COVID-19: Hygiene monitoring during the Coronavirus Disease 2019 outbreak in a Chinese hospital.

COVID-19:Hygiene monitoring during the Coronavirus Disease 2019 outbreak in a Chinese hospital. Jefferson T, Heneghan C.

Published on July 23, 2020

Reference Wang J, Feng H, Zhang S, et al. SARS-CoV-2 RNA detection of hospital isolation wards hygiene monitoring during the Coronavirus Disease 2019 outbreak in a Chinese hospital.  Int J Infect Dis. 2020;94:103-106. 2020
Study type
Country China
Setting Hospital
Funding Details Zhejiang Province Medical and Health Science and Technology Project
Transmission mode Fomites, orofecal
Exposures Hospital environment

Bottom Line

SARS-Cov-2 RNA were positive from inlets of the sewage disinfection pool and negative from the outlet of the last sewage disinfection pool but no viable virus was detected by culture. Strict disinfection and hand hygiene could decrease the hospital-associated COVID-19 infection risk of the staffs in isolation wards.

Evidence Summary

There were no SARS-Cov-2 RNA isolates from the 36 objects surface samples and nine staff PPE samples in the isolation wards (33 laboratory-confirmed patients were in the isolation wards in the hospital). 

Three sewage samples from the inlet of preprocessing disinfection pool was positive for SARS-CoV-2 RNA and the sample from the outlet of pre-processing disinfection pool was weakly positive but the sewage sample from the outlet of the last disinfection pool was negative. 

All of the five  sewage samples from various points were culture-negative by viral culture of SARS-Cov-2. None of the respiratory specimens of staff in the isolation wards were positive. 

What did they do?

The study reports the monitoring for the presence of SARS-Cov-2 in the hospital environment, surfaces, sewage, and staff PPE in isolation wards in the First Affiliated Hospital of Zhejiang University in China during the period 19th to 24 February 2020.

Swab samples were taken from hospital environmental surfaces and staff PPE in 3 isolation wards as well as sewage from various inlet and outlets. Respiratory and stool specimens of patients were collected and respiratory specimens of staff from the isolation wards were sampled once a week. Surfaces of objects were routinely wiped with a chlorine based solution and air and sewage disinfection done routinely. Viral culture was done on samples positive for SARS-Cov-2 RNA. 

Study reliability

The study is small and requires replication, the air from ventilation ducts was not sampled and not few of the stool specimens from sewage had viral culture. No sampling had taken place in toilets.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes No Yes No Yes

What else should I consider?

This study did not have a protocol and its small size means that the results require replication.

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Tom Jefferson

Tom Jefferson, epidemiologist.