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Cate JD, Sullivan YZ, King MD. Inhibition of Microbial Growth and Biofilm Formation in Pure and Mixed Bacterial Samples. Microorganisms 2024; 12:1500. [PMID: 39065268 PMCID: PMC11278618 DOI: 10.3390/microorganisms12071500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Hydraulic fracturing, or fracking, requires large amounts of water to extract fossil fuel from rock formations. As a result of hydraulic fracturing, the briny wastewater, often termed back-produced fracturing or fracking water (FW), is pumped into holding ponds. One of the biggest challenges with produced water management is controlling microbial activity that could reduce the pond water's reusable layer and pose a significant environmental hazard. This study focuses on the characterization of back-produced water that has been hydraulically fractured using chemical and biological analysis and the development of a high-throughput screening method to evaluate and predict the antimicrobial effect of four naturally and commercially available acidic inhibitors (edetic acid, boric acid, tannic acid, and lactic acid) on the growth of the FW microbiome. Liquid cultures and biofilms of two laboratory model strains, the vegetative Escherichia coli MG1655, and the spore-forming Bacillus atrophaeus (also known as Bacillus globigii, BG) bacteria, were used as reference microorganisms. Planktonic bacteria in FW were more sensitive to antimicrobials than sessile bacteria in biofilms. Spore-forming BG bacteria exhibited more sensitivity to acidic inhibitors than the vegetative E. coli cells. Organic acids were the most effective bacterial growth inhibitors in liquid culture and biofilm.
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Affiliation(s)
| | | | - Maria D. King
- Biological and Agricultural Engineering, Texas A&M University, College Station, TX 77843, USA; (J.D.C.); (Y.Z.S.)
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2
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Fang Z, Zhou X, Liao H, Xu H. A meta-analysis of Legionella pneumophila contamination in hospital water systems. Am J Infect Control 2023; 51:1250-1262. [PMID: 37054892 DOI: 10.1016/j.ajic.2023.04.002] [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: 02/03/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Legionella pneumophila is a common cause of community-acquired pneumonia. We aimed to determine the pooled rates of L pneumophila contamination in the water environment of the hospital. METHODS We searched PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, WangFang and Science Direct, The Cochrane Library, and Science Finder, for relevant studies published until December 2022. Stata 16.0 software was used to determine pooled contamination rates, publication bias, and subgroup analysis. RESULTS Forty-eight eligible articles with a total of 23,640 samples of water were evaluated, and the prevalence of L pneumophila was 41.6%. The results of the subgroup analysis showed that the pollution rate of L pneumophila in hot water (47.6%) was higher than that in other water bodies. The rates of L pneumophila contamination were higher in developed countries (45.2%), culture methods (42.3%), published between 1985 and 2015 (42.9%), and studies with a sample size of less than 100 (53.0%). CONCLUSIONS L pneumophila contamination in medical institutions is still very serious and should be paid attention to, especially in developed countries and hot water tanks.
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Affiliation(s)
- Zisi Fang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaocong Zhou
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hui Liao
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hong Xu
- Department of Environmental Health, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
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3
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Najjar-Debbiny R, Feldman M, Groizberg-Schwartzman D, Sobeh S, Khoury L, Yassin R, Weber G, Salach O, Shaked-Mishan P, Schwartz N, Saliba W. Unveiling the hidden threat of carbapenemase-producing Enterobacteriaceae in hospital water environments: A single-center study. Am J Infect Control 2023; 51:1279-1281. [PMID: 37499760 DOI: 10.1016/j.ajic.2023.07.006] [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: 05/26/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
This retrospective study examined the presence of carbapenemase-producing Enterobacteriaceae in hospital water environments. Results showed that carbapenemase-producing Enterobacteriaceae was detected in 41.5% of the samples within 1 m of a water source (showers or sinks), with 20.6% of the positive samples associated with shower water sources.
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Affiliation(s)
- Ronza Najjar-Debbiny
- Infection Prevention and Control unit, Lady Davis Carmel medical center, Haifa, Israel; Ruth and Bruce Rappaport, Faculty of medicine, Technion, Haifa, Israel.
| | - Marina Feldman
- Infection Prevention and Control unit, Lady Davis Carmel medical center, Haifa, Israel
| | | | - Shereen Sobeh
- Infection Prevention and Control unit, Lady Davis Carmel medical center, Haifa, Israel
| | - Lina Khoury
- Infection Prevention and Control unit, Lady Davis Carmel medical center, Haifa, Israel
| | - Rabah Yassin
- Infectious Diseases unit, Lady Davis Carmel medical center, Haifa, Israel
| | - Gabriel Weber
- Infectious Diseases unit, Lady Davis Carmel medical center, Haifa, Israel
| | - Ola Salach
- Clinical Microbiology Lab, Lady Davis Carmel medical center, Haifa, Israel
| | | | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport, Faculty of medicine, Technion, Haifa, Israel; Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
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4
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Logan-Jackson AR, Batista MD, Healy W, Ullah T, Whelton AJ, Bartrand TA, Proctor C. A Critical Review on the Factors that Influence Opportunistic Premise Plumbing Pathogens: From Building Entry to Fixtures in Residences. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:6360-6372. [PMID: 37036108 DOI: 10.1021/acs.est.2c04277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Residential buildings provide unique conditions for opportunistic premise plumbing pathogen (OPPP) exposure via aerosolized water droplets produced by showerheads, faucets, and tubs. The objective of this review was to critically evaluate the existing literature that assessed the impact of potentially enhancing conditions to OPPP occurrence associated with residential plumbing and to point out knowledge gaps. Comprehensive studies on the topic were found to be lacking. Major knowledge gaps identified include the assessment of OPPP growth in the residential plumbing, from building entry to fixtures, and evaluation of the extent of the impact of typical residential plumbing design (e.g., trunk and branch and manifold), components (e.g., valves and fixtures), water heater types and temperature setting of operation, and common pipe materials (copper, PEX, and PVC/CPVC). In addition, impacts of the current plumbing code requirements on OPPP responses have not been assessed by any study and a lack of guidelines for OPPP risk management in residences was identified. Finally, the research required to expand knowledge on OPPP amplification in residences was discussed.
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Affiliation(s)
- Alshae' R Logan-Jackson
- Building Energy and Environment Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, United States
| | - Marylia Duarte Batista
- Building Energy and Environment Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, United States
| | - William Healy
- Building Energy and Environment Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, United States
| | - Tania Ullah
- Building Energy and Environment Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, United States
| | - Andrew J Whelton
- Lyles School of Civil Engineering, Division of Environmental and Ecological Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Timothy A Bartrand
- Environmental Science, Policy, and Research Institute, Bala Cynwyd, Pennsylvania 19004, United States
| | - Caitlin Proctor
- Agricultural and Biological Engineering, Division of Environmental and Ecological Engineering, Purdue University, West Lafayette, Indiana 47907, United States
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5
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Garvey MI, Williams N, Gardiner A, Ruston C, Wilkinson M, Kiernan M, Walker J, Holden E. The sink splash zone. J Hosp Infect 2023; 135:154-156. [PMID: 36870392 DOI: 10.1016/j.jhin.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB; Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB; Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Nathan Williams
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
| | - Alyson Gardiner
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
| | - Charlotte Ruston
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
| | - Martyn Wilkinson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB; Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB
| | - Martin Kiernan
- University of West London, Richard Wells Research Centre, London, United Kingdom
| | | | - Elisabeth Holden
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, B15 2WB
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6
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Succar A, Lefebvre X, Prévost M, Bédard E, Robert E. Characterization of the aerosol produced from an aerated jet. WATER RESEARCH 2023; 229:119432. [PMID: 36495852 DOI: 10.1016/j.watres.2022.119432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Faucet aerators that form aerated water jets generate aerosols, which can constitute a risk of infection if the water is contaminated, particularly for vulnerable individuals near the sink. In this study, we characterize the size and trajectory of water droplets produced from an aerated jet. The detected particle diameter ranged from 3 to 150μm. The concentration of droplets in the air varied from near-zero to a maximum of 2×1011particles/m3, depending on the location relative to the jet. We found four relevant categories of droplets based on their trajectories following their emission at the jet's free surface: particles with inertia high enough to escape the immediate vicinity of the jet (category 1), particles moving towards the jet (category 2), particles drawn into the aerator, which only included particles with a diameter smaller than 50μm (category 3), and particles with a near-vertical trajectory (category 4). Tracing category 1 particles to their generation location on the water interface shows a higher emission rate near the aerator. Finally, we employ a numerical model to compute the subsequent trajectories of droplets detected at the limits of the sampled domain. We find that particles whose diameter is smaller than 55μm completely dry and become airborne. Larger droplets deposit within a radius of 7cm around the jet, assuming a surface is located 20cm below the aerator tip. These results increase the fundamental understanding of the emission mechanisms of droplets in aerated jets and their fate in the sink environment.
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Affiliation(s)
- Antonella Succar
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, QC, Canada.
| | - Xavier Lefebvre
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Michèle Prévost
- Industrial Chair on Drinking Water, Department of Civil, Geological and Mining Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Emilie Bédard
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Etienne Robert
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, QC, Canada
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7
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Shen Y, Haig SJ, Prussin AJ, LiPuma JJ, Marr LC, Raskin L. Shower water contributes viable nontuberculous mycobacteria to indoor air. PNAS NEXUS 2022; 1:pgac145. [PMID: 36712351 PMCID: PMC9802317 DOI: 10.1093/pnasnexus/pgac145] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
Nontuberculous mycobacteria (NTM) are frequently present in municipal drinking water and building plumbing, and some are believed to cause respiratory tract infections through inhalation of NTM-containing aerosols generated during showering. However, the present understanding of NTM transfer from water to air is insufficient to develop NTM risk mitigation strategies. This study aimed to characterize the contribution of shower water to the abundance of viable NTM in indoor air. Shower water and indoor air samples were collected, and 16S rRNA and rpoB genes were sequenced. The sequencing results showed that running the shower impacted the bacterial community structure and NTM species composition in indoor air by transferring certain bacteria from water to air. A mass balance model combined with NTM quantification results revealed that on average 1/132 and 1/254 of NTM cells in water were transferred to air during 1 hour of showering using a rain and massage showerhead, respectively. A large fraction of the bacteria transferred from water to air were membrane-damaged, i.e. they had compromised membranes based on analysis by live/dead staining and flow cytometry. However, the damaged NTM in air were recoverable as shown by growth in a culture medium mimicking the respiratory secretions of people with cystic fibrosis, implying a potential infection risk by NTM introduced to indoor air during shower running. Among the recovered NTM, Mycobacterium mucogenicum was the dominant species as determined by rpoB gene sequencing. Overall, this study lays the groundwork for future pathogen risk management and public health protection in the built environment.
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Affiliation(s)
| | | | - Aaron J Prussin
- Department of Civil and Environmental Engineering, Virginia Tech, 418 Durham Hall, Blacksburg, VA 24061, USA
| | - John J LiPuma
- Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Linsey C Marr
- Department of Civil and Environmental Engineering, Virginia Tech, 418 Durham Hall, Blacksburg, VA 24061, USA
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8
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Pasalari H, Akbari H, Ataei-Pirkooh A, Adibzadeh A, Akbari H. Assessment of rotavirus and norovirus emitted from water spray park: QMRA, diseases burden and sensitivity analysis. Heliyon 2022; 8:e10957. [PMID: 36254289 PMCID: PMC9568861 DOI: 10.1016/j.heliyon.2022.e10957] [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] [Received: 07/23/2022] [Revised: 09/06/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
A quantitative model on exposure to pathogenic viruses in air of recreational area and their corresponding health effects is necessary to provide mitigation actions in content of emergency response plans (ERP). Here, the health risk associated with exposure to two pathogenic viruses of concern: Rotavirus (RoV) and Norovirus (NoV) in air of water spray park were estimated using a quantitative microbial risk assessment (QMRA) model. To this end, real-time Reverse Transcriptase polymerase chain reaction (real-time RT-PCR) was employed to measure the concentration levels of RoV and NoV over a twelve-month period. The probability of infection, illness and diseases burden of gastrointestinal illness (GI) caused by RoV and NoV for both workers and visitors were estimated using QMRA and Monto-Carlo simulation technique. The annual mean concentration for RoV and NoV in sampling air of water spray park were 20and 1754, respectively. The %95 confidence interval (CI) calculated annual DALY indicator for RoV (Workers: 2.62 × 10-4-2.62 × 10-1, Visitors: 1.50 × 10-5-2.42 × 10-1) and NoV (Workers: 5.54 × 10-3-2.53 × 10-1; Visitors: 5.18 × 10-4-2.54 × 10-1) were significantly higher the recommended values by WHO and US EPA (10-6-10-4 DALY pppy). According to sensitivity analysis, exposure dose and disease burden per case (DBPC) were found as the most influencing factors on disease burden as a consequences of exposure to RoV and NoV, respectively. The comprehensive information on DALY and QMRA can aid authorities involved in risk assessment and recreational actions to adopt proper approach and mitigation actions to minimize the health risk.
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Affiliation(s)
- Hasan Pasalari
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Akbari
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Angila Ataei-Pirkooh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Adibzadeh
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamed Akbari
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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9
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Xu PC, Zhang CM, Wang XC. Numerical simulation for spatial distribution of water aerosol produced from nozzle spray and health risk related to Legionella pneumophila in spray scenarios. WATER RESEARCH 2022; 216:118304. [PMID: 35325820 DOI: 10.1016/j.watres.2022.118304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
Water spray facilities are widely used in public places for sprinkling or beautifying the environment. However, the potential health risk induced by water aerosols increasingly calls for attention. In this study, the spatial distribution of water aerosols was investigated through the molecular sieve adsorption method, and predicted by discrete phase model (DPM). On this basis, the health risk regarding Legionella pneumophila for specific spray scenarios was evaluated by quantitative microbial risk assessment (QMRA). The results showed that the original droplet size can be described by the Rosin_Rommaler distribution (R2>0.99). The spatial distribution of water aerosols produced from a nozzle spray can be well predicted by the DPM. The concentration of water aerosols showed a sharp decline within 5 m from the nozzle and was not significantly different within 5 m (p>0.05) as for various spray scenarios. However, the difference was significant outside 5 m (p<0.05). Furthermore, a safe contact distance of exceeding 8 m is proposed in spray scenarios considering the risk threshold of 0.0001. Sensitivity analysis demonstrated the concentration of Legionella pneumophila in water aerosols as the critical factor affecting the health risk.
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Affiliation(s)
- Peng-Cheng Xu
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Key Lab of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Chong-Miao Zhang
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Key Lab of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
| | - Xiaochang C Wang
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Key Lab of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China; International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China
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10
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Nathu VD, Virkutyte J, Rao MB, Nieto-Caballero M, Hernandez M, Reponen T. Direct-Read Fluorescence-Based Measurements of Bioaerosol Exposure in Home Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063613. [PMID: 35329300 PMCID: PMC8951687 DOI: 10.3390/ijerph19063613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Home healthcare workers (HHCWs) are subjected to variable working environments which increase their risk of being exposed to numerous occupational hazards. One of the potential occupational hazards within the industry includes exposure to bioaerosols. This study aimed to characterize concentrations of three types of bioaerosols utilizing a novel fluorescence-based direct-reading instrument during seven activities that HHCWs typically encounter in patients’ homes. Bioaerosols were measured in an indoor residence throughout all seasons in Cincinnati, OH, USA. A fluorescence-based direct-reading instrument (InstaScope, DetectionTek, Boulder, CO, USA) was utilized for all data collection. Total particle counts and concentrations for each particle type, including fluorescent and non-fluorescent particles, were utilized to form the response variable, a normalized concentration calculated as a ratio of concentration during activity to the background concentration. Walking experiments produced a median concentration ratio of 52.45 and 2.77 for pollen and fungi, respectively. Fungi and bacteria produced the highest and lowest median concentration ratios of 17.81 and 1.90 for showering, respectively. Lastly, our current study showed that sleeping activity did not increase bioaerosol concentrations. We further conclude that utilizing direct-reading methods may save time and effort in bioaerosol-exposure assessment.
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Affiliation(s)
- Vishal D. Nathu
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
| | - Jurate Virkutyte
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
| | - Marepalli B. Rao
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
| | - Marina Nieto-Caballero
- Department of Environmental Engineering, College of Engineering & Applied Science, University of Colorado Boulder, Boulder, CO 80309-0428, USA; (M.N.-C.); (M.H.)
| | - Mark Hernandez
- Department of Environmental Engineering, College of Engineering & Applied Science, University of Colorado Boulder, Boulder, CO 80309-0428, USA; (M.N.-C.); (M.H.)
| | - Tiina Reponen
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0056, USA; (V.D.N.); (J.V.); (M.B.R.)
- Correspondence:
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11
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Sasahara T, Ogawa M, Fujimura I, Ae R, Kosami K, Morisawa Y. Efficacy and Effectiveness of Showerheads Attached with Point-of-use (POU) Filter Capsules in Preventing Waterborne Diseases in a Japanese Hospital. Biocontrol Sci 2020; 25:223-230. [PMID: 33281180 DOI: 10.4265/bio.25.223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Tap water contamination is a growing concern in healthcare facilities, and despite chlorination, tap water in these facilities contains several pathogenic microorganisms causing healthcare-associated waterborne infections or nosocomial outbreaks. Shower units are particularly prone to contamination as they are conducive for bacterial growth and can even produce bioaerosols containing pathogenic bacteria. Shower units coupled with point-of-use (POU) water filters are a simple and safe option; however, their efficacy has been under-reported. Therefore, we determined the efficacy of showerheads attached with a POU filter capsule in preventing infections in our hospital. We investigated the presence of pathogenic bacteria in water sampled from three shower units. After replacing the original shower units with new ones incorporated with a sterile-grade water filter capsule (0.2 µm; QPoint™), the water samples were analyzed for up to 2 months. The POU filters removed several pathogenic bacteria (Mycobacterium, Pseudomonas, Stenotrophomonas, Aeromonas, and Klebsiella spp.). Filter effectiveness depends on regional water quality and we believe that effective tap water treatment combined with the use of POU filters (introduced at a reasonable cost in healthcare facilities) can considerably minimize waterborne diseases in hospitals and improve patient care.
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Affiliation(s)
- Teppei Sasahara
- Department of Infection and Immunity, School of Medicine, Jichi Medical University.,Health Service Center, Jichi Medical University.,Division of Public Health, Center for Community Medicine, Jichi Medical University
| | | | | | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Yuji Morisawa
- Department of Infection and Immunity, School of Medicine, Jichi Medical University
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12
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Lampl BMJ, Lang M, Wodnick S. Can mandatory monitoring in rental apartments effectively prevent legionellosis? A retrospective analysis of data from Regensburg with a review of the literature. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc14. [PMID: 32685358 PMCID: PMC7336046 DOI: 10.3205/dgkh000349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background:Legionella pneumophila can cause severe, often fatal, pneumonia in humans. Mandatory water sampling in commercially used buildings (mainly rental apartments) as regulated in the Drinking Water Ordinance (Trinkwasserverordnung) aim to protect the population against infection with Legionella. However, no data exist to date that could prove the effectiveness of the measures. At the same time, having the Public Health Department’s Infection Control Division deal with Legionalla is very time consuming. Methods: A retrospective analysis of data from the city and district of Regensburg, a selective literature search, a prospective survey of workload using an anonymous questionnaire were performed. Results: The evaluated data from the city/district of Regensburg suggest underreporting to a similar extent as shown by the RKI’s data in the compared period. Neither is the actual incidence known, nor can exposures be clearly determined in most cases. The exposure categories “travel” and “private/occupational” seem to be the most pertinent. The potential public hazard of Legionella posed by domestic plumbing systems is unclear. A connection between exceeding the technical measurement limit (Technischer Maßnahmenwert, TMW) in routine tests in rental apartments and disease cases cannot be shown. A survey among non-medical personnel in the field of infection control and hygiene on the time spent on the topic of Legionella yielded a mean number of 39% of daily working hours for the observed 2-month period. Conclusion: The data on incidence, exposure, and causality are incomplete. Evidence of effective protection by the current practice of sampling in apartment buildings could not be found. For many aspects, there are no unambiguous data in the literature. Restricting mandatory monitoring to certain public/commercial institutions should be discussed, given the high workload for the Public Health Department and the unproven protective effect. Further research on this topic is necessary.
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Affiliation(s)
| | - Markus Lang
- Public Health Department, Regensburg, Germany
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13
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Allegra S, Riffard S, Leclerc L, Girardot F, Stauffert M, Forest V, Pourchez J. A valuable experimental setup to model exposure to Legionella's aerosols generated by shower-like systems. WATER RESEARCH 2020; 172:115496. [PMID: 31972415 DOI: 10.1016/j.watres.2020.115496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
The mechanism underlying Legionella aerosolization and entry into the respiratory tract remains poorly documented. In previous studies, we characterized the aerodynamic behaviour of Legionella aerosols and assessed their regional deposition within the respiratory tract using a human-like anatomical model. The aim of this study was to assess whether this experimental setup could mimic the exposure to bioaerosols generated by showers. To achieve this objective we performed experiments to measure the mass median aerodynamic diameter (MMAD) as well as the emitted dose and the physiological state of the airborne bacteria generated by a shower and two nebulizers (vibrating-mesh and jet nebulizers). The MMADs of the dispersed bioaerosols were characterized using a 12-stage cascade low-pressure impactor. The amount of dispersed airborne bacteria from a shower was quantified using a Coriolis® Delta air sampler and compared to the airborne bacteria reaching the thoracic region in the experimental setup. The physiological state and concentration of airborne Legionella were assessed by qPCR for total cells, culture for viable and cultivable Legionella (VC), and flow cytometry for viable but non-cultivable Legionella (VBNC). In summary, the experimental setup developed appears to mimic the bioaerosol emission of a shower in terms of aerodynamic size distribution. Compared to the specific case of a shower used as a reference in this study, the experimental setup developed underestimates by 2 times (when the jet nebulizer is used) or overestimates by 43 times (when the vibrating-mesh nebulizer is used) the total emitted dose of airborne bacteria. To our knowledge, this report is the first showing that an experimental model mimics so closely an exposure to Legionella aerosols produced by showers to assess human lung deposition and infection in well-controlled and safe conditions.
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Affiliation(s)
- Séverine Allegra
- University of Lyon, University Jean Monnet of Saint-Etienne, CNRS, EVS-ISTHME UMR 5600, F-42023, Saint-Etienne, France.
| | - Serge Riffard
- University of Lyon, University Jean Monnet of Saint-Etienne, CNRS, EVS-ISTHME UMR 5600, F-42023, Saint-Etienne, France
| | - Lara Leclerc
- Mines Saint-Etienne, University of Lyon, University Jean Monnet of Saint-Etienne, INSERM, U 1059 Sainbiose, Centre CIS, F-42023, Saint-Etienne, France
| | - Françoise Girardot
- University of Lyon, University Jean Monnet of Saint-Etienne, CNRS, EVS-ISTHME UMR 5600, F-42023, Saint-Etienne, France
| | - Magalie Stauffert
- University of Lyon, University Jean Monnet of Saint-Etienne, CNRS, EVS-ISTHME UMR 5600, F-42023, Saint-Etienne, France
| | - Valérie Forest
- Mines Saint-Etienne, University of Lyon, University Jean Monnet of Saint-Etienne, INSERM, U 1059 Sainbiose, Centre CIS, F-42023, Saint-Etienne, France
| | - Jérémie Pourchez
- Mines Saint-Etienne, University of Lyon, University Jean Monnet of Saint-Etienne, INSERM, U 1059 Sainbiose, Centre CIS, F-42023, Saint-Etienne, France
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Hopman J, Meijer C, Kenters N, Coolen JPM, Ghamati MR, Mehtar S, van Crevel R, Morshuis WJ, Verhagen AFTM, van den Heuvel MM, Voss A, Wertheim HFL. Risk Assessment After a Severe Hospital-Acquired Infection Associated With Carbapenemase-Producing Pseudomonas aeruginosa. JAMA Netw Open 2019; 2:e187665. [PMID: 30768189 PMCID: PMC6484879 DOI: 10.1001/jamanetworkopen.2018.7665] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Resistance of gram-negative bacilli to carbapenems is rapidly emerging worldwide. In 2016, the World Health Organization defined the hospital-built environment as a core component of infection prevention and control programs. The hospital-built environment has recently been reported as a source for outbreaks and sporadic transmission events of carbapenemase-producing gram-negative bacilli from the environment to patients. OBJECTIVE To assess risk after the identification of an unexpected, severe, and lethal hospital-acquired infection caused by carbapenemase-producing Pseudomonas aeruginosa in a carbapenemase-low endemic setting. DESIGN, SETTINGS, AND PARTICIPANTS A case series study in which a risk assessment was performed on all 11 patients admitted to the combined cardiothoracic surgery and pulmonary diseases ward and the hospital-built environment in the Radboud University Medical Center, the Netherlands, in February 2018. EXPOSURES Water and aerosols containing carbapenemase-producing (Verona integron-mediated metallo-β-lactamase [VIM]) P aeruginosa. MAIN OUTCOMES AND MEASURES Colonization and/or infection of patients and/or contamination of the environment after the detection of 1 patient infected with carbapenemase-producing (VIM) P aeruginosa. RESULTS A total of 5 men (age range, 60-84 years) and 6 women (age range, 55-74 years) were admitted to the combined cardiothoracic surgery and pulmonary diseases ward. The risk assessment was performed after carbapenemase-producing (VIM) P aeruginosa was unexpectedly detected in a man in his early 60s, who had undergone a left-sided pneumonectomy and adjuvant radiotherapy. No additional cases (colonization or infection) of carbapenemase-producing (VIM) P aeruginosa were detected. Plausible transmission of carbapenemase-producing P aeruginosa from the hospital environment to the patient via the air was confirmed by whole-genome sequencing, which proved the relation of Pseudomonas strains from the patient, the shower drains in 8 patient rooms, 1 sink, and an air sample. CONCLUSIONS AND RELEVANCE This study suggests that rethinking the hospital-built environment, including shower drains and the sewage system, will be crucial for the prevention of severe and potential lethal hospital-acquired infections.
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Affiliation(s)
- Joost Hopman
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corianne Meijer
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nikki Kenters
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jordy P. M. Coolen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mohammad R. Ghamati
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Shaheen Mehtar
- Academic Unit for Infection Prevention and Control, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Reinout van Crevel
- Center for Infectious Diseases, Department of Internal Medicine Radboudumc, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J. Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ad F. T. M. Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Andreas Voss
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Heiman F. L. Wertheim
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Abstract
Bacteria thrive in showerheads and throughout household water distribution systems. While most of these bacteria are innocuous, some are potential pathogens, including members of the genus Mycobacterium that can cause nontuberculous mycobacterial (NTM) lung infection, an increasing threat to public health. We found that showerheads in households across the United States and Europe often harbor abundant mycobacterial communities that vary in composition depending on geographic location, water chemistry, and water source, with households receiving water treated with chlorine disinfectants having particularly high abundances of certain mycobacteria. The regions in the United States where NTM lung infections are most common were the same regions where pathogenic mycobacteria were most prevalent in showerheads, highlighting the important role of showerheads in the transmission of NTM infections. Bacteria within the genus Mycobacterium can be abundant in showerheads, and the inhalation of aerosolized mycobacteria while showering has been implicated as a mode of transmission in nontuberculous mycobacterial (NTM) lung infections. Despite their importance, the diversity, distributions, and environmental predictors of showerhead-associated mycobacteria remain largely unresolved. To address these knowledge gaps, we worked with citizen scientists to collect showerhead biofilm samples and associated water chemistry data from 656 households located across the United States and Europe. Our cultivation-independent analyses revealed that the genus Mycobacterium was consistently the most abundant genus of bacteria detected in residential showerheads, and yet mycobacterial diversity and abundances were highly variable. Mycobacteria were far more abundant, on average, in showerheads receiving municipal water than in those receiving well water and in U.S. households than in European households, patterns that are likely driven by differences in the use of chlorine disinfectants. Moreover, we found that water source, water chemistry, and household location also influenced the prevalence of specific mycobacterial lineages detected in showerheads. We identified geographic regions within the United States where showerheads have particularly high abundances of potentially pathogenic lineages of mycobacteria, and these “hot spots” generally overlapped those regions where NTM lung disease is most prevalent. Together, these results emphasize the public health relevance of mycobacteria in showerhead biofilms. They further demonstrate that mycobacterial distributions in showerhead biofilms are often predictable from household location and water chemistry, knowledge that advances our understanding of NTM transmission dynamics and the development of strategies to reduce exposures to these emerging pathogens.
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Roccaro P, Vagliasindi FGA. Indoor release of asbestiform fibers from naturally contaminated water and related health risk. CHEMOSPHERE 2018; 202:76-84. [PMID: 29554510 DOI: 10.1016/j.chemosphere.2018.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
This study investigates the occurrence of airborne asbestiform fibers released in indoor ambient due to the use of asbestos naturally contaminated water. Some experiments employed a laboratory physical model using an ultrasonic humidifier charged with contaminated groundwater. Other experiments were carried out at full scale to assess the release of asbestiform fibers during showering. Obtained results show that the concentration of the airborne asbestiform fibers released in the bathroom during showering is higher than the limit value set by the European and Italian Regulations, while the concentration of fibers released by the humidifier is much lower. However, it is noteworthy that the use of the humidifier at high exposure time results in similar health risk. Strong correlations were found between the concentration of the airborne asbestiform fibers and a novel surrogate parameter (i.e. the exposure-specific-water-consumption). These correlations can be used to monitor the asbestiform fibers concentration at varying operating conditions and therefore, to control the resulting health risk.
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Affiliation(s)
- Paolo Roccaro
- Department of Civil Engineering and Architecture, University of Catania, Viale A. Doria 6, Catania, Italy.
| | - Federico G A Vagliasindi
- Department of Civil Engineering and Architecture, University of Catania, Viale A. Doria 6, Catania, Italy
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