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Lee SJ, Lee WS, Roh JY, Lee SH, Kim ES, Yeo MS. Post-occupancy evaluation on temporary negative pressure isolation wards with portable high-efficiency particulate air filter units used during the COVID-19 pandemic in South Korea. Am J Infect Control 2024:S0196-6553(24)00692-8. [PMID: 39245359 DOI: 10.1016/j.ajic.2024.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/30/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, in South Korea, several inpatient wards were converted to temporary negative pressure isolation (TNPI) wards by using portable high-efficiency particulate air filter units (PHUs). This study proposes improvements to the TNPI ward to prepare for airborne infections. METHODS Existing air-conditioning systems were investigated during the pandemic in 4 hospitals through a document review and field investigation with staff interviews. On-site experiments and measurements were conducted under vacant conditions. Differential pressure (∆P) between spaces was measured in all 4 hospitals, while tracer gas tests were carried out in 2 hospitals. RESULTS The investigation revealed that thermal discomfort caused the existing systems remaining perpetually active. Additionally, the noise generated by the PHU caused an unexpected shutdown of that equipment. Furthermore, the ∆P of over -2.5 Pa was measured as a result of the operating status of equipment. These situations can cause duct backflow and gas diffusion through unsealed diffusers. Moreover, low airtightness of existing facilities can affect indoor environment, pressure difference, and gas diffusion. CONCLUSIONS When using existing facilities as TNPI wards, the airtightness and existing systems should be considered. We concluded that it is important to increase the airtightness and seal unused diffusers in order to prevent cross-infection by unpredictable airflow.
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Affiliation(s)
- Se Jin Lee
- Department of Architecture and Architectural Engineering, Graduate School, Seoul National University, Seoul, South Korea
| | - Won Seok Lee
- Department of Architecture and Architectural Engineering, Graduate School, Seoul National University, Seoul, South Korea
| | - Joo Yeon Roh
- Department of Architecture and Architectural Engineering, Graduate School, Seoul National University, Seoul, South Korea
| | - Shin Hye Lee
- Department of Architecture and Architectural Engineering, Graduate School, Seoul National University, Seoul, South Korea
| | - Eun Seok Kim
- Seoul Public Health Research Institute, Seoul Medical Center, Seoul, South Korea
| | - Myoung Souk Yeo
- Department of Architecture and Architectural Engineering, College of Engineering, Seoul National University, Seoul, South Korea; Institute of Construction and Environmental Engineering (ICEE), Seoul National University, Seoul, South Korea.
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2
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Nadi ZB, Raisali F, Jafari N, Bayramzadeh S. The influence of physical environment on health care-associated infections: A literature review. Am J Infect Control 2024; 52:229-242. [PMID: 37356457 DOI: 10.1016/j.ajic.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a common issue in health care settings, caused by environmental microorganisms, leading to health risks and financial strain. Despite efforts to reduce HAIs, the role of the physical environment in reducing HAIs is not fully understood. This literature review aimed to identify physical environment variables contributing to HAIs. METHODS A literature search was conducted in scientific databases between 2016 and 2022 using keywords associated with infections and physical environment variables. After screening retrieved articles for eligibility, the articles were analyzed for relevant environmental and infection variables. RESULTS Out of 145, 27 articles were identified. The findings were grouped into 8 categories, including layout design, surfaces, behavior, lighting, Internet of Things, materials, airflow, and air quality, with sub-themes in each group. CONCLUSIONS The physical environment in health care facilities plays a crucial role in reducing and preventing the spread of HAIs. Proper design and construction of health care buildings, including ventilation and air conditioning systems, help prevent infection spread between functional areas. Antimicrobial materials, cleaning and disinfection protocols, and personal hygiene practices, such as hand hygiene, are key factors in infection control. The positioning of hand hygiene stations is also essential to improve compliance among health care professionals.
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Affiliation(s)
- Zeekra B Nadi
- Healthcare Design Program, College of Architecture and Environmental Design, Kent State University, Kent, OH
| | - Farimah Raisali
- Healthcare Design Program, College of Architecture and Environmental Design, Kent State University, Kent, OH
| | - Nazli Jafari
- Healthcare Design Program, College of Architecture and Environmental Design, Kent State University, Kent, OH
| | - Sara Bayramzadeh
- Healthcare Design Program, College of Architecture and Environmental Design, Kent State University, Kent, OH.
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3
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Schaffzin JK, Thampi N, Fullerton J. Negative-pressure rooms and Aspergillus risk-Air balance alone is insufficient. Infect Control Hosp Epidemiol 2023; 44:2096-2097. [PMID: 37694734 DOI: 10.1017/ice.2023.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Joshua K Schaffzin
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nisha Thampi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Fullerton
- Planning and Development Department, The Ottawa Hospital, Ottawa, Ontario, Canada
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4
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Voidarou C, Rozos G, Stavropoulou E, Giorgi E, Stefanis C, Vakadaris G, Vaou N, Tsigalou C, Kourkoutas Y, Bezirtzoglou E. COVID-19 on the spectrum: a scoping review of hygienic standards. Front Public Health 2023; 11:1202216. [PMID: 38026326 PMCID: PMC10646607 DOI: 10.3389/fpubh.2023.1202216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic.
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Affiliation(s)
| | - Georgios Rozos
- Veterinary Directorate, South Aegean Region, Ermoupolis, Greece
| | - Elisavet Stavropoulou
- Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Elpida Giorgi
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Stefanis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Vakadaris
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Natalia Vaou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Yiannis Kourkoutas
- Laboratory of Applied Microbiology and Biotechnology, Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eugenia Bezirtzoglou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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5
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Yoon KW, Wi W, Choi MS, Gil E, Park CM, Yoo K. Feasibility of Ultrasound-Guided, Peripherally Inserted Central Catheter Placement at the Bedside in a Communicable-Disease Isolation Unit. J Pers Med 2023; 13:jpm13050863. [PMID: 37241033 DOI: 10.3390/jpm13050863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Previous studies have investigated the safety of peripherally inserted central catheters (PICCs) in the intensive care unit (ICU). However, it remains uncertain whether PICC placement can be successfully carried out in settings with limited resources and a challenging environment for procedures, such as communicable-disease isolation units (CDIUs). METHODS This study investigated the safety of PICCs in patients admitted to CDIUs. These researchers used a handheld portable ultrasound device (PUD) to guide venous access and confirmed catheter-tip location with electrocardiography (ECG) or portable chest radiography. RESULTS Among 74 patients, the basilic vein and the right arm were the most common access site and location, respectively. The incidence of malposition was significantly higher with chest radiography compared to ECG (52.4% vs. 2.0%, p < 0.001). CONCLUSIONS Using a handheld PUD to place PICCs at the bedside and confirming the tip location with ECG is a feasible option for CDIU patients.
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Affiliation(s)
- Kyoung Won Yoon
- Division of Critical Care, Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong 14353, Republic of Korea
| | - Wongook Wi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong 14353, Republic of Korea
| | - Moon Suk Choi
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Republic of Korea
| | - Eunmi Gil
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Keesang Yoo
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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6
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Zhong B, Gao H, Ding L, Wang Y. A Blockchain-Based Life-Cycle Environmental Management Framework for Hospitals in the COVID-19 Context. ENGINEERING (BEIJING, CHINA) 2023; 20:208-221. [PMID: 36245898 PMCID: PMC9540700 DOI: 10.1016/j.eng.2022.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/13/2022] [Accepted: 06/16/2022] [Indexed: 06/16/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) emergency, many hospitals were built or renovated around the world to meet the challenges posed by the rising number of infected cases. Environmental management in the hospital life cycle is vital in preventing nosocomial infection and includes many infection control procedures. In certain urgent situations, a hospital must be completed quickly, and work process approval and supervision must therefore be accelerated. Thus, many works cannot be checked in detail. This results in a lack of work liability control and increases the difficulty of ensuring the fulfillment of key infection prevention measures. This study investigates how blockchain technology can transform the work quality inspection workflow to assist in nosocomial infection control under a fast delivery requirement. A blockchain-based life-cycle environmental management framework is proposed to track the fulfillment of crucial infection control measures in the design, construction, and operation stages of hospitals. The proposed framework allows for work quality checking after the work is completed, when some work cannot be checked on time. Illustrative use cases are selected to demonstrate the capabilities of the developed solution. This study provides new insights into applying blockchain technology to address the challenge of environmental management brought by rapid delivery requirements.
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Affiliation(s)
- Botao Zhong
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Han Gao
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
- Department of Civil and Building Systems, Technische Universität Berlin, Berlin 13156, Germany
| | - Lieyun Ding
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yuhang Wang
- National Center of Technology Innovation for Digital Construction, Huazhong University of Science and Technology, Wuhan 430074, China
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
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7
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Shang Y, Dong J, Tian L, He F, Tu J. An improved numerical model for epidemic transmission and infection risks assessment in indoor environment. JOURNAL OF AEROSOL SCIENCE 2022; 162:105943. [PMID: 35034977 PMCID: PMC8748225 DOI: 10.1016/j.jaerosci.2021.105943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 05/08/2023]
Abstract
Social distance will remain the key measure to contain COVID-19 before the global widespread vaccination coverage expected in 2024. Containing the virus outbreak in the office is prioritised to relieve socio-economic burdens caused by COVID-19 and potential pandemics in the future. However, "what is the transmissible distance of SARS-CoV-2" and "what are the appropriate ventilation rates in the office" have been under debate. Without quantitative evaluation of the infection risk, some studies challenged the current social distance policies of 1-2 m adopted by most countries and suggested that longer social distance rule is required as the maximum transmission distance of cough ejected droplets could reach 3-10 m. With the emergence of virus variants such as the Delta variant, the applicability of previous social distance rules are also in doubt. To address the above problem, this study conducted transient Computational Fluid Dynamics (CFD) simulations to evaluate the infection risks under calm and wind scenarios. The calculated Social Distance Index (SDI) indicates that lower humidity leads to a higher infection risk due to weaker evaporation. The infection risk in office was found more sensitive to social distance than ventilation rate. In standard ventilation conditions, social distance of 1.7 m-1.8 m is sufficient distances to reach low probability of infection (PI) target in a calm scenario when coughing is the dominant transmission route. However in the wind scenario (0.25 m/s indoor wind), distance of 2.8 m is required to contain the wild virus type and 3 m is insufficient to contain the spread of the Delta variant. The numerical methods developed in this study provide a framework to evaluate the COVID-19 infection risk in indoor environment. The predicted PI will be beneficial for governments and regulators to make appropriate social-distance and ventilation rules in the office.
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Affiliation(s)
- Yidan Shang
- College of Air Transportation, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Jingliang Dong
- School of Engineering, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia
| | - Lin Tian
- School of Engineering, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia
| | - Fajiang He
- College of Air Transportation, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Jiyuan Tu
- School of Engineering, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia
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8
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Humphreys H. Infection prevention and control considerations regarding ventilation in acute hospitals. Infect Prev Pract 2022; 3:100180. [PMID: 34988422 PMCID: PMC8696268 DOI: 10.1016/j.infpip.2021.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022] Open
Abstract
Infection prevention and control team members (IPCTM) are often intimidated by aspects of ventilation as they relate to healthcare, because they consider them technical and outside their area of comfort and expertise. However, engineers, estates departments and planners need IPCTM input to ensure appropriate design and use. The main areas of importance centre on the operating theatre, the provision of air-controlled ventilated isolation rooms, and how to respond to major outbreaks/pandemics. Concentrating on basic principles of infection prevention and control, developing relationships with key departments and individuals, and applying best practice to these and other areas as they arise, are of great value. Some background, information and suggestions are provided for IPCTM with a view to providing simple practical advice in these areas.
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Key Words
- ACH, air changes per hour
- ACV, air controlled ventilated
- Air sampling
- Air-controlled ventilation
- ED, emergency department
- IPC, infection prevention and control
- IPCTM, infection prevention and control team members
- Isolation facilities
- MIS, minimally invasive surgery
- NIPPV, non-invasive positive pressure ventilation
- Operating theatres
- PJA, prosthetic joint arthroplasty
- Pandemic preparedness
- SSI, surgical site infection
- UDAF, unidirectional air flow
- Upgrades/refurbishments
- cfu, colony forming units
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Affiliation(s)
- Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Bueno de Mesquita PJ, Delp WW, Chan WR, Bahnfleth WP, Singer BC. Control of airborne infectious disease in buildings: Evidence and research priorities. INDOOR AIR 2022; 32:e12965. [PMID: 34816493 DOI: 10.1111/ina.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.
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Affiliation(s)
| | - William W Delp
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Wanyu R Chan
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - William P Bahnfleth
- Department of Architectural Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Brett C Singer
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
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10
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Squire MM, Munsamy M, Lin G, Telukdarie A, Igusa T. Modeling hospital energy and economic costs for COVID-19 infection control interventions. ENERGY AND BUILDINGS 2021; 242:110948. [PMID: 33814682 PMCID: PMC7997299 DOI: 10.1016/j.enbuild.2021.110948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/13/2021] [Accepted: 03/19/2021] [Indexed: 05/10/2023]
Abstract
The study objective assessed the energy demand and economic cost of two hospital-based COVID-19 infection control interventions: negative pressure (NP) treatment rooms and xenon pulsed ultraviolet (XP-UV) equipment. After projecting COVID-19 hospitalizations, a Hospital Energy Model and Infection De-escalation Models quantified increases in energy demand and reductions in infections. The NP intervention was applied to 11, 22, and 44 rooms for small, medium, and large hospitals, while the XP-UV equipment was used eight, nine, and ten hours a day. For small, medium, and large hospitals, the annum kWh for NP rooms were 116,700 kWh, 332,530 kWh, 795,675 kWh, which correspond to annum energy costs of $11,845 ($1,077/room), $33,752 ($1,534/room), and $80,761 ($1,836/room). For XP-UV, the annum-kilowatt-hours (and costs) were 438 ($45), 493 ($50), and 548 ($56) for small, medium, and large hospitals. While energy efficiencies may be expected for the large hospital, the hospital contained more energy-intensive use rooms (ICUs) which resulted in higher operational and energy costs. XP-UV had a greater reduction in secondary COVID-19 infections in large and medium hospitals. NP rooms had a greater reduction in secondary SARS-CoV-2 transmission in small hospitals. Early implementation of interventions can result in realized cost savings through reduced hospital-acquired infections.
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Affiliation(s)
- Marietta M Squire
- Johns Hopkins University, Department of Civil and Systems Engineering, 3400 N. Charles St, Baltimore, MD 21218, USA
| | - Megashnee Munsamy
- Mangosuthu University of Technology, Mangosuthu Highway, Umlazi, Durban, South Africa
| | - Gary Lin
- Center for Disease Dynamics, Economics & Policy, Silver Spring, MD 20910, USA
| | | | - Takeru Igusa
- Johns Hopkins University, Department of Civil and Systems Engineering, 3400 N. Charles St, Baltimore, MD 21218, USA
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11
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Taylor M, Reynolds C, Jones R. Challenges and Potential Solutions for Patient Safety in an Infectious-Agent-Isolation Environment: A Study of 484 COVID-19-Related Event Reports Across 94 Hospitals. PATIENT SAFETY 2021. [DOI: 10.33940/infection/2021.6.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Previous research has shown that patients in infectious-agent isolation are at greater risk for certain types of safety-related events. We conducted a study to explore the relationship between the various types of events that occur in an isolation environment and the associated factors, which may have implications for the likelihood of the event and severity of patient harm. We conducted a query of the Pennsylvania Patient Safety Reporting System (PA-PSRS) database to identify event reports submitted by acute care hospitals between January 1 and September 30, 2020. We identified 484 relevant event reports from 94 hospitals for inclusion in our descriptive study (excluding near-miss events). We measured the frequency of relationship between categories of safety-related event types and 18 categories of associated factors. Among the seven categories of event types, the most frequently identified were skin integrity (141 of 484, 29%), falls (129 of 484, 27%), and medication-related (78 of 484, 16%). Across all 18 categories of associated factors, which had or may have had an influence on the event type, the most frequent were patient’s mental status (80 of 484, 17%), staff’s time to don personal protective equipment (62 of 484, 13%), and patient’s interference with equipment/supplies (45 of 484, 9%). Overall, our results revealed that the frequency of certain associated factors varied considerably from one event type to another, which indicates that the relation between event types and associated factors should guide selection of risk mitigation strategies. We encourage readers to leverage our results along with Table 9, which provides a list of challenges identified in an isolation environment and potential solutions. We envision hospital staff proactively and systematically using the information in our manuscript to facilitate their evaluation of the isolation environment and prioritization of risk mitigation strategies.
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12
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Safaeinili N, Vilendrer S, Williamson E, Zhao Z, Brown-Johnson C, Asch SM, Shieh L. Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study. JMIR Form Res 2021; 5:e26452. [PMID: 34033576 PMCID: PMC8211098 DOI: 10.2196/26452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33%), attending physicians (5/15, 33%), and resident physicians (5/15, 33%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient–clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team.
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Affiliation(s)
- Nadia Safaeinili
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Stacie Vilendrer
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Emma Williamson
- Department of Engineering, Stanford University, Stanford, CA, United States
| | - Zicheng Zhao
- Department of Comparative Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Cati Brown-Johnson
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Steven M Asch
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States.,Center for Innovation to Implementation, Veterans Affairs, Palo Alto, CA, United States
| | - Lisa Shieh
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
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13
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A novel box for aerosol and droplet guarding and evacuation in respiratory infection (BADGER) for COVID-19 and future outbreaks. Sci Rep 2021; 11:3179. [PMID: 33542400 PMCID: PMC7862311 DOI: 10.1038/s41598-021-82675-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/19/2021] [Indexed: 01/25/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions and killed more than 1.7 million people worldwide as of December 2020. Healthcare providers are at increased risk of infection when caring for patients with COVID-19. The mechanism of transmission of SARS-CoV-2 is beginning to emerge as airborne spread in addition to direct droplet and indirect contact as main routes of transmission. Here, we report on the design, construction, and testing of the BADGER (Box for Aerosol and Droplet Guarding and Evacuation in Respiratory Infection), an affordable, scalable device that contains droplets and aerosol particles, thus minimizing the risk of infection to healthcare providers. A semi-sealed environment is created inside the BADGER, which is placed over the head of the patient and maintains at least 12-air changes per hour using in-wall vacuum suction. Multiple hand-ports enable healthcare providers to perform essential tasks on a patient’s airway and head. Overall, the BADGER has the potential to contain large droplets and small airborne particles as demonstrated by simulated qualitative and quantitative assessments to provide an additional layer of protection for healthcare providers treating COVID-19 and future respiratory contagions.
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Pfenninger EG, Christ P, Neumüller M, Dinse-Lambracht A. [Assessment of the risk of infection from SARS-CoV-2 for healthcare workers-findings from practice]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:304-313. [PMID: 33496803 PMCID: PMC7837074 DOI: 10.1007/s00103-021-03277-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023]
Abstract
Das SARS-CoV-2-Virus als Erreger der COVID-19-Erkrankung hat sich innerhalb kurzer Zeit weltweit in der Bevölkerung ausgebreitet. Bei der Abfassung des Beitrags stehen noch keine Schutzimpfung und keine spezifische Therapie gegen SARS-CoV‑2 zur Verfügung. Bei Veröffentlichung des Artikels werden mindestens zwei Impfstoffe zur Verfügung stehen. In der internationalen Laienpresse wird das Risiko für medizinisches Personal, an SARS-CoV‑2 zu erkranken, als hoch eingeschätzt; das Robert Koch-Institut stuft das Risiko für die Gesamtbevölkerung in Deutschland als „hoch“ ein. Das Ziel des vorliegenden Beitrags ist es, das Infektions- und Erkrankungsrisiko für medizinisches Personal basierend auf Praxiserfahrungen, nationalen Verordnungen und Richtlinien sowie Infektionszahlen zu diskutieren und neu einzuschätzen. Dabei wird sowohl ungeschütztes als auch mit persönlicher Schutzausrüstung (PSA) ausgestattetes medizinisches Personal betrachtet. Eine entsprechende Risikomatrix wird erstellt. Das Infektionsrisiko für ungeschütztes medizinisches Personal entspricht dem in der Gesamtbevölkerung und ist mit „hoch“ einzustufen. Mit entsprechender persönlicher Schutzausrüstung ist das Infektionsrisiko für medizinisches Personal dagegen als „mittel“ einzuschätzen. Zur PSA gehören ein flüssigkeitsdichter Schutzkittel, Handschuhe, Maske – Schutzstufe FFP2 oder FFP3 – bei Tätigkeiten mit Tröpfchen oder Aerosolbildung, Kopfhaube und eine geeignete Schutzbrille. Ungenügende Handhygienemaßnahmen, falsche Handhabung der Schutzkleidung sowie lange Dienstzeiten erhöhen das Infektionsrisiko.
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Affiliation(s)
- Ernst G Pfenninger
- Stabsstelle Katastrophenschutz, Universitätsklinikum Ulm, Albert-Einstein-Allee 29, 89071, Ulm, Deutschland.
| | - Pascal Christ
- Stabsstelle Sicherheit, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Martin Neumüller
- Stabsstelle Sicherheit, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Alexander Dinse-Lambracht
- Zentrale Interdisziplinare Notaufnahme, Universitätsklinikum Ulm, Ulm, Deutschland.,Interdisziplinäres Notfallzentrum, Kliniken Aurich-Emden-Norden, Emden, Deutschland
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Zia H, Singh R, Seth M, Ahmed A, Azim A. Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge. Indian J Crit Care Med 2021; 25:453-460. [PMID: 34045813 PMCID: PMC8138644 DOI: 10.5005/jp-journals-10071-23792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the various strategies for the prevention of airborne transmission, engineering measures are placed high in the hierarchy of control. Modern hospitals in high-income countries have mechanical systems of building ventilation also called HVAC (heating, ventilation, and air-conditioning) but installation and maintenance of such systems is a challenging and resource-intensive task. Even when the state-of-the-art technology was used to build airborne infection isolation rooms (AIIRs), recommended standards were often not met in field studies. The current coronavirus disease-2019 pandemic has highlighted the need to find cost-effective and less resource-intensive engineering solutions. Moreover, there is a need for the involvement of interdisciplinary teams to find innovative infection control solutions and doctors are frequently lacking in their understanding of building ventilation-related problems as well as their possible solutions. The current article describes building ventilation strategies (natural ventilation and hybrid ventilation) for hospitals where HVAC systems are either lacking or do not meet the recommended standards. Other measures like the use of portable air cleaning technologies and temporary negative-pressure rooms can be used as supplementary strategies in situations of demand surge. It can be easily understood that thermal comfort is compromised in buildings that are not mechanically fitted with HVAC systems, therefore the given building ventilation strategies are more helpful when climatic conditions are moderate or other measures are combined to maintain thermal comfort.
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Affiliation(s)
- Hina Zia
- Department of Architecture, Jamia Millia Islamia (Central University), New Delhi, India
| | - Ritu Singh
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Manu Seth
- Department of Critical Care Medicine and Anesthesiology, Nishat Hospital and Research Centre, Lucknow, Uttar Pradesh, India
| | - Armin Ahmed
- Department of Critical Care Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Lokesh PK, Chowdhary S, Pol SA, Rajeswari M, Saxena SK, Alexander A. Quantification of biomaterial dispersion during otologic procedures and role of barrier drapes in Covid 2019 era - a laboratory model. J Laryngol Otol 2020; 134:1-6. [PMID: 33143756 PMCID: PMC7684199 DOI: 10.1017/s002221512000239x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic. OBJECTIVE To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery. METHODS The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1-10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed. RESULTS Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027). CONCLUSION Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.
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Affiliation(s)
- P K Lokesh
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S Chowdhary
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S A Pol
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - M Rajeswari
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S K Saxena
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - A Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
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Construction of a container isolation ward: A rapidly scalable modular approach to expand isolation capacity during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2020; 42:1162-1164. [PMID: 32962768 PMCID: PMC7562929 DOI: 10.1017/ice.2020.1222] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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18
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Kulkarni P, Mahadevappa M, Alluri S. COVID-19 Pandemic and the Impact on the Cardiovascular Disease Patient Care. Curr Cardiol Rev 2020; 16:173-177. [PMID: 32564757 PMCID: PMC7536811 DOI: 10.2174/1573403x16666200621154842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has emerged as a serious global threat causing a large number of fatalities and putting enormous strain on the health care resources across the world. This has resulted in preferentially triaging the coronavirus infected patients and placing others, especially cardiovascular patients at increased risk for adverse complications. The effective management of cardiac patients in the hospital environment during this COVID-19 pandemic has emerged as a real challenge. We try to address this issue and also highlight the interplay between COVID-19 and cardiovascular diseases. We hereby review the available literature and emerging guidelines about cardiovascular implications related to COVID-19 which will have a bearing on the patient care, health care professionals and cardiac centres.
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Affiliation(s)
- Prashanth Kulkarni
- Department of Cardiology, Care Hospitals, Hi-Tech City, Hyderabad, India
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Ing RJ, Barrett C, Chatterjee D, Twite M, Whitney GM. Perioperative Preparations for COVID-19: The Pediatric Cardiac Team Perspective. J Cardiothorac Vasc Anesth 2020; 34:2307-2311. [PMID: 32451272 PMCID: PMC7187810 DOI: 10.1053/j.jvca.2020.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Richard J Ing
- Department of Anesthesiology; University of Colorado School of Medicine
| | - Cindy Barrett
- University of Colorado School of Medicine; Department of Cardiology, Children's Hospital Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Mark Twite
- Department of Anesthesiology; University of Colorado School of Medicine
| | - Gina M Whitney
- Department of Anesthesiology; University of Colorado School of Medicine
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20
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Morawska L, Tang JW, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, Cao J, Dancer S, Floto A, Franchimon F, Haworth C, Hogeling J, Isaxon C, Jimenez JL, Kurnitski J, Li Y, Loomans M, Marks G, Marr LC, Mazzarella L, Melikov AK, Miller S, Milton DK, Nazaroff W, Nielsen PV, Noakes C, Peccia J, Querol X, Sekhar C, Seppänen O, Tanabe SI, Tellier R, Tham KW, Wargocki P, Wierzbicka A, Yao M. How can airborne transmission of COVID-19 indoors be minimised? ENVIRONMENT INTERNATIONAL 2020; 142:105832. [PMID: 32521345 PMCID: PMC7250761 DOI: 10.1016/j.envint.2020.105832] [Citation(s) in RCA: 554] [Impact Index Per Article: 138.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 05/17/2023]
Abstract
During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.
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Affiliation(s)
- Lidia Morawska
- International Laboratory for Air Quality and Heath (ILAQH), WHO Collaborating Centre for Air Quality and Health, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - William Bahnfleth
- Department of Architectural Engineering, The Pennsylvania State University, USA
| | - Philomena M Bluyssen
- Faculty of Architecture and the Built Environment, Delft University of Technology, the Netherlands
| | - Atze Boerstra
- REHVA (Federation of European Heating, Ventilation and Air Conditioning Associations), BBA Binnenmilieu, the Netherlands
| | - Giorgio Buonanno
- Department if Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Junji Cao
- Key Lab of Aerosol Chemistry and Physics Chinese Academy of Sciences, Xi'an, Beijing, China
| | - Stephanie Dancer
- Edinburgh Napier University and NHS Lanarkshire, Scotland, United Kingdom
| | - Andres Floto
- Department of Medicine, University of Cambridge, United Kingdom
| | | | - Charles Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jaap Hogeling
- International Standards at ISSO, ISSO International Project, the Netherlands
| | | | - Jose L Jimenez
- Department of Chemistry, and Cooperative Institute for Research in Environmental Sciences (CIRES) University of Colorado, Boulder, USA
| | - Jarek Kurnitski
- REHVA Technology and Research Committee, Tallinn University of Technology, Estonia
| | - Yuguo Li
- Department of Mechancal Engineering, Hong Kong University, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Marcel Loomans
- Department of the Built Environment, Eindhoven University of Technology (TU/e), the Netherlands
| | - Guy Marks
- Centre for Air quality Research and evaluation (CAR), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | | | | | - Arsen Krikor Melikov
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Denmark
| | - Shelly Miller
- Mechanical Engineering, University of Colorado, Boulder, USA
| | - Donald K Milton
- Environmental Health, School of Public Health, University of Maryland, USA
| | - William Nazaroff
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
| | - Peter V Nielsen
- Faculty of Engineering and Science, Department of Civil Engineering, Aalborg University, Denmark
| | - Catherine Noakes
- School of Civil Engineering, University of Leeds, United Kingdom
| | | | - Xavier Querol
- Institute of Environmental Assessment and Water Research, Department of Geosciences, Spanish National Research Council, Barcelona, Spain
| | - Chandra Sekhar
- Department of Building, National University of Singapore, Singapore
| | | | | | | | - Kwok Wai Tham
- Department of Building, National University of Singapore, Singapore
| | - Pawel Wargocki
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Denmark
| | | | - Maosheng Yao
- College of Environmental Sciences and Engineering, Peking University, Beijing, China
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Nishimura H, Fan Y, Sakata S. New applications of a portable isolation hood for use in several settings and as a clean hood. J Thorac Dis 2020; 12:3500-3506. [PMID: 32802428 PMCID: PMC7399428 DOI: 10.21037/jtd-20-1211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background We previously reported that we developed a compact and portable isolation hood that covers the top half of a patient sitting or lying in bed. The negative pressure inside the hood is generated by a fan-filter-unit (FFU) through which infectious aerosols from a patient are filtered. The outside area is kept clean which decreases the risk of nosocomial infections in hospital wards. We tried new applications of the hood. Methods The negative pressure hood was newly applied in an intensive care unit (ICU) as a place where a staff performs the practice of suctioning that generates much aerosol from the patient, as well as a waiting space for patients. Furthermore, the possibility that the hood can be converted to a positive pressure hood as a clean hood by switching the airflow direction of FFU was assessed. The cleaning efficacy of the inside of the hood was tested using an aerosolized cultured influenza virus tracer and an optimal airflow rate was determined according to the test results. Results The hood, named Barrihood, was found to be competent to be used (I) for tracheal suctioning in ICU, (II) as a waiting space for a child in a nursery who suddenly showed symptoms of the disease and waiting to be picked-up by the guardian, and (III) as a waiting space in a special outpatient clinic in a hospital for COVID-19 suspected cases to prevent dissemination of airborne pathogens. The positive pressure hood was also competent in keeping clean air quality that meets the standard class 100 of NASA's bio-clean room category. Conclusions The proposed new applications will broaden the range of the hood's usage. The isolation hood could be useful in many settings to protect people outside the hood from a patient inside, or to protect an individual inside from air particles outside the hood, such as airborne pathogens, allergens, or hazardous particulate matter like PM2.5.
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Affiliation(s)
- Hidekazu Nishimura
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
| | - Yuxuan Fan
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
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22
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Huang WN, Zhuang MS, Cheng TJ, Hsiao SH. Simplest Way to Establish COVID-19 Quarantine Observation Wards Within 24 Hours. Asia Pac J Public Health 2020; 32:357-359. [PMID: 32795092 PMCID: PMC7521007 DOI: 10.1177/1010539520947874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reducing nosocomial transmission within health care facilities is important, but the number of negative-pressure airborne infection isolation rooms for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is limited. It is a daunting challenge to cope with a surge of suspected infectious patients in hospitals. We installed air exhaust fans on the windows to change the pressure direction within the wards rapidly. The best location for the fans was 90 cm from the floor and 90 cm from the edge of bed whether the indoor air conditioners were on or off. The noise level should be <60 dB(A) as per government regulations. General wards can be transformed into makeshift negative-pressure rooms easily and effectively within 24 hours, which is really the simple, fast, and effective way for the transformation being applied.
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Affiliation(s)
- Wen-Nan Huang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mao-Song Zhuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsun-Jen Cheng
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Tsun-Jen Cheng, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Sanmin District, Kaohsiung City 80756, Taiwan.
| | - Shih-Huai Hsiao
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
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Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Reply to "Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care". J Endod 2020; 46:1342. [PMID: 32810475 PMCID: PMC7428684 DOI: 10.1016/j.joen.2020.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rapid expansion of temporary, reliable airborne-infection isolation rooms with negative air machines for critical COVID-19 patients. Am J Infect Control 2020; 48:822-824. [PMID: 32371066 PMCID: PMC7194055 DOI: 10.1016/j.ajic.2020.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/03/2022]
Abstract
More airborne-infection isolation rooms are needed in centers that treat severely affected coronavirus 2019 patients. Wards and rooms must be carefully checked to ensure an ample supply of medical air and oxygen. Anterooms adjacent to airborne-infection isolation rooms are required to maintain pressure differentials and provide an area for donning/doffing or disinfecting medical equipment.
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Nishimura H, Sakata S. Development of a lightweight, 'on-bed', portable isolation hood to limit the spread of aerosolized influenza and other pathogens. J Thorac Dis 2020; 12:3682-3687. [PMID: 32802447 PMCID: PMC7399422 DOI: 10.21037/jtd-20-1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The annual seasonal influenza epidemics in the winter season lead to many hospital admissions, increasing risks of nosocomial infections. Infectious diseases caused by contagious respiratory pathogens also pose a great risk to hospitals as has been seen in the current epidemic by a novel coronavirus infection. Such risk occurs in high density patient settings with few or no partitions, since the pathogens are transmitted by aerosols discharged from the patients. Possible interventions against the transmission are needed. Methods We developed a compact, lightweight, and portable hood designed to cover just the top half of a patient sitting or lying in bed, to limit the dissemination of infectious aerosols, constructed out of lightweight pipes, transparent plastic curtains, and a fan-filter-unit (FFU). The containment efficacy of the product was tested using an aerosolized cultured influenza virus tracer and an optimal airflow rate was determined according to the test results. It was tested for use in hospital wards during the 2016–2018 influenza seasons. Results The hood, named as Barrihood®, had dimensions height 172 cm, width 97 cm, length 38 cm, weighed 26 kg, and easily strolled and unfolded from its stored to its fully operational state of length 125 cm within a few minutes by a single operator. Optimal operational airflow-rate of the FFU was 420 L/min for containment of the aerosol particles. Eighty-one uninfected patients remained for 176 cumulative person-days within 1–4 m of influenza-infected patients isolated within the hood, without acquiring influenza infection. Conclusions With the use of the hood, secondary influenza infection cases significantly decreased, compared to previous influenza seasons. It may be suited to hospitals with not enough/no negative pressure facilities, or without enough number of individual patient isolation rooms, and could contribute to decrease the risk of nosocomial infections.
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Affiliation(s)
- Hidekazu Nishimura
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
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A safe and efficient, naturally ventilated structure for COVID-19 surge capacity in Singapore. Infect Control Hosp Epidemiol 2020; 42:630-632. [PMID: 32578525 PMCID: PMC7417981 DOI: 10.1017/ice.2020.309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Management of healthcare areas for the prevention of COVID-19 emergency in an Italian teaching hospital in Pisa, Tuscany: A hospital renovation plan. Infect Control Hosp Epidemiol 2020; 41:1368-1369. [PMID: 32336306 PMCID: PMC7417986 DOI: 10.1017/ice.2020.177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The novel coronavirus 2019-nCoV first appeared in December 2019 in Wuhan, China. While most of the initial cases were linked to the Huanan Seafood Wholesale Market, person-to-person transmission has been verified. Given that a vaccine cannot be developed and deployed for at least a year, preventing further transmission relies upon standard principles of containment, two of which are the isolation of known cases and the quarantine of persons believed at high risk of exposure. This note presents probability models for assessing the effectiveness of case isolation and quarantine within a community during the initial phase of an outbreak with illustrations based on early observations from Wuhan.
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Affiliation(s)
- Edward H Kaplan
- William N. and Marie A. Beach Professor of Operations Research, Professor of Public Health, Professor of Engineering, Yale School of Management, 165 Whitney Avenue, New Haven, 06511, CT, USA.
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Kochhar AS, Bhasin R, Kochhar GK, Dadlani H, Thakkar B, Singh G. Dentistry during and after COVID-19 Pandemic: Pediatric Considerations. Int J Clin Pediatr Dent 2020; 13:399-406. [PMID: 33149414 PMCID: PMC7586470 DOI: 10.5005/jp-journals-10005-1782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This article is a rumination on the outbreak of the dreaded coronavirus disease-2019 (COVID-19) pandemic which has engulfed both the developed and the developing countries, thereby causing widespread global public health concerns and threats to human lives. Although countries have made varied efforts, the pestilence is escalating due to the high infectivity. It is highly likely that dental professionals in upcoming days will come across COVID-19 patients and SARS-CoV-2 carriers, and hence must ensure a tactful handling of such patients to prevent its nosocomial spread. Despite the avalanche of information that has exploded in relation to this rapidly spreading disease, there is a lack of consolidated information to guide dentists regarding clinical management including precautions to take materials to use and postprocedure care, during and after the COVID-19 pandemic. Available sources of information have been analyzed, while relying on peer-reviewed reports followed by information available from the most respected authoritative sources, such as WHO, Centers for Disease Control and Prevention (CDC), and ADA. This review aims to provide a comprehensive summary from the available literature on COVID-19, its insinuation in dentistry, recommendations that have been published, and the actual in-practice implications, so a plan can be formulated and adapted to the circumstances of each dental practice during the pandemic and the times to follow.
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Affiliation(s)
| | - Ritasha Bhasin
- International Dentist Advanced Placement Program, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Gulsheen Kaur Kochhar
- Department of Pediatric and Preventive Dentistry, National Dental College and Hospital, Dera Bassi, Punjab, India
| | - Himanshu Dadlani
- Department of Periodontology, Kalka Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Balvinder Thakkar
- Jaipur Dental Hospital and Orthodontic Centre, Jaipur, Rajasthan, India
| | - Gurkeerat Singh
- Department of Orthodontics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
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30
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Green MS, LeDuc J, Cohen D, Franz DR. Confronting the threat of bioterrorism: realities, challenges, and defensive strategies. THE LANCET. INFECTIOUS DISEASES 2018; 19:e2-e13. [PMID: 30340981 PMCID: PMC7106434 DOI: 10.1016/s1473-3099(18)30298-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 01/30/2023]
Abstract
Global terrorism is a rapidly growing threat to world security, and increases the risk of bioterrorism. In this Review, we discuss the potential threat of bioterrorism, agents that could be exploited, and recent developments in technologies and policy for detecting and controlling epidemics that have been initiated intentionally. The local and international response to infectious disease epidemics, such as the severe acute respiratory syndrome and west African Ebola virus epidemic, revealed serious shortcomings which bioterrorists might exploit when intentionally initiating an epidemic. Development of new vaccines and antimicrobial therapies remains a priority, including the need to expedite clinical trials using new methodologies. Better means to protect health-care workers operating in dangerous environments are also needed, particularly in areas with poor infrastructure. New and improved approaches should be developed for surveillance, early detection, response, effective isolation of patients, control of the movement of potentially infected people, and risk communication. Access to dangerous pathogens should be appropriately regulated, without reducing progress in the development of countermeasures. We conclude that preparedness for intentional outbreaks has the important added value of strengthening preparedness for natural epidemics, and vice versa.
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Affiliation(s)
- Manfred S Green
- School of Public Health, University of Haifa, Haifa, Israel.
| | - James LeDuc
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - David R Franz
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
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