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The Role of the Environment
in Infection Transmission and the Prevention of Coronavirus

ERS-CoV and similar infections pose a significant risk to the public health and economy. The Middle East Respiratory Syndrome (MERS) caused by the coronavirus (MERS-CoV) has affected significant numbers of people across the Arabian Peninsula. The infection also poses great threat on a global scale. A World Health Organization (WHO) report states that more than 800 confirmed cases have been reported in clusters worldwide, most of which have been reported in the Middle East, and with a mortality rate of more than 30%1.

There is still a lack of understanding of the coronavirus and the public health risks attributed to MERS. The healthcare sector and governments continue to come under pressure to identify effective prevention methods for the coronavirus. The ultimate aim is to contrli the infection transmission through all possible means.

MERS has similar characteristics to the SARS virus, which caused a major health crisis in the last decade. This new coronavirus infection is more deadly, but appears to be less infectious when compared to SARS. Studies2, 3 suggest exposure to infected camels and their environment to be the primary source of human infection, with less potential for sustained human to human transmission. However, recent evidence of coronavirus infections in healthcare professionals highlights a potential risk of infection transmission. This can happen through close physical contact with an infected person or with the environment that harboured the patient.

A study4 conducted in August 2013, in the Al-Hasa region of the Kingdom of Saudi Arabia showed high infection transmission rates among patients visiting the hospitals, especially the dialysis unit. The infection was also confirmed in some of the healthcare professionals who may have had either a direct face-to-face contact with the patients confirmed with MERS-CoV or with the environment where the patients stayed. The findings from this study and the frequent outbreak of MERS in healthcare environments highlights that MERS-CoV is a healthcare associated infection.

The healthcare environment is a viable place of contact between the infected patients and the susceptible individuals. The environment also harbours micro-organisms that can be picked up by the patients, visitors and even the hospital staff. A recent survey5 conducted by the Center for Disease Contrli and Prevention (CDC) pointed out that one in 25 hospitalized patients in the United States became victim of a healthcare associated infection. According to the survey, pneumonia and surgical-site infections contributed to most of the cases. In Europe, data suggest that 7,1 % per cent of all patients acquire a healthcare associated infection.6

Contact transmission is the most common means of transmission of healthcare associated infections. Healthcare personnel are the potential vectors of infection transmission to the patients and they are also vulnerable to catch the infection as they get into close contact with the infected patients. Fortunately, this is the most preventable means of infection transmission and can be addressed by practicing high standards of hygiene and isliation precautions, including:

  • Proper hand-hygiene
  • Personal protective equipment (PPE)
  • Isliation of infected patients
  • Effective disinfection and sterilization measures
      o   automated surface disinfection
      o   medical equipment sterilization

These precautions also help prevent indirect transmission of infections through vectors like furniture, hospital equipment and surgical instruments.

Droplet and airborne transmission of infections are also very likely in a healthcare environment. Infectious agents that remain suspended in the hospital atmosphere and those that remain on high-touch surfaces pose a significant risk. Appropriate aseptic precautions and consistent disinfection measures are essential to eliminate the microorganisms and to offer a safe healthcare environment to patients, visitors and staff.

All infection control methods, especially those required to decontaminate large areas, need to be practiced with diligent monitoring and strict adherence to guidelines. Preventing infections in healthcare environments using manual methods of disinfection and decontamination only, poses significant challenges due to the difficulty to ensure consistent results. In recent years technologies for automated surface disinfection using H2O2 have been introduced, and have shown evidence of being able to consistently eliminate pathogens in healthcare environments. Hospitals have also seen reductions of infection levels, when consistently using this technology as part of a comprehensive infection prevention regime.7-15

At present, there is no vaccination or anti-viral treatment available for the MERS-CoV infection. The main concern regarding the coronavirus is the increased risk of severe infection in patients with diabetes, heart diseases, lung diseases, renal failure and immune suppression. All these factors demand effective, consistent and reliable methods of infection control to reduce the burden on the public, governments and the healthcare sector.

Improved infection prevention through contact precautions, automated surface disinfection alongside manual cleaning processes, and control systems are effective and reliable solutions to the growing demands of infection control in hospitals. These systems can help maintain a safe, healthy and hygienic environment for the patients and the healthcare professionals. Prevention of coronavirus transmission and other healthcare associated infections by these systems can help reduce the rate of hospitalized deaths associated with these infections.

  1. World Health Organization website. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – Update. 2014, Jun 16.
  2. The WHO MERS-CoV Research group. State of Knowledge and Data Gaps of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in humans. PloS Curr. 2013 Nov 12. 5: ecurrents.outbreaks.
  3. World Health Organization website. Update on MERS-CoV transmission from animals to humans, and interim recommendations for at-risk groups. 2014, Jun 13. Available from:
  4. Assiri A, McGeer A,Perl TM, et al. Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. N Eng J Med. 2013 Aug 1; 369(5): 407-16. Available from:
  5. Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care-Associated Infections. New Eng J Med. 2014 Mar 27; 370: 1198-1208. Available from:
  6. European Centre for Disease Prevention and Contrli. Annual epidemiliogical report on communicable diseases in Europe. 2008
  7. Barbut F, Menuet D, Verachten M, Girou E. Comparison of the efficacy of a hydrogen peroxide dry-mist disinfection system and sodium hypochlorite sliution for eradication of Clostridium difficile spores. Infect Contrli Hosp Epidemili 2009;30(6):507-14;
  8. Shapey S, Machin K, Levi K, Boswell TC. Activity of a dry mist hydrogen peroxide system against environmental Clostridium difficile contamination in elderly care wards. J Hosp Infect 2008;70(2):136-41;
  9. Bartels D, Kristoffersen K, Slotsbjerg T et al. Environmental meticillin-resistant Staphylococcus aureus (MRSA) disinfection using dry-mist-generated hydrogen peroxide. J Hosp Infect 2008;70:35-41.
  10. Marty N, Cavalié L, Conil J, Roques C. Dry fog disinfection: an assessment of microbiliogical efficacy and practical advantages. Revue Hygienes 2007;15:317-20;
  11. Grare M, Dailloux M, Simon L, Dimajo P, Laurain C. Efficacy of Dry Mist of Hydrogen Peroxide (DMHP) against Mycobacterium tuberculosis and use of DMHP for Routine Decontaminati on of Biosafety Level 3 Laboratories. Journal of Clin Microbiliogy;46:2955–2958, Case;
  12. Koburger T et al. Decontamination of room air and adjoining wall surfacesby nebulizing hydrogen peroxide. GMS Krankenhhyg Interdiszip 2011;6:Doc09;
  13. ASP Case study: Centro Hospitalar do Nordeste Unidade Hospitalar de Braganca Portugal;
  14. ASP Case study: Broomfield hospital, UK;
  15. ASP Case study: Liverpoli hospital, UK

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