SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities

SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities

Authors

  • M. Gola
  • G. Caggiano
  • O. De Giglio
  • C. Napoli
  • G. Diella
  • M. Carlucci
  • L. F. Carpagnano
  • D. D'Alessandro
  • C. M. Joppolo
  • S. Capolongo
  • M. T. Montagna

Keywords:

Healthcare facilities, COVID-19, SARS-CoV-2, management, HVAC (heating, ventilation and air conditioning) and ventilation systems, best practices

Abstract

Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades.

It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials.

Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems’ management and filters’ efficiency.

In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.

References

1. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020. doi: 10.1016/S0140-6736(20)30154-9.

2. Capolongo S, Rebecchi A, Buffoli, M, et al. COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities. Acta Biomedica. 2020; 91(2):13-22. doi: 10.23750/abm.

v91i2.9615.

3. Astley P, Capolongo S, Gola M, Tartaglia A. Operative and design adaptability in healthcare facilities. Technè 2015; 9: 162-70. doi: 10.13128/ Techne-16118.

4. Capolongo S, Cocina GG,Gola M, Peretti G, Pollo R. Horizontality and verticality in architectures for health. Technè 2019; 17: 152-60. doi: 10.13128/Techne-24028.

5. Montagna MT, De Giglio O, Cristina ML, et al. Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study. Int J Environ Res Public Health 2017; 14(7): 670. doi: 10.3390/ijerph14070670.

6. Caggiano G, Napoli C, Coretti C, et al. Mold contamination in a controlled hospital environment: a 3-year surveillance in southern Italy. BMC Infect Dis 2014; 14: 595. doi: 10.1186/ s12879-014-0595-z.

7. Brambilla A, Rebecchi A, Capolongo S. Evidence Based Hospital Design. A literature review of the recent publications about the EBD impact of built environment on hospital occupants’ and organizational outcomes. Ann Ig 2019; 31(2): 165-80. doi: 10.7416/ai.2019.2269.

8. Sehulster L, Chinn RY. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

(HICPAC). MMWR Recomm Rep 2003, 52(RR-

10): 1-42.

9. Joppolo CM, Romano F. HVAC System Design in Health Care Facilities and Control of Aerosol Contaminants: Issues, Tools and Experiments. In: Capolongo S, Settimo G, Gola M, Eds. Indoor Air Quality in Healthcare Facilities. New York: Springer Public Health, 2017: 83-94. doi: 10.1007/978-3-319-49160-8_8.

10. D’Amico A, Montagna MT, Caggiano G, et al. Observational study on hospital building heritage and microbiological air quality in the orthopedic operating theatre: the IM.PA.C.T. Project. Ann Ig 2019; 31(5): 482-95. doi:10.7416/ ai.2019.2309.

11. Capolongo S, Gola M, Brambilla A, Morganti A, Mosca EI, Barach P. COVID-19 and Healthcare Facilities. A Decalogue of Design Strategies for Resilient Hospitals. Acta Biomedica 2020; 91: 50-60. doi: 10.23750/abm.v91i9-S.10117.

12. Settimo G, Bertinato L, Bonadonna, L, D’Ancona, P, Santarsiero, A, Soggiu, ME. Indicazioni ad interim per la prevenzione e gestione degli ambienti indoor in relazione alla trasmissione dell’infezione da virus SARS-CoV-2. Roma: Istituto Superiore di

Sanità, 2020 (Rapporto ISS COVID-19 n. 5/2020, Rev.). Available on: https://www.iss. it/documents/20126/0/Rapporto+ISS+COVID19+n.+5_2020+REV.pdf/2d27068f-6306-94ea47e8-0539f0119b91?t=1588146889381. [Last accessed: 2020, Sep 9].

13. Associazione Italiana Condizionamento dell’Aria, Riscaldamento e Refrigerazione (AICAAR). Protocollo per la riduzione del rischio da diffusione del SARS-CoV-2 mediante gli impianti di climatizzazione e ventilazione in ambienti sanitari. Rome: AICAAR, 2020.

14. Gola M, Settimo G, Capolongo S. Indoor Air Quality in Inpatient Environments: A Systematic Review on Factors that Influence Chemical Pollution in Inpatient Wards. J Healthc Eng 2019; 8358306. doi: 10.1155/2019/8358306.

15. Śmiełowska M, Marć M, Zabiegała B. Indoor air quality in public utility environments—A review. Environ Sci Pollut Res 2017; 24: 11166-76. doi:

10.1007/s11356-017-8567-7.

16. Gola M, Settimo G, Capolongo S. Indoor air in healing environments: Monitoring chemical pollution in inpatient rooms. Facilities 2019; 37(9/10): 600-23. doi: 10.1108/F-01-2018-0008.

17. Montagna MT, Rutigliano S, Trerotoli, P, et al. Evaluation of Air Contamination in Orthopaedic Operating Theatres in Hospitals in Southern Italy: The IMPACT Project. Int J Environ Res Public Health. 2019; 16(19): 3581. doi: 10.3390/ ijerph16193581.

18. Pasquarella C, Pitzurra O, Savino A. The index of microbial air contamination. J Hosp Infect 2000; 46(4): 241-56. doi: 10.1053/jhin.2000.0820.

19. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARSCoV-2 as Compared with SARS-CoV-1. N Engl

J Med 2020; 382(16): 1564-7. doi: 10.1056/ NEJMc2004973.

20. Casini B, Tuvo B, Cristina ML, et al. Evaluation of an ultraviolet C (UVC) light-emitting device for disinfection of high touch surfaces in hospital critical areas. Int J Environ Res Public Health 2019; 16(19): 3572. doi: 10.3390/ ijerph16193572.

21. Cheng VCC, Wong SC, Chen JHK, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol 2020; 1-24. doi: 10.1017/ice.2020.58.

22. Ong SWX, Tan YK, Chia PY, et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA 2020; 323(16): 1610-12. doi: 10.1001/jama.2020.3227.

23. Chin A, Chu J, Perera M, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020. doi:

10.1101/2020.03.15.20036673.

24. Bianchi CL, Sacchi B, Capelli S, et al. Microsized TiO2 as photoactive catalyst coated on industrial porcelain grès tiles to photodegrade drugs in water. Environ Sci Pollut Res 2018; 25(21): 20348-53. doi: 10.1007/s11356-017-9066-6.

25. Zanelli A, Campioli A, Monticelli C, Viscuso S, Giabardo G. Novel Textile-Based Solutions of Emergency Shelters: Case Studies and Field Tests of S(P)EEDKITS Project. In: Aste N, Della Torre S, Talamo C, Adhikari R, Rossi C, Eds. Innovative Models for Sustainable Development in Emerging African Countries. Cham: Springer, Research for Development, 2020. doi:10. 1007/978-3-030-33323-2_10.

26. Guo ZD, Wang ZY, Zhang SF, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020; 26(7). doi: 10.3201/eid2607.200885.

27. Otter JA, Donskey C, Yezli S, Douthwaite S, Goldenberg SD, Weber DJ. Transmission of SARS and MERS coronaviruses andinfluenza virus in healthcare settings: the possible role of dry surface contamination. J Hosp Infect 2016; 92(3): 235e50. doi: 10.1016/j.jhin.2015.08.027.

28. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020; 104(3): 246-51. doi: 10.1016/j.jhin.2020.01.022.

29. Moscato U, Borghini A, Teleman AA. HVAC

Management in Health Facilities. In: Capolongo

S, Settimo G, Gola M, Eds. Indoor Air Quality in Healthcare Facilities. New York: Springer Public Health, 2017: 95-106. doi:10.1007/9783-319-49160-8_9.

30. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). Position Document on Infectious Aerosols. ASHRAE, 2020. Available on: https://www. ashrae.org/file%20library/about/position%20 documents/pd_infectiousaerosols_2020.pdf [Last accessed: 2020, Sep 8].

31. Mkhatshwa T, Mummert A. Modeling superspreading events for infectious diseases: Case study SARS. IAENG Int J Appl Math 2011; 41(2): 82–88.

32. Li Y, Leun GM, Tang JW, et al. Role of ventilation in airborne transmission of infectious agents in the built environment? A multidisciplinary systematic review. Indoor Air 2007; 17(1): 2-18.

doi:10.1111/j.1600-0668.2006.00445.x.

33. Shiu EYC, Leung NHL, Cowling BJ. Controversy around airborne versus droplet transmission of respiratory viruses. Curr Opin Infect Dis 2019; 32(4): 372-9. doi:10.1097/ QCO.0000000000000563.

34. Correia G, Rodrigues L, Gameiro da Silva M, Gonçalves T. Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission. Med Hypotheses 2020; 141: 109781. doi:10.1016/j. mehy.2020.109781.

35. Centers for Disease Control and Prevention (CDC). Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings. MMWR Recomm Rep 2005; 54(RR17): 1-141.

36. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). Method of Testing General Ventilation Air-Cleaning Devices for Removal Efficiency by Particle Size. Standard 52.2, 2017.

37. Centers for Disease Control and Prevention

(CDC). Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID19). 2019. Pandemic. Available on: https://www. cdc.gov/coronavirus/2019-ncov/hcp/infectioncontrol-recommendations.html [Last accessed: 2020, Sep 8].

38. Centers for Disease Control and Prevention (CDC). Guidelines for environmental infection control in health-care facilities: recommenda-

tions of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (2003). Updated in 2017. Available on: https:// www.cdc.gov/infectioncontrol/guidelines/environmental [Last accessed: 2020, Sep 8].

39. Kurnitski J, Boerstra A, Franchimon F, et al. Federation of European Heating, Ventilation and Air Conditioning Association (REHVA). COVID-19 guidance document, 2020. How to operate and use building services in order to prevent the spread of the COVID-19. REHVA, 2020: 1-6.

40. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE).

ASHRAE Standards. Health care facilities.

In: ASHRAE. Heating, Ventilating, and AirConditioning applications. Atlanta: ASHRAE Handbook, 1995.

41. Morawska L, Tang, JW, Bahnfleth W, et al. How can airborne transmission of COVID-19 indoors be minimised? Environ Internat 2020; 142: 105832. doi: 10.1016/j.envint.2020.105832.

42. Rezaei N, Jafari M, Nazari A, et al. A novel methodology and new concept of SARSCoV-2 elimination in heating and ventilating air conditioning systems using waste heat recovery. AIP Adv 2020; 10(8): 085308. doi:

10.1063/5.0021575.

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Published

2025-09-04

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Section

Original research

How to Cite

1.
Gola M, Caggiano G, De Giglio O, et al. SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities. Ann Ig. 2025;33(4):381-392. doi:10.7416/ai.2020.2396