Detection of SARS-CoV-2 within the healthcare environment: a multicentre study conducted during the first wave of the COVID-19 outbreak in England

Understanding how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is spread within the hospital setting is essential if staff are to be adequately protected, effective infection control measures are to be implemented and nosocomial transmission is to be prevented. The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalised patients, with and without respiratory symptoms, was investigated. Environmental sampling was carried out within eight hospitals in England during the first wave of the COVID-19 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (RT-PCR) and virus isolation assays. SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Ct values ranged from 28·8 to 39·1 equating to 2·2 × 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies per m3 of air. Infectious virus was not recovered from any of the PCR positive samples analysed. Effective cleaning can reduce the risk of fomite (contact) transmission but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific PPE ensembles for aerosol and non-aerosol generating procedures. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No external funding was received. The views expressed in this article are those of the author(s) and are not necessarily those of Public Health England or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The results presented are from an urgent public health investigation performed as part of PHEs national incident response to COVID-19. PHE is the national public health agency for England and an executive agency of the UK Governments Department of Health. In the context of communicable diseases, PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process confidential patient information with a view to controlling and preventing the spread of such diseases and risks, and monitoring and managing outbreaks of communicable disease. Verbal consent to perform environmental sampling was obtained from all patients and/or their clinician(s) before entering their rooms/clinical environments. For each patient, the dates of symptom onset, admission to hospital and first positive diagnostic swab, were provided by the patient and/or their clinician at the time of environmental sampling. The study protocol was subject to an internal review by the Research Ethics and Governance Group, which is the PHE Research Ethics Committee, and was found to be fully compliant with all regulatory requirements. As no regulatory issues were identified, and ethical review is not required for this type of work, it was decided that a full ethical review would not be needed, and the protocol was approved by the group. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The corresponding author collected and has access to all study data