originating from the same pre-symptomatic index case. Journal of hazardous materials, 425, 128051. https://doi.org/10.1016/j.jhazmat.2021.128051
Seems like the implementation of infection prevention technologies could solve some of the identified issues. What are your thoughts on the effect of automated disinfection solutions? Share your insights in the comments below.
To read the full article on the study, click here.
Barry Hunt, a co-founder of the CHAIR Coalition and a respected board member, has long been a significant influence in molding patient-centered healthcare standards. His expansive experience and deep-rooted expertise have made him an authoritative voice in the field. His most recent contributions to a myriad of healthcare standards have strongly emphasized the urgent need to create safer and more efficient healthcare environments. This is essential, particularly in the ongoing battle against the spread of airborne diseases.
In the development of the Z8004 standard, a guideline that specifically deals with the operation of long-term care homes and the prevention of infections, Hunt has offered a wealth of insightful suggestions. He insists on the absolute necessity for readily available respirators for all staff, residents, and visitors in long-term care facilities. In addition, he is a strong advocate for the implementation of superior ventilation strategies. These include increasing the air change per hour rate and the use of portable HEPA filters or Upper Air UV systems to enhance air quality and safety.
The Z317.2 standard, which is primarily focused on the operation of heating, ventilation, and air-conditioning (HVAC) systems, has also benefited from Hunt's critical input. His proposals significantly underscore the need for the development of more effective HVAC systems in order to reduce the transmission of pathogens significantly. He recommends a maximum noise level of 45 dB for portable air cleaners and places emphasis on the involvement of experts in bioaerosol science and infection prevention during the early design stages. Furthermore, he highlights the need for maintaining a minimum of 40% relative humidity in patient care areas as a measure to reduce healthcare-acquired infections.
In terms of the comprehensive Z8000 Canadian Healthcare Facilities standard, Hunt's suggestions span a broad spectrum. These include key areas such as infection prevention, patient control of the environment, and the integration of automated disinfection technologies. He robustly advocates for the inclusion of engineered infection prevention measures in the initial project development plans. He also recognizes the need for the adoption of automated disinfection technologies. These include automated UVC disinfection in bathrooms, copper self-sanitizing high-touch surfaces, and self-sanitizing ROS sinks which can significantly enhance hygiene and safety.
Taking a forward-thinking and future-oriented view, Hunt discusses the likely increase in infectious diseases due to the impact of climate change. He also mentions the potential rise in hospital utilization as a consequence of the long-term effects of Covid-19, and the impending labor shortages in the healthcare sector. His proposals strongly underscore the need for progressive, forward-thinking, and innovative approaches in the design and operation of healthcare facilities.
In conclusion, Barry Hunt's significant contributions to healthcare standards provide a clear vision for the future. A future where safer and more efficient healthcare environments are created that cater effectively to evolving needs and emerging challenges. His work is a resounding call to action for all those involved in healthcare design and operation to earnestly consider these significant advancements and insights.
If you'd like to dive deeper into Barry's comments and proposaled changes, we invite you to review them in detail here.
In the historical journey of hospital cleanliness, Florence Nightingale emerges as a pioneer, recognizing the role of a clean environment in reducing contagion. Fast forward to the late 1990s, and hospital cleaning gained recognition as a remedy for Healthcare-Associated Infections (HAIs). Despite earlier skepticism, studies linking contaminated surfaces to outbreaks prompted a shift in perspective. Microbiological standards for surface cleanliness became imperative, with the understanding that removing dirt is a science in itself. However, the status of hospital cleaning faces challenges, from varying standards to the overlooked frontline heroes – the cleaning personnel. The future demands a paradigm shift towards evidence-based benchmarks, training, and recognition for cleaners. As we navigate the post-COVID era, attention turns to indoor air cleaning, emphasizing the holistic approach needed for infection prevention. Hospital cleaning, once the Cinderella of infection control, steps into the spotlight in the 21st century, highlighting its crucial role in protecting public health.
For an in-depth exploration of the history and future outlook of hospital cleaning, you can read the full article here.
Let us remember that the pursuit of excellence in hospital cleaning is a continuous journey. By embracing innovation, collaboration, and a steadfast commitment to cleanliness, we pave the way for a healthier and safer healthcare environment for all.
In a recent study, researchers explored the profound effects of hospital infrastructure on the prevalence of vancomycin-resistant Enterococcus faecium (VRE), a notorious antibiotic-resistant bacterium. The investigation centered around the Royal Papworth Hospital in England, which transitioned to a new facility with nearly 100% single-occupancy rooms. VRE, responsible for severe infections in immunocompromised patients, has been a significant concern due to its resistance to various antibiotics, including vancomycin.
The findings revealed a remarkable decrease in environmental contamination of VRE, dropping from 29% to less than 6% after the hospital's move. This reduction correlated with a nearly 50% decrease in VRE infection rates in the year following the relocation, contrasting with an increase observed in a neighboring hospital during the same period. The study emphasized the critical role hospital design plays in limiting the spread of antibiotic-resistant pathogens and highlighted the potential benefits of single-occupancy rooms in enhancing infection control, particularly for vulnerable patient populations.
To dive deeper into the impact of hospital design on combating antibiotic-resistant infections, explore the comprehensive study document here. This insightful research sheds light on the transformative role that strategic infrastructure plays in reducing environmental contamination and controlling the spread of formidable pathogens like vancomycin-resistant Enterococcus faecium (VRE). Understanding these dynamics is crucial for refining healthcare practices, especially in the face of emerging challenges such as pandemics and antibiotic resistance threats.
