The Environmental Deposition of Severe Acute Respiratory Syndrome Coronavirus 2 in Nosocomial Settings: Role of the Aerosolized Hydrogen Peroxide

Background: Data on the role of aerosolized hydrogen peroxide (AHP) systems in the control of the COVID-19 pandemic are still emerging. This study provides evidence of the environmental shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the hospital environment, and the efficacy of AHP to eliminate it. Methods: A total of 324 environmental sites (224 surfaces and 100 air samples) belonging to 54 patient rooms were contextually collected and tested for genes of SARS-CoV-2 using RT-PCR assays and Xpert (R) Xpress SARS-CoV-2. Results: The SARS-CoV-2 viral genome was detected in seven sites (2.5%) of three patients' rooms, including six highly touched surfaces and one air sample. Viral shedding was directly related to the distance from the patient, with 1, 1.9, and 3.5% of samples testing positive at 3, 2, and 1 meter, respectively (P-value=0.02). None of the sites showed the viral genome following application of 6% AHP. Of note, the viral genome was detected at 2 meters of a mildly symptomatic case on a face mask in the absence of aerosol generating procedures. Conclusion: Our data support the possible role of the hospital environment as a source of infection, and the efficacy of AHP to eliminate the virus. Further studies are needed to address the viability of the pathogen in these nosocomial sites and the cost-effectiveness of routine hospital disinfection procedures using AHP for SARS-CoV-2.

Automated summary

This study provides evidence of SARS-CoV-2 shedding in the hospital environment and shows the efficacy of AHP in eliminating the virus.The viral shedding was directly related to the distance from the patient, and AHP was successful in eliminating the viral genome, indicating the hospital environment as a possible source of infection that requires further cost-effectiveness studies.