Particle and bioaerosol characteristics in a paediatric intensive care unit

Insights into the Profile of the Human Expiratory Microbiota and Its Associations with Indoor Microbiotas

Microorganisms residing in the human respiratory tract can be exhaled, and they constitute a part of environmental microbiotas. However, the expiratory microbiota community and its associations with environmental microbiotas remain poorly understood. Here, expiratory bacteria and fungi and the corresponding microbiotas from the living environments were characterized by DNA amplicon sequencing of residents' exhaled breath condensate (EBC) and environmental samples collected from 14 residences in Nanjing, China. The microbiotas of EBC samples, with a substantial heterogeneity, were found to be as diverse as those of skin, floor dust, and airborne microbiotas. Model fitting results demonstrated the role of stochastic processes in the assembly of the expiratory microbiota. Using a fast expectation-maximization algorithm, microbial community analysis revealed that expiratory microbiotas were differentially associated with other types of microbiotas in a type-dependent and residence-specific manner. Importantly, the expiratory bacteria showed a composition similarity with airborne bacteria in the bathroom and kitchen environments with an average of 12.60%, while the expiratory fungi showed a 53.99% composition similarity with the floor dust fungi. These differential patterns indicate different relationships between expiratory microbiotas and the airborne microbiotas and floor dust microbiotas. The results here illustrated for the first time the associations between expiratory microbiotas and indoor microbiotas, showing a potential microbial exchange between the respiratory tract and indoor environment. Thus, improved hygiene and ventilation practices can be implemented to optimize the indoor microbial exposome, especially in indoor bathrooms and kitchens.

Indoor Air Quality in Healthcare Units—A Systematic Literature Review Focusing Recent Research

The adequate assessment and management of indoor air quality in healthcare facilities is of utmost importance for patient safety and occupational health purposes. This study aims to identify the recent trends of research on the topic through a systematic literature review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. A total of 171 articles published in the period 2015–2020 were selected and analyzed. Results show that there is a worldwide growing research interest in this subject, dispersed in a wide variety of scientific journals. A textometric analysis using the IRaMuTeQ software revealed four clusters of topics in the sampled articles: physicochemical pollutants, design and management of infrastructures, environmental control measures, and microbiological contamination. The studies focus mainly on hospital facilities, but there is also research interest in primary care centers and dental clinics. The majority of the analyzed articles (85%) report experimental data, with the most frequently measured parameters being related to environmental quality (temperature and relative humidity), microbiological load, CO2 and particulate matter. Non-compliance with the WHO guidelines for indoor air quality is frequently reported. This study provides an overview of the recent literature on this topic, identifying promising lines of research to improve indoor air quality in healthcare facilities.

A review of the emergence of antibiotic resistance in bioaerosols and its monitoring methods

Despite significant public health concerns regarding infectious diseases in air environments, potentially harmful microbiological indicators, such as antibiotic resistance genes (ARGs) in bioaerosols, have not received significant attention. Traditionally, bioaerosol studies have focused on the characterization of microbial communities; however, a more serious problem has recently arisen due to the presence of ARGs in bioaerosols, leading to an increased prevalence of horizontal gene transfer (HGT). This constitutes a process by which bacteria transfer genes to other environmental media and consequently cause infectious disease. Antibiotic resistance in water and soil environments has been extensively investigated in the past few years by applying advanced molecular and biotechnological methods. However, ARGs in bioaerosols have not received much attention. In addition, ARG and HGT profiling in air environments is greatly limited in field studies due to the absence of suitable methodological approaches. Therefore, this study comprehensively describes recent findings from published studies and some of the appropriate molecular and biotechnological methods for monitoring antibiotic resistance in bioaerosols. In addition, this review discusses the main knowledge gaps regarding current methodological issues and future research directions.

Study on the transmission route of virus aerosol particles and control technology of air conditioning in the enclosed space

The patient's breathing and air conditioning system in the enclosed space are the main factors that cause indoor cross-infection. However, the research on the influence and the control mechanism of different air conditioning systems on the transmission path of virus aerosol particles exhaled by patients is still limited. To evaluate the effects of different air conditioning systems on the spread of human exhaled pollutants, computational fluid dynamics (CFD) was used to study the movement and diffusion of exhaled air from two rows of 12 sitting adults in a hospital's closed transfusion room. In this paper, three different air conditioning systems are considered: Ceil-supply and Down-return (Ceil-to-Down), Up-supply and Down-return (Up-to-Down), Down-supply and Up-return (Down-to-Up). The distribution of exhaled air velocity, temperature, and virus particle concentration were studied, and it is found that the horizontal diffusion distance of exhaled pollutants is about 0.75 -1.1 m. When up to down systems are used, the air conditioning system shall be closed in time in case of respiratory infectious diseases, so as to avoid cross-infection in the enclosed space. A relatively clean air area with a height of about 1.1 m will be formed, which can inhibit the transmission of the virus to a certain extent when using the down-to-up system. But for those who are exposed to the enclosed space for a long time, the down-to-up system is not the most suitable air conditioning system.

Full-scale experimental and numerical study of bioaerosol characteristics against cross-infection in a two-bed hospital ward

The transmission and deposition of pathogenic bioaerosols and the subsequent contamination of the air and surfaces is well recognized as a potential route of hospital cross-infection. A full-scale experiment using Bacillus subtilis and computational fluid dynamics were utilized to model the bioaerosol characteristics in a two-bed hospital ward with a constant air change rate (12 ACH). The results indicated that the bioaerosol removal efficiency of unilateral downward ventilation was 50% higher than that of bilateral downward ventilation. Additionally, health care workers (HCWs) and nearby patients had lower breathing zone concentrations in the ward with unilateral downward ventilation. Furthermore, a partition played a positive role in protecting patients by reducing the amount of bioaerosol exposure. However, no obvious protective effect was observed with respect to the HCWs. Only 10% of the bioaerosol was deposited on the surfaces in the ward with unilateral downward ventilation, while up to 35% of the bioaerosol was deposited on the surfaces in the ward with bilateral downward ventilation during the 900 s. The main deposition locations of the bioaerosols were near the wall on the same side of the room as the patient's head in all cases. This study could provide scientific evidence for controlling cross-infection in hospital wards, as well as several guidelines for the disinfection of hospital wards.

Prevention of surgical site infection under different ventilation systems in operating room environment

Biological particles in the operating room (OR) air environment can cause surgical site infections (SSIs). Various ventilation systems have been employed in ORs to ensure an ultraclean environment. However, the effect ofdifferent ventilation systems on the control ofbacteria-carrying particles (BCPs) released from the surgical staff during surgery is unclear. In this study, the performance of four different ventilation systems (vertical laminar airflow ventilation (VLAF), horizontal laminar airflow ventilation (HLAF), differential vertical airflow ventilation (DVAF), and temperature-controlled airflow ventilation (TAF)) used in an OR was evaluated and compared based on the spatial BCP concentration. The airflow field in the OR was solved by the Renormalization Group (RNG) k-ε turbulence model, and the BCP phase was calculated by Lagrangian particle tracking (LPT) and the discrete random walk (DRW) model. It was found that the TAF system was the most effective ventilation system among the four ventilation systems for ensuring air cleanliness in the operating area. This study also indicated that air cleanliness in the operating area depended not only on the airflow rate of the ventilation system but also on the airflow distribution, which was greatly affected by obstacles such as surgical lamps and surgical staff.

Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic

BACKGROUND

Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations.

METHODS

A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category.

RESULTS

Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission.

CONCLUSIONS

During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.

Comparison of culturable antibiotic-resistant bacteria in polluted and non-polluted air in Beijing, China

BACKGROUND

Air pollution has been a serious health issue in Beijing for years. Airborne antibiotic-resistant bacteria could be a potential health crisis as reserve of antibiotic resistance transmission in environment. The composition and antibiotic resistance pattern of culturable bacterial community and how these are affected by air pollution remain unclear.

OBJECTIVES

This study aimed to compare the compositions and antibiotic resistance patterns of culturable bacteria in polluted and non-polluted weather conditions in Beijing.

METHODS

Air samples were collected indoors and outdoors during polluted and non-polluted weather using six-stage Andersen Samplers. For each isolated bacterium, the 16S ribosomal RNA gene was amplified, sequenced, and blasted against the National Center for Biotechnology Information database Antibiotic resistance was conducted by antimicrobial susceptibility testing.

RESULTS

Bacterial concentration in polluted weather was significantly higher than in non-polluted weather, both indoors and outdoors (P < 0.05). Gram-positive bacteria (GPB) were dominant in both weathers but gram-negative bacteria (GNB) were more abundant in polluted weather than non-polluted weather both indoors and outdoors. Multidrug-resistant (MDR) bacteria occupied 23.7% of all bacterial isolates, 22.4% of isolates from polluted weather and 27.8% of isolates from non-polluted weather. Penicillins were resisted by 72.4% and 83.3% of isolates from polluted and non-polluted weather, respectively.

CONCLUSIONS

The bacterial concentration was significantly higher in polluted weather, compared to non-polluted weather. Polluted weather is correlated with changes in the bacterial composition in the air, with a greater abundance of GNB. Penicillins was resisted by over 70% of bacterial isolates. The abundance of MDR bacteria suggested potential risks for human health.

Evaluation of bioaerosol samplers for the detection and quantification of influenza virus from artificial aerosols and influenza virus-infected ferrets

BACKGROUND

Bioaerosol sampling devices are necessary for the characterization of infectious bioaerosols emitted by naturally-infected hosts with acute respiratory virus infections. Assessment of these devices under multiple experimental conditions will provide insight for device use.

OBJECTIVES

The primary objective of this study was to assess and compare bioaerosol sampling devices using a) an in vitro, environmentally-controlled artificial bioaerosol system at a range of different RH conditions and b) an in vivo bioaerosol system of influenza virus-infected ferrets under controlled environmental conditions. Secondarily, we also sought to examine the impact of NSAIDs on bioaerosol emission in influenza virus-infected ferrets to address its potential as a determinant of bioaerosol emission.

METHODS

We examined the performance of low and moderate volume bioaerosol samplers for the collection of viral RNA and infectious influenza virus in vitroand in vivo using artificial bioaerosols and the ferret model of influenza virus infection. The following samplers were tested: the polytetrafluoroethylene filter (PTFE filter), the 2-stage National Institute of Occupational Safety and Health cyclone sampler (NIOSH cyclone sampler) and the 6-stage viable Andersen impactor (Andersen impactor).

RESULTS

The PTFE filter and NIOSH cyclone sampler collected similar amounts of viral RNA and infectious virus from artificially-generated aerosols under a range of relative humidities (RH). Using the ferret model, the PTFE filter, NIOSH cyclone sampler and the Andersen impactor collected up to 3.66 log₁₀ copies of RNA/L air, 3.84 log₁₀ copies of RNA/L air and 6.09 log₁₀ copies of RNA/L air respectively at peak recovery. Infectious virus was recovered from the PTFE filter and NIOSH cyclone samplers on the peak day of viral RNA recovery.

CONCLUSION

The PTFE filter and NIOSH cyclone sampler are useful for influenza virus RNA and infectious virus collection and may be considered for clinical and environmental settings.

Antibiotic Resistance of Airborne Viable Bacteria and Size Distribution in Neonatal Intensive Care Units

Despite their significant impact on public health, antibiotic resistance and size distributions of airborne viable bacteria in indoor environments in neonatal intensive care units (NICU) remain understudied. Therefore, the objective of this study was to assess the antibiotic resistance of airborne viable bacteria for different sizes (0.65-7 µm) in private-style and public-style neonatal intensive care units (NICU). Airborne bacteria concentrations were assessed by a six-stage Andersen impactor, operating at 28.3 L/min. Public-style NICU revealed higher concentrations of airborne viable bacteria (53.00 to 214.37 CFU/m3) than private-style NICU (151.94-466.43), indicating a possible threat to health. In the public-style NICU, Staphylococcus was the highest bacterial genera identified in the present study, were Staphylococcus saprophyticus and Staphylococcus epidermidis predominated, especially in the second bronchi and alveoli size ranges. Alloiococcus otitidis, Bacillus subtiles, Bacillus thuringiensis, Kocuria rosea, and Pseudomonas pseudoalcaligene, were identified in the alveoli size range. In NICU#2, eight species were identified in the alveoli size range: Bacillus cereus, Bacillus subtilis, Bacillus thuringiensis, Eikenella corrodens, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus gordoni. Multi-drug-resistant organisms (MDROs) were found in both of the NICUs. Bacillus cereus strains were resistant to Ampicillin, Cefoxitin, Ceftaroline, and Penicillin G. Staphylococcus cohnii ssp. cohnii was resistant in parallel to ampicillin and G penicillin. Staphylococcus saprophyticus strains were resistant to Ampicillin, Penicillin G, Oxaxilin, and Erythromycin. Results may indicate a potential threat to human health due to the airborne bacteria concentration and their antibiotic resistance ability. The results may provide evidence for the need of interventions to reduce indoor airborne particle concentrations and their transfer to premature infants with underdeveloped immune systems, even though protocols for visitors and cleaning are well-established.

Investigating the effect of several factors on concentrations of bioaerosols in a well-ventilated hospital environment

This study characterized and quantified the bacterial and fungal bioaerosols in nine wards of the Razavi Hospital (Mashhad, Iran) that is equipped with an advanced heating, ventilating, and air conditioning (HVAC) system including HEPA filters for air cleaning. In this study, 432 samples were taken from the indoor air of multiple hospital wards during the morning and afternoon shifts during summer and autumn. The particle number concentrations with sizes of > 0.3, > 0.5, > 1, > 2, > 5, and > 10 μm were measured using a 6-channel handheld particle counter. A greater diversity of bioaerosol types were observed during the morning shifts and during summer. The microbial load was not affected significantly by the temperature, relative humidity, working shift, season, and number of visitors, indicating the effectiveness of a well-designed ventilation system to eliminate site-specific variations. For microbial number concentrations, a significant correlation was only observed between the number of particles with a diameter of > 10 μm and the airborne microbial loading. Thus, passive sampling may not properly reflect the actual concentrations of smaller bioaerosols. In conclusion, HEPA filters in the HVAC system successfully decreased the bioaerosol concentrations in the hospital environment. Additionally, we recommend that active sampling be used in cases where a well-functioning HVAC system exists.

Assessing the seasonality of occupancy number-associated CO2 level in a Taiwan hospital

This study enabled the assessment of indoor CO₂ levels and evaluated the relationship between occupancy numbers with CO₂ levels in a Taiwan hospital. The measurements were conducted over four seasons for five working days (Monday to Friday), with sampling conducted simultaneously from 09:00 am to 5:00 pm and across six locations (for spatial variability): hall (H), registration and cashier (RC), waiting area (WA), occupational therapy room (OT), physical therapy room (PT), and outdoors (O). Based on the analysis, three of the five indoor sampling sites showed significant differences in seasonal CO₂ concentrations (p < 0.0001). Based on our result, the physical therapy room had the highest level of CO₂ concentration that exceeded the IAQ standard in Taiwan Environmental Protection Agency (EPA) in all seasons, in that the number of occupants contributing to nearly 40% of the variation in CO₂ measured. Our results also showed that the indoor/outdoor (I/O) ratios of CO₂ concentration for all locations and seasons exceeded 1 in ~ 100% of those locations. The median I/O ratio at sites WA and OT was 2.37 and 2.08 during four seasons, respectively. The highest median I/O ratio was found at site PT, with a calculated range of 2.69 in spring to 3.90 in fall. The highest correlation of occupancy number and CO₂ concentration also occurred in PT which correlation coefficients were estimated at 0.47, 0.65, 0.63, and 0.40 in spring, summer, fall, and winter. The findings of the present study can be used to understand occupancy number and its effect on CO₂ levels in a hospital environment, as well as the effect of time of day (Monday to Friday) on the number of patients admitted.

Assessment of bioaerosol particle characteristics at different hospital wards and operating theaters: A case study in Tehran

This study was aimed to investigate the types and number of bacterial and fungal bioaerosols in indoor air of hospitals according to the type of wards and operating theaters. Bacterial and fungal samples were collected using the passive sampling method of 1/1/1 scheme during a six months' period in the Khatam-Al-Anbia hospital, Tehran, Iran. A simple linear regression was used to determine the relationship between bioaerosol concentrations and the number of active beds. Bacterial bioaerosol concentrations were mainly higher than fungi in all sampling sites. A significant association was found between airborne fungal concentrations and the numbers of beds (R2 = 0.76, p < 0.05), but not observed for bacteria (R2 = 0.02, p < 0.05). Our findings provided an exposure database of airborne bacterial and fungal bioaerosol in hospital wards and operating theaters in Tehran. •Due to the importance of the exposure risk to bioaerosols for patients and medical personnel, we focused on identification of the density and diversity of bacterial and fungal bioaerosols in different wards and operating theaters.•Our results showed that the numbers of the beds have a significant effect on airborne fungal concentrations.•The results of this study can be used to set indoor air quality standards for hospital wards and operating theatres.

Clothing as a transport vector for airborne particles: Chamber study

Strong evidence suggests that clothing serves as a reservoir of chemical pollutants and particles, including bioaerosols, which may have health significance. However, little is known about the role that clothing may play as a transport vector for inhaled airborne particles. Here, we contribute toward bridging the knowledge gap by conducting experiments to investigate clothing release fraction (CRF), determined as the size-dependent ratio of released to deposited particulate matter in the diameter range 0.5-10 μm. In a fully controlled chamber with low background particle levels, we deployed a programmable robot to reproducibly quantify the size-dependent CRF as a function of motion type and intensity, dust loadings, and activity duration. On average, 0.3%-3% of deposited particles were subsequently released with fabric motion, confirming that clothing can act as a vehicle for transporting airborne particles. The CRF increased with the vigor of movement and with dust loading. Rubbing and shaking the fabric were more effective than fabric stretching in resuspending particles. We also found that most of the release happened quickly after the onset of the resuspension activity. Particle size substantially influenced the CRF, with larger particles exhibiting higher values.