Indoor/outdoor PM2.5 elemental composition and organic fraction medications, in a Greek hospital

Airborne influenza virus shedding by patients in health care units: Removal mechanisms affecting virus transmission

In this study, we characterize the distribution of airborne viruses (influenza A/B) in hospital rooms of patients with confirmed infections. Concurrently, we monitored fine particulate matter (PM2.5 & PM10) and several physical parameters including the room air exchange rate, temperature, and relative humidity to identify corresponding correlations with virus transport and removal determinants. The results continue to raise concerns about indoor air quality (IAQ) in healthcare facilities and the potential exposure of patients, staff and visitors to aerosolized viruses as well as elevated indoor PM levels caused by outdoor sources and/or re-suspension of settled particles by indoor activities. The influenza A virus was detected in 42% of 33 monitored rooms, with viruses detectible up to 1.5 m away from the infected patient. Active coughing was a statistically significant variable that contributed to a higher positive rate of virus detection in the collected air samples. Viral load across patient rooms ranged between 222 and 5,760 copies/m3, with a mean of 820 copies/m3. Measured PM2.5 and PM10 levels exceeded IAQ daily exposure guidelines in most monitored rooms. Statistical and numerical analyses showed that dispersion was the dominant viral removal pathway followed by settling. Changes in the relative humidity and the room's temperature were had a significant impact on the viral load removal. In closure, we highlight the need for an integrated approach to control determinants of IAQ in patients' rooms.

Size distribution and relationship of airborne SARS-CoV-2 RNA to indoor aerosol in hospital ward environments

Aerosol particles proved to play a key role in airborne transmission of SARS-CoV-2 viruses. Therefore, their size-fractionated collection and analysis is invaluable. However, aerosol sampling in COVID departments is not straightforward, especially in the sub-500-nm size range. In this study, particle number concentrations were measured with high temporal resolution using an optical particle counter, and several 8 h daytime sample sets were collected simultaneously on gelatin filters with cascade impactors in two different hospital wards during both alpha and delta variants of concern periods. Due to the large number (152) of size-fractionated samples, SARS-CoV-2 RNA copies could be statistically analyzed over a wide range of aerosol particle diameters (70-10 µm). Our results revealed that SARS-CoV-2 RNA is most likely to exist in particles with 0.5-4 µm aerodynamic diameter, but also in ultrafine particles. Correlation analysis of particulate matter (PM) and RNA copies highlighted the importance of indoor medical activity. It was found that the daily maximum increment of PM mass concentration correlated the most with the number concentration of SARS-CoV-2 RNA in the corresponding size fractions. Our results suggest that particle resuspension from surrounding surfaces is an important source of SARS-CoV-2 RNA present in the air of hospital rooms.

Spatial and seasonal variations in the carbon and lead isotopes of PM2.5 in air of residential buildings and their applications for source identification

To understand isotope distributions of PM_2.5 in residential buildings and apply them for source identification, carbon (δ¹³C) and lead (Pb) isotope ratios in indoor and outdoor air of residential buildings were analyzed. Moreover, factor analysis (FA) was employed to investigate sources, which were compared through isotopic analyses. The average δ¹³C values of indoor air are -26.94 ± 1.22‰ and -27.04 ± 0.44‰ in warm (August to October) and cold (February to March) seasons, respectively, and the corresponding values for outdoor air are -26.77 ± 0.54‰ and -26.57 ± 0.39‰. The average ²⁰⁶Pb/²⁰⁷Pb (²⁰⁸Pb/²⁰⁷Pb) ratios of indoor air are 1.1584 ± 0.0091 (2.4309 ± 0.0125) and 1.1529 ± 0.0032 (2.4227 ± 0.0081) in warm and cold seasons, respectively, and the corresponding values for outdoor air are 1.1594 ± 0.0069 (2.4374 ± 0.0103) and 1.1538 ± 0.0077 (2.4222 ± 0.0085). Seasonal variation in δ¹³C values or Pb isotope ratios of indoor air was not significant, and similar results were obtained for outdoor air. Significant differences were not observed between δ¹³C values or Pb isotope ratios of indoor and outdoor air. Traffic emission is the major contributor to indoor and outdoor PM_2.5 based on isotopic analyses; this result was consistent with the results of FA. The δ¹³C values of indoor air in buildings with poor ventilation conditions were significantly lighter than those of outdoor air. In summary, the spatial and seasonal variations of isotopes were similar in residential buildings, which can be used to identify sources of indoor PM_2.5, and ventilation condition is an influencing factor.

Chemical characteristics and oxidative potential of indoor and outdoor PM2.5 in densely populated urban slums

A significant proportion of population in metropolitan cities in India live in slums which are highly dense and crowded informal housing settlements with poor environmental conditions including high exposure to air pollution. Recent studies report that toxicity is induced by oxidative processes, mediated by the water-soluble PM chemical components leading to reactive oxygen species production thereby causing inflammatory disorders. Hence, for the first time, this study assessed the chemical characteristics and oxidative potential (OP) of indoor and outdoor PM_2.5 in two slums in Mumbai, India. Daily gravimetric PM_2.5 was measured in ∼40 homes each in a low- and a high-traffic slum and analysed for 18 water-soluble elements and organic carbon (WSOC). Subsequently, OP was assessed through the Dithiothreitol (DTT) assay. Average WSOC was similar in indoor and outdoor environments while the water-soluble concentrations of total elements ranged 4.5-6.5 μg/m³ indoors and 6.4-19.2 μg/m³ outdoors, with S, Ca, K, Na and Zn being the most abundant elements. Spatial distributions of indoor concentrations were influenced by outdoor sources such as local traffic emissions for Cd, Fe, Al and Zn. The influence of outdoor-origin particles was enhanced in homes reporting high air exchange rates. OP was higher outdoors than indoors in both low-traffic slum (0.04-0.51 nmol min^-1m^-3 outdoors and 0.02-0.38 nmol min^-1m^-3 indoors) and high-traffic slum (0.03-1.06 nmol min^-1m^-3 outdoors and 0.04-0.77 nmol min^-1m^-3 indoors). Outdoor and indoor OP was also more influenced by outdoor road dust showing significant correlation with tracer elements Cu and Al (r ≥ 0.45; p < 0.05). Similar to OP, the non-carcinogenic health risk associated with indoor PM_2.5 were also higher in high-traffic slum (Hazard Index, HI = 1.60) than in low-traffic slum (HI = 0.43). Overall, this study shows that the indoor PM_2.5 and its chemical constituents in Mumbai slums are primarily of outdoor origin with higher toxicity and non-carcinogenic health risk in high-traffic slums.

Association between ambient air pollution and blood sex hormones levels in men

Concerns are growing over time on the adverse health effects of air pollution. However, the association between ambient air pollution and blood sex hormones in men is poorly understood. We included 72,917 men aged 20-55 years from February 2014 to December 2019 in Beijing, China in this study. Blood testosterone, follicle stimulating hormone, luteinizing hormone, estradiol, and prolactin levels of each participant were measured. We collected exposure data of daily ambient levels of particulate matter ≤10 μm (PM₁₀) and ≤2.5 μm (PM_2.5), nitrogen dioxide, sulfur dioxide (SO₂), carbon monoxide, and ozone. Generalized linear mixed models were used to analyze the potential association between ambient air pollution exposure and blood sex hormone levels. The results showed that both immediate and short-term cumulative PM_2.5, PM₁₀, and SO₂ exposure was related to altered serum sex hormone levels in men, especially testosterone. An increase of 10 μg/m³ in PM_2.5 and PM₁₀ in the current day was related to a 1.6% (95% confidence interval [CI]: 0.9%-2.3%) and 1.1% (95% CI: 0.5%-1.6%) decrease in testosterone, respectively, and a decreasing tendency of accumulated effects persisted within lag 0-30 days. The present study demonstrated that it is important to control ambient air pollution exposure to reduce effects on the reproductive health of men.

Airborne bacterial and PM characterization in intensive care units: correlations with physical control parameters

In this study, the spatial variation of airborne bacteria in intensive care units (ICUs) was characterized. Fine particulate matter and several physical parameters were also monitored including temperature and relative humidity. The results showed that the total bacterial load ranged between 20.4 and 134.3 CFU/m³ across the ICUs. Bacterial cultures of the collected samples did not isolate any multi-drug-resistant Gram-negative bacilli indicating the absence of such aerosolized pathogens in the ICUs. Meanwhile, particulate matter levels in several ICUs were found to exceed the international guidelines set for 24-h PM exposure. Moreover, examining bacterial load contribution by size suggested that bacteria with sizes less than 0.65 µm contributed the least to the total bacterial loads, while those with sizes between 0.65 and 1.1 µm contributed the most. A multiple linear regression model was also built to predict the bacterial loads in the ICUs. The regression analysis explained 77% of the variability observed in the measured bacterial concentrations. The model showed that the level of activity in the ICU rooms as well as its occupancy level had strong positive correlations with bacterial loads, while distance away from the patient had a non-linear relationship with measured loads. No statistically significant correlation was found between bacterial load and particulate matter concentrations.

Estimations of infiltration factors of diurnal PM2.5 and heavy metals in children's bedrooms

Children are the sensitive population to fine particulate matter (PM_2.5 ) exposure and spend most of their time in bedroom. Infiltration factor (F_inf ) can be used to calculate the fraction of total indoor PM_2.5 with outdoor origin to increase the accuracy of exposure assessment. However, studies have ignored the diurnal variations of PM_2.5 F_inf values, and a few studies have estimated F_inf values for heavy metals in PM_2.5 in children's bedrooms. To calculate the PM_2.5 F_inf , real-time indoor and outdoor PM_2.5 concentrations and occupants' activities were collected in 56 study bedrooms. At 22 of the 56 study bedrooms, PM_2.5 samples were also collected for heavy metals analysis. We noted the PM_2.5 F_inf was higher during the daytime (0.70 ± 0.23) than nighttime (0.54 ± 0.27) during the hot season, and the time of air conditioner use was longer at nighttime. The largest F_inf value of heavy metal was V (0.88 ± 0.25), followed by Pb (0.85 ± 0.28), Mn (0.72 ± 0.26), Cr (0.69 ± 0.35), and Zn (0.61 ± 0.32), with a larger variation. Our findings suggest that the estimations of diurnal PM_2.5 and heavy metals F_inf values are necessary to increase the accuracy of exposure assessment.

Emission characteristics, sources, and airborne fate of speciated organics in particulate matters in a Hong Kong residence

A growing number of studies warn of the adverse health effects of indoor particulate matters (PM). However, little is known about the molecular compositions and emission characteristics of PM-bound organics (OM) indoors, a critical group of species with highest concentration and complexity in indoor PM. In a Hong Kong residence where prescribed activities were performed with normal frequency and intensity, we found that the activities significantly elevated not only the total concentration but also the fraction of OM in indoor PM. However, the concentration of the total PM-bound OM outdoors (10.3 ± 0.7 μg/m³ ) surpassed that for the indoor counterpart during the undisturbed period (8.2 ± 0.1 μg/m³ ), that is, period when there was no activity with high emission of PM but the residual effects of previous activities might remain. Emissions of indoor activities involving combustion or high-temperature processes significantly elevated the indoor-to-outdoor (I/O) ratios for a majority of organic species. In addition, gas-to-particle partitioning, secondary formation, carrying-over (residues of pollutants in the air), and re-emission also modulated the I/O ratios of some compounds. Chemically comprehensive emission profiles of speciated organics were obtained for 5 indoor activities in the residence. While the indoor contribution to PM-bound OM was estimated to be not higher than 13.1% during the undisturbed period, carrying-over and/or re-emission seemed to exist for certain compounds emitted from cigarette smoking and incense burning. This study enhances knowledge on emissions and airborne fate of speciated organics in indoor PM.

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.

Indoor concentrations of PM2.5 and associated water-soluble and labile heavy metal fractions in workplaces: implications for inhalation health risk assessment

PM2.5 (i.e., particles with aerodynamic diameters less than 2.5 μm) and the associated water-soluble, dissolved, and labile fractions of heavy metals (Cu, Pb, Mn, Ni, Co, Zn, Cr, and Cd) were determined in indoor air of twenty workplaces in Alexandroupolis (Northeastern Greece). PM2.5 concentrations exhibited significant variance across the workplaces ranging from 11.5 μg m-3 up to 276 μg m-3. The water-soluble metal concentrations varied between 0.67 ± 2.52 ng m-3 for Co and 27.8 ± 19.1 ng m-3 for Ni exhibiting large variations among the different workplaces. The water-soluble metal fractions were further treated to obtain the labile metal fraction (by binding with Chelex 100-chelating resin) that might represent a higher potential for bioaccessibility than the total water-soluble fraction. The largest labile (chelexed) fractions (48-67% of the corresponding water-soluble concentrations) were found for Cd, Mn, Cu, and Ni, while the labile fractions of Pb, Cr, Co, and Zn were relatively lower (34-42% of the corresponding water-soluble concentrations). Water-soluble and labile concentrations of heavy metals were further used to calculate cancer and non-cancer risks via inhalation of the PM2.5-bound metals. To our knowledge, this is the first study estimating the health risks due to the inhalation of water-soluble and labile metal fractions bound to indoor PM.

Evaluating size-fractioned indoor particulate matter in an urban hospital in Iran

Hospitals host vulnerable people with potentially enhanced sensitivity to air pollutants. We measured particulate matter (PM) including PM₁, PM_2.5, and PM₁₀ with a portable device in a hospital, a nearby reference building, and ambient air in Shiraz, Iran. Indoor/outdoor (I/O) ratio values were calculated to infer on the origin of size-fractioned PM. The mean hospital indoor concentrations of PM_2.5 and PM₁₀ (4.7 and 38.7 μg/m³, respectively) but not PM₁ were higher than in the reference building and lower than in ambient air. The highest hospital PM₁₀ mean concentrations were found in the radiotherapy ward (77.5 μg/m³) and radiology ward (70.4 μg/m³) while the lowest were found in the bone marrow transplantation (BMT) ward (18.5 μg/m³) and cardiac surgery ward (19.8 μg/m³). The highest PM_2.5 concentrations were found in the radiology (8.7 μg/m³) and orthopaedic wards (7.7 μg/m³) while the lowest were found in the BMT ward (2.8 μg/m³) and cardiac surgery ward (2.8 μg/m³). The I/O ratios and the timing of peak concentrations during the day (7 a.m. to 4 p.m.) indicated the main roles of outdoor air and human activity on the indoor levels. These suggest the need for mechanical ventilation with PM control for a better indoor air quality (IAQ) in the hospital.

Toxic metals in outdoor/indoor airborne PM2.5 in port city of Northern, China: Characteristics, sources, and personal exposure risk assessment

Outdoor and indoor PM_2.5 samples were simultaneously collected over four seasons (2017-2018) in Caofeidian, China, and analyzed for 15 elements to investigate the characteristics, sources, and health risks of PM_2.5-bound metals. Source-specific PM_2.5-bound metals were analyzed using positive matrix factorization, combined with the conditional probability function and potential source contribution function model. The health risks were evaluated using the health risk assessment model, which included the exposure parameters of indoor and outdoor activities of Chinese residents. The annual median of PM_2.5 concentrations (89.68 μg/m³) and total metals (2.67 μg/m³) from the outdoor samples significantly surpassed that of the indoor samples (51.56 μg/m³) and total metals (1.51 μg/m³) (P < 0.05). In addition, the indoor/outdoor concentration ratios indicated that most indoor metals mainly originated from outdoor emission sources. In the annual analysis of PM_2.5-bound metal sources, this study identified five metal sources: coal combustion, resuspended dust, traffic emissions, fuel combustion sources, and industrial sources, among which industry sources (36.6%) contributed the most. The non-carcinogenic risks of metals for adults (2.81) and children (2.80) all exceed the acceptable non-carcinogenic risk level (1). The non-carcinogenic risk of Mn (1.46 for children, 1.48 for adults) was a key factor in the total non-carcinogenic risk. The total carcinogenic risk of metals for children (3.75 × 10^-5) was above the acceptable level (1.0 × 10^-6) but within the tolerant limit (1.0 × 10^-4), and that for adults (1.48 × 10^-4) was above the tolerant limit. The lifetime carcinogenic risk of Cr⁶⁺ had the highest proportion of the total carcinogenic risk for children (87.5%) and adults (87.8%). Our results revealed that both adults and children suffered carcinogenic and non-carcinogenic risks from the PM_2.5-bound metals in Caofeidian. The corresponding emission control measures of metals in atmosphere should be considered.

Relationship between ambient PM2.5 exposure and blood cadmium level in children under 14 years in Beijing, China

Ambient PM_2.5 pollution is a global environmental problem. PM_2.5 can act as a carrier of heavy metals. However, the relationship between PM_2.5 exposure and blood cadmium (Cd) level in children was less understood. Based on the data of hourly collected PM_2.5 and blood Cd level of 13,626 children aged 0-14 years from Apr. 2008 to Feb. 2013 in Beijing of China, we investigated the short-term effects of PM_2.5 exposure on blood Cd level. Generalized linear mixed models (GLMMs) were utilized to explore the potential association between PM_2.5 exposure and blood Cd level of children. The results showed that the mean blood Cd level was 0.64 μg/L. There was a significant association between PM_2.5 exposure and blood Cd level (P < 0.05). Age was negatively associated with blood Cd level (P < 0.05), and the younger children were more sensitive to Cd from PM_2.5 exposure. There wasn't a significant difference in PM_2.5 concentration between heating and non-heating seasons in winter (P > 0.05); there was also no gender difference of children on blood Cd level (P > 0.05). The present study demonstrates the importance of controlling the PM_2.5 bound Cd exposure, and environmental countermeasures should be implemented stringently to reduce their impact on children's health.

Chemical and stable isotopic characteristics of PM2.5 emitted from Chinese cooking

This study investigated the characteristics of air pollutants generated from preparing Chinese cuisine and analyzed the isotopic compositions of carbon and nitrogen in particulate matter with a diameter <2.5 μm (PM_2.5) to source apportionment study. The CO and CO₂ concentrations and temperatures were measured using suitable instruments in real time during cooking, including stir-fry, fry, deep-fry, hot-pot, and mixed cooking, and periods with non-cooking. Personal environmental monitoring instruments were used to collect PM_2.5 for carbon and nitrogen elements and isotopes analysis. Our data indicated that the concentrations of CO and CO₂ and the temperature were higher during periods of cooking, especially for the fry and stir-fry methods, than during periods with non-cooking. The concentrations of PM_2.5, total carbon, and total nitrogen were also higher during cooking; the maximum concentrations were measured during fry. The values of δ¹³C were considerably lower during the periods of cooking (mean: -28.15‰) than during non-cooking (-27.18‰). The average values of δ¹⁵N were 8.63‰ and 11.74‰ during deep-fry and hot-pot cooking, respectively. The δ¹³C values can be used to distinguish between cooking and other non-cooking sources and further assess the effect of different cooking activities on PM_2.5. The δ¹⁵N only can be used to investigate the effect of deep-fry on PM_2.5. Moreover, the δ¹³C signature suggested that fry emits higher products of incomplete combustion than do other cooking activities. These findings can assist in pollution source identification of PM_2.5, emission control, and the study of combustion characteristics.

A Systematic Review of Air Quality Sensors, Guidelines, and Measurement Studies for Indoor Air Quality Management

The existence of indoor air pollutants—such as ozone, carbon monoxide, carbon dioxide, sulfur dioxide, nitrogen dioxide, particulate matter, and total volatile organic compounds—is evidently a critical issue for human health. Over the past decade, various international agencies have continually refined and updated the quantitative air quality guidelines and standards in order to meet the requirements for indoor air quality management. This paper first provides a systematic review of the existing air quality guidelines and standards implemented by different agencies, which include the Ambient Air Quality Standards (NAAQS); the World Health Organization (WHO); the Occupational Safety and Health Administration (OSHA); the American Conference of Governmental Industrial Hygienists (ACGIH); the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE); the National Institute for Occupational Safety and Health (NIOSH); and the California ambient air quality standards (CAAQS). It then adds to this by providing a state-of-art review of the existing low-cost air quality sensor (LCAQS) technologies, and analyzes the corresponding specifications, such as the typical detection range, measurement tolerance or repeatability, data resolution, response time, supply current, and market price. Finally, it briefly reviews a sequence (array) of field measurement studies, which focuses on the technical measurement characteristics and their data analysis approaches.

Evaluation of the complexity of indoor air in hospital wards based on PM2.5, real-time PCR, adenosine triphosphate bioluminescence assay, microbial culture and mass spectrometry

Background

The aim of this study was to establish a set of assessment methods suitable for evaluating the complex indoor environment of hospital wards and to ascertain the composition of bacteria and microbial ecology of hospital wards.

Methods

Colony-forming units (CFUs), PM2.5 detection, real-time PCR, and adenosine triphosphate (ATP) bioluminescence assay were employed to evaluate the complexity of indoor air in 18 wards of nine departments in a hospital and two student dormitories in a university. Subsequently, the microbial samples were quantified and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).

Results

Although the studied indices were relatively independent, the PM2.5 content was correlated with bacterial CFUs determined by passive sedimentation method, bacterial and fungal counts measured by real-time PCR, and ATP bioluminescence assay. The composition of microorganisms in the air of hospital wards differed from that in the air of student dormitories. The dominant genera in hospital wards were Staphylococcus (39.4%), Micrococcus (21.9%), Corynebacterium (11.7%), Kocuria (4.4%), Bacillus (2.9%), Streptococcus (1.6%), Moraxella (1.6%), and Enterococcus (1.3%), and the microbial ecology differed between Respiration Dept. III and other hospital departments. Additionally, 11.1 and 27.3% of bacteria in hospital wards and student dormitories were not identified, respectively.

Conclusions

Assessment of environmental quality of hospital wards should be based on comprehensive analysis with multiple indicators. There may be imbalances in the microbial diversity in the hospital wards, therefore, monitoring of the environmental quality of hospitals is important in the prevention of nosocomial infections.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4249-z) contains supplementary material, which is available to authorized users.

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.

Mapping the noise in a Greek general hospital

Sound pressure levels were monitored in a general hospital, in Greece, at ten indoor locations and at three outdoor locations, in the yard of the building. The selected indoor locations are representative of distinct activities that are common in every hospital, such as the emergency department, patient wards and several supporting services, like washing the clothes or the dishes. Noise levels were highly variable in each monitoring location and depended on the activities in the room, such as conversations, medical equipment in use, analytical devices or other machinery in operation. The highest noise levels that were recorded were in the blood donation unit and in the laundry room (the L_10,8h was 73 and 79 dB(A) respectively), mainly due to the opening/closing of the metal lids of garbage bins in the first location and due to the wringing of the clothes in the second. Indoor background noise levels i.e. the L_95,8h values, were more than 55 dB(A) and higher than the respective outdoor values (except of the L_95,8h in one ward of the paediatric ward). The calculated average L_{EX, 8h} was 69.3 dB(A), below the European Union lower exposure action limit value, i.e. 87 dB(A), that was set to prevent hearing loss of the employees. However, noise levels in the wards, in the emergency and the outpatient department were above the values suggested by international guidelines for a healing environment. Sound spectra revealed peaks in frequencies that were representative of the sources of the noise and also the presence of low frequency noise components.

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.

Indoor air quality in two French hospitals: Measurement of chemical and microbiological contaminants

In addition to being influenced by the environment, the indoor air pollution in hospitals may be associated with specific compounds emitted from various products used, health care activities and building materials. This study has enabled assessment of the chemical and microbiological concentrations of indoor air in two French hospitals. Based on an integrated approach, the methodology defined aims to measure concentrations of a wide range of chemical compounds (>50 volatile and semi-volatile organic compounds), particle concentrations (PM₁₀ and PM_2.5), microorganisms (fungi, bacteria and viruses) and ambient parameters (temperature, relative humidity, pressure and carbon dioxide). Chemical and microbiological air concentrations were measured during two campaigns (winter and summer) and across seven rooms (for spatial variability). The results have shown that indoor air contains a complex mixture of chemical, physical and microbiological compounds. Concentrations in the same order of magnitude were found in both hospitals. Compared to dwelling indoor air, our study shows low, at least equivalent, contamination for non-hospital specific parameters (aldehydes, limonene, phthalates, aromatic hydrocarbons), which is related to ventilation efficiency. Chemical compounds retrieved at the highest concentration and frequencies are due to healthcare activities, for example alcohol - most commonly ethanol - and hand rubbing (median concentration: ethanol 245.7 μg/m³ and isopropanol 13.6 μg/m³); toluene and staining in parasitology (highest median concentration in Nancy laboratory: 2.1 μg/m³)).

A review of the chemical and biological pollutants in indoor air in hospitals and assessing their effects on the health of patients, staff and visitors

Indoor air quality in hospitals has been specifically considered in terms of its impact on health. Air quality is an important risk factor influencing the health of staff and patients who are in contact with indoor air inhaled in hospitals. Over the past two decades, hundreds of studies have been developed to assess pollution in hospital environment. Two hundred and fitfy papers from around the world, from the last two decades, were identified and reviewed. Recent studies have found that the presence of various chemical and biological pollutants affected the health of patients, staff and visitors. Nearly all the reports agree that chemical and biological pollutants in the hospital environment have adverse effects. In most of the reviewed papers, analysis of health hazards was conducted for personnel and patients to toxic metals, chlorine, fine (PM2.5) and coarse (PM2.5−10) particles, and bio-aerosol in the inhaled air of the hospital environment. Some papers showed that some of the metals are carcinogens and others do not have a carcinogenic risk. Bio-aerosols as a biological pollutant are usually defined as airborne bacteria, fungi, viruses, pollen and their by products. These biological pollutants are associated with a wide range of health effects in hospital environments. This review can serve as an introduction and as the statement of the problem for more original research in this regard.

Sources, health effects and control strategies of indoor fine particulate matter (PM2.5): A review

Indoor air quality is directly influenced by indoor PM_2.5. Short-term and long-term exposure of PM_2.5 in the micro environment would severely detriment the health of both humans and animals. The researches both at home and abroad dating from 2000 were analyzed and summarized mainly in the following 3 sections: source apportionment, health effects and control methods. Health effects were illustrated in both epidemiology and toxicology. The epidemiology was explicated in morbidity and mortality, the toxicology was illuminated in inflammatory reaction, oxidative stress, genotoxicity, mutagenicity and carcinogenicity. Control methods were showed in two aspects (sources and means of transmission), of which each was resolved by corresponding control strategy. Abundant investigations indicated that comprehensive control strategies were needed for sources decrement and health burden mitigation of indoor PM_2.5. Based on the increasingly wide research of indoor PM_2.5, the concept of indoors was essentially expanded, and on the basis of the summary of all the aspects mentioned above, both the scope and depth of indoor PM_2.5 research were found insufficiently. Meantime, the potential direction of development in indoor PM_2.5 research were projected, in hope of contributing to further relevant study of engineers in ambient environment and building environment.

In vitro and in silico investigations of the binary-mixture toxicity of phthalate esters and cadmium (II) to Vibrio qinghaiensis sp.-Q67

Phthalate esters (PAEs) are widely used as plasticizers and have become one of the emerging contaminants with an increasing public concern. The residues of PAEs frequently co-exist with heavy metals such as cadmium (Cd) in waters; however, their joint ecotoxicity remains largely unknown. We herein investigated the single and joint toxicity of commonly used PAEs and Cd using freshwater luminescent bacteria Vibrio qinghaiensis sp.-Q67. The median effective concentration (EC₅₀) of benzyl butyl phthalate (BBP), dibutyl phthalate (DBP), diethyl phthalate (DEP), dimethyl phthalate (DMP), diisooctyl phthalate (DIOP) and di-n-octyl phthalate (DOP) were determined to be in the range from 134.4mg/L to as high as 1000mg/L, indicating very weak toxicity to Vibrio qinghaiensis sp.-Q67. The toxicity of single PAEs showed a significant linear relationship with Log K_ow, indicating the dependence of the elevated toxicity on the increasing hydrophilicity. The toxicity of binary mixture of PAEs was further evaluated in silico using the independent action (IA) model and concentration addition (CA) model. DMP-DEP, DEP-DBP or DMP-DBP exhibited antagonistic effects with the toxic unit value higher than 1.2. The CA and IA models poorly predicted the joint toxicity of DMP-DEP, DEP-DBP or DMP-DBP. The joint toxicity of the binary mixtures of DMP, DEP or DBP with Cd was simple additive as predicted by the CA and IA models. Our results indicated the potentially higher risk of PAEs in the presence of Cd, emphasizing the importance of determining the impact of their joint effects on aquatic organisms. The integrated in vitro and in silico methods employed in this study will be beneficial to study the joint toxicity and better assess the aquatic ecological risk of PAEs.

Physiochemical characteristics of aerosol particles in the typical microenvironment of hospital in Shanghai, China

Health risk of populations dwelling in the hospital has been a global concern, but has not been adequately examined. PM_2.5 and PM₁ samples were collected in two indoor locations (outpatient department and inpatient department) and one outdoor location (courtyard) of the hospital in Shanghai. The concentrations of size-fractionated trace metals and the morphology of single particles were determined to accurately assess the health risk for populations in the hospital. The results indicated that the mean concentrations of PM_2.5 and PM₁ were in the order of outpatient department>courtyard>inpatient department. The mean concentrations of PM₁ decreased with floors (first floor: 78.0μg/m³, second floor: 64.1μg/m³, fourth floor: 48.4μg/m³). However, the mean PM_2.5 concentrations were in the order of first floor (124.0μg/m³)>fourth floor (91.4μg/m³)>second floor (90.6μg/m³), which was likely associated with the number of patients. The PM_2.5 and PM₁ concentrations have begun to increase rapidly from 9:00am and decreased after 15:00pm in the first floor, whereas they remain relatively stable in the second and fourth floor. The abundance of Mg, Ca, Al and K in the fine particles and coarse particles were both higher than other elements for all floors. The concentrations of trace metals (e.g., Zn, Ba, Fe, Mn, Cr, Ca, Ti, Na, and K) except Mg and Al in the coarse particles (>2.5μm) decreased with floors, whereas Zn, Ba, Fe, and Cr in the fine particles (<2.5μm) displayed opposite variation. Trace metals in the first floor were mainly concentrated in the >2.5μm and 1-2.5μm, whereas they chiefly peaked at 0.25-0.5μm and below 0.25μm in the second and fourth floor. Single particles analysis showed that mineral particles, soot, and Fe-rich particles were mainly concentrated in the first floor, indicating the impacts of walking of patients, traffic emissions, and food cooking, respectively. Sulfate particles were internally mixed with soot, fly ash and Fe-rich particles in the second floor, which suggested that these sulfate particles probably underwent aging processes during the atmospheric long-range transport. In the fourth floor, fly ash, sulfate particles, Zn-rich particles, and biogenic particles were identified under the transmission electron microscopy (TEM). Higher abundance of sulfates and absence of chlorate hinted existence of heterogeneous reactions during long-range transport with the Cl^- replaced by SO₄^2-. The index of average daily intake (ADI), hazard quotient (HQ), and carcinogenic risks (CR) indicated that Cr pose carcinogenic risks to the surrounding populations, while non-carcinogenic risks of Mn, Zn, and Cr were not remarkable.