Adequacy of air change rate as the sole indicator of an air distribution system's effectiveness to mitigate airborne infectious disease transmission caused by a cough release in the room with overhead mixing ventilation: A case study

Viral infection transmission and indoor air quality: A systematic review

Respiratory disease transmission in indoor environments presents persistent challenges for health authorities, as exemplified by the recent COVID-19 pandemic. This underscores the urgent necessity to investigate the dynamics of viral infection transmission within indoor environments. This systematic review delves into the methodologies of respiratory infection transmission in indoor settings and explores how the quality of indoor air (IAQ) can be controlled to alleviate this risk while considering the imperative of sustainability. Among the 2722 articles reviewed, 178 were retained based on their focus on respiratory viral infection transmission and IAQ. Fifty eight articles delved into SARS-CoV-2 transmission, 21 papers evaluated IAQ in contexts of other pandemics, 53 papers assessed IAQ during the SARS-CoV-2 pandemic, and 46 papers examined control strategies to mitigate infectious transmission. Furthermore, of the 46 papers investigating control strategies, only nine considered energy consumption. These findings highlight clear gaps in current research, such as analyzing indoor air and surface samples for specific indoor environments, oversight of indoor and outdoor parameters (e.g., temperature, relative humidity (RH), and building orientation), neglect of occupancy schedules, and the absence of considerations for energy consumption while enhancing IAQ. This study distinctly identifies the indoor environmental conditions conducive to the thriving of each respiratory virus, offering IAQ trade-offs to mitigate the risk of dominant viruses at any given time. This study argues that future research should involve digital twins in conjunction with machine learning (ML) techniques. This approach aims to enhance IAQ by analyzing the transmission patterns of various respiratory viruses while considering energy consumption.

The air we breathe: Numerical investigation of ventilation strategies to mitigate airborne dispersion of MERS-CoV in inpatient wards

Ventilation strategies for infection control in hospitals has been predominantly directed towards isolation rooms and operating theatres, with relatively less emphasis on perceived low risk spaces, such as general wards. Typically, the ventilation systems in general wards are intended to optimize patient thermal comfort and energy conservation. The emission of pathogens from exhalation activity, such as sneezing, by an undiagnosed infectious patient admitted to general wards, is a significant concern for infection outbreaks. However, the ventilation guidelines for general wards with respect to infection control are vague. This research article presents a numerical study on the effect of varying air change rates (3 h-1, 6 h-1, 9 h-1, 13 h-1) and exhaust flow rates (10%, 50% of supply air quantity) on the concentration of airborne pathogens in a mechanically ventilated general inpatient ward. The findings imply that the breathing zone directly above the source patient has the highest level of pathogen exposure, followed by the breathing zones at the bedside and adjacent patients close to the source patient. The dispersion of pathogens throughout the ward over time is also apparent. However, a key difference while adopting a lower ACH (3 h-1) and a higher ACH (13 h-1) in this study was that the latter had a significantly lower number of suspended pathogens in the breathing zone than the former. Thus, this research suggests high ventilation rates for general wards, contrary to current ventilation standards. In addition, combining a higher air change rate (13 h-1) with a high exhaust flow rate (50% of supply air) through a local exhaust grille dramatically reduced suspended pathogens within the breathing zone, further mitigating the risk of pathogen exposure for ward users. Therefore, this study presents an effective ventilation technique to dilute and eliminate airborne infectious pathogens, minimizing their concentration and the risk of infection.

Airborne transmission of biological agents within the indoor built environment: a multidisciplinary review

The nature and airborne dispersion of the underestimated biological agents, monitoring, analysis and transmission among the human occupants into building environment is a major challenge of today. Those agents play a crucial role in ensuring comfortable, healthy and risk-free conditions into indoor working and leaving spaces. It is known that ventilation systems influence strongly the transmission of indoor air pollutants, with scarce information although to have been reported for biological agents until 2019. The biological agents' source release and the trajectory of airborne transmission are both important in terms of optimising the design of the heating, ventilation and air conditioning systems of the future. In addition, modelling via computational fluid dynamics (CFD) will become a more valuable tool in foreseeing risks and tackle hazards when pollutants and biological agents released into closed spaces. Promising results on the prediction of their dispersion routes and concentration levels, as well as the selection of the appropriate ventilation strategy, provide crucial information on risk minimisation of the airborne transmission among humans. Under this context, the present multidisciplinary review considers four interrelated aspects of the dispersion of biological agents in closed spaces, (a) the nature and airborne transmission route of the examined agents, (b) the biological origin and health effects of the major microbial pathogens on the human respiratory system, (c) the role of heating, ventilation and air-conditioning systems in the airborne transmission and (d) the associated computer modelling approaches. This adopted methodology allows the discussion of the existing findings, on-going research, identification of the main research gaps and future directions from a multidisciplinary point of view which will be helpful for substantial innovations in the field.

Modeling impacts of ventilation and filtration methods on energy use and airborne disease transmission in classrooms

Lowering the potential of airborne disease transmission in school buildings is especially important in the wake of the COVID-19 pandemic. The benefits of increased ventilation and filtration for reducing disease transmission compared to drawbacks of reduced thermal comfort and increased energy consumption and electricity demand are not well described. A comprehensive simulation of outdoor air ventilation rates and filtration methods was performed with a modified Wells-Riley equation and EnergyPlus building simulation to understand the trade-offs between infection probability and energy consumption for a simulated classroom in 13 cities across the US. A packaged heating, ventilation, and air conditioning unit was configured, sized, and simulated for each city to understand the impact of five ventilation flow rates and three filtration systems. Higher ventilation rates increased energy consumption and resulted in a high number of unmet heating and cooling hours in most cities (excluding Los Angeles and San Francisco). On average, across the 13 cities simulated, annual energy consumed by an improved filtration system was 31% lower than the energy consumed by 100% outdoor air ventilation. In addition, the infection probability was 29% lower with improved filtration. An economizer, which activates cooling based on an outdoor temperature setpoint, increased ventilation and reduced both energy consumption and infection probability. It was also concluded that ventilation and filtration measures better reduced absolute infection probability when the quanta generation rate for an infectious disease was higher. Dynamic outdoor airflow rate controls and filtration technologies that consider both health and energy consumption are an important area for further research.

Transmission characteristics of respiratory droplets aerosol in indoor environment: an experimental study

Transmission of droplets has been recognized as an important form of infection for the respiratory diseases. This study investigated the distribution of human respiratory droplets and assessed the effects of air change rate and generated velocity on droplet transmission using an active agent in an enclosed chamber (46 m³). Results revealed that the higher the air change rate was, the fewer viable droplets were detected in the range of <3.3 μm with ventilation; an increased air change rate can increase the attenuation of droplet aerosol. Without ventilation, the viable droplet size was observed to mainly distribute greater than 3.3 μm, which occupied up 87.5% of the total number. When the generated velocity was increased to 20 m/s, 29.38% of the viable droplets were detected at the position of 2.0 m. The findings are excepted to be useful for developing the technology of reducing droplet propagation and providing data verification for simulation research.

Ventilation strategies and design impacts on indoor airborne transmission: A review

The COVID-19 outbreak has brought the indoor airborne transmission issue to the forefront. Although ventilation systems provide clean air and dilute indoor contaminated air, there is strong evidence that airborne transmission is the main route for contamination spread. This review paper aims to critically investigate ventilation impacts on particle spread and identify efficient ventilation strategies in controlling aerosol distribution in clinical and non-clinical environments. This article also examines influential ventilation design features (i.e., exhaust location) affecting ventilation performance in preventing aerosols spread. This paper shortlisted published documents for a review based on identification (keywords), pre-processing, screening, and eligibility of these articles. The literature review emphasizes the importance of ventilation systems' design and demonstrates all strategies (i.e., mechanical ventilation) could efficiently remove particles if appropriately designed. The study highlights the need for occupant-based ventilation systems, such as personalized ventilation instead of central systems, to reduce cross-infections. The literature underlines critical impacts of design features like ventilation rates and the number and location of exhausts and suggests designing systems considering airborne transmission. This review underpins that a higher ventilation rate should not be regarded as a sole indicator for designing ventilation systems because it cannot guarantee reducing risks. Using filtration and decontamination devices based on building functionalities and particle sizes can also increase ventilation performance. This paper suggests future research on optimizing ventilation systems, particularly in high infection risk spaces such as multi-storey hotel quarantine facilities. This review contributes to adjusting ventilation facilities to control indoor aerosol transmission.

Systematic summary and analysis of Chinese HVAC guidelines coping with COVID-19

Heating, Ventilation, and Air-Conditioning (HVAC) system that is almost indispensable service system of modern buildings is recognized as the most important engineering control measure against pandemics. However, the effectiveness of HVAC systems has been questioned on their ability to control airborne transmission. After the outbreak of COVID-19, China has controlled the spread within a relatively short period. Considering the large population, high population density, busy transportation and the overall underdeveloped economy, China's control measures may have some implications to other countries, especially those with limited resources. This paper intends to provide a systematic summary of Chinese ventilation guidelines issued to cope with COVID-19 transmission. The following three aspects are the main focus of these guidelines: (1) general operation and management schemes of various types of HVAC systems, (2) operation and management schemes of HVAC system in typical types of buildings, and (3) design schemes of HVAC system of makeshift hospitals. In addition, some important differences in HVAC guidelines between China and other countries/institutions are identified and compared, and the possible reasons are discussed. Further discussions are made on the following topics, including the required fresh air supply, the extended operation time, the use of auxiliary equipment, the limited capacity of existing systems, and the use of personalized systems.

Impact of natural ventilation on exposure to SARS-CoV 2 in indoor/semi-indoor terraces using CO2 concentrations as a proxy

Nowadays, it is necessary a better airborne transmission understanding of respiratory diseases in shared indoor and semi-indoor environments with natural ventilation in order to adopt effective people's health protection measures. The aim of this work is to evaluate the relative exposure to SARS-CoV 2 in a set of virtual scenarios representing enclosed and semi-enclosed terraces under different outdoor meteorological conditions. For this purpose, indoor CO₂ concentration is used as a proxy for the risk assessment. Airflow and people exhaled CO₂ in different scenarios are simulated through Computational Fluid Dynamics (CFD) modelling with Unsteady Reynolds-Averaged Navier-Stokes (URANS) approach. Both spatial average concentrations and local concentrations are analyzed. In general, spatial average concentrations decrease as ventilation increases, however, depending on the people arrangement inside the terrace, spatial average concentrations and local concentrations can be very different. Therefore, for assessing the relative exposure to SARS-CoV 2 it is necessary to consider the indoor flow patterns between infectors and susceptibles. This research provides detailed information about CO₂ dispersion in enclosed/semi-enclosed scenarios, which can be very useful for reducing the transmission risk through better natural ventilation designs and improving the classic risk models since it allows to check their hypotheses in real-world scenarios. Although CFD ventilation studies in indoor/semi-indoor environments have been already addressed in the literature, this research is focused on restaurant terraces, scenarios scarcely investigated. Likewise, one of the novelties of this study is to take into account the outdoor meteorological conditions to appropriately simulate natural ventilation.

A review of different ventilation modes on thermal comfort, air quality and virus spread control

In the era of Corona Virus Disease 2019 (COVID-19), inappropriate indoor ventilation may turn out to be the culprit of microbial contamination in enclosed spaces and deteriorate the environment. To collaboratively improve the thermal comfort, air quality and virus spread control effect, it was essential to have an overall understanding of different ventilation modes. Hence, this study reviewed the latest scientific literature on indoor ventilation modes and manuals of various countries, identified characteristics of different ventilation modes and evaluated effects in different application occasions, wherefore to further propose their main limitations and solutions in the epidemic era. For thermal comfort, various non-uniform ventilation modes could decrease the floor-to-ceiling temperature difference, draft rate or PPD by 60%, 80% or 33% respectively, or increase the PMV by 45%. Unsteady ventilation modes (including intermittent ventilation and pulsating ventilation) could lower PPD values by 12%-37.8%. While for air quality and virus spread control, non-uniform ventilation modes could lower the mean age of air or contaminants concentration by 28.3%-47% or 15%-47% respectively, increase the air change efficiency, contaminant removal effectiveness or protection efficiency by 6.6%-10.4%, 22.6% or 14%-50% respectively. Unsteady ventilation mode (pulsating ventilation) could reduce the peak pollutant concentration and exposure time to undesirable concentrations by 31% and 48% respectively. Non-uniform modes and unsteady modes presented better performance in thermal comfort, air quality and virus spread control, whereas relevant performance evaluation indexes were still imperfect and the application scenarios were also limited.

Quantifying the effectiveness of desk dividers in reducing droplet and airborne virus transmission

The utilization of physical dividers has been recommended as a practical approach to reducing the droplet and aerosol transmissions of the COVID-19 virus (SARS-CoV-2). This study conducted a series of experiments using video recording with a high-speed camera, particle image velocimetry (PIV) technique, and concentration measurements. The effectiveness of Perspex desk dividers impeding the transient transmission during coughing in five representative layouts was investigated. The results showed that the divider effectively protected the exposed person from an infector's cough seated in a face-to-face arrangement at a distance of 1.5 m. The aerosol concentration at the breathing zone was reduced by 99% compared to the layout without dividers. However, the reflection of aerosols from the dividers increased the exposure risk to the person seated beside the infector. Such risk was substantially reduced if the dividers were placed parallel between the infector and exposed person seated side-by-side. When the exposed person was staggered (face-to-face but displaced sideways laterally) to the infector with a 0.55-m lateral distance, the dividers reduced the potential exposure at the breathing zone by 60%. Considering the effectiveness in exposure reduction, the staggered configuration of desk dividers between the infector and exposed persons offers the best reduction to exposure.

Measured influence of overhead HVAC on exposure to airborne contaminants from simulated speaking in a meeting and a classroom

Tracer gas experiments were conducted in a 158 m³ room with overhead supply diffusers to study dispersion of contaminants from simulated speaking in physically distanced meeting and classroom configurations. The room was contained within a 237 m³ cell with open plenum return to the HVAC system. Heated manikins at desks and a researcher operating the tracer release apparatus presented 8-9 thermal plumes. Experiments were conducted under conditions of no forced air and neutral, cooled, or heated air supplied at 980-1100 cmh, and with/out 20% outdoor air. CO₂ was released at the head of one manikin in each experiment to simulate small (<5 µm diameter) respiratory aerosols. The metric of exposure relative to perfectly mixed (ERM) is introduced to quantify impacts, based on measurements at manikin heads and at three heights in the center and corners of the room. Chilled or neutral supply air provided good mixing with ERMs close to one. Thermal stratification during heating produced higher ERMs at most manikins: 25% were ≥2.5 and the highest were >5× perfectly mixed conditions. Operation of two within-zone air cleaners together moving ≥400 cmh vertically in the room provided enough mixing to mitigate elevated exposure variations.

SARS-CoV-2 Aerosol Transmission Indoors: A Closer Look at Viral Load, Infectivity, the Effectiveness of Preventive Measures and a Simple Approach for Practical Recommendations

There is uncertainty about the viral loads of infectious individuals required to transmit COVID-19 via aerosol. In addition, there is a lack of both quantification of the influencing parameters on airborne transmission and simple-to-use models for assessing the risk of infection in practice, which furthermore quantify the influence of non-medical preventive measures. In this study, a dose-response model was adopted to analyze 25 documented outbreaks at infection rates of 4-100%. We show that infection was only possible if the viral load was higher than 108 viral copies/mL. Based on mathematical simplifications of our approach to predict the probable situational attack rate (PARs) of a group of persons in a room, and valid assumptions, we provide simplified equations to calculate, among others, the maximum possible number of persons and the person-related virus-free air supply flow necessary to keep the number of newly infected persons to less than one. A comparison of different preventive measures revealed that testing contributes the most to the joint protective effect, besides wearing masks and increasing ventilation. In addition, we conclude that absolute volume flow rate or person-related volume flow rate are more intuitive parameters for evaluating ventilation for infection prevention than air exchange rate.

Expert elicitation on the relative importance of possible SARS-CoV-2 transmission routes and the effectiveness of mitigations

OBJECTIVES

To help people make decisions about the most effective mitigation measures against SARS-CoV-2 transmission in different scenarios, the likelihoods of transmission by different routes need to be quantified to some degree (however uncertain). These likelihoods need to be communicated in an appropriate way to illustrate the relative importance of different routes in different scenarios, the likely effectiveness of different mitigation measures along those routes, and the level of uncertainty in those estimates. In this study, a pragmatic expert elicitation was undertaken to supply the underlying quantitative values to produce such a communication tool.

PARTICIPANTS

Twenty-seven individual experts from five countries and many scientific disciplines provided estimates.

OUTCOME MEASURES

Estimates of transmission parameters, assessments of the quality of the evidence, references to relevant literature, rationales for their estimates and sources of uncertainty.

RESULTS AND CONCLUSION

The participants' responses showed that there is still considerable disagreement among experts about the relative importance of different transmission pathways and the effectiveness of different mitigation measures due to a lack of empirical evidence. Despite these disagreements, when pooled, the majority views on each parameter formed an internally consistent set of estimates (for example, that transmission was more likely indoors than outdoors, and at closer range), which formed the basis of a visualisation to help individuals and organisations understand the factors that influence transmission and the potential benefits of different mitigation measures.

A fresh (air) look at ventilation for COVID-19: Estimating the global energy savings potential of coupling natural ventilation with novel radiant cooling strategies

Radiant cooling-assisted natural ventilation is an innovative technical approach that combines new radiant cooling technology with natural ventilation to increase fresh air delivery into buildings year-round with minimal energy cost and improvment of air quality. Currently, the standard paradigm for HVAC (heating, ventilation and air conditioning) is based on central air systems that tie the delivery of heating and cooling to the delivery of fresh air. To prevent heat loss, the delivery of fresh air must be tightly controlled and is often limited through recirculation of already heated or cooled air. Buildings are designed with airtight envelopes, which do not allow for natural ventilation, and depend on energy-intensive central-air systems. As closed environments, buildings have become sites of rapid COVID-19 transmission. In this research, we demonstrate the energy cost of increasing outdoor air supply with standard systems per COVID-19 recommendations and introduce an alternative HVAC paradigm that maximizes the decoupling of ventilation and thermal control. We first consider a novel analysis of the energy costs of increasing the amount of conditioned fresh air using standard HVAC systems to address COVID-19 concerns. We then present an alternative that includes a novel membrane-assisted radiant system we have studied for cooling in humid climates, in place of an air conditioning system. The proposed system can work in conjunction with natural ventilation and thus decreases the risk of indoor spread of infectious diseases and significantly lowers energy consumption in buildings. Our results for modeling HVAC energy in different climates show that increasing outdoor air in standard systems can double cooling costs, while increasing natural ventilation with radiant systems can halve costs. More specifically, it is possible to add up to 100 days' worth of natural ventilation while saving energy when coupling natural ventilation and radiant systems. This combination decreases energy costs by 10-45% in 60 major cities globally, while increasing fresh air intake.

Droplet fate, efficacy of face mask, and transmission of virus-laden droplets inside a conference room

The second and third waves of coronavirus disease-2019 (COVID-19) pandemic have hit the world. Even after more than a year, the economy is yet to return to a semblance of normality. The conference/meeting room is one of the critical sections of offices that might be difficult not to use. This study analyzes the distribution of the virus-laden droplets expelled by coughing inside a conference room, the effect of ventilation rates, and their positioning. The efficacy of masks is studied to get quantitative information regarding the residence time of the droplets. The effects of evaporation, turbulent dispersion, and external forces have been considered for calculating the droplets' trajectories. We have analyzed six cases, of which two are with masks. Change in the ventilation rate from four air changes per hour (ACH) to eight resulted in a 9 % increment in the number of droplets entrained in the outlet vent, while their average residence time was reduced by ∼   8   s . The shift in the vents' location has significantly altered droplets' distribution inside a conference room. It results in ∼   1.5 % of the injected droplets reaching persons sitting across the table, and a similar indoor environment is not recommended. Wearing a mask in the case of eight ACH has presented the best scenario out of the six cases, with a 6.5 % improvement in the number of droplets entrained in the outlet vent and a 9   s decrease in their average residence time compared to the case without a mask. No droplets have reached persons sitting across the table when the infected person is wearing the mask, which follows that a social distancing of 6   ft with a mask is adequate in indoor environments.

Performance characteristics of a fan filter unit (FFU) in mitigating particulate matter levels in a naturally ventilated classroom during haze conditions

The performance of a low-cost fan filter unit (FFU) in mitigating hazardous particulate matter (PM) levels in a naturally ventilated school classroom is presented. The FFU can be considered as a simplified mechanical ventilation and air-conditioning system without heating and cooling functions. The FFU improves indoor air quality through introduction of cleaned outdoor air to flush out internally generated heat and moisture and reducing infiltration by maintaining indoor pressurization. Indoor particle number concentrations were reduced between 85% and 95%. The particle removal performance (PRF_FFU ) of the FFU is determined and incorporated into the augmented façade penetration factor (P_aug ). A case-specific recursive dynamic mass balance model is used to characterize the infiltration factor (F_INF ), deposition rate (K), and the penetration efficiency (P_aug ) from continuously monitored indoor and outdoor mass concentration levels. Computed "P_aug " (0.07, 0.09, and 0.13) and "F_INF " (0.06, 0.08, and 0.11), respectively, for PM10, PM2.5, and PM1 suggest that exposure to PM was significantly reduced indoors. The effectiveness of the FFU for reduced "F_INF " and "P_aug " may be attributed to its superior filtration, dilution, and exfiltration mechanisms. In comparison with alternative PM mitigation solutions, the FFU is effective, affordable, and sustainable.

Numerical Study of Three Ventilation Strategies in a prefabricated COVID-19 inpatient ward

Prefabricated inpatient wards have been proven to be an efficient alternative to quickly extend the caring capacity for patients. In this study, three typical ventilation strategies were studied using computational fluid dynamics in a prefabricated Coronavirus disease 2019 double-patient ward. Pollutants are the respiratory droplets and aerosols injected from two manikins. They are modelled as particles with different diameters (3 μm, 6 μm, 12 μm, 20 μm, 45 μm and 175 μm) by the Eulerian-Lagrangian model. Three ventilation strategies with an identical air change rate of 12.3 h^-1 but different layouts of inlets and outlets are implemented. The flow field, flow structures and particle trajectories have been analysed and compared among the three ventilation strategies. The fate of particles is analysed and compared quantitatively. It is found that small particles (<20 μm) can move along with the main flow streams. Most of them are removed by ventilation to the outlet(s). Large particles (>45 μm) cannot move with the flow streams over a long path. Most of them deposit on solid surfaces in different regions of the ward in each ventilation strategy. Health workers should pay close attention to these polluted areas. Targeted cleaning of the polluted areas is necessary in a prefabricated inpatient ward. To promote the removal of some large particles (e.g., 45 μm) by the outlet(s), the outlet(s) should be installed inside the landing area of large particles and close to the polluted source(s).

Ventilation mode performance against airborne respiratory infections in small office spaces: limits and rational improvements for Covid-19

The Coronavirus disease (Covid-19), caused by the SARS-CoV-2 virus, has produced significant social and economic disruptions in different countries. Current evidence suggests a strong correlation between the infection and the cohabitation of indoor spaces. International organizations and experts consider that the airborne transmission through aerosols can occur in specific conditions and that inadequate ventilation increases the risk of infection. As a result, the increase in ventilation rates and air filtration efficiencies are recommended for public buildings in the context of Covid-19, with significant impacts on energy consumption, and a paradigm shift in the design of ventilation systems is necessary for this new context. Therefore, this study has assessed the comparative performance of the displacement ventilation and the mixed ventilation mode on reducing the risk of long-range airborne infection for the Covid-19 in a small office application. A coupled multizone-CFD (Computational Fluid Dynamics) software developed by the National Institute of Standards and Technology was used in this study to assess the relative performance of several design solutions related to different ventilation modes, filter efficiencies, and outdoor air flow rates. The results demonstrate that the displacement ventilation technique produces a better overall performance in reducing the SARS-CoV-2 airborne infection risk than the conventional mixed ventilation for all the studied cases.

A numerical study of ventilation strategies for infection risk mitigation in general inpatient wards

Aerial dispersion of human exhaled microbial contaminants and subsequent contamination of surfaces is a potential route for infection transmission in hospitals. Most general hospital wards have ventilation systems that drive air and thus contaminants from the patient areas towards the corridors. This study investigates the transport mechanism and deposition patterns of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) within a typical six bedded general inpatient ward cubicle through numerical simulation. It demonstrates that both air change and exhaust airflow rates have significant effects on not only the airflow but also the particle distribution within a mechanically ventilated space. Moreover, the location of an infected patient within the ward cubicle is crucial in determining the extent of infection risk to other ward occupants. Hence, it is recommended to provide exhaust grilles in close proximity to a patient, preferably above each patient's bed. To achieve infection prevention and control, high exhaust airflow rate is also suggested. Regardless of the ventilation design, all patients and any surfaces within a ward cubicle should be regularly and thoroughly cleaned and disinfected to remove microbial contamination. The outcome of this study can serve as a source of reference for hospital management to better ventilation design strategies for mitigating the risk of infection.

Influence of pulmonary ventilation rate and breathing cycle period on the risk of cross-infection

This study examined the characteristics of the exhaled airflow pattern and breathing cycle period of human subjects and evaluated the influence of pulmonary ventilation rate and breathing cycle period on the risk of cross-infection. Measurements with five human subjects and a breathing thermal manikin were performed, and the peak exhaled airflow velocity from the mouth and the breathing cycle period were measured. Experiments on cross-infection between two breathing thermal manikins were then conducted in a full-scale test room, in which the pulmonary ventilation rate and breathing cycle period were varied systematically. Both peak flow velocity and breathing cycle length varied considerably between different subjects. The breathing cycle period in a standing posture was 18.9% lower than in a sitting posture. The influence of pulmonary ventilation rate and breathing cycle period extended up to a separation distance of 1.0 m between the two manikins. Increasing the pulmonary ventilation rate of the exposed person greatly increased the risk of cross-infection. Decreasing the breathing cycle period from the widely used "6 second" value led to a considerable increase in the risk of cross-infection. Standing posture resulted in a higher risk of cross-infection than sitting posture.

Airborne transmission between room occupants during short-term events: Measurement and evaluation

This study experimentally examines and compares the dynamics and short-term events of airborne cross-infection in a full-scale room ventilated by stratum, mixing and displacement air distributions. Two breathing thermal manikins were employed to simulate a standing infected person and a standing exposed person. Four influential factors were examined, including separation distance between manikins, air change per hour, positioning of the two manikinsand air distribution. Tracer gas technique was used to simulate the exhaled droplet nuclei from the infected person and fast tracer gas concentration meters (FCM41) were used to monitor the concentrations. Real-time and average exposure indices were proposed to evaluate the dynamics of airborne exposure. The time-averaged exposure index depends on the duration of exposure time and can be considerably different during short-term events and under steady-state conditions. The exposure risk during short-term events may not always decrease with increasing separation distance. It changes over time and may not always increase with time. These findings imply that the control measures formulated on the basis of steady-state conditions are not necessarily appropriate for short-term events.

Effects of indoor environmental parameters related to building heating, ventilation, and air conditioning systems on patients' medical outcomes: A review of scientific research on hospital buildings

The indoor environment of a mechanically ventilated hospital building controls infection rates as well as influences patients' healing processes and overall medical outcomes. This review covers the scientific research that has assessed patients' medical outcomes concerning at least one indoor environmental parameter related to building heating, ventilation, and air conditioning (HVAC) systems, such as indoor air temperature, relative humidity, and indoor air ventilation parameters. Research related to the naturally ventilated hospital buildings was outside the scope of this review article. After 1998, a total of 899 papers were identified that fit the inclusion criteria of this study. Of these, 176 papers have been included in this review to understand the relationship between the health outcomes of a patient and the indoor environment of a mechanically ventilated hospital building. The purpose of this literature review was to summarize how indoor environmental parameters related to mechanical ventilation systems of a hospital building are impacting patients. This review suggests that there is a need for future interdisciplinary collaborative research to quantify the optimum range for HVAC parameters considering airborne exposures and patients' positive medical outcomes.

Assessment of displacement ventilation systems in airborne infection risk in hospital rooms

Efficient ventilation in hospital airborne isolation rooms is important vis-à-vis decreasing the risk of cross infection and reducing energy consumption. This paper analyses the suitability of using a displacement ventilation strategy in airborne infection isolation rooms, focusing on health care worker exposure to pathogens exhaled by infected patients. The analysis is mainly based on numerical simulation results obtained with the support of a 3-D transient numerical model validated using experimental data. A thermal breathing manikin lying on a bed represents the source patient and another thermal breathing manikin represents the exposed individual standing beside the bed and facing the patient. A radiant wall represents an external wall exposed to solar radiation. The air change efficiency index and contaminant removal effectiveness indices and inhalation by the health care worker of contaminants exhaled by the patient are considered in a typical airborne infection isolation room set up with three air renewal rates (6 h-1, 9 h-1 and 12 h-1), two exhaust opening positions and two health care worker positions. Results show that the radiant wall significantly affects the air flow pattern and contaminant dispersion. The lockup phenomenon occurs at the inhalation height of the standing manikin. Displacement ventilation renews the air of the airborne isolation room and eliminates the exhaled pollutants efficiently, but is at a disadvantage compared to other ventilation strategies when the risk of exposure is taken into account.

Airborne spread of expiratory droplet nuclei between the occupants of indoor environments: A review

This article reviews past studies of airborne transmission between occupants in indoor environments, focusing on the spread of expiratory droplet nuclei from mouth/nose to mouth/nose for non-specific diseases. Special attention is paid to summarizing what is known about the influential factors, the inappropriate simplifications of the thermofluid boundary conditions of thermal manikins, the challenges facing the available experimental techniques, and the limitations of available evaluation methods. Secondary issues are highlighted, and some new ways to improve our understanding of airborne transmission indoors are provided. The characteristics of airborne spread of expiratory droplet nuclei between occupants, which are influenced correlatively by both environmental and personal factors, were widely revealed under steady-state conditions. Owing to the different boundary conditions used, some inconsistent findings on specific influential factors have been published. The available instrumentation was too slow to provide accurate concentration profiles for time-dependent evaluations of events with obvious time characteristics, while computational fluid dynamics (CFD) studies were mainly performed in the framework of inherently steady Reynolds-averaged Navier-Stokes modeling. Future research needs in 3 areas are identified: the importance of the direction of indoor airflow patterns, the dynamics of airborne transmission, and the application of CFD simulations.

Advanced air distribution: improving health and comfort while reducing energy use

Indoor environment affects the health, comfort, and performance of building occupants. The energy used for heating, cooling, ventilating, and air conditioning of buildings is substantial. Ventilation based on total volume air distribution in spaces is not always an efficient way to provide high-quality indoor environments at the same time as low-energy consumption. Advanced air distribution, designed to supply clean air where, when, and as much as needed, makes it possible to efficiently achieve thermal comfort, control exposure to contaminants, provide high-quality air for breathing and minimizing the risk of airborne cross-infection while reducing energy use. This study justifies the need for improving the present air distribution design in occupied spaces, and in general the need for a paradigm shift from the design of collective environments to the design of individually controlled environments. The focus is on advanced air distribution in spaces, its guiding principles and its advantages and disadvantages. Examples of advanced air distribution solutions in spaces for different use, such as offices, hospital rooms, vehicle compartments, are presented. The potential of advanced air distribution, and individually controlled macro-environment in general, for achieving shared values, that is, improved health, comfort, and performance, energy saving, reduction of healthcare costs and improved well-being is demonstrated. Performance criteria are defined and further research in the field is outlined.

Effectiveness of a personalized ventilation system in reducing personal exposure against directly released simulated cough droplets

The inhalation intake fraction was used as an indicator to compare effects of desktop personalized ventilation and mixing ventilation on personal exposure to directly released simulated cough droplets. A cough machine was used to simulate cough release from the front, back, and side of a thermal manikin at distances between 1 and 4 m. Cough droplet concentration was measured with an aerosol spectrometer in the breathing zone of a thermal manikin. Particle image velocimetry was used to characterize the velocity field in the breathing zone. Desktop personalized ventilation substantially reduced the inhalation intake fraction compared to mixing ventilation for all investigated distances and orientations of the cough release. The results point out that the orientation between the cough source and the breathing zone of the exposed occupant is an important factor that substantially influences exposure. Exposure to cough droplets was reduced with increasing distance between cough source and exposed occupant.

PRACTICAL IMPLICATIONS

The results from this study show that an advanced air distribution system such as personalized ventilation reduces exposure to cough-released droplets better than commonly applied overhead mixing ventilation. This work can inform HVAC engineers about different aspects of air distribution systems’ performance and can serve as an aid in making critical design decisions.

Human convection flow in spaces with and without ventilation: personal exposure to floor-released particles and cough-released droplets

The effects of the human convective boundary layer (CBL), room airflow patterns, and their velocities on personal exposure are examined. Two pollutants are studied which simulate particles released from the feet and generated at distances of 2 and 3 m by a human cough. A thermal manikin whose body shape, size, and surface temperatures correspond to those of an average person is used to simulate the CBL. The findings of the study reveal that for accurate predictions of personal exposure, the CBL needs to be considered, as it can transport the pollution around the human body. The best way to control and reduce personal exposure when the pollution originates at the feet is to employ transverse flow from in front and from the side, relative to the exposed occupant. The flow from the above opposing the CBL create the most unfavorable velocity field that can increase personal exposure by 85%, which demonstrates a nonlinear dependence between the supplied flow rate and personal exposure. In the current ventilation design, it is commonly accepted that an increased amount of air supplied to the rooms reduces the exposure. The results of this study suggest that the understanding of air patterns should be prioritized.

PRACTICAL IMPLICATIONS

A human convective boundary layer plays an important role in pollution transport around the human body. It interacts with the surrounding airflows which modifies air movement around the human body and personal exposure. Understanding the influence of this interaction on the pollution spread around the human can be used to control and reduce personal exposure and improve HVAC design.

Human convective boundary layer and its interaction with room ventilation flow

This study investigates the interaction between the human convective boundary layer (CBL) and uniform airflow with different velocity and from different directions. Human body is resembled by a thermal manikin with complex body shape and surface temperature distribution as the skin temperature of an average person. Particle image velocimetry (PIV) and pseudocolor visualization (PCV) are applied to identify the flow around the manikin's body. The findings show that the direction and magnitude of the surrounding airflows considerably influence the airflow distribution around the human body. Downward flow with velocity of 0.175 m/s does not influence the convective flow in the breathing zone, while flow at 0.30 m/s collides with the CBL at the nose level reducing the peak velocity from 0.185 to 0.10 m/s. Transverse horizontal flow disturbs the CBL at the breathing zone even at 0.175 m/s. A sitting manikin exposed to airflow from below with velocity of 0.30 and 0.425 m/s assisting the CBL reduces the peak velocity in the breathing zone and changes the flow pattern around the body, compared to the assisting flow of 0.175 m/s or quiescent conditions. In this case, the airflow interaction is strongly affected by the presence of the chair.