Scientists have issued an urgent call to protect health workers in hospitals after finding “extensive” levels of coronavirus contamination in specialist wards and intensive-care units and on equipment ranging from keyboards to gel hand sanitisers.
The widespread contamination was revealed by more than 600 swabs taken throughout a major hospital in Wuhan, China, as the outbreak swept through the city in February, with patients and visitors filling the wards and nearby waiting areas.
Despite extra cleaning procedures that were introduced at the 3,000-bed Zhongnan medical centre at Wuhan University, researchers found significant contamination in intensive care units and obstetric wards caring for people with the virus, where nearly one-third of swabs tested positive.
A fifth of swabs from wards used to isolate coronavirus patients were also contaminated, along with 17% of swabs from the outpatient lobby. More than a 10th of the swabs from the emergency department and clinical labs bore traces of the virus.
The scientists found substantial contamination on common hospital equipment too. Tests on swabs taken from hand sanitisers and self-service printers that patients use to print out copies of their medical reports found that 20% tested positive. Keyboards, doorknobs and desktops also harboured the virus, with 16% to 17% of swabs containing traces of the germ. One in eight telephone swabs also tested positive.
The researchers, led by Xinghuan Wang at the hospital, describe the findings as “an urgent call” to protect healthcare workers. “These findings suggest that the hospital environment could potentially be a source of virus spread, including among healthcare workers, patients and visitors,” their report states, adding that the results emphasised the pressing need to ensure adequate environmental cleaning and infection prevention training among healthcare workers during the outbreak.
Coronavirus is spread primarily by droplets that are coughed or sneezed into the air by people who have the infection. But the global movement that is under way to encourage regular and effective handwashing aims to reduce infections that are spread by touching contaminated surfaces.
According to the study, the highest levels of contamination found in Zhongnan should inform others about the most effective cleaning and disinfection procedures.
Susan Michie, a professor of health psychology at University College London, said there was no reason for hospitals to be contaminated if they had enough staff and resources. But in many cases they did not, she added.
“We are starting on the back foot. We are not in a good place because of the austerity measures. In order to keep everything really clean you need to have staff paying attention, so you need to have enough staff. This is where contamination will creep in,” she said.
The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the coronavirus, for which there is no specific cure or vaccine.
The UN agency advises people to:
- Frequently wash their hands with an alcohol-based hand rub or warm water and soap
- Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
- Avoid close contact with anyone who has a fever or cough
- Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
- Avoid direct, unprotected contact with live animals and surfaces in contact with animals when visiting live markets in affected areas
- Avoid eating raw or undercooked animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination with uncooked foods.
Despite a surge in sales of face masks in the aftermath of the coronavirus outbreak, experts are divided over whether they can prevent transmission and infection. There is some evidence to suggest that masks can help prevent hand-to-mouth transmissions, given the large number of times people touch their faces. The consensus appears to be that wearing a mask can limit – but not eliminate – the risks, provided it is used correctly.
Many countries are now enforcing or recommending curfews or lockdowns. In the UK any household where a person develops a fever or a new continuous cough are recommended to self-isolate for 14 days.
Dr Sian Williams, a consultant in occupational medicine in London, said it was vital for healthcare workers to be protected, but infection-control teams were often underresourced. One problem, she said, was the spread of keyboards and other technologies that are difficult to sterilise. “There are keyboards that can be wiped clean easily and some hospitals have those in A&E. But there hasn’t been a push [to expand their use] because we haven’t had this situation in the past,” she said.
UK hospitals may face further problems because many hospitals use contract cleaners who do not get paid for the first three days they are ill. “If they develop a cough, these people won’t be able to afford to stay away and self-isolate,” she said.
