cord-007545-oguse5gt	2004	title: The effectiveness of training and taste testing when using respirator masks The nursing staff swirl screening swabs from various sites into a single SMB that is labelled with the patient''s identification details. We conclude that swirling of screening swabs directly into SMB is a sensitive, cost-effective and convenient method to screen for ciprofloxacinresistant MRSA in hospitals. The effectiveness of training and taste testing when using respirator masks Using the test hoods, we also looked at staff in the accident and emergency department and the intensive care unit who had not received any formal training in mask fitting but who were expected to follow the manufacturer''s instructions. We have changed our practice and now recommend that staff working in high-risk areas receive training on mask fitting at induction and pass a fit test. Briefly, since January 2004, laboratories have been asked to test all diarrhoeal specimens from patients aged 65 years and over for C.
cord-007554-1nz6wdlo	2004	title: Laboratory evaluation of selective mannitol broth for MRSA screening Laboratory evaluation of selective mannitol broth for MRSA screening Screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage in patients admitted to hospital features prominently in strategies for control of MRSA. 5 This letter describes our evaluation and use of a recently described selective mannitol broth (SMB) for rapid ciprofloxacin-resistant MRSA screening. Ten-fold serial dilutions (range 10 K1 -10 K8 ) of an overnight broth culture of MRSA (NCTC 13143, ciprofloxacin resistant) were made. Material and labour costs of screening using the conventional method of salt broth enrichment followed by subculture were compared with those using SMB. Our results show that SMB can detect 1-2 cfu/mL of MRSA (Table I) and that it has a shelf life of three We conclude that swirling of screening swabs directly into SMB is a sensitive, cost-effective and convenient method to screen for ciprofloxacinresistant MRSA in hospitals.
cord-010154-99j5t7ha	2019	Sir, Testing for respiratory virus infections (RVIs) is performed less frequently in patients with cystic fibrosis (CF), although they are known to contribute to bacterial infections and exacerbations by various mechanisms [1e3] . This prompted a PDSA (Plan, Do, Study, Act) quality service improvement evaluation to assess the utility of routine respiratory virus testing in the management of adult CF patients during a respiratory exacerbation. This had several aims, including: earlier RVI detection, early targeted antiviral treatment (for influenza alone), checking vaccination history and correlation with the test result (for influenza alone), and exploring the possible role of occupation in the exposure and acquisition of RVIs. Routine screening for seasonal RVIs for all adult CF patients took place between November 2017 and April 2018. Following this service evaluation (PDSA Cycle 1), routine RVI testing is now being considered for all adult CF patients presenting with an exacerbation during the annual influenza season.
cord-034481-zi9q96lj	2020	Although close exposure to respiratory droplets from an infected patient is the main transmission route of SARS-CoV-2, touching contaminated surfaces and objects might also contribute to transmission of this virus. Here, we provide a report of our study of the stability of SARS-CoV-2 on various environmental surfaces and in human excreta (feces and urine). SARS-CoV-2 was more stable in urine than in feces, and infectious virus was detected up to 3 days in two adult urine and 4 days in one child urine. Prior to our study, two research teams had just reported the stability of SARS-CoV-2 on different material surfaces [4, 5] . In comparison with the above two studies, our data displayed a prolonged survival time of this virus on environmental surfaces. In Chin''s study, a five microliters of virus stock with the infectious titer of 10 6.8 TCID 50 /ml was deposited on the surface.
cord-252730-ihpden9q	2020	In the recent review article ''Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents'' [1] , the authors claim that "data obtained with benzalkonium chloride at reasonable contact times were conflicting. In that paper [2] , a disinfectant solution having an active ingredient concentration of 0.2% appeared to show no efficacy against the enveloped human coronavirus, whereas it showed remarkable activity (>5.12 log reduction) against a non-enveloped coxsackie virus. A second study cited by the authors, this time dating from 1998, showed a >3.7 log reduction of coronavirus in 10 minutes, used a 0.05% solution of a pharmacopeial grade of benzalkonium chloride (i.e. not a formulated disinfectant product) [3] . In another paper cited by the authors, a more contemporary formulated benzalkonium chloride disinfectant, when tested at a 0.5% concentration, gave a >6.13 log reduction of coronavirus in 30 minutes in both clean and dirty conditions [4] .
cord-256135-v75qvb1i	2020	authors: Persoon, Ilona F.; Stankiewicz, Nikolai; Smith, Andrew; de Soet, Hans (J.J.); Volgenant, Catherine M.C. title: A review of respiratory protection measures recommended in Europe for dental procedures during the COVID-19 pandemic During the COVID-19 pandemic period, the World Health Organisation (WHO) recommends wearing respiratory protection when undertaking aerosol generating procedures (AGP) to reduce the risks of cross-infection between patients and healthcare worker (HCW) and vice versa 2 . When patients do not show symptoms of COVID-19, 54% of countries recommend respiratory protection FFP2 / FFP3 when performing AGP. A considerable number of countries also recommend respiratory protection FFP2 / FFP3 when performing non AGPs, both in patients with (63%) and without symptoms of COVID-19 (33%). However, the effectiveness of these respirators to prevent transmission of pathogens highly depends on proper fit and use of the equipment 9 In conclusion, the recommendations on respiratory protection when undertaking dental healthcare in European countries vary considerably.
cord-256705-gexh2wtd	2020	In view of this, a cross-sectional survey of front-line healthcare workers (HCWs) at two large acute NHS hospital trusts in England was undertaken to assess their confidence and perceived level of preparedness for the virus. As such we carried out an online cross sectional questionnaire based survey of front line HCW at two large acute NHS hospital Trusts in England to ascertain how prepared they felt to manage COVID-19. We designed an online cross-sectional questionnaire-based survey using Online Surveys (formerly BOS) to ascertain how confident and prepared front line HCW felt in managing potential COVID-19 cases. At the time the survey went live work in both hospital Trusts had already begun to prepare front line HCW for COVID-19. As the threat of COVID-19 grows, we wanted to assess how confident our front line HCW felt to manage possible cases.
cord-257468-woyycghi	2020	This study evaluated transmission of infection from a symptomatic patient with COVID-19 to 60 HCWs exposed ≤2 m for ≥15 minutes, or during aerosol generating procedures. Following ≥106 unique high-risk contacts, none of the HCWs tested positive for SARS-CoV-2 RNA or had developed antibodies. These results were in accordance with other reports and should reassure HCWs and further stimulate a broader evaluation of the foundation for the current practice of home-quarantine of non-symptomatic HCWs. During the Coronavirus Disease-19 (COVID-19) pandemic, the proportion of health care workers (HCWs) amongst verified, infected individuals, has been reported somewhere between 10 and 20 % [1, 2] . In this study we found that ≥106 unique close contact exposures, including 12 contacts during AGPs with a nonisolated patient with COVID-19, resulted in no SARS-CoV-2 transmissions from patient to HCWs. With one exception, all included HCWs were certain or quite certain that their adherence to the hand hygiene procedure had been proper at the time of exposure.
cord-259855-7sn2coni	2020	Tight-fitting FFP3 facemasks are ideal respiratory protective equipment during aerosol generating procedures in Covid-19 environment, and require a Fit Test (FT) to assess mask-face seal competency. Tight-fitting respirator facemasks such as N95 or FFP3 masks are considered to be the gold standard respiratory protective equipment (RPE) for healthcare workers (HCW) working in aerosol generating procedure (AGP) environments 1 involving Covid-19. The purpose of the study is to describe an innovative potential solution called ''Singh Thattha'' technique, where we have used an under-mask beard cover to overcome the facial hair factor for wearing a respirator mask in bearded individuals. A. Singh Thattha technique was adopted by 27 male bearded Sikh dentists in the UK who subjected themselves to Bitrex QFT conducted by certified fit testers to existing industry standards set by British Safety Industry Federation. Tight-fitting respirator masks, which depend on a seal of the mask with the wearer''s face, are considered as ideal protective RPE for HCWs working in AGP environment involving Covid-19.
cord-260024-yrhlg6wm	2015	The Korea Centers for Disease Control and Prevention (KCDC) under the Ministry of Health and Welfare (MW) insisted on not sharing MERS information from the hospitals with the public at the initial stage of the outbreak under the pretext of hospital protection, although in reality this decision may have been based on nepotism. Considering that the MERS outbreak was not only a health issue but also an emergency management issue, the model for controlling similar epidemics or pandemics in the future-oriented model should involve all stakeholders in an early and co-ordinated response. Although many stakeholders tried to play their own roles during the MERS outbreak in Korea, their responses were somewhat late and unco-ordinated, and thus contributed to the national crisis. The key tenet is that Korea must not consider the MERS outbreak to be a hospital infection control issue.
cord-262027-z90wujlo	2020	title: Disinfection of N95 respirators by ionized hydrogen peroxide during pandemic coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 Letter to the Editor Disinfection of N95 respirators by ionized hydrogen peroxide during pandemic coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 has been spreading globally, and the World Health Organization declared a pandemic on 11 th March 2020 [1] . Therefore, we attempted to disinfect N95 respirators using SteraMist Binary Ionization Technology solution delivered through a SteraMist Surface Unit, registered with the US Environmental Protection Agency [5] . N95 respirators inoculated with influenza A virus without disinfection were used as the positive control. Reuse of N95 respirators has been proposed by CDC [4] , but this carries a risk of contamination and infection of HCWs. Disinfection of N95 respirators may provide an alternative option. Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong
cord-263016-28znb322	2015	Infection prevention/control and management guidelines for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection Infection prevention and control guidelines for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection Revised interim case definition for reporting to WHO e Middle East respiratory syndrome coronavirus (MERS-CoV) Revised interim case definition for reporting to WHO e Middle East respiratory syndrome coronavirus (MERS-CoV) Investigation of cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV); interim guidance updated 3 Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels Middle East respiratory syndrome coronavirus infection in dromedary camels in Saudi Arabia Investigation of an imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in
cord-264057-z5arb1k5	2007	This short-term observational study of infection control practice was performed in the medical emergency outpatient department (EMOPD) of a tertiary-care hospital in India when threatened by an outbreak of severe acute respiratory syndrome (SARS). Infection control measures such as fumigation and cleaning were noted, as was the EMOPD laboratory function, use of personnel protection and display of information on infectious diseases. The EMOPDs in key hospitals need be able to screen for infectious diseases, especially in view of the threats from SARS and Avian influenza. The need to screen all patients with suspected infectious disease in the medical emergency outpatient department (EMOPD), and for control and prevention of infection, was recognized. In addition, the patient/attendant load, patient flow, and medical staff practice were observed, and information displayed on SARS or other infectious diseases was noted.
cord-265820-xfq2s412	2010	Not wearing a surgical mask either by the exposed persons during contact with the index cases (4/4 vs 264/832, P = 0.010) or vice versa (4/4 vs 300/832, P = 0.017, Fisher''s exact test) were found to be significant risk factors for nosocomial acquisition of S-OIV. This included repeated open staff forum achieving high attendance; early recognition of index cases among inpatients by liberal testing; early relief of sick staff from work; directly observed hand hygiene practice during outbreaks; and monitoring of compliance with infection control practice. Not wearing surgical mask by the exposed persons during contact with the index cases (4/4 vs 264/832, P ¼ 0.010) or vice versa (4/4 vs 300/832, P ¼ 0.017, Fisher''s exact test) was found to be a significant risk factor for nosocomial infection of S-OIV (Table I) .
cord-266977-5swwc6kr	2020	authors: Secker, Thomas.J.; Leighton, Timothy.G.; Offin, Douglas.G.; Birkin, Peter.R.; Hervé, Rodolphe.C.; Keevil, Charles.W. title: Journal of Hospital Infection A cold water, ultrasonic activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel Aim: To test the efficacy of an ultrasonically activated stream for the removal of tissue 27 proteins, including prion-associated amyloid, from surgical stainless steel (SS) surfaces. This study has tested the efficacy of UAS technology for the removal of 239 total protein and prion-amyloid from stainless steel, which is considered the most difficult 240 contaminant to decontaminate in the surgical field. 335 J o u r n a l P r e -p r o o f Tissue protein (Dark grey bars) and prion-associated amyloid (light grey bars) attachment 545 from different prion-infected brain homogenates (22L, ME7 and 263K) to surgical stainless 546 steel pre and post treatment with an ultrasonically activated stream (UAS) (Graph A).
cord-267132-nb0j6k3h	2013	Clinical effectiveness (i.e. using prevention measures that are based on reliable evidence of efÀ cacy) is a core component of an effective strategy designed to protect patients from the risk of infection, and when combined with quality improvement methods can account for signiÀ cant reductions in HCAI such as meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difÀ cile. Full text conÀ rms that the article: relates to infections associated with hospital hygiene; is written in English; is primary research (randomised controlled trials, prospective cohort, interrupted time series, controlled before-after, quasi-experimental, experimental studies answering speciÀ c questions), a systematic review or a meta-analysis including the above designs; and informs one or more of the review questions. 334 In a prospective cohort study using data from two randomised trials and a systematic review to estimate rates of PICC-related bloodstream infection in hospitalised patients, the author concluded that PICCs used in high-risk hospitalised patients are associated with a rate of CR-BSI similar to conventional CVCs placed in the internal jugular or subclavian veins (two to À ve per 1000 catheter-days).
cord-267570-e58jrxaj	2020	title: Strategies for qualified triage stations and fever clinics during the outbreak of COVID-2019 in the county hospitals of Western Chongqing Here we report the strategies of makeshift for qualified triage stations and fever clinics during the outbreak of COVID-2019 in the 37 county hospitals of Western Chongqing. In the tent, a second time temperature measurement using a more precise infrared thermometer is undertaken, to further assess suspected patients and to minimize the risk of contact transmission to medical staff. [3, [5] [6] One cannot overemphasize the importance of the triage station and fever clinic during the contagious disease outbreak in terms of timely patient management and minimizing the risk of nosocomial transmission. Thus, thanks to qualified triage station and fever clinics altogether with community isolation, quarantine, medical support, COVID-2019 has been rapidly and well controlled in all of the counties in Western Chongqing. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics
cord-267917-belkwihy	2020	1 The experiments reported in this letter compared the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on a number of different surfaces. The work showed that "SARS-CoV-2 remained viable in aerosols throughout the duration of (the) experiment (3 hours), with a reduction in infectious titer from 10 3.5 to 10 2.7 TCID50 per liter of air. [2] [3] [4] These media articles'' assertions include that SARS-Co V-2 can last "three hours after being coughed out into the air", 4 and that the van Doremalen et al. 2 The media even went as far as suggesting that the aerosols generated by the three-jet Collison nebulizer "duplicated the microscopic droplets created in a cough or a sneeze". It is for these reasons that the WHO and infection prevention specialists continue to support assertion that transmission of SARS-CoV-2 is primarily through droplets and contact (including indirect contact with contaminated surfaces).
cord-269408-6qncy0nd	2020	AIMS: This study was performed to evaluate the prevalence and clinical outcomes of Healthcare-associated COVID-19 infections (HA-COVID-19) during the 2020 epidemic and study factors which may promote or correlate with its incidence and transmission in a Teaching Hospital NHS Trust in London, England. Factors studied included the utility of a single combined throat and nose swab (CTNS) for patient placement, delayed RNA positivity (DRP), selfreported COVID-19 sickness absence among hospital staff, total hospital bed occupancy, community incidence of COVID-19 (CIC19) and the change in incidence of other significant hospital-acquired bacterial infections (HAB). When a HA-COVID-19 case was identified, actions included staff refresher training for correct PPE usage, rapid transfer of patients to a COVID-19 positive cohort ward, deep cleaning (washing walls and carpets) followed by increasing the cleaning frequency until no further transmission was seen (defined as no new symptom onset within 2 weeks of last known case and in haematology and geriatrics a CNTS was tested for SARS-CoV-2 RNA twice weekly for all contacts up to 2 weeks from last positive case regardless of symptoms).
cord-272904-4iv8ezg7	2020	Healthcare personnel (HCP) constitute a high-risk group for SARS-CoV-2 infection. Factors significantly associated with an increased risk for SARS-CoV-2 infection were: working in a non-referral hospital compared to a COVID-19 referral hospital, working in a hospital with a high number of employees, and working in a hospital with an increased number of COVID-19 patients. These findings underscore the need for continuous education of HCP in order to achieve high compliance rates with infection control guidelines, regardless of direct care of COVID-19 patients. In conclusion, our study confirms that HCP constitute a high-risk group for SARS-CoV-2 infection. SARS-CoV-2 infection in healthcare personnel with high-risk occupational exposure: evaluation of seven-day exclusion from work policy Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient
cord-274119-jjiox4it	2005	pylori infection rate among patients undergoing endoscopy for upper gastrointestinal symptoms in Italy is as high as 71.3%; 28 therefore, medical and nursing staff involved in endoscopic procedures could have a high risk of occupational exposure. The purpose of this study was to determine whether different staff groups of healthcare workers, either with or without direct patient contact, are at equal risk of acquiring H. 28, 29 An inverse relationship between educational attainment and infection in the overall population was seen in univariate analysis, showing more risk for healthcare personnel with %8 years of education compared with staff with a university education (Table II) . pylori prevalence in endoscopy personnel and general medical staff by age group (!40 vs R40 years old). pylori infection rate has been reported frequently in gastrointestinal endoscopy personnel, very few studies have been carried out on the prevalence of infection in different groups of hospital employees.
cord-274368-s1h3p5s9	2020	Nosocomial infection is defined as an infection that is acquired in hospital by a patient who was admitted for a reason other than that infection (at least 15 days prior to a positive COVID-19 diagnosis), and in whom the pathogen was not incubating at the time of admission. However, a large study in the United States reported that non-ventilator associated nosocomial pneumonia occurred in 2.1% of all hospital admissions, with a mortality rate of 13.1% (12) . There is no current published data for nosocomial versus community acquired COVID-19 in UK hospitals, leaving uncertainty around morbidity or mortality and heightened public anxiety. Clinical teams at each site screened in-patient admission lists for eligibility and had access to infection control records of positive COVID-19 laboratory testing. Since hospital workers or patient visitors with COVID-19 were not included in the definition of NC infection, or were patients with a positive diagnosis less than 15 days prior to their admission.
cord-274562-0mtwbwkk	2020	title: Infection prevention partners up with psychology in a Danish Hospital successfully addressing staffs fear during the COVID-19 pandemic We have worked hard at NOH hard to prepare for the pandemic building COVID-19 cohort isolation wards using existing wards, creating new workflows, tripling the available number of intensive care beds, and initiating intensive education of literally all groups of staff. We pride ourselves to be used to a high standard regarding hand hygiene [2] , we are well familiar with the occasional seasonal occurrence of influenza, norovirus, CDIFF and VRE [3] ; However, COVID19 is a new virus and reports of deaths among healthcare staff from Italy, China and Spain are scary reading, especially for front line healthcare personal. Recently the mental health care for medical staff in China during the COVID-19 outbreak including various remedial actions was reported [4, 5] . Mental health care for medical staff in China during the COVID-19 outbreak
cord-275696-xag08e8h	2020	In response to COVID-19, we developed a rapid-cycle in situ simulation (ISS) programme to facilitate identification and resolution of systems-based latent safety threats. Rapid cycle simulation has been described previously in medical education as a way of providing real time feedback and opportunities for learners to practice [7] , and there are examples of in situ simulation being used in an iterative fashion to find solutions to latent safety threats over months to years [7, 8] . Given our experience from SARS, our ISS team understood that the highest risk of this emerging respiratory pathogen would be in the case of a critically-ill patient presenting to triage and ultimately requiring aerosol-generating procedures in the ED [8, 9] . The rapid-cycle ISS programme was created to identify latent safety threats (LST) to staff and mitigate these with innovative solutions that could subsequently be tested in the next simulation. This rapid-cycle ISS programme provides an opportunity to identify and iteratively address latent safety threats in caring for patients with possible COVID-19 in a time-sensitive fashion.
cord-278618-7tu5c7m1	2020	This is based on previous knowledge [1] and the doctrine that: a patient positive for SARS-CoV-2 is contagious by respiratory secretions (>10μm in size) that disseminate only on short distance (<1m); SARS-CoV-2 carried on large droplets settles onto local surfaces and is not stable in the air; SARS-CoV-2 aerosol dispersion is possible during AGPs which extensively expose HCWs and therefore HCWs need to wear a respirator for a higher respiratory protection during AGPs. However, an experimental study of van Doremalen et al, [2] assessed the sustainability of SARS-CoV-2 in aerosols (<5μm at 65% of hygrometry (expressed in %RH for relative humidity)) performed using a high-powered machine that does not reflect normal cough conditions (https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-implicationsfor-ipc-precaution-recommendations). They showed that SARS-CoV-2 remained viable and infective at least 3 hours in aerosols, which opened the debate on SARS-CoV-2 transmission through longdistance aerosols (>1m), and questioned the appropriateness of respiratory protection for HCWs. An individual who is well, emits 10 to 10 4 particles per liter of expired air, including 95% of <1μm-size particles [3] .
cord-278723-rirmvf3l	2020	This observation highlights the need to evaluate the existing Public Health England PPE guidance [4] in HD units that recommends fluid repellent surgical masks and plastic aprons in conjunction with bare below the elbows policy in HCWs treating COVID-19-suspected or -confirmed patients not involved in aerosol-generating procedures [5] instead of ECDC [2] and CDC [6] recommended FFP2/3 masks and long-sleeved gowns in similar clinical settings. At the beginning of the COVID-19 pandemic in the North West of England initially one shift (19 th March 2020) and subsequently the whole main hospital HD unit (6 th April 2020) was designated for treatment of suspected or confirmed COVID-19 patients receiving HD. Public Health England PPE guidance [5] was followed for staff caring for suspected and confirmed COVID-19 patients including surgical masks, plastic aprons, protective eyewear and gloves and there were no issues with PPE supplies.
cord-279436-kftdqzg0	2010	authors: Au, S.S.W.; Gomersall, C.D.; Leung, P.; Li, P.T.Y. title: A randomised controlled pilot study to compare filtration factor of a novel non-fit-tested high-efficiency particulate air (HEPA) filtering facemask with a fit-tested N95 mask We carried out a randomised controlled cross-over study to compare the efficacy of such a mask (Totobobo, Dream Lab One Pte Ltd, Singapore) with fit-tested N95 masks (1860 or 1860s or 1862; 3M, St Paul, MN, USA) in 22 healthy volunteers. In view of the potential benefits of this new mask, we carried out a controlled cross-over pilot study to compare the in-vivo filtration capacity of trimmed but non-fittested Totobobo masks with a fit-tested N95 mask (1860 or 1860s or 1862; 3 M, St Paul, MN, USA). This was a prospective unblinded study of healthy Chinese volunteers using two different protective devices: a Totobobo mask (Dream Lab One Pte. Ltd, Singapore) and a fitted N95 filtering facepiece respirator (1860 or 1860s or 1862, 3M, St Paul, MN, USA).
cord-280285-mwuix1tv	2017	title: Consecutive yearly outbreaks of respiratory syncytial virus in a haemato-oncology ward and efficacy of infection control measures In December 2015 three patients on the haematology ward with respiratory symptoms tested positive for RSV in a 24 h period. On the day of ward closure a fourth patient with respiratory symptoms tested positive for RSV and was isolated with precautions in place. Confirmed case of RSV Any patient or staff member with respiratory symptoms and a positive respiratory sample for RSV Probable case of RSV Any patient or staff member with respiratory symptoms Asymptomatic carrier Any patient or staff member in whom RSV was detected on screening in the absence of respiratory symptoms or fever measuring both standard and transmission-based infection control precautions at the time of ward reopening, and a training package was put in place for ward staff.
cord-280419-odqo3o4w	2020	In this study the authors made modifications to two different SS systems to incorporate high-efficiency particulate air (HEPA) filters to the inlets to the fan to assess their potential as a method of providing a reusable system for PPE for the surgeon with regard to protection from a respiratory droplet spread virus. The results show that using a layer of HEPA filter cut to size, and sealed to the inlet for the fan in the helmet will reduce the downstream particulate at the user''s mouth by over 99.5% which is equivalent to that of a respirator mask. With the modification of the HEPA filter to the inlet of the T5 helmet as described, the downstream penetration was reduced to 0.46% (σ = 0.24%) which is significantly better than all other test configurations and offers a particulate filtration similar to FFP3 and N99 or other equivalent respirator mask.
cord-283165-mdkr9qo0	2015	The aim of this study was to retrospectively evaluate the accuracy of the diagnosis of HAP in inpatients on acute internal medicine and general surgical wards receiving intravenous antimicrobials for a clinical diagnosis of HAP made by the patient''s team. This was a retrospective observational cohort study of medical and surgical inpatients receiving intravenous antimicrobials for a clinical diagnosis of HAP at a tertiary care hospital in Edinburgh, UK. To be classified as radiologically confirmed HAP in this study, chest X-ray evidence of a new or progressive lung infiltrate was required (reported by a radiologist), consistent with the 2005 ATS/IDSA guidelines. In comparison to community-acquired pneumonia, where the culture-positive rate of sputum samples at our institution has been reported as 30%, a bacterial pathogen was identified from 17 of 35 (48.6%) samples from patients with radiologically confirmed HAP and therefore has greater potential to influence management.
cord-284532-b6tsjmfs	2020	A prominent strategy to improve hand hygiene, developed by the World Health Organization (WHO), includes an effective six-step handwashing technique and has led to broad uptake through the use of a multimodal approach; however encouraging consistent compliance can be challenging [1] . In addition to needing to remember all six steps of the technique and needing to wash hands for the required duration of time, there can be a lack of awareness regarding the importance of handwashing technique on reducing the microbial burden on hands. In the context of the 3/6 evolving COVID-19 pandemic, the near-ubiquitous melody of Brother John provided an opportunity for international, interdisciplinary collaboration to translate and rapidly disseminate the musical mnemonic globally. A clear advantage of this six-step handwashing song is that it highlights the importance of correct technique, in addition to the recommended 20-second duration (such as singing "happy birthday" twice, another popular approach). Figure 1: WHO six-step handwashing technique 1 and handwashing song lyrics, set to the tune of Brother John.
cord-286062-gzntdlp8	2017	METHODS: Children aged less than two years admitted to hospital with a clinical diagnosis of bronchiolitis with positive results for either RSV or RV were included in this study. The aim of this study was to determine the clinicopathological outcomes in a cohort of infants and young children aged less than two years admitted with bronchiolitis, where the presence of either RSV or RV as a single pathogen was detected on analysis of NPA samples. Data were collected on median age at presentation, sex, associated risk factors (chronic lung disease, prematurity, congenital heart disease, genetic conditions), therapeutic interventions (intravenous fluids, intravenous antibiotics, chest X-ray), need for respiratory support (high flow oxygen, continuous positive airway pressure, ventilation), management in high-dependency unit (HDU)/paediatric intensive care unit (PICU) and outcome [length of stay (LOS) and any deaths].
cord-288483-y9fyslgo	2020	Studies were eligible for inclusion if the following criteria were met: 1) The study was original research, including systematic reviews; 2) The study evaluated surgical facemask PPE or their components; 3) The study evaluated any intervention(s) to decontaminate, sterilize or treat surgical masks (applied either before or after their use) for the purposes of reuse as PPE; 4) At least one of the following efficacy or safety outcomes of interest was reported: a) mask performance (i.e. filtration efficiency and airflow resistance); b) reduction in pathogen load; c) in vivo infection rates following use of decontaminated masks; d) changes in physical appearance (i.e. mask appearance or physical degradation); e) adverse effects experienced by the wearer (e.g. skin irritation); or f) feasibility of the intervention (e.g. time, cost, resource utilization).
cord-288553-fez60jyn	2020	title: Lack of SARS-CoV-2 RNA environmental contamination in a tertiary referral hospital for infectious diseases in Northern Italy. Health care workers are at increased risk of acquiring COVID-19 infection, possibly due to direct contact with the patients. In this regard, studies suggest that surfaces and suspensions can carry HCoVs, increasing the risk of contact transmission that could lead to hospital acquired HCoVs infections [4, 5] Since February 21, 2020, when the first autochthonous case in Italy was confirmed, an overwhelming number of SARS-CoV-2 infections is continuously being detected, exceeding 8,000 cases at the time of writing. Fondazione IRCCS Policlinico San Matteo, Pavia, is a 1,300-bed tertiary teaching hospital in Northern Italy and a national SARS-CoV-2 referral center. Survival of human coronaviruses 229E and OC43 in suspension and after drying on surfaces: A possible source of hospital-acquired infections Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination
cord-288859-19jwawrm	2017	title: High reproduction number of Middle East respiratory syndrome coronavirus in nosocomial outbreaks: mathematical modelling in Saudi Arabia and South Korea Therefore, the IDEA model was used to evaluate and compare the MERS R 0 values from the outbreaks in both KSA and South Korean hospitals. Since the IDEA model is parameterized using epidemic generation time, incidence case counts were aggregated at serial intervals of six, seven and eight days in the present study [10] . The IDEA model was fitted to the daily KSA and Korea MERS-CoV case data according to the onset date. Figure 3 shows that the IDEA model provided well-fitted curves for the cumulative data regarding South Korean MERS symptom-onset dates for all cases. The present study used the IDEA model to estimate R 0 values from the MERS outbreaks in KSA and South Korea. Best-fit reproduction number (R 0 ) by serial intervals of Middle East respiratory syndrome in South Korea, 2015, using the incidence decay with exponential adjustment model.
cord-288980-kig6xnkb	2020	title: Multidrug resistant infections in the COVID-19 era, a framework for considering the potential impact The recent report by Jolivet et al highlights the progress being made on Multidrug-resistant (MDR) infections [1] . However, this report predates the COVID-19 pandemic and it is unclear what the impact will be on MDR infections globally. There are reports of a high use of broad-spectrum antibiotics in the hospital setting, recognised as a risk factor for hospital-acquired infections (HAI) with MDR organisms [2] [3] [4] . Equally, wider recognition of the importance of nosocomial infections, with stricter hygiene policies, high use of PPE, and patients being cared for in new temporary hospitals, could all mitigate against this threat [2, 3] . Impact of colonisation pressure on acquisition of extendedspectrum β-lactamase-producing Enterobacteriaceae and meticillin-resistant Staphylococcus aureus in two intensive care units: a 19-year retrospective surveillance Management of multidrug-resistant organisms in health care settings Bed occupancy rates and hospital-acquired infections--should beds be kept empty
cord-290305-8u2zxsam	2013	METHODS: The bundle included active surveillance on admission and transfer/discharge to identify ward-based acquisition of MRSA, isolation and cohorting of MRSA-infected patients, enhanced hand hygiene initiatives, and publicly displayed feedback of MRSA acquisition and hand hygiene compliance rates. 6e9 Effective interventions for controlling MRSA transmission in a hospital setting are well known and include active surveillance, improving hand hygiene compliance, and isolating all MRSA cases, whereas general strategies such as obtaining focused and committed hospital leadership are critical towards lowering implementation barriers and improving sustainability. À Other measures included a bare-below-the-elbows policy for all clinical staff, coloured bracelets to identify all colonized and infected patients, and cash rewards (of around US$250) for exemplary performances by wards or departments with regards to hand hygiene compliance and MRSA transmission rates to enjoy a celebratory lunch or similar.
cord-294839-qxn22td0	2014	The intervention reduced the presence of adenovirus [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1–5.0], rhinovirus (OR 5.3, 95% CI 2.3–12.4) and respiratory syncytial virus (OR 4.1, 95% CI 1.5–11.2) compared with the control group, but the intervention had no effect on sickness absence or disease patterns in the nurseries. The aim of this study was to determine whether regular systematic cleaning and disinfection of toys would decrease the prevalence of bacteria and respiratory viruses in the nursery environment, and reduce sickness absence in Danish nurseries. Nurseries were questioned about their policies and procedures for hygiene and cleaning of toys before commencement of the study, and randomized to intervention (N ¼ 6) and control (N ¼ 6) groups. Fortnightly cleaning and disinfection of toys reduced the frequency of detection of some respiratory viruses, but not the bacterial load, and did not reduce the number of days of absence due to respiratory infection or sickness as a whole.
cord-295322-9kye4w9g	2020	title: Adaptation of the ''Assembly Line'' and ''Brick System'' techniques for hospital resource management of personal protective equipment, as preparedness for mitigating the impact of the COVID-19 pandemic in a large public hospital in India An assembly line was put in place where components of the PPE kit were added in sequence until the final completed product was packed and ready for distribution. It is typically used inventory management of the personal kit issued to each fighting unit and also used by the United Nations Peace Keeping Forces (The UN Brick) [1] . The requisite number of in-house PPE kits for the various wards were then assembled into one brick(a carton) and supplied to that unit on a daily basis. Bricks of varying sizes and levels help in rationing of PPE between different wards based on differentiating essential and elective patients.
cord-297023-0qlo0mun	2020	While healthcare personnel (HCP) potentially has an increased risk of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the era of the pandemic [1] , the approach to testing HCP for the virus has not been uniform [2] . Given the significant percentage of asymptomatic coronavirus disease 2019 (COVID-19) infection [3] , universal testing of HCP could allow infected workers to be identified and isolated early, reduce in-hospital transmission, mitigate potential workforce depletion, and enhance healthcare workers'' safety [4] . This study aimed to evaluate the effectiveness of the universal staff screening for COVID-19 and identify any risk factor for viral infection. The staff were encouraged to notify the occupational health nurse for SARS-CoV-2 test any time if they had any suspicious symptoms of COVID-19 or close contact with COVID-19 patients. Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19 COVID-19: the case for healthcare worker screening to prevent hospital transmission
cord-301299-flb5wwzg	2020	AIM: The aim of this study was to describe the epidemiological and clinical characteristics of COVID-19 among healthcare workers (HCWs) between February 24(th) to April 30(th), 2020 in a hospital in Madrid, Spain. Therefore, we designed a retrospective cohort study whose aim was to describe the epidemiological and clinical characteristics of SARS-CoV-2 infection among HCWs in a hospital in Madrid, Spain. During the study period, HCWs experiencing symptoms consistent with probable COVID-19 were instructed to present at the Occupational Health outpatient clinic, where they were managed according to the hospital protocol: a nasopharyngeal swab was collected and analysed with polymerase chain reaction (PCR) for SARS-CoV-2. A case of COVID-19 was defined as any HCW presenting to the Occupational Health outpatient clinic with symptoms consistent with COVID-19 and with positive SARS-CoV-2 PCR.
cord-303966-z6u3d2ec	2007	In many hospitals serving the poorest communities of Africa and other parts of the developing world, infection control activities are limited by poor infrastructure, overcrowding, inadequate hygiene and water supply, poorly functioning laboratory services and a shortage of trained staff. Summary In many hospitals serving the poorest communities of Africa and other parts of the developing world, infection control activities are limited by poor infrastructure, overcrowding, inadequate hygiene and water supply, poorly functioning laboratory services and a shortage of trained staff. Many medical journals are currently devoting part of their current issues to the themes of poverty and infection in the developing world, in recognition of the commitments made by the G8 Summit and the United Nations (UN) Millenium Development Goals (MDGs) to improve maternal healthcare, reduce childhood mortality and the impact of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS), malaria and other communicable diseases.
cord-304170-cmeiqvnp	2020	authors: van Straten, B.; de Man, P.; van den Dobbelsteen, J.; Koeleman, H.; van der Eijk, A.; Horeman, T. title: Sterilization of disposable face masks by means of standardized dry and steam sterilization processes; an alternative in the fight against mask shortages due to COVID-19 In preparation for that scarcity we performed a study to investigate the possibility of reprocessing disposable FFP2 face masks in order to verify their re-usability with a method that could be applied in practice using already available equipment. The results of our experiences and experiments indicate that our sterilization process did not influence the functionality of the masks tested. The sterilization process of available standard autoclaves in hospitals may have to be adjusted in order to use this sterilization method. However, our method seems to be a potentially useful way to reuse mouth masks; other hospitals facing a shortage of masks may wish to test and validate this approach to reusing masks.
cord-309274-2npxrrhr	2007	authors: Lee, M.K.; Chiu, C.S.; Chow, V.C.; Lam, R.K.; Lai, R.W. title: Prevalence of hospital infection and antibiotic use at a University Medical Center in Hong Kong Hospital infection prevalence surveys were performed in our 1400-bed University medical centre in Hong Kong from 1985 to 1988. We investigated the rates of four major hospital-acquired infections (HAIs) (pneumonia, symptomatic urinary tract infection, surgical site infection and laboratory-confirmed bloodstream infection) in order to identify current distribution and any changes after 15 years. Demographic information, admission diagnosis, use of medical device and antibiotic were recorded by the ward nursing staff who had attended briefing sessions on each ward on the point prevalence survey with instructions on correct filling of a data collection form. The last survey in our hospital was performed over 15 years ago and some interesting changes in nosocomial infection rate and antibiotic use were found.
cord-311012-wyglrpqh	2020	AIM: There are few data showing the efficacy of multiple concentrations of EtOH, IPA, and SH on a human coronavirus (HCoV) dried on surfaces using short contact times. FINDINGS: Concentrations of EtOH and IPA from 62% to 80% were very efficient at inactivating high numbers of HCoV dried on tile surfaces even with a 15 sec contact time. CONCLUSIONS: EtOH, IPA, and SH at multiple concentrations efficiently inactivated infectious virus on hard surfaces, typical of those found in public places. Interestingly, at the highest concentrations tested, 95% EtOH and 95% IPA, we observed significant reductions in inactivating, with some contact times producing less than a 2 log 10 reduction of infectious virus. Our studies demonstrate that EtOH and IPA at concentrations ranging from 62% to 80% are highly effective at inactivating HCoV on tile surfaces even with contact times as low as 15 sec.
cord-314449-ukqux772	2008	Interventions such as proper hand and surface cleaning, better nutrition, sufficient numbers of nurses, better ventilator management, use of coated urinary and central venous catheters and use of high-efficiency particulate air (HEPA) filters have all been associated with significantly lower nosocomial infection rates. This review is not exhaustive and will not attempt mathematical data analysis but will examine recent research that examines non-pharmacological interventions for reducing HAIs. It will also include a brief description of the morbidity, mortality and medical costs associated with nosocomial infections, along with a brief discussion of the routes by which HAIs spread. Many terms were used in the literature searches including nosocomial, hospital acquired, MRSA (meticillin-resistant Staphylococcus aureus), staphyloccoccus, streptococcus, VRE (vancomycinresistant enterococcus), Clostridium difficile, legionella, klebsiella, tuberculosis, airborne infection, waterborne infection, hand washing, hospital cleaning, urinary catheters, central catheters, haemodialysis, ultraviolet light, HEPA (high-efficiency particulate air) filtration and many others.
cord-314554-ltej7wvo	2020	key: cord-314554-ltej7wvo authors: Nakamura, Itaru; Watanabe, Hidehiro; Itoi, Takao title: Protective barrier box to mitigate exposure to airborne virus particles with minimum personal protective equipment when obtaining nasal PCR samples date: 2020-07-01 journal: J Hosp Infect cord_uid: ltej7wvo can be minimized to a gown, nonsterile gloves, and a medical mask, and only glove exchange is thought to be necessary to perform nasal sampling on the next patient. Although contamination after use was indicated as a disadvantage of the aerosol box 3 , this PCR box designed to be easily cleaned by wiping with a disinfectant after sampling. In preparation for the next epidemic, we must develop these types of protective devices, which can reduce the exposure risks and reduce the need for PPE. How to Obtain a Nasopharyngeal Swab Specimen More on Barrier Enclosure during Endotracheal Intubation More on Barrier Enclosure during Endotracheal Intubation The authors declare no conflict of interest
cord-314963-sk8pqjrh	2020	Studies were eligible for inclusion in this systematic review if they satisfied all of the following criteria: (1) Original publication or systematic review; (2) Study reported on decontamination procedures for NIOSH-approved N95 (including SN95) FFRs or their components; (3) At least one of the decontamination procedures evaluated used one of the J o u r n a l P r e -p r o o f following chemical disinfectants: sodium hypochlorite; liquid hydrogen peroxide, vaporized hydrogen peroxide, hydrogen peroxide gas plasma, or ionized hydrogen peroxide; ethanol or isopropyl alcohol; (4) The study reported on at least one of the following outcomes of interest: (i) impact of the disinfectant on FFR performance, with a specific focus on aerosol penetration and airflow resistance (pressure drop); (ii) effectiveness of the disinfectant at removing viral or bacterial load; (iii) observations related to changes in physical traits following decontamination with a disinfectant; (iv) impact of each disinfectant on FFR fit; or (v) findings or observations related to user safety or irritation.
cord-320454-dhfl92et	2007	Neonatal intensive care units are vulnerable to outbreaks and sporadic incidents of healthcare-associated infections (HAIs). Summary Neonatal intensive care units are vulnerable to outbreaks and sporadic incidents of healthcare-associated infections (HAIs). We reviewed 125 articles regarding HAIs from both advanced and resource-limited neonatal units in order to study risk factors, aetiological agents, antimicrobial susceptibility patterns and reported successes in infection control interventions. We reviewed 125 articles regarding HAIs from both advanced and resource-limited neonatal units in order to study risk factors, aetiological agents, antimicrobial susceptibility patterns and reported successes in infection control interventions. This review on healthcare-associated neonatal infections studies the definitions, associated risk factors and the aetiological agents involved with their antimicrobial susceptibility patterns in two contrasting worlds. Risk factors for hospital-acquired infections in the neonatal intensive care unit Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit
cord-323732-7nzjrvla	2020	title: An Observational Study to Identify Types of Personal Protective Equipment Breaches on Inpatient Wards In response to the COVID-19 pandemic, UK Infection Prevention & Control (IP&C) guidelines have been published on using personal protective equipment (PPE) in various healthcare settings [1] . We conducted a behavioural observation study to investigate whether, based on national guidelines [1] , healthcare workers wear correct PPE, what breaches occur, and how frequently. ''All PPE'' zones require a fluid-resistant surgical face mask (FRSM), disposable apron, disposable gloves, and, subject to risk assessment, eye protection. Eye protection was not reported as part of the ''required'' PPE on non-COVID wards as this could not be objectively measured in the context of individual risk assessments. Eye protection was not counted as part of the ''required'' PPE on non-COVID wards as this could not be objectively measured in the context of individual risk assessments.
cord-325612-a24qbiyd	2020	METHOD: Observations measured different environmental features at three different departments and questionnaires asked HCP''s perception of safety from infectious diseases and coping behaviors (e.g., avoidance and disinfection). FINDINGS: This study has implications for potential interventions that enough HH stations at convenient locations would increase HH compliance rate from psychological perspectives, perception of safety from infectious diseases. The participants were asked to report the 12 degree of their perceptions of safety from infectious diseases at work (α = 0.92) and perceived 13 vulnerability on the 7-Likert scale (strongly disagree to strongly agree), the likelihoods of a 14 physical object being contaminated and causing infection (α = 0.94) on the 0-100 scale (not at all 15 to extremely likely), their behaviours (α = 0.94) on the 5-Likerts scale (never to always), and HH 16 compliance rates among the HCPs themselves.
cord-328455-kg2pg8y2	2020	Since the SARS-CoV-2 is predominantly transmitted via droplet and contact routes, hand hygiene with appropriate PPE are key infection control measures to protect HCWs. 2 We therefore expected hand hygiene compliance among our HCWs to increase further during the COVID-19 pandemic. It is unexpected to observe relatively lower hand hygiene compliance among HCWs working in ward B, of which some of the beds are used for caring suspected or confirmed COVID-19 patients. Hand hygiene among HCWs has become even more important in the context of the COVID-19 pandemic, 6 especially with evidence of SARS-CoV-2 transmission while presymptomatic or asymptomatic. Absence of nosocomial transmission of coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in the pre-pandemic phase in Hong Kong Hand hygiene compliance among healthcare workers in two paediatric units before and during COVID-19 pandemic All authors report no conflicts of interest relevant to this article.
cord-329135-g8fuax6p	2016	Numerous successful studies are described that point to best practice in bioaerosol sampling, from the use of small personal samplers to monitor workers'' pathogen exposure through to large static samplers collecting airborne microbes in various healthcare settings. 11, 53 If the target microbe is unknown and a general assessment of bioaerosol particles present in an environment is sought, then the use of different types of sampling devices will mitigate the limitations of individual samplers, making a comprehensive study more likely. Correlation between active and passive sampling was also described during a study comparing different ventilation regimes in OTs. 12 Using a Surface Air System sampler (SAS, International Pbi, Milan, Italy) operating at 180 L/min and settle plates, both with tryptic soy agar, the study showed that unidirectional airflows within OTs did not guarantee low counts of airborne bacteria. Effect of sampling time and air humidity on the bioefficiency of filter samplers for bioaerosol collection
cord-334738-k6002qzb	2016	In September 2015, a confirmed case of Middle East respiratory syndrome (MERS) was diagnosed in a healthcare worker in Jeddah, Saudi Arabia. The investigation identified a probable source of an index case who had been in hospital in Jordan in August 2015 while there was an ongoing MERS outbreak and who then subsequently sought medical care in Jeddah. Once the MERS-CoV diagnosis was confirmed, patient A was moved to a negative pressure isolation room in the intensive care unit (ICU). Infection control measures were taken as follows: all patients present in ED on the day of patient A''s diagnosis were screened for MERS-CoV using lower respiratory tract samples or NP samples using RTePCR. Patients who had fever, cough, leucopenia, hypo-oxygenation or infiltrates on chest X-ray were considered highly suspected MERS-CoV cases and were therefore moved to negative pressure isolation rooms while screening was undertaken.
cord-336259-gtb8ictv	2020	Physical and chemical methods of decontamination have been tested for treatment of FFRs with ultraviolet germicidal irradiation, sterilization by steam, ethylene oxide and vaporous hydrogen peroxide, demonstrating the most promising results thus far. Decontamination of masks to facilitate safe re-use has been postulated as one, albeit controversial 8 , solution with a number of studies over the last 20 years investigating the effectiveness of different decontamination methods on the performance of the treated FFR in protecting the HCW and/or removing the potential of the FFR to act as a fomite [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] . Filter performance does not appear to be significantly impacted either with autoclave, oven and microwave-based methods demonstrated to have no significant effect on FFR particle filtration 10, 15, 17 , including after several cycles of exposure to steam decontamination 12 . A pandemic influenza preparedness study: use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets
cord-339203-5oextxkm	2020	To date, no healthcare worker has contracted COVID-19 in a Singapore healthcare institution. However, healthcare workers including non-clinical staff have contracted COVID-19 in the community and from overseas travel 6 . Whilst some had continued working for a short period prior to diagnosis, thus far there have been no cases of healthcare worker-to-patient COVID-SARS which was predominantly transmitted nosocomially in Singapore 5 , COVID-19 is predominantly acquired in the community. This presents a different challenge to preventing COVID-19 infection in healthcare workers. In Singapore, we have put in place strict staff management policies that have progressed as the infection continues its spread worldwide. All staff with travel to affected regions are placed on a 14-day compulsory leave of absence with overseas travel strongly discouraged as the infection has now spread across the globe. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers
cord-341069-kngf6qpe	2020	AIM: The aim of this study was to investigate the infectivity of SARS-CoV-2 under various environmental factors, disinfectants and different pH conditions. The viability of virus was determined after treatment with different disinfectants and pH solutions at room temperature (20∼25(o)C). SARS-CoV-2 could be detected under a wide range of pH conditions from pH4 to pH11 for several days and 1 to 2 days in stool at room temperature but lost 5 logs of infectivity. One hundred microliters of SARS-CoV-2 with 114 10 6.5 TCID 50 /ml was added into each bottles of 0.9 ml VTM and incubated at room temperature 115 (20-25 o C). When SARS-CoV-2 was added in VTM with pH ranging from 2 to 13, the virus remained 163 viable up to 6 days but lost between 2.9 and 5.33 logs of infectivity from pH5 to pH9 and up 164 to 1~2 days in pH4 and pH11 ( Table 2) .
cord-341462-gxpia9rs	2020	title: Face Masks and Containment of Coronavirus Disease 2019 (COVID-19): Experience from South Korea The professional medical societies in South Korea have warned about health hazards from impaired infant health to increased adult mortality rate, and people are advised to wear a facial mask when PM level is very high (6) (7) (8) (9) (10) . This increasing public concern regarding PM has made wearing a face mask a matter of everyday life during epidemics of respiratory diseases in South Korea. A recently published article clearly showed the effectiveness of surgical face masks in reducing respiratory viral shedding (17) To conclude, considering the relatively low incidences of severe cases or mortality and good control of COVID-19 in several countries where self-quarantine principles are well established, wearing protective masks is an important strategy to stop the spread of respiratory viruses such as SARS-CoV-2. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis
cord-342277-v6310fjh	2011	The aim of this study was to monitor surfaces and air in hospital settings to reveal the presence of hepatitis C virus, human adenovirus, norovirus, human rotavirus and torque teno virus by nucleic acid assays, in parallel with measurements of total bacterial count and haemoglobin presence. Moreover, viral agents transmitted via the faecaleoral route, such as rotavirus, human adenovirus 40 and 41 and norovirus, are frequently associated with healthcare setting infections spread by air, hand and surface contamination. The nucleic acids extracted from samples were analysed according to published protocols of nested (RT)ePCR to detect and distinguish the target viruses: the primers, virus genome regions and reaction conditions are reported in Table I . Although this is particularly true for viruses, where detection on surfaces and in air is very difficult, the low reliability of bacterial counts as indicators of viral contamination, suggests studying alternative parameters for assessing virological safety.
cord-344468-ocrhgoba	2020	Most existing studies investigate masks made of cotton, but there are many promising materials that have not been formally tested, ranging from medical textiles like surgical wrap to consumer goods like non-woven polypropylene shopping bags. This innovation was publicized in the media before it was noted that the 99% efficiency of the surgical wrap refers to a measure called the bacterial filtration efficiency (BFE), and thus could not be meaningfully compared with N95 masks that are tested on their ability to remove much smaller particles. Other FDA-recognized filtration tests measure PFE, BFE, and viral filtration efficiency (VFE) using transmission of 0.1 micron polystyrene latex particles, S. Because each method uses different sized particles to test filtration, the significance of different metrics varies greatly and meaningful conclusions cannot be drawn by comparing, say, a standalone BFE to an N95 efficiency.
cord-346745-wowihqea	2005	The simple water tank and food dye model shows that movement of air from opening the door could have resulted in the exposure of the susceptible nurse to airborne VZV from the patient in the isolation room ( Figure 1 ). 7,8 Therefore, there is a distinct possibility that despite the negative pressure inside the room, transmission of VZV may have occurred via infectious aerosol as the nurse stood at the door. In summary, we report a case of nosocomial transmission of VZV to a nurse that may have occurred via aerosol transmission, despite negative-pressure isolation of the infected patient. Thus, this case report recommends that susceptible personnel should not stand at the entrances of isolation rooms containing patients with respiratory infections since, despite negative pressure, nosocomial transmission via an airborne route may still be possible.
cord-347351-emdj66vj	2020	Originating from a single travel-associated primary case from China, the first documented chain of multiple human-to-human transmissions of SARS-CoV-2 outside of Asia allowed a detailed study of transmission events and identified several factors (e.g. cumulative face-toface contact, direct contact with secretions or body fluids of a patient, personal protective equipment) to classify contacts as low or high risk [32] . In the close surrounding of COVID-19 patients in hospitals SARS-CoV-2 RNA is detected more frequently compared to surfaces outside the patient rooms but samples were so far consistently negative for infectious virus. General disinfection of frequently touched surfaces in the public such as shopping carts or door handles is, however, unlikely to add any protective value because even in COVID-19 wards inanimate surfaces were mainly contaminated in the permanent and immediate surrounding of symptomatic patients (detection of viral RNA, not of infectious virus) and only rarely one room away [138] suggesting that the risk to find SARS-CoV-2 on frequently touched surfaces in the public is low.