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Toilets dominate environmental detection of SARS-CoV-2 virus in a hospital

By Zhen Ding, Hua Qian, Bin Xu, Ying Huang, Te Miao, Hui-Ling Yen, Shenglan Xiao, Lunbiao Cui, Xiaosong Wu, Wei Shao, Yan Song, Li Sha, Lian Zhou, Yan Xu, Baoli Zhu, Yuguo Li

Posted 07 Apr 2020
medRxiv DOI: 10.1101/2020.04.03.20052175

BackgroundRespiratory and faecal aerosols play a suspected role in transmitting the SARS-CoV-2 virus. We performed extensive environmental sampling in a dedicated hospital building for Covid-19 patients in both toilet and non-toilet environments, and analysed the associated environmental factors. MethodsWe collected data of the Covid-19 patients. 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected were collected within and beyond the four three-bed isolation rooms. We reviewed the environmental design of the building and the cleaning routines. We conducted field measurement of airflow and CO2 concentrations. FindingsThe 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms (ventilated at 30-60 L/s), and 36 from other surfaces outside isolation rooms in the hospital. Four of these samples were positive, namely two ward door-handles, one bathroom toilet-seat cover and one bathroom door-handle; and three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever and one bathroom ceiling-exhaust louvre. One of the 46 air samples was weakly positive, and this was a corridor air sample. The two exhaled condensate samples and the two expired air samples were negative. InterpretationThe faecal-derived aerosols in patients toilets contained most of the detected SARS-CoV-2 virus in the hospital, highlighting the importance of surface and hand hygiene for intervention. FundingThe work were partially supported by the National Natural Science Foundation of China (no 41977370), the Research Grants Council of Hong Kongs (no 17202719) (no C7025-16G), and Scientific Research Fund of Jiangsu Provincial Department of Health (no S21017002).

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