COVID-19: What a New Study Says and Doesn’t Say About the Possibility of Airborne Transmission

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published: March 20. 

As we have become a little more comfortable with the concept of social distancing as a way to mitigate the spread of this new coronavirus, a new worry seemed to dominate conversations this week: the idea that the virus can linger in the air. The takeaway for many people, at least in the conversations I’ve been having, is that you can become infected by simply walking down the street. There is no evidence that this is true (unless, of course, someone sneezes in your face!).

Results of recent experiment deepen our understanding.

A March 17 research letter published in the New England Journal of Medicine reported on experiments in which SARS-CoV-2, the virus that causes COVID-19, was artificially aerosolized. (For comparisons, SARS-CoV-1, which causes SARS, was also aerosolized.) A nebulizer was used to aerosolize the virus, and the aerosol was fed into a rotating drum. The drum apparatus helps to keep the suspended aerosols from settling out of the air, so that their dynamics can be more closely studied.

Under these controlled conditions, the researchers were able to demonstrate that artificially aerosolized virus remained viable and infectious for three hours, and that therefore it’s “plausible” that, if something causes the virus to aerosolize outside of the lab, this could be another mode of […]

2020-03-20T14:14:49-04:00March 20th, 2020|infection control, infectious diseases, Nursing, Public health|4 Comments
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Making Sense of Interim CDC Guidance on N95 vs. Surgical Masks for COVID-19

Surprising new CDC guidance.

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published: March 13, 2020. New posts will appear on this blog about aspects of the pandemic as the situation and our knowledge about the virus continue to evolve.

For nurses, the biggest news this week wasn’t the declaration of the COVID-19 epidemic as an official pandemic. It was the CDC’s release on March 10 of new interim infection prevention and control recommendations for COVID-19.

Many of us were taken aback to read the new document, which recommends the use of regular surgical face masks instead of N95s and the routine placement of patients suspected or confirmed of having COVID-19 infection in private rooms with the door closed instead of housing them in a negative pressure isolation room (which are always in short supply).

Unfortunately, without first acknowledging the concerns such a change from longstanding infection control practice might occasion among nurses and others, the CDC presented it as necessary due to an N95 shortage, stating, “When the supply chain is restored, facilities . . . should return to use of respirators for patients with known or suspected COVID-19.”

While it’s clear the CDC could have crafted this message more carefully, are caregivers being thrown […]

2020-03-16T10:25:22-04:00March 13th, 2020|infection control, Public health|2 Comments
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If I Want to Wear a Face Mask to Prevent COVID-19, Why Shouldn’t I?

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published. March 6; updated March 12.

Times are uncertain. We don’t know how the spread of the new coronavirus will play out, or what parts of the country will be affected next. Many people continue to insist that wearing a mask in public places is “added insurance” against infection. But the reasons for NOT wearing a face mask far outweigh the purported benefit of keeping your nose and mouth covered when you’re out and about.

First, some background.

Health care workers use two main kinds of mouth and nose protection: either a regular surgical face mask, or an N95 respirator.

The purpose of a surgical mask is to prevent the wearer’s respiratory secretions from contaminating other people or surfaces. This is an example of “source control” in preventing infections. It is the reason the surgical team wears masks during operations and other invasive procedures.

N95 respirators look very much like face masks. They are designed to protect the wearer from inhaling hazardous particles (infectious agents, dust, etc.). Health care workers wear these when caring for people with COVID-19 or other serious respiratory infections.

But at least a face mask provides a physical barrier. Why shouldn’t I […]

2020-03-11T12:10:37-04:00March 6th, 2020|infection control, Nursing, Public health|0 Comments
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As Another Coronavirus Begins to Spread, Follow Reasonable Precautions and Avoid Fear-Mongering

(Editor’s note: Published January 24. The situation has considerably changed in the intervening weeks, during which the virus has rapidly spread across the globe. We obviously now know a great deal more about the dangers it presents.)

Emerging infections are part of our world—more evident these days because we have the tools and global communication networks to quickly identify them. This month, we’ve begun another crash course in the initial management of a new pathogen.

Short timeline from first cases to screening test availability.

Rumors of a concerning cluster of undiagnosed pneumonia in Wuhan, China, surfaced on social media on December 31. The patients weren’t responding to antibiotic therapy, but tests were negative for the usual viral suspects. World Health Organization staff quickly connected with Chinese health officials and testing and epidemiological investigations kicked into high gear.

Many of the infected patients had worked at a fish and live animal market in Wuhan, suggesting that the illnesses might be zoonotic (passing from animals to human) in origin. On January 7, the pathogen was identified as a new coronavirus, related (though not closely) to the coronaviruses that cause SARS and MERS. The viral genome was quickly sequenced, and on January 12, China shared the genetic sequence with the global scientific community. By […]

2020-03-19T17:12:45-04:00January 24th, 2020|infection control, infectious diseases, Nursing, Public health|1 Comment
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Infections in Acute Care: Still More to Do

A sharply increased focus on hospital-acquired infections (HAIs).

This month marks the 14th anniversary of the National Healthcare Safety Network (NHSN), the CDC’s data repository for health care–associated infections. Since 2005, when a limited number of hospitals began reporting infections data, the health care community has sharply increased its focus on the prevention, early recognition, and treatment of infections in the hospital. Research on risk factors, closer attention to limiting device use (urinary catheters, central lines), and support for meticulous hand hygiene and environmental cleaning protocols have decreased rates of CAUTIs, CLABSIs, and surgical site infections.

The risk is always there.

Still, as nurses well know, hospitalized patients remain at increased risk for developing infections, especially if they are immunosuppressed or have diabetes, need invasive devices, have many comorbidities, or stay in a critical care unit.

The current evidence reviewed.

In “Infection in Acute Care: Evidence for Practice” in this month’s AJN, Douglas Houghton reviews the latest evidence on common infections in acute care settings, including community- and hospital-acquired pneumonia, surgical site infections, and C. difficile. […]

2019-10-09T10:09:54-04:00October 9th, 2019|infection control, Nursing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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