CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(05): E701-E705
DOI: 10.1055/a-1395-6946
Original article

Prospective analysis of SARS-CoV-2 dissemination to environmental surfaces during endoscopic procedures

Carter C. Somerville
1   Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
,
Muhammad Shoaib
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
3   Department of Emergency Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, United States
,
Cyrus E. Kuschner
4   Department of Emergency Medicine, Northwell Health, New York, United States
,
Zarina Brune
1   Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Arvind J. Trindade
5   Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, United States
,
Petros C. Benias
5   Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, United States
,
Lance B. Becker
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
3   Department of Emergency Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, United States
4   Department of Emergency Medicine, Northwell Health, New York, United States
› Author Affiliations

Abstract

Background and study aims The COVID-19 pandemic has disrupted routine medical care due to uncertainty regarding the risk of viral spread. One major concern for viral transmission to both patients and providers is performing aerosol-generating procedures such as endoscopy. As such, we performed a prospective study to examine the extent of viral contamination present in the local environment before and after endoscopic procedures on COVID-19 positive patients.

Materials and methods A total of 82 samples were collected from 23 surfaces in the procedure area of four COVID-positive patients undergoing upper endoscopic procedures. Samples were collected both before and after the procedure. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was extracted and quantified using reverse transcription quantitative polymerase chain reaction with primers to detect nucleocapsid RNA, and results reported as the number of viral copies per square centimeter of contaminated surface.

Results A total of six positive samples were detected from three of the four patients. The floor beneath the patient bed was the most common site of viral RNA, but RNA was also detected on the ventilator monitor prior to the procedure and the endoscope after the procedure.

Conclusions The risk of SARS-CoV-2 transmission associated with upper endoscopy procedures is low based on the low rate of surface contamination. Some surfaces in close proximity to the patient and endoscopist may pose a higher risk for contamination. Patient positioning and oxygen delivery methods may influence the directionality and extent of viral spread. Our results support the use of appropriate personal protection to minimize risk of viral transmission.



Publication History

Received: 13 November 2020

Accepted: 03 February 2021

Article published online:
22 April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/
  • 2 Wiersinga WJ, Rhodes A, Cheng AC. et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus Disease 2019 (COVID-19): a review. JAMA 2020; 25: 782-793
  • 3 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointestinal Endoscopy 2020; 92: 192-197
  • 4 Al-Omar K, Bakkar S, Khasawneh L. et al. Resuming elective surgery in the time of COVID-19: a safe and comprehensive strategy. Updates Surg 2020; 72: 291-295
  • 5 Sinonquel P, Roelandt P, Demedts I. et al. COVID-19 and gastrointestinal endoscopy: What should be taken into account?. Dig Endosc 2020; 32: 723-731
  • 6 Magro F, Abreu C, Rahier JF. The daily impact of COVID-19 in gastroenterology. United European Gastroenterol J 2020; 8: 520-527
  • 7 Mouton C, Hirschmann MT, Ollivier M. et al. COVID-19 - ESSKA guidelines and recommendations for resuming elective surgery. J Exp Orthop 2020; 7: 28
  • 8 Zietsman M, Phan LT, Jones RM. Potential for occupational exposures to pathogens during bronchoscopy procedures. J Occup Environ Hyg 2019; 16: 707-716
  • 9 Guo Z-D, Wang Z-Y, Zhang S-F. et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerging Infect Dis J 2020; 26: 1583
  • 10 Repici A, Aragona G, Cengia G. et al. Low risk of covid-19 transmission in GI endoscopy. Gut 2020; 69: 1925-1927
  • 11 Tran K, Cimon K, Severn M. et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7: e35797
  • 12 Chan JF-W, Yuan S, Kok K-H. et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; 395: 514-523
  • 13 Liu Y, Ning Z, Chen Y. et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature 2020; 582: 557-560
  • 14 Cevik M, Tate M, Lloyd O. et al. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis. Lancet Microbe 2020; 2: e13-e22
  • 15 Geneva: World Health Organization. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 73. 2020
  • 16 Leonardo MG, Manuel MS, Cristiano S. A safe endoscopy during COVID-19 pandemia. Gastrointest Endosc 2020; 92: 1274-1275
  • 17 Zhou J, Otter JA, Price JR. et al. Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London. Clin Infect Dis 2020; ciaa905
  • 18 Razzini K, Castrica M, Menchetti L. et al. SARS-CoV-2 RNA detection in the air and on surfaces in the COVID-19 ward of a hospital in Milan, Italy. Sci Total Environ 2020; 742: 140540