SARS-CoV-2 RNA and viable virus contamination of hospital emergency department surfaces and association with patient COVID-19 status and aerosol generating procedures

Background Infectious aerosols and droplets generated by SARS-CoV-2–positive patient aerosol generating procedures (AGPs), coughing, or exhalation could potentially contaminate surfaces, leading to indirect SARS-CoV-2 spread via fomites. Our objective was to determine SARS-CoV-2 surface contamination frequency in Emergency Department (ED) patient rooms with respect to patient SARS-CoV-2 status and AGP receipt. Methods Swabs were collected from fixed surfaces or equipment in the rooms of patients under investigation for COVID-19 or known to be SARS-CoV-2-positive. Environmental swabs were tested for SARS-CoV-2 RNA by RT-qPCR; RNA-positive samples were cultured in Vero E6 cells. Room contamination was also evaluated by clinical severity of COVID-19 and time since symptom onset. Results In total, 202 rooms were sampled: 42 SARS-CoV-2–positive AGP patient rooms, 45 non-AGP SARS-CoV-2–positive patient rooms, and 115 SARS-CoV-2–negative AGP patient rooms. SARS-CoV-2 RNA was detected on 36 (3.6%) surfaces from 29 (14.4%) rooms. RNA contamination was detected more frequently in rooms occupied by non-AGP SARS-CoV-2– positive patients than SARS-CoV-2-positive AGP patients (28.9% vs 14.3%, p=0.078). Infectious virus was cultured from one non-AGP SARS-CoV-2-positive patient room. There was no significant difference in room positivity according to COVID-19 severity or time since symptom onset. Conclusion SARS-CoV-2 RNA contamination of ED room surfaces was highest and most frequent in rooms occupied by SARS-CoV-2–positive patients who did not undergo an AGP, which may be attributable to disease stage and viral shedding; however, there was no difference in room contamination according to COVID-19 severity or time since symptom onset. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by U.S. Centers for Disease Control and Prevention Broad Agency Announcement 75D301–20–R–68024, Applied Research to Address the Coronavirus (COVID–19) Continued Public Health Emergency – Developing Strategies for Protection, Prevention, & Control in Communities [contract# 75D30120C09810]. ### 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 IRB of Yale University waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. 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 All data produced in the present study are available upon reasonable request to the authors.