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

Amani Alnimr; Aisha Alamri; Khaled F Salama; Mahmoud Radi; Huda Bukharie; Bashayer Alshehri; Ali A Rabaan; Mohammed Alshahrani

doi:10.2147/RMHP.S336085

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

Risk Manag Healthc Policy. 2021 Nov 1:14:4469-4475. doi: 10.2147/RMHP.S336085. eCollection 2021.

Authors

Amani Alnimr¹, Aisha Alamri², Khaled F Salama³, Mahmoud Radi⁴, Huda Bukharie⁴, Bashayer Alshehri⁵, Ali A Rabaan^{6

7}, Mohammed Alshahrani⁸

Affiliations

¹ Department of Microbiology, College of Medicine & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
² Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
³ Department of Environmental Health, College of Public Health & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
⁴ Department of Infection Control, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
⁵ Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
⁶ Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
⁷ Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan.
⁸ Emergency and Critical Care Department, College of Medicine & King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.

Abstract

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^® 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.

Keywords: AHP; COVID-19; SARS-CoV-2; aerosolized hydrogen peroxide; decontamination; disinfection; environmental.