COVID-19 Outbreak and Hospital Air Quality: A Systematic Review of Evidence on Air Filtration and Recirculation

A comprehensive review of microbial contamination in the indoor environment: sources, sampling, health risks, and mitigation strategies

The quality of the indoor environment significantly impacts human health and productivity, especially given the amount of time individuals spend indoors globally. While chemical pollutants have been a focus of indoor air quality research, microbial contaminants also have a significant bearing on indoor air quality. This review provides a comprehensive overview of microbial contamination in built environments, covering sources, sampling strategies, and analysis methods. Microbial contamination has various origins, including human occupants, pets, and the outdoor environment. Sampling strategies for indoor microbial contamination include air, surface, and dust sampling, and various analysis methods are used to assess microbial diversity and complexity in indoor environments. The review also discusses the health risks associated with microbial contaminants, including bacteria, fungi, and viruses, and their products in indoor air, highlighting the need for evidence-based studies that can relate to specific health conditions. The importance of indoor air quality is emphasized from the perspective of the COVID-19 pandemic. A section of the review highlights the knowledge gap related to microbiological burden in indoor environments in developing countries, using India as a representative example. Finally, potential mitigation strategies to improve microbiological indoor air quality are briefly reviewed.

The burden and dynamics of hospital-acquired SARS-CoV-2 in England

Hospital-based transmission had a dominant role in Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) epidemics1,2, but large-scale studies of its role in the SARS-CoV-2 pandemic are lacking. Such transmission risks spreading the virus to the most vulnerable individuals and can have wider-scale impacts through hospital-community interactions. Using data from acute hospitals in England, we quantify within-hospital transmission, evaluate likely pathways of spread and factors associated with heightened transmission risk, and explore the wider dynamical consequences. We estimate that between June 2020 and March 2021 between 95,000 and 167,000 inpatients acquired SARS-CoV-2 in hospitals (1% to 2% of all hospital admissions in this period). Analysis of time series data provided evidence that patients who themselves acquired SARS-CoV-2 infection in hospital were the main sources of transmission to other patients. Increased transmission to inpatients was associated with hospitals having fewer single rooms and lower heated volume per bed. Moreover, we show that reducing hospital transmission could substantially enhance the efficiency of punctuated lockdown measures in suppressing community transmission. These findings reveal the previously unrecognized scale of hospital transmission, have direct implications for targeting of hospital control measures and highlight the need to design hospitals better equipped to limit the transmission of future high-consequence pathogens.

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.

Stopping Traffic: An Analysis of Number of Scrubbed Personnel and Infection in Implant-Based Breast Reconstruction

BACKGROUND

Postoperative surgical site infection (SSI) is a devastating complication of implant-based breast reconstruction. Its occurrence may require additional hospitalization and ultimately necessitate prosthesis removal. The effect of foot traffic in the operating room has not yet been investigated within plastic surgery.

OBJECTIVES

This study analyzed the influence of scrubbed and unscrubbed personnel on postoperative SSI in immediate implant-based breast reconstruction.

METHODS

This was a retrospective review of 223 consecutive patients who underwent immediate implant-based reconstruction from 2015 to 2021 at the authors' institution. Patient demographics, comorbidities, smoking status, laterality, number of personnel, use of drains, and length of surgery were collected. The primary outcome assessed was surgical site infection with secondary outcomes of delayed wound healing, skin necrosis, hematoma, seroma, and reoperation within 90 days.

RESULTS

Patients who had a postoperative SSI had a mean number of 8.7 scrubbed individuals, whereas those who did not have a postoperative SSI had a mean number of 7.9 individuals scrubbed (P < .05). Univariate analysis demonstrated that increasing number of scrubbed individuals was predictive of SSI (odds ratio [OR]: 1.239, CI: 1.064-1.444, P < .05). A multivariate logistic regression demonstrated increased likelihood of SSI with increasing number of individuals scrubbed (OR: 1.232, CI: 1.027-1.478, P < .05).

CONCLUSIONS

This study demonstrates an increased risk of SSI in immediate, implant-based breast reconstruction with an increased number of personnel in the operative field. The findings highlight the importance of reducing foot traffic in the operating room when feasible to reduce risk of postoperative SSI and its associated morbidity.

The Benefits of Nursing Home Air Purification on COVID-19 Outcomes: A Natural Experiment

OBJECTIVES

Improving indoor air quality is one potential strategy to reduce the transmission of SARS-CoV-2 in any setting, including nursing homes, where staff and residents have been disproportionately and negatively affected by the COVID-19 pandemic.

DESIGN

Single group interrupted time series.

SETTING AND PARTICIPANTS

A total of 81 nursing homes in a multifacility corporation in Florida, Georgia, North Carolina, and South Carolina that installed ultraviolet air purification in their existing heating, ventilation, and air conditioning systems between July 27, 2020,k and September 10, 2020.

METHODS

We linked data on the date ultraviolet air purification systems were installed with the Nursing Home COVID-19 Public Health File (weekly data reported by nursing homes on the number of residents with COVID-19 and COVID-19 deaths), public data on data on nursing home characteristics, county-level COVID-19 cases/deaths, and outside air temperature. We used an interrupted time series design and ordinary least squares regression to compare trends in weekly COVID-19 cases and deaths before and after installation of ultraviolet air purification systems. We controlled for county-level COVID-19 cases, death, and heat index.

RESULTS

Compared with pre-installation, weekly COVID-19 cases per 1000 residents (-1.69; 95% CI, -4.32 to 0.95) and the weekly probability of reporting any COVID-19 case (-0.02; 95% CI, -0.04 to 0.00) declined in the post-installation period. We did not find any difference pre- and post-installation in COVID-19-related mortality (0.00; 95% CI, -0.01 to 0.02).

CONCLUSIONS AND IMPLICATIONS

Our findings from this small number of nursing homes in the southern United States demonstrate the potential benefits of air purification in nursing homes on COVID-19 outcomes. Intervening on air quality may have a wide impact without placing significant burden on individuals to modify their behavior. We recommend a stronger, experimental design to estimate the causal effect of installing air purification devices on improving COVID-19 outcomes in nursing homes.

Triboelectric-induced ion mobility for artificial intelligence-enhanced mid-infrared gas spectroscopy

Isopropyl alcohol molecules, as a biomarker for anti-virus diagnosis, play a significant role in the area of environmental safety and healthcare relating volatile organic compounds. However, conventional gas molecule detection exhibits dramatic drawbacks, like the strict working conditions of ion mobility methodology and weak light-matter interaction of mid-infrared spectroscopy, yielding limited response of targeted molecules. We propose a synergistic methodology of artificial intelligence-enhanced ion mobility and mid-infrared spectroscopy, leveraging the complementary features from the sensing signal in different dimensions to reach superior accuracy for isopropyl alcohol identification. We pull in "cold" plasma discharge from triboelectric generator which improves the mid-infrared spectroscopic response of isopropyl alcohol with good regression prediction. Moreover, this synergistic methodology achieves ~99.08% accuracy for a precise gas concentration prediction, even with interferences of different carbon-based gases. The synergistic methodology of artificial intelligence-enhanced system creates mechanism of accurate gas sensing for mixture and regression prediction in healthcare.

Aero-manufacture of nanobulges for an in-place anticoronaviral on air filters

The interest in removing contagious viruses from indoor air using ventilation and filtration systems is increasing rapidly because people spend most of the day indoors. The development of an effective platform to regenerate the antiviral function of air filters during use and safe abrogation of used filters containing infectious viruses is a challenging task, because an on-demand safe-by-design manufacture system is essential for in-place antiviral coatings, but it has been rarely investigated. With these considerations, an electrically operable dispenser was prepared for decorating continuous ultrafine Fe-Zn, Fe-Ag, or Fe-Cu particles (<5 nm) onto SiO₂ nanobeads (ca. 130 nm) to form nanobulges (i.e., nanoroughness for engaging coronavirus spikes) in the aerosol state for 3 min direct deposition on the air filter surfaces. The resulting nanobulges were exposed to human coronaviruses (HCoV; surrogates of SARS-CoV-2) to assess antiviral function. The results were compared with similar-sized individual Zn, Ag, and Cu particles. The nanobulges exhibited comparable antiviral activity to Zn, Ag, and Cu particles while retaining biosafety in both in vitro and in vivo models because of the significantly smaller metallic fractions. This suggests that the bimetallic bulge structures generate reactive oxygen species and Fenton-mediated hydroxyl radicals for inactivating HCoV.

Estimating the restraint of SARS-CoV-2 spread using a conventional medical air-cleaning device: Based on an experiment in a typical dental clinical setting

OBJECTIVES

Droplets or aerosols loaded with SARS-CoV-2 can be released during breathing, coughing, or sneezing from COVID-19-infected persons. To investigate whether the most commonly applied air-cleaning device in dental clinics, the oral spray suction machine (OSSM), can provide protection to healthcare providers working in clinics against exposure to bioaerosols during dental treatment.

METHOD

In this study, we measured and characterized the temporal and spatial variations in bioaerosol concentration and deposition with and without the use of the OSSM using an experimental design in a dental clinic setting. Serratia marcescens (a bacterium) and ΦX174 phage (a virus) were used as tracers. The air sampling points were sampled using an Anderson six-stage sampler, and the surface-deposition sampling points were sampled using the natural sedimentation method. The Computational Fluid Dynamics method was adopted to simulate and visualize the effect of the OSSM on the concentration spatial distribution.

RESULTS

During dental treatment, the peak exposure concentration increased by up to 2-3 orders of magnitude (PFU/m³) for healthcare workers. Meanwhile, OSSM could lower the mean bioaerosol exposure concentration from 58.84 PFU/m³ to 4.10 PFU/m³ for a healthcare worker, thereby inhibiting droplet and airborne transmission. In terms of deposition, OSSM significantly reduced the bioaerosol surface concentration from 28.1 PFU/m³ to 2.5 PFU/m³ for a surface, effectively preventing fomite transmission.

CONCLUSION

The use of OSSM showed the potential to restraint the spread of bioaerosols in clinical settings. Our study demonstrates that OSSM use in dental clinics can reduce the exposure concentrations of bioaerosols for healthcare workers during dental treatment and is beneficial for minimizing the risk of infectious diseases such as COVID-19.

Airborne transmission of SARS-Cov2: What consequences for digestive endoscopy?

The SARS-Cov-2 disease disrupted essential hospital procedures, such as gastrointestinal (GI) endoscopy, due to concerns about air transmission and the risk of exposing health care workers. With the spread of the pandemic, air transmission was considered as the main source of SARS-Cov2 transmission. This raised the problem of transmission by aerosolization of viral particles in operating rooms as well as endoscopy units. This is in line with the known airborne transmission of many other respiratory viruses. The risk of SARS-Cov-2 transmission during GI endoscopy was initially reduced by controlled measures, involving personal protections (mask…), restricted access to endoscopy rooms, and detection of infected patients. Gastrointestinal endoscopy generates aerosols, which may carry viruses. In addition, the endoscopy system may facilitate the diffusion of virus particles or fomites considering the forced-air cooling system used to maintain a stable temperature inside the box (25°C). The volume of air that goes through the light source box is high (240-300 m³ for a 1-h period). Moreover, the light system contains an air pump to inflate air inside the gut lumen. In order to isolate people from hazard, different levels of protection and solutions to avoid airborne transmission of microorganisms should be proposed, such as the reinforcement of personal protective equipment, the change in the way people work and engineering control of the risk.

Smart Mask as Wearable for Post-Pandemic Personal Healthcare

A mask serves as a simple external barrier that protects humans from infectious particles from poor air conditions in the surrounding environment. As an important personal protective equipment (PPE) to protect our respiratory system, masks are able not only to filter pathogens and dust particles but also to sense, reflect or even respond to environmental conditions. This smartness is of particular interest among academia and industries due to its potential in disease detection, health monitoring and caring aspects. In this review, we provide an overlook of the current air filtration strategies used in masks, from structural designs to integrated functional modules that empower the mask's ability to sense and transfer physiological or environmental information to become smart. Specifically, we discussed recent developments in masks designed to detect macroscopic physiological signals from the wearer and mask-based disease diagnoses, such as COVID-19. Further, we propose the concept of next-generation smart masks and the requirements from material selection and function design perspectives that enable masks to interact and play crucial roles in health-caring wearables.

Evaluating Therapeutic Healthcare Environmental Criteria: Architectural Designers' Perspectives

This study presents architectural designers’ perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents’ personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.

Development of a high-speed bioaerosol elimination system for treatment of indoor air

We developed a high-speed filterless airflow multistage photocatalytic elbow aerosol removal system for the treatment of bioaerosols such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Human-generated bioaerosols that diffuse into indoor spaces are 1-10 μm in size, and their selective and rapid treatment can reduce the risk of SARS-CoV-2 infection. A high-speed airflow is necessary to treat large volumes of indoor air over a short period. The proposed system can be used to eliminate viruses in aerosols by forcibly depositing aerosols in a high-speed airflow onto a photocatalyst placed inside the system through inertial force and turbulent diffusion. Because the main component of the deposited bioaerosol is water, it evaporates after colliding with the photocatalyst, and the nonvolatile virus remains on the photocatalytic channel wall. The residual virus on the photocatalytic channel wall is mineralized via photocatalytic oxidation with UVA-LED irradiation in the channel. When this system was operated in a 4.5 m³ aerosol chamber, over 99.8% aerosols in the size range of 1-10 μm were removed within 15 min. The system continued delivering such performance with the continuous introduction of aerosols. Because this system exhibits excellent aerosol removal ability at a flow velocity of 5 m/s or higher, it is more suitable than other reactive air purification systems for treating large-volume spaces.

Ozone Generation from a Germicidal Ultraviolet Lamp with Peak Emission at 222 nm

Recent interest in commercial devices containing germicidal ultraviolet lamps with a peak emission wavelength at 222 nm (GUV222) has focused on mitigating virus transmission indoors while posing minimum risk to human tissue. However, 222 nm light can produce ozone (O3) in air. O3 is an undesirable component of indoor air because of health impacts from acute to chronic exposure and its ability to degrade indoor air quality through oxidation chemistry. In seven four-hour experiments we measured O3 produced from a single filtered GUV222 lamp in a 31.5 m3 stainless steel chamber. Using an emission model, we determined an O3 generation rate of 19.4 ppbv h-1 ± 0.3 ppbv h-1 (equivalent to 1.22 mg h-1 ± 0.02 mg h-1). We estimated the fluence rate from the lamp using two methods: (1) chemical actinometry using tetrachloroethylene (actinometry) and (2) geometric projection of the irradiance field from radial and angular distribution measurements of the GUV222 lamp fluence (irradiance). Using the estimated lamp fluence rates of 2.2 μW cm-2 (actinometry) and 3.2 μW cm-2 (irradiance) we predicted O3 production in our chamber within 20 % of the average measured mixing ratio. Future studies should evaluate the indoor air quality impacts of GUV222 technologies.

Experimental studies of particle removal and probability of COVID-19 infection in passenger railcars

A series of experiments in stationary and moving passenger railcars was conducted to measure the removal rates of particles in the size ranges of SARS-CoV-2 viral aerosols, and the air changes per hour provided by the existing and modified air handling systems. The effect of ventilation and air filtration systems on removal rates and their effects on estimated probability (i.e., risk) of infection was evaluated in a range of representative conditions: (1) for two different ratios of recirculated air (RA) to outdoor air (OA) (90:10 RA:OA and 67:33 RA:OA); (2) using minimum efficiency reporting value (MERV) filters with standard (MERV-8) and increased (MERV-13) filtration ratings; and (3) in the presence and absence of a portable high-efficiency particulate-air (HEPA) room air purifier system operated at clean air delivery rate (CADR) of 150 and 550 cfm. The higher-efficiency MERV-13 filters significantly increased particle removal rates on average by 3.8 to 8.4 hr-1 across particle sizes ranging from 0.3 to 10 µm (p < 0.01) compared to MERV-8 filters. The different RA:OA ratios and the use of a portable HEPA air purifier system had little effect on particle removal rates. MERV-13 filters reduced the estimated probability of infection by 42% compared to the MERV-8 filter. The use of a HEPA-air purifier with a MERV-13 filter causes a 50% reduction in the estimated probability of infection. Upgrading the efficiency of HVAC filters from MERV-8 to MERV-13 in public transit vehicles is the most effective exposure control method resulting in a clear reduction in the removal rates of aerosol particles and the estimated probability of infection.

SARS-CoV-2 airborne transmission: a review of risk factors and possible preventative measures using air purifiers

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting worldwide death toll have prompted worries regarding its transmission mechanisms. Direct, indirect, and droplet modes are the basic mechanisms of transmission. SARS-CoV-2 spreads by respiratory droplets (size range >10 μm size ranges), aerosols (5 μm), airborne, and particulate matter. The rapid transmission of SARS-CoV-2 is due to the involvement of tiny indoor air particulate matter (PM_2.5), which functions as a vector. SARS-CoV-2 is more contagious in the indoor environment where particulate matter floats for a longer period and greater distances. Extended residence time in the environment raises the risk of SARS-CoV-2 entering the lower respiratory tract, which may cause serious infection and possibly death. To decrease viral transmission in the indoor environment, it is essential to catch and kill the SARS-CoV-2 virus and maintain virus-free air, which will significantly reduce viral exposure concerns. Therefore, effective air filters with anti-viral, anti-bacterial, and anti-air-pollutant characteristics are gaining popularity recently. It is essential to develop cost-effective materials based on nanoparticles and metal-organic frameworks in order to lower the risk of airborne transmission in developing countries. A diverse range of materials play an important role in the manufacturing of effective air filters. We have summarized in this review article the basic concepts of the transmission routes of SARS-CoV-2 virus and precautionary measures using air purifiers with efficient materials-based air filters for the indoor environment. The performance of air-filter materials, challenges and alternative approaches, and future perspectives are also presented. We believe that air purifiers fabricated with highly efficient materials can control various air pollutants and prevent upcoming pandemics.

Recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 patients: A comparison of international guidelines

This mini-review provides the practice guideline recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 Patients. Remodeled "quasi-negative-pressure" isolation wards had been proved a feasible, inexpensive, safe, and effective measure to contain nosocomial outbreaks. We should first determine the minimum required ventilation volume of an isolation ward based on the severity of COVID-19 patients. Mechanical ventilation remains the mainstay for achieving the requirement, while the assistance of recirculation is also helpful. Beyond adequate ventilation volume, the "clean to less-clean" directional airflow remains the golden rule for the solution of indoor ventilation. The virus-laden exhaust should be treated with HEPA/UV device or be kept away from living organisms, buildings, and air inlets.

Binary Polyamide-Imide Fibrous Superelastic Aerogels for Fire-Retardant and High-Temperature Air Filtration

Fibrous air filtration materials are highly desirable for particle removal from high-temperature emission sources. However, the existing commercial filter materials suffer from either low filtration efficiency or high pressure drop, due to the difficulty in achieving small fiber diameter and high porosity simultaneously. Herein, we report a facile strategy to fabricate mechanical robust fibrous aerogels by using dual-scale sized PAI/BMI filaments and fibers, which are derived from wet spinning and electrospinning technologies, respectively. The creativity of this design is that PAI/BMI filaments can serve as the enhancing skeleton and PAI/BMI fibers can assemble into high-porosity interconnected networks, enabling the improvement of both mechanical property and air filtration performance. The resultant dual-scale sized PAI/PBMI fibrous aerogels show a compressive stress of 8.36 MPa, a high filtration efficiency of 90.78% (particle diameter of 2.5 μm); for particle diameter over 5 μm, they have 99.99% ultra-high filtration efficiency, a low pressure drop of 20 Pa, and high QF of 0.12 Pa^-1, as well as thermostable and fire-retardant properties (thermal decomposition temperature up to 342.7 °C). The successive fabrication of this material is of great significance for the govern of industrial dust.

Hospital indoor air quality and its relationships with building design, building operation, and occupant-related factors: A mini-review

Indoor air quality (IAQ) has recently gained substantial traction as the airborne transmission of infectious respiratory disease becomes an increasing public health concern. Hospital indoor environments are complex ecosystems and strategies to improve hospital IAQ require greater appreciation of its potentially modifiable determinants, evidence of which are currently limited. This mini-review updates and integrates findings of previous literature to outline the current scientific evidence on the relationship between hospital IAQ and building design, building operation, and occupant-related factors. Emerging evidence has linked aspects of building design (dimensional, ventilation, and building envelope designs, construction and finishing materials, furnishing), building operation (ventilation operation and maintenance, hygiene maintenance, access control for hospital users), and occupants' characteristics (occupant activities, medical activities, adaptive behavior) to hospital IAQ. Despite the growing pool of IAQ literature, some important areas within hospitals (outpatient departments) and several key IAQ elements (dimensional aspects, room configurations, building materials, ventilation practices, adaptive behavior) remain understudied. Ventilation for hospitals continues to be challenging, as elevated levels of carbon monoxide, bioaerosols, and chemical compounds persist in indoor air despite having mechanical ventilation systems in place. To curb this public health issue, policy makers should champion implementing hospital IAQ surveillance system for all areas of the hospital building, applying interdisciplinary knowledge during the hospital design, construction and operation phase, and training of hospital staff with regards to operation, maintenance, and building control manipulation. Multipronged strategies targeting these important determinants are believed to be a viable strategy for the future control and improvement of hospital IAQ.

A review of strategies and their effectiveness in reducing indoor airborne transmission and improving indoor air quality

Airborne transmission arises through the inhalation of aerosol droplets exhaled by an infected person and is now thought to be the primary transmission route of COVID-19. Thus, maintaining adequate indoor air quality levels is vital in mitigating the spread of the airborne virus. The cause-and-effect flow of various agents involved in airborne transmission of viruses has been investigated through a systematic literature review. It has been identified that the airborne virus can stay infectious in the air for hours, and pollutants such as particulate matter (PM10, PM2.5), Nitrogen dioxide (NO2), Sulphur dioxide (SO2), Carbon monoxide (CO), Ozone (O3), Carbon dioxide (CO2), and Total Volatile Organic Compounds (TVOCs) and other air pollutants can enhance the incidence, spread and mortality rates of viral disease. Also, environmental quality parameters such as humidity and temperature have shown considerable influence in virus transmission in indoor spaces. The measures adopted in different research studies that can curb airborne transmission of viruses for an improved Indoor Air Quality (IAQ) have been collated for their effectiveness and limitations. A diverse set of building strategies, components, and operation techniques from the recent literature pertaining to the ongoing spread of COVID-19 disease has been systematically presented to understand the current state of techniques and building systems that can minimize the viral spread in built spaces This comprehensive review will help architects, builders, realtors, and other organizations improve or design a resilient building system to deal with COVID-19 or any such pandemic in the future.

Clinical studies of detecting COVID-19 from exhaled breath with electronic nose

The COVID-19 pandemic has attracted numerous research studies because of its impact on society and the economy. The pandemic has led to progress in the development of diagnostic methods, utilizing the polymerase chain reaction (PCR) as the gold standard for coronavirus SARS-CoV-2 detection. Numerous tests can be used at home within 15 min or so but of with lower accuracy than PCR. There is still a need for point-of-care tests available for mass daily screening of large crowds in airports, schools, and stadiums. The same problem exists with fast and continuous monitoring of patients during their medical treatment. The rapid methods can use exhaled breath analysis which is non-invasive and delivers the result quite fast. Electronic nose can detect a cocktail of volatile organic com-pounds (VOCs) induced by virus infection and disturbed metabolism in the human body. In our exploratory studies, we present the results of COVID-19 detection in a local hospital by applying the developed electronic setup utilising commercial VOC gas sensors. We consider the technical problems noticed during the reported studies and affecting the detection results. We believe that our studies help to advance the proposed technique to limit the spread of COVID-19 and similar viral infections.

Nano-treatment of HEPA filters in COVID-19 isolation rooms in an academic medical center in Saudi Arabia

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has spread globally. The major reservoir for SARS-CoV-2 transmission remains controversial, with the airborne route remaining a possible transmission vehicle for carrying the virus within indoor environments. This study aimed to detect contamination of SARS-CoV-2 in high-efficiency particulate air (HEPA) filters within hospital isolation rooms of confirmed COVID-19 patients, exploring the role of nano-treatment of these filters with silver and titanium dioxide nanoparticles (Ag/TiO₂ NPs).

MATERIALS AND METHODS

We investigated the effectiveness of Ag-NPs/TiO₂-treated HEPA filters in the air of rooms occupied by patients with confirmed COVID-19 in a university teaching hospital in the Eastern province of Saudi Arabia during the first wave of the pandemic. Ag/TiO₂ NPs were designed and coated on HEPA filters to examine the filtration efficiency and antiviral ability in the presence of aerosolized virus particles. A total of 20 viral swab samples were collected from five patients' rooms before and after treatment with nanoparticle-prepared solutions into the sterile virus-transporting media. Samples were evaluated for SARS-CoV-2 with a reverse transcription-polymerase chain reaction.

RESULTS

Two samples taken from the HEPA filter air exhaust outlets prior to nano-treatment tested positive for SARS-CoV-2 RNA in the intensive care unit, which has stringent aerosolization control procedures, suggesting that small virus-laden droplets may be displaced by airflow. All air samples collected from the HEPA filters from the rooms of patients with confirmed COVID-19 following nano-treatment were negative.

CONCLUSION

We recommend further experimental exploration using a larger number of HEPA filters in areas with aerosol-generating procedures, along with viability studies on the HEPA filters to facilitate decision-making in high-risk facilities regarding the replacement, storage, and disposal of HEPA filters in wards occupied by cases diagnosed with a highly transmissible disease.

The Removal of Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Other Microbial Bioaerosols by Air Filtration on Coronavirus Disease 2019 (COVID-19) Surge Units

Airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in a coronavirus disease 19 (COVID-19) ward before activation of HEPA-air filtration but not during filter operation; SARS-CoV-2 was again detected following filter deactivation. Airborne SARS-CoV-2 was infrequently detected in a COVID-19 intensive care unit. Bioaerosol was also effectively filtered.

Reducing the Effectiveness of Ward Particulate Matter, Bacteria and Influenza Virus by Combining Two Complementary Air Purifiers

Air purifiers should pay much attention to hospital-associated infections, but the role of a single air purifier is limited. The goal of this study was to evaluate the effectiveness of the combined application of the nonequilibrium positive and negative oxygen ion purifier (PNOI) and the high-efficiency particulate air filter (HEPA) on a complex, polluted environment. Two of the better performing purifiers were selected before the study. The efficacy of their use alone and in combination for purification of cigarette particulate matter (PM), Staphylococcus albicans, and influenza virus were then evaluated under a simulated contaminated ward. PNAI and HEPA alone are deficient. However, when they were combined, they achieved 98.44%, 99.75%, and 100% 30 min purification rates for cigarette PM, S. albus, and influenza virus, respectively. The purification of pollution of various particle sizes and positions was optimized and reduced differentials, and a subset of airborne influenza viruses is inactivated. Furthermore, they were superior to ultraviolet disinfection for microbial purification in air. This work demonstrates the strong purification capability of the combined application of these two air purifiers for complex air pollution, which provides a new idea for infection control in medical institutions.

SARS-CoV-2 detection in hospital indoor environments, NW Iran

This study aimed to investigate the potential contamination of SARS-CoV-2 in indoor settled dust and surfaces of Amir Al-Muminin hospital in Maragheh, Iran. Samples were taken from surfaces and settled dust using a passive approach and particulate matter (PM) using an active approach from different hospital wards. SARS-CoV-2 was detected in 15% of settled dust samples (N = 4/26) and 10% of surface samples (3/30). SARS-CoV-2 has been detected in 13.8% and 9.1% of the dust samples collected at a distance of fewer than 1 m and more than 3 m from the patient bed, respectively. SARS-CoV-2 was found in 11% of surface samples from low-touch surfaces and 8% from high touch surfaces. The relationship between PM_2.5, PM₁₀, humidity, temperature, and positive samples of SARS-CoV-2 was investigated. A positive correlation was observed between relative humidity, PM_2.5, and positive SARS-CoV-2 samples. Principal component analysis (PCA) suggested positive correlation between positive SARS-CoV-2 samples, relative humidity, and PM_2.5. Risk assessment results indicated that the annual mean infection risk of SARS-CoV-2 for hospital staff with illness and death was 2.6 × 10^-2 and 7.7 × 10^-4 per person per year. Current findings will help reduce the permanence of viral particles in the COVID 19 tragedy and future similar pandemics e.g., novel influenza viruses.

The Effectiveness of the Anteroom (Vestibule) Area on Hospital Infection Control and Health Staff Safety: A Systematic Review

The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.

Risk Mitigation Strategy against SARS-CoV-2 Infection for Healthcare Provider at Harapan Bersama General Hospital, Singkawang, Indonesia

Working in one of the countries with highest number of COVID-19 cases, healthcare providers in Indonesia are at higher risk of contracting COVID-19. Therefore, risk mitigation strategy is crucial to protect the healthcare workers, especially in hospitals with limited resources such as Harapan Bersama General Hospital. This study aims to analyze risk mitigation strategy against SARS-CoV-2 infection for hospital workers in hospital with limited resource. Action Research study was performed through four stages. COVID-19 risk factor identification was carried out among healthcare workers who came in contact with COVID-19 patients between October 2020 and February 2021. Risk mitigation strategies were evaluated using Hospital Readiness Checklist for COVID-19. Implementation of risk mitigation strategies was done using hierarchy of control against infection transmission. Long period of close contact, inadequate PPE, and inadequate ventilation increased the risk of COVID-19 among healthcare workers.

Fabrication of air filters with advanced filtration performance for removal of viral aerosols and control the spread of COVID-19

COVID-19 is caused via the SARS-CoV-2 virus, a lipid-based enveloped virus with spike-like projections. At present, the global epidemic of COVID-19 continues and waves of SARS-CoV-2, the mutant Delta and Omicron variant which are associated with enhanced transmissibility and evasion to vaccine-induced immunity have increased hospitalization and mortality, the biggest challenge we face is whether we will be able to overcome this virus? On the other side, warm seasons and heat have increased the need for proper ventilation systems to trap contaminants containing the virus. Besides, heat and sweating accelerate the growth of microorganisms. For example, medical staff that is in the front line use masks for a long time, and their facial sweat causes microbes to grow on the mask. Nowadays, efficient air filters with anti-viral and antimicrobial properties have received a lot of attention, and are used to make ventilation systems or medical masks. A wide range of materials plays an important role in the production of efficient air filters. For example, metals, metal oxides, or antimicrobial metal species that have anti-viral and antimicrobial properties, including Ag, ZnO, TiO₂, CuO, and Cu played a role in this regard. Carbon nanomaterials such as carbon nanotubes, graphene, or derivatives have also shown their role well. In addition, natural materials such as biopolymers such as alginate, and herbal extracts are employed to prepare effective air filters. In this review, we summarized the utilization of diverse materials in the preparation of efficient air filters to apply in the preparation of medical masks and ventilation systems. In the first part, the employing metal and metal oxides is examined, and the second part summarizes the application of carbon materials for the fabrication of air filters. After examination of the performance of natural materials, challenges and progress visions are discussed.

Effectiveness of a novel, non-intrusive, continuous-use air decontamination technology to reduce microbial contamination in clinical settings: A multi-centric study

BACKGROUND

Despite rigorous disinfection and fumigation, healthcare associated infection (HAI) remains a significant concern in health care settings. We have developed a novel airborne-microbicidal technology "ZeBox" which clears over 99.999% of airborne microbial load under controlled lab conditions [1].

AIM

To evaluate the clinical performance of ZeBox in reducing airborne and surface microbial load.

METHODS

The study was conducted in single bed and multi bed ICU of two hospitals. Airborne and surface microbial loads were sampled pre- and post-deployment of ZeBox at pre-determined sites. Statistical significance of the reduction was determined using Mann-Whitney's U test.

RESULTS

ZeBox brought statistically significant reduction of both airborne and surface bacterial and fungal load. In both hospital ICUs, airborne and surface bacterial load decreased by 90% and 75% on average respectively, providing a low bioburden zone of ∼10-15 feet diameter around the unit. The reduced microbial level was maintained during ZeBox's operation over several weeks. Most clinical bacterial isolates recovered from one of the hospitals were antibiotic resistant, highlighting ZeBox's ability to eliminate antimicrobial-resistant bacteria among others.

CONCLUSIONS

ZeBox significantly reduces airborne and surface microbial burden in clinical settings. It thereby serves an unmet need for reducing the incidence of HAI.

The Science Behind Safe School Re-opening: Leveraging the Pillars of Infection Control to Support Safe Elementary and Secondary Education During the COVID-19 Pandemic

There are limited tools for adapting coronavirus disease 2019 (COVID-19) infection control plans to school settings. We present an infection prevention model for optimizing safe re-opening for elementary and secondary schools during the global COVID-19 pandemic and review the current evidence behind various infection prevention interventions in school settings. The model is adapted from the Centers for Disease Control and Prevention fundamental pillars for infection prevention and includes 4 categories of intervention: epidemiologic controls (town prevalence metrics, diagnostic testing, quarantine strategies), administrative controls (state vaccination policies, alternative school models, symptom screens, quarantine breaks), engineering/environmental controls (distancing, outdoor space, ventilation), and personal protective equipment (PPE)/hand hygiene (face coverings, hand sanitizing).

The adapted infection control pillars model utilizes implementation science–informed considerations to maximize pragmatism and adherence by leveraging evidence-based strategies. It highlights the necessity of redundant infection prevention interventions, acknowledges the importance of community buy-in to achieve real-world effectiveness, and addresses tactics to overcome implementation barriers. Recommendations are grounded in the Dynamic Sustainability Framework and include suggestions to maintain infection prevention effectiveness over time to ensure ongoing safety.

Demonstration of Hollow Fiber Membrane-Based Enclosed Space Air Remediation for Capture of an Aerosolized Synthetic SARS-CoV-2 Mimic and Pseudovirus Particles

Reduction of airborne viral particles in enclosed spaces is critical in controlling pandemics. Three different hollow fiber membrane (HFM) modules were investigated for viral aerosol separation in enclosed spaces. Pore structures were characterized by scanning electron microscopy, and air transport properties were measured. Particle removal efficiency was characterized using aerosols generated by a collision atomizer from a defined mixture of synthetic nanoparticles including SARS-CoV-2 mimics (protein-coated 100 nm polystyrene). HFM1 (polyvinylidene fluoride, ~50-1300 nm pores) demonstrated 96.5-100% efficiency for aerosols in the size range of 0.3-3 μm at a flow rate of 18.6 ± 0.3 SLPM (~1650 LMH), whereas HFM2 (polypropylene, ~40 nm pores) and HFM3 (hydrophilized polyether sulfone, ~140-750 nm pores) demonstrated 99.65-100% and 98.8-100% efficiency at flow rates of 19.7 ± 0.3 SLPM (~820 LMH) and 19.4 ± 0.2 SLPM (~4455 LMH), respectively. Additionally, lasting filtration with minimal fouling was demonstrated using ambient aerosols over 2 days. Finally, each module was evaluated with pseudovirus (vesicular stomatitis virus) aerosol, demonstrating 99.3% (HFM1), >99.8% (HFM2), and >99.8% (HFM3) reduction in active pseudovirus titer as a direct measure of viral particle removal. These results quantified the aerosol separation efficiency of HFMs and highlight the need for further development of this technology to aid the fight against airborne viruses and particulate matter concerning human health.

Photothermal inactivation of universal viral particles by localized surface plasmon resonance mediated heating filter membrane

This study introduces localized surface plasmon resonance (L-SPR) mediated heating filter membrane (HFM) for inactivating universal viral particles by using the photothermal effect of plasmonic metal nanoparticles (NPs). Plasmonic metal NPs were coated onto filter membrane via a conventional spray-coating method. The surface temperature of the HFM could be controlled to approximately 40-60 °C at room temperature, owing to the photothermal effect of the gold (Au) NPs coated on them, under irradiation by visible light-emitting diodes. Due to the photothermal effect of the HFMs, the virus titer of H1Npdm09 was reduced by > 99.9%, the full inactivation time being < 10 min, confirming the 50% tissue culture infective dose (TCID50) assay. Crystal violet staining showed that the infectious samples with photothermal inactivation lost their infectivity against Mardin-Darby Canine Kidney cells. Moreover, photothermal inactivation could also be applied to reduce the infectivity of SARS-CoV-2, showing reduction rate of 99%. We used quantitative reverse transcription polymerase chain reaction (qRT-PCR) techniques to confirm the existence of viral genes on the surface of the HFM. The results of the TCID50 assay, crystal violet staining method, and qRT-PCR showed that the effective and immediate reduction in viral infectivity possibly originated from the denaturation or deformation of membrane proteins and components. This study provides a new, simple, and effective method to inactivate viral infectivity, leading to its potential application in various fields of indoor air quality control and medical science.

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.

Characterization of the indoor near-field aerosol transmission in a model commercial office building☆

To evaluate the exposure potential of infectious aerosols containing SARS-CoV-2 in an office building setting, synthetic test aerosols were used to experimental study airborne particle transmission in a multizone small office test building at the Oak Ridge National Laboratory. Nine measurement points in a single zone using active aerosol impactors report that the coefficient of variation of the time-averaged concentration is <10% in two campaigns and < 15% in one campaign, so a nearly well-mixed condition was noted. To understand the effect of HVAC system operation on the dynamic concentration of aerosols in office spaces, an aerosol transport model that includes factors such as outside air (OA) ratio, filtration, return air fraction, transport loss in air ducts, and particle deposition has been developed. The results of model fitting demonstrate strong agreement with experimental data. Our investigation finds the return air fraction effects outweigh other mechanisms for the aerosol recirculation in this study, and the impact of air change rate (ACR) is more important than the small particle deposition for aerosol removal. Because ACR dominates the aerosol transport, the full model can be simplified to just one factor, the ACR, while maintaining an acceptable representation of the experimental data.

Control of airborne infectious disease in buildings: Evidence and research priorities

The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.

Design and in-vitro testing of a portable patient isolation chamber for bedside aerosol containment and filtration

The emergence of the SARS-CoV-2 pandemic has imposed a multitude of complications on healthcare facilities. Healthcare professionals had to develop creative solutions to deal with resource shortages and isolation spaces when caring for COVID positive patients. Among many other solutions, facilities have utilized engineering strategies to mitigate the spread of viral contamination within the hospital environment. One of the standard solutions has been the use of whole room negative pressurization (WRNP) to turn a general patient room into an infection isolation space. However, this has not always been easy due to many limitations, such as direct access to the outdoors and the availability of WRNP units. In operating rooms where a patient is likely to go through aerosol-generating procedures, other solutions must be considered because most operating rooms use positive pressure ventilation to maintain sterility. The research team has designed, built, and tested a Covering for Operations during Viral Emergency Response (COVER), a low-cost, portable isolation chamber that fits over a patient's torso on a hospital bed to contain and remove the pathogenic agents at the source (i.e., patient's mouth and nose). This study tests the performance of the COVER system under various design and performance scenarios using particle tracing techniques and compares its efficiency with WRNP units. The results show that COVER can dramatically reduce the concentration of particles within the room, while WRNP is only effective in preventing the room-induced particles from migrating to adjacent spaces.

Low-Voltage Bacterial and Viral Killing Using Laser-Induced Graphene-Coated Non-woven Air Filters

Laser-induced graphene (LIG) is uniquely positioned to advance applications in which electrically conductive carbon coatings are required. Recently, the antifouling, antiviral, and antibacterial properties of LIG have been proven in both air and water filtration applications. For example, an unsupported LIG based filter (pore size: ∼0.3 μm) demonstrated exceptional air filtration properties, while its joule heating effects successfully sterilized and removed unwanted biological components in air despite persisting challenges such as pressure drop, energy consumption, and lack of mechanical robustness. Here, we developed a polyimide (PI) non-woven supported LIG air filter with negligible pressure drop changes compared to the non-woven support material and showed that low electrical current density inactivates aerosolized bacteria. A current density of 4.5 mA/cm² did not cause significant joule heating, and 97.2% bacterial removal was obtained. The low-voltage antibacterial mechanism was elucidated using bacterial inhibition experiments on a titanium surface and on an LIG surface fabricated on dense PI films. Complete sterilization was obtained using current densities of ∼8 mA/cm² applied for 2 min or ∼ 6 mA/cm² for 10 min upon the dense PI-LIG surface. Lastly, >98% bacterial removal was observed using a low-resistance LIG-coated non-woven polyimide air filter at 5 V. However, only very low voltages (∼0.3 V) were needed to remove ∼99% Pseudomonas aeruginosa bacteria and 100% of T4 virus when the LIG-coated filters were hybridized with a stainless steel mesh. Our results show that low current density levels at very low voltages are sufficient for substantial bacterial and viral inactivation, and that these principles might be effectively used in a wide number of air filtration applications such as air conditioners or other ventilation systems, which might limit the spread of infectious particles in hospitals, homes, workplaces, and the transportation industry.

Transparent Polymeric Formulations Effective against SARS-CoV-2 Infection

The main route of the transmission of the SARS-CoV-2 virus is through airborne small aerosol particles containing viable virus as well as through droplets transmitted between people within close proximity. Transmission via contaminated surfaces has also been recognized as an important route for the spread of SARS-CoV-2 coronavirus. Among a variety of antimicrobial agents currently in use, polymers represent a class of biocides that have become increasingly important as an alternative to existing biocidal approaches. Two transparent polymeric compounds, containing silver and benzalkonium ions electrostatically bound to a polystyrene sulfonate backbone, were synthesized, through simple procedures, and evaluated for their antimicrobial properties against Gram-positive and Gram-negative bacteria and Candida albicans (ISO EN 1276) and for their antiviral activity toward 229E and SARS-CoV-2 coronaviruses (ISO UNI EN 14476:2019). The results showed that the two tested formulations are able to inhibit the growth of (1.5-5.5) × 1011 CFU of Gram-positive bacteria, Gram-negative bacteria, and of the fungal species Candida albicans. Both compounds were able to control the 229E and SARS-CoV-2 infection of a target cell in a time contact of 5 min, with a virucidal effect from 24 to 72 h postinfection, according to the European Medicines Agency (EMA) guidelines, where a product is considered virucidal upon achieving a reduction of 4 logarithms. This study observed a decrease of more than 5 logarithms, which implies that these formulations are likely ideal candidates for the realization of transparent surface coatings that are capable of maintaining remarkable antibacterial activity and SARS-CoV-2 antiviral properties over time.

Room HVAC Influences on the Removal of Airborne Particulate Matter: Implications for School Reopening during the COVID-19 Pandemic

(1) Background: Many schools and higher education settings have confronted the issue of reopening their facilities after the COVID-19 pandemic. In response, several airflow strategies spanning from adding portable air purifiers to major mechanical overhauls have been suggested to equip classrooms with what is necessary to provide a safe and reliable environment. Yet, there are many unknowns about specific contributions of the building system and its design and performance on indoor air quality (IAQ) improvements. (2) Methods: this study examined the combined effect of ventilation type, airflow rates, and filtration on IAQ in five different classrooms. Experiments were conducted by releasing inert surrogate particles into the classrooms and measuring the concentrations in various locations of the room. (3) Results: we showed that while the distribution of particles in the space is a complex function of space geometry and air distribution configurations, the average decay rate of contaminants is proportional to the number of air changes per hour in the room. (4) Conclusions: rooms with a central HVAC system responded quicker to an internal source of contamination than rooms with only fan coil units. Furthermore, increasing the ventilation rate without improved filtration is an inefficient use of energy.

Improved estimates of 222 nm far-UVC susceptibility for aerosolized human coronavirus via a validated high-fidelity coupled radiation-CFD code

Transmission of SARS-CoV-2 by aerosols has played a significant role in the rapid spread of COVID-19 across the globe. Indoor environments with inadequate ventilation pose a serious infection risk. Whilst vaccines suppress transmission, they are not 100% effective and the risk from variants and new viruses always remains. Consequently, many efforts have focused on ways to disinfect air. One such method involves use of minimally hazardous 222 nm far-UVC light. Whilst a small number of controlled experimental studies have been conducted, determining the efficacy of this approach is difficult because chamber or room geometry, and the air flow within them, influences both far-UVC illumination and aerosol dwell times. Fortunately, computational multiphysics modelling allows the inadequacy of dose-averaged assessment of viral inactivation to be overcome in these complex situations. This article presents the first validation of the WYVERN radiation-CFD code for far-UVC air-disinfection against survival fraction measurements, and the first measurement-informed modelling approach to estimating far-UVC susceptibility of viruses in air. As well as demonstrating the reliability of the code, at circa 70% higher, our findings indicate that aerosolized human coronaviruses are significantly more susceptible to far-UVC than previously thought.

Irrational Beliefs about COVID-19: A Scoping Review

Since the emergence of the recent Coronavirus Disease of 2019 (COVID-19) and its spread as a pandemic, there has been a parallel spread of false and misleading information, known as an infodemic. The COVID-19 infodemic has induced distrust in scientific communities, governments, institutions and the population, and a confidence crisis that has led to harmful health behaviours, also impacting on mental health. The aim of this study is to provide a scoping review of the scientific literature about COVID-19-related misinformation and conspiracy theories, focusing on the construction of a conceptual framework which is useful for the interpretation of the conspiracy theory phenomenon surrounding COVID-19, and its consequences. Particular socio-environmental conditions (i.e., low educational level, younger age), psychological processes and attitudes (such as low levels of epistemic trust, the avoidance of uncertainty, extraversion, collective narcissism, and a conspiracy-prone mindset), and contextual factors (e.g., high levels of self-perceived risk and anxiety) seem to underpin the adherence to beliefs that are not solely the domain of paranoids and extremists but a widespread phenomenon that has caused important health, social and political consequences.

Using Low-Cost Sensors to Assess Fine Particulate Matter Infiltration (PM2.5) during a Wildfire Smoke Episode at a Large Inpatient Healthcare Facility

Wildfire smoke exposure is associated with a range of acute health outcomes, which can be more severe in individuals with underlying health conditions. Currently, there is limited information on the susceptibility of healthcare facilities to smoke infiltration. As part of a larger study to address this gap, a rehabilitation facility in Vancouver, Canada was outfitted with one outdoor and seven indoor low-cost fine particulate matter (PM_2.5) sensors in Air Quality Eggs (EGG) during the summer of 2020. Raw measurements were calibrated using temperature, relative humidity, and dew point derived from the EGG data. The infiltration coefficient was quantified using a distributed lag model. Indoor concentrations during the smoke episode were elevated throughout the building, though non-uniformly. After censoring indoor-only peaks, the average infiltration coefficient (range) during typical days was 0.32 (0.22–0.39), compared with 0.37 (0.31–0.47) during the smoke episode, a 19% increase on average. Indoor PM_2.5 concentrations quickly reflected outdoor conditions during and after the smoke episode. It is unclear whether these results will be generalizable to other years due to COVID-related changes to building operations, but some of the safety protocols may offer valuable lessons for future wildfire seasons. For example, points of building entry and exit were reduced from eight to two during the pandemic, which likely helped to protect the building from wildfire smoke infiltration. Overall, these results demonstrate the utility of indoor low-cost sensors in understanding the impacts of extreme smoke events on facilities where highly susceptible individuals are present. Furthermore, they highlight the need to employ interventions that enhance indoor air quality in such facilities during smoke events.

Occupational Health and Safety Measures in Healthcare Settings during COVID-19: Strategies for Protecting Staff, Patients and Visitors

The COVID-19 (SARS-CoV-2) pandemic has profoundly impacted almost every aspect of healthcare systems worldwide, placing the health and safety of frontline healthcare workers at risk, and it still continues to remain an important public health challenge. Several hospitals have put in place strategies to manage space, staff, and supplies in order to continue to deliver optimum care to patients while at the same time protecting the health and safety of staff and patients. However, the emergence of the second and third waves of the virus with the influx of new cases continue to add an additional level of complexity to the already challenging situation of containing the spread and lowering the rate of transmission, thus pushing healthcare systems to the limit. In this narrative review paper, we describe various strategies including administrative controls, environmental controls, and use of personal protective equipment, implemented by occupational health and safety departments for the protection of healthcare workers, patients, and visitors from SARS-CoV-2 virus infection. The protection and safeguard of the health and safety of healthcare workers and patients through the implementation of effective infection control measures, adequate management of possible outbreaks and minimization of the risk of nosocomial transmission is an important and effective strategy of SARS-CoV-2 pandemic management in any healthcare facility. High quality patient care hinges on ensuring that the care providers are well protected and supported so they can provide the best quality of care to their patients.

Preliminary Study on Light-Activated Antimicrobial Agents as Photocatalytic Method for Protection of Surfaces with Increased Risk of Infections

Preventing and controlling the spread of multidrug-resistant (MDR) bacteria implicated in healthcare-associated infections is the greatest challenge of the health systems. In recent decades, research has shown the need for passive antibacterial protection of surfaces in order to reduce the microbial load and microbial biofilm development, frequently associated with transmission of infections. The aim of the present study is to analyze the efficiency of photocatalytic antimicrobial protection methods of surfaces using the new photocatalytic paint activated by light in the visible spectrum. The new composition is characterized by a wide range of analytical methods, such as UV-VIS spectroscopy, electron microscopy (SEM), X-ray powder diffraction (PXRD) or X-ray photoelectron spectroscopy (XPS). The photocatalytic activity in the UV-A was compared with the one in the visible light spectrum using an internal method developed on the basis of DIN 52980: 2008-10 standard and ISO 10678—2010 standard. Migration of metal ions in the composition was tested based on SR EN1186-3: 2003 standard. The new photocatalytic antimicrobial method uses a type of photocatalytic paint that is active in the visible spectral range and generates reactive oxygen species with inhibitory effect against all tested microbial strains.

SARS-CoV-2 and the role of airborne transmission: a systematic review

Background: Airborne transmission is the spread of an infectious agent caused by the dissemination of droplet nuclei (aerosols) that remain infectious when suspended in the air. We carried out a systematic review to identify, appraise and summarise the evidence from studies of the role of airborne transmission of SARS-CoV-2. Methods: We searched LitCovid, MedRxiv, Google Scholar and the WHO Covid-19 database from 1 February to 20 December 2020 and included studies on airborne transmission. Data were dual extracted and we assessed quality using a modified QUADAS 2 risk of bias tool. Results: We included 67 primary studies and 22 reviews on airborne SARS-CoV-2. Of the 67 primary studies, 53 (79%) reported data on RT-PCR from air samples, 12 (18%) report cycle threshold values and 18 (127%) copies per sample volume. All primary studies were observational and of low quality. The research often lacked standard methods, standard sampling sizes and reporting items. We found 36 descriptions of different air samplers deployed. Of the 42 studies conducted in-hospital that reported binary RT-PCR tests, 24 (57%) reported positive results for SARs-CoV-2 (142 positives out of 1,403 samples: average 10.1%, range 0% to 100%). There was no pattern between the type of hospital setting (ICU versus non-ICU) and RT-PCR positivity. Seventeen studies reported potential air transmission in the outdoors or in the community, of which seven performed RT-PCR sampling, and two studies reported weak positive RNA samples for 2 or more genes (5 of 125 samples positive: average 4.0%). Ten studies attempted viral culture with no serial passage. Conclusion:  SARS-CoV-2 RNA is detected intermittently in the air in various settings. Standardized guidelines for conducting and reporting research on airborne transmission are needed. The lack of recoverable viral culture samples of SARS-CoV-2 prevents firm conclusions from being drawn about airborne transmission.

Ethics Guidance for Environmental Scientists Engaged in Surveillance of Wastewater for SARS-CoV-2

The COVID-19 pandemic has given rise to rapid and widespread international pursuit of wastewater surveillance for genetic signals of SARS-CoV-2, the virus causing the pandemic. Environmental scientists and engineers familiar with the techniques required for this endeavor have responded. Many of the environmental scientists engaged in these investigations have not necessarily had experience with the ethical obligations associated with generating and handling human health data. The Canadian Water Network facilitated adoption of these surveillance methods by creating a national coalition, which included a public health advisory group that recognized a need for ethics guidance for the wastewater approach to public health surveillance. This Policy Analysis addresses that need and is based on a review of relevant ethics literature tightly focused on ethics applicable to public health surveillance. That review revealed that classical health bioethics governing clinical practice and general public health ethics guidance did not adequately address key issues in wastewater surveillance. The 2017 World Health Organization guidelines, directly based on a systematic literature review, specifically addressed ethical issues in public health surveillance. The application of relevant ethical guidance to wastewater surveillance is analyzed and summarized for environmental scientists.

Nurses' Perceptions of Oral Health Care Provision After the COVID-19 Lockdown

OBJECTIVE

This study aimed to investigate nurses' perceptions of oral health care provision to inpatients in Japanese hospitals and the infection control measures taken by them after the coronavirus disease 2019 (COVID-19) lockdown to promote collaborative oral health care.

METHOD

The participants were 1037 nurses working in inpatient wards at 4 hospitals in Fukuoka Prefecture, Japan. Data were collected through a questionnaire survey approximately 6 months after the first COVID-19 lockdown.

RESULTS

More than 90% of the 734 nurses participating in this study positively perceived the preventive effect of oral health care on aspiration pneumonia, ventilator-associated pneumonia, and viral infection. However, approximately half of them had negative perceptions about their knowledge and confidence regarding the control of COVID-19 with oral health care provision, and 84.7% expected to be provided with the necessary information by oral health professionals. Further, 537 nurses (73.2%) provided oral health care to their patients; 9 nurses (1.7%) responded that those patients who received oral health care decreased after the lockdown; and 12 (2.4%) responded that they could no longer collaborate with oral health professionals because of the lockdown. Additionally, 41.7% of them used neither protective glasses nor face shields even after the lockdown began.

CONCLUSIONS

This study showed that almost all the nurses perceived the benefcial effect of oral health care for the prevention of viral infection and pneumonia. However, some nurses perceived that their oral health care provision and collaborative oral health care were negatively affected. It also showed that most nurses' knowledge, confidence, and use of infection control measures were insufficient. The results indicate that oral health professionals should support nurses in providing oral health care by providing them with information on COVID-19 infection control measures to prevent infection transmission.

Portable HEPA Purifiers to Eliminate Airborne SARS-CoV-2: A Systematic Review

OBJECTIVE

Current epidemiologic predictions of COVID-19 suggest that SARS-CoV-2 mitigation strategies must be implemented long-term. In-office aerosol-generating procedures pose a risk to staff and patients while necessitating examination room shutdown to allow aerosol decontamination by indwelling ventilation. This review summarizes the current state of knowledge on portable high-efficiency particulate air (HEPA) purifiers' effectiveness in eliminating airborne SARS-CoV-2 from indoor environments.

DATA SOURCES

Medline, Embase, Cochrane Databases, and the World Health Organization's COVID-19 Global Literature on Coronavirus Disease.

REVIEW METHODS

Data sources were systematically searched for original English-language published studies indexed up to January 14, 2021 per the following search strategy: ("HEPA" OR "High-efficiency" OR "High-efficiency particulate air" OR "Efficiency particulate" OR "Purifier" OR "Filter" OR "Cleaner" OR "Filtration") AND ("COVID" OR "COVID-19" OR "SARS-CoV-2" OR "Coronavirus"). Additional relevant studies were identified by searching the reference lists of included articles.

RESULTS

Eleven published studies have evaluated the effectiveness of portable HEPA purifiers in eliminating airborne SARS-CoV-2 with relevantly sized surrogate particles. Ten studies evaluated aerosols and submicron particles similar in size to SARS-CoV-2 virions. In all studies, portable HEPA purifiers were able to significantly reduce airborne SARS-CoV-2-surrogate particles. The addition of portable HEPA purifiers augmented other decontamination strategies such as ventilation.

CONCLUSION

Experimental studies provide evidence for portable HEPA purifiers' potential to eliminate airborne SARS-CoV-2 and augment primary decontamination strategies such as ventilation. Based on filtration rates, additional air exchanges provided by portable HEPA purifiers may be calculated and room shutdown times potentially reduced after aerosol-generating procedures.