Measuring SARS-CoV-2 Aerosolization in Rooms of Hospitalized Patients

Background: Airborne spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a significant concern among healthcare workers (HCWs). Understanding transmission of SARS-CoV-2 in the hospital can help minimize nosocomial infection. The objective of this study is to measure aerosolization of SARS-CoV-2 in the hospital rooms of COVID-19 patients. Methods: Two air samplers (Inspirotec) were placed at one and four m away from hospitalized adults with SARS-CoV-2 infection at an urban, academic tertiary care hospital from June to October 2020. SARS-CoV-2 viral load was measured by quantitative reverse transcription PCR and analyzed by clinical parameters and patient demographics. Findings: 13 patients with COVID-19 (8 females [61·5%], median age: 57 years old, range 25— 82) presenting with shortness of breath (100%), cough (38·5%) and fever (15·4%). Respiratory therapy during air sampling varied: mechanical ventilation via endotracheal tube (n=3), high flow nasal cannula (n=4), nasal cannula (n=4), respiratory helmet (n=1), and room air (n=1). SARS-CoV-2 RNA was identified in 4 patient rooms (30·8%): all intubated patients (3/3) were found to have detectable viral RNA in at least one positive air sampler compared to 1 out of 10 of the non-intubated patients (p = 0·014). Viral load decreased with distance (1 vs. 4m) in rooms of intubated patients, though the difference was not significant (p = 0·250). Interpretation: Hospital rooms of intubated patients had higher levels of aerosolized SARS-CoV-2, consistent with increased airway viral load in patients with severe disease or treatment with positive pressure ventilation through an endotracheal tube. This has safety implications for HCWs and protective measures in the hospital. Funding Information: This project was supported by the Rostik and Joan Zajtchuk fund in the Section of Otolaryngology-Head and Surgery, the Pritzker School of Medicine Summer Research Program, and the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Declaration of Interests: The authors declare no relevant conflicts of interest. Ethics Approval Statement: Written, informed consent was obtained immediately prior to placement of the air sampler devices by the patient or by proxy as determined by the Illinois Healthcare Surrogate Act. The study protocol was approved by the University of Chicago Biological Sciences Division Institutional Review Board and the Office of Research Safety.