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Air Quality in Dental Care Facilities: Update to Current Management and Control Strategies Implementing New Technologies: A Comprehensive Review. Vaccines (Basel) 2022; 10:vaccines10060847. [PMID: 35746455 PMCID: PMC9227829 DOI: 10.3390/vaccines10060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
The quality of indoor air in healthcare facilities, with an emphasis on dental offices, attracted the attention of the scientific community in the late 1960s. Since then, it has become evident that the indoor air quality is critical in modern dental care facilities for limiting the spread of airborne infections, including vaccine-preventable diseases, and a key component of safety for healthcare personnel and patients. In the past decades, the role of indoor air quality has also been recognized in non-healthcare facilities, given the increasing time spent indoors by humans. During the provision of dental care services, mainly in the field of restorative dentistry, high-speed dental handpieces emitting air and water are used, producing large quantities of aerosol and hovering inside the operations area. In modern dental offices, new devices emitting air/powder for cavities improvement and cleaning as well as for periodontal prophylactic cleaning and aesthetics are used. In addition, a new therapeutic protocol for the removal of bacterial biofilm, targeting treatment for peri-implant diseases and conditions using air-abrasive decontamination technology, has been introduced in daily dental practice. The aim of this non-systemic review is to present the current state of knowledge on the nature and dynamics of air splatters and to provide an update to management and control strategies in dental care facilities, focusing on air purification and ultraviolet devices proposed and used. The findings arising from the limited number of related published articles documenting the reduction in levels of particular matter 2.5 (PM2.5), PM10 and volatile organic compounds, allow us to conclude that the continuous operation of air purifiers during and after treatment, contributes considerably to the improvement of the indoor air quality in dental care facilities. Moreover, the utilization of air purifiers is highly recommended in dental practice to mitigate spread of infections, including vaccine-preventable diseases. Frequent cleaning and maintenance of the purifier sieves and filters and frequent renovation of the indoor air through physical ventilation by mean of open windows is imperative. More research on environmental contamination and particularly on viral contamination under real dental care conditions is needed.
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Abstract
OBJECTIVE To characterize the presence and magnitude of viruses in the air and on surfaces in the rooms of hospitalized patients with respiratory viral infections, and to explore the association between care activities and viral contamination. DESIGN Prospective observational study. SETTING Acute-care academic hospital. PARTICIPANTS In total, 52 adult patients with a positive respiratory viral infection test within 3 days of observation participated. Healthcare workers (HCWs) were recruited in staff meetings and at the time of patient care, and 23 wore personal air-sampling devices. METHODS Viruses were measured in the air at a fixed location and in the personal breathing zone of HCWs. Predetermined environmental surfaces were sampled using premoistened Copan swabs at the beginning and at the end of the 3-hour observation period. Preamplification and quantitative real-time PCR methods were used to quantify viral pathogens. RESULTS Overall, 43% of stationary and 22% of personal air samples were positive for virus. Positive stationary air samples were associated with ≥5 HCW encounters during the observation period (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.2-37.8). Viruses were frequently detected on all of the surfaces sampled. Virus concentrations on the IV pole hanger and telephone were positively correlated with the number of contacts made by HCWs on those surfaces. The distributions of influenza, rhinoviruses, and other viruses in the environment were similar. CONCLUSIONS Healthcare workers are at risk of contracting respiratory virus infections when delivering routine care for patients infected with the viruses, and they are at risk of disseminating virus because they touch virus-contaminated fomites.
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Ding H, Wu S, Dai X, Gao Y, Niu Y, Fang N, Song Y, Zhang M, Wang X, Chen T, Zhang G, Wu J, Li Y, Han J. Pharmacokinetic behavior of peramivir in the plasma and lungs of rats after trans-nasal aerosol inhalation and intravenous injection. Biomed Pharmacother 2020; 129:110464. [PMID: 32768954 DOI: 10.1016/j.biopha.2020.110464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022] Open
Abstract
Peramivir, a neuraminidase inhibitor, was approved globally and is indicated for the treatment of uncomplicated influenza in adults and children. However, the only approved intravenous formulation of peramivir limits its clinical application due to the need for the specialized dosing techniques and increases the risk of contracting influenza virus infection among healthcare professionals when dosing within a short distance to the patient. The purpose of this study was to investigate the pharmacokinetic profile of peramivir in plasma and the lung of rats and to compare the profiles following administration through trans-nasal aerosol inhalation (0.0888, 0.1776, and 0.3552 mg/kg) and intravenous injection (30 mg/kg). The plasma concentration reached the Cmax within 1.0 h (upon inhalation) and decreased at a t1/2 of 6.71 and 10.9 h after inhalation and injection, respectively. The absolute bioavailability of peramivir after inhalation was 78.2 %. Overall, the pharmacokinetic exposure of peramivir in the lungs was higher than that in the plasma after aerosol inhalation. After inhalation, the Cmax of peramivir in the lung was achieved within 1.0 h, and the elimination of the drug was slower than in the case of intravenous injection with t1/2 values 1.81 h for injection and 5.72, 53.5, and 32.1 h for low, middle, and high doses administered through inhalation. The Cmax and AUC0-t values for peramivir in the lungs increased linearly with the increased inhalation dose. The results elucidate the pharmacokinetic process of peramivir after trans-nasal aerosol inhalation to rats and provide useful information for further rational application of this drug formulation.
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Affiliation(s)
- Hao Ding
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Siyang Wu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Xianhui Dai
- Department of Respiratory Medicine, Chengyang People's Hospital, Qingdao, 266109, China
| | - Yang Gao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ying Niu
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Na Fang
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Yang Song
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Muzihe Zhang
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Xiaoyang Wang
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Tengfei Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Guangping Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100102, China
| | - Yingfei Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Jin Han
- Department of Pharmacy, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
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Schutzer-Weissmann J, Magee DJ, Farquhar-Smith P. Severe acute respiratory syndrome coronavirus 2 infection risk during elective peri-operative care: a narrative review. Anaesthesia 2020; 75:1648-1658. [PMID: 32652529 PMCID: PMC7404908 DOI: 10.1111/anae.15221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
The protection of healthcare workers from the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is a paramount concern. SARS‐CoV‐2 is likely to remain endemic and measures to protect healthcare workers against nosocomial infection will need to be maintained. This review aims to inform the assessment and management of the risk of SARS‐CoV‐2 transmission to healthcare workers involved in elective peri‐operative care. In the absence of data specifically related to the risk of SARS‐CoV‐2 transmission in the peri‐operative setting, we explore the evidence‐base that exists regarding modes of viral transmission, historical evidence for the risk associated with aerosol‐generating procedures and contemporaneous data from the COVID‐19 pandemic. We identify a significant lack of data regarding the risk of transmission in the management of elective surgical patients, highlighting the urgent need for further research.
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Affiliation(s)
- J Schutzer-Weissmann
- Department of Anaesthesia, Peri-operative Medicine, Pain and Critical Care, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D J Magee
- Imperial School of Anaesthesia, London, UK.,The Institute of Cancer Research, London, UK
| | - P Farquhar-Smith
- Department of Anaesthesia, Peri-operative Medicine, Pain and Critical Care, Royal Marsden Hospital NHS Foundation Trust, London, UK
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Weber RT, Phan LT, Fritzen-Pedicini C, Jones RM. Environmental and Personal Protective Equipment Contamination during Simulated Healthcare Activities. Ann Work Expo Health 2019; 63:784-796. [DOI: 10.1093/annweh/wxz048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 05/21/2019] [Indexed: 01/26/2023] Open
Abstract
Abstract
Providing care to patients with an infectious disease can result in the exposure of healthcare workers (HCWs) to pathogen-containing bodily fluids. We performed a series of experiments to characterize the magnitude of environmental contamination—in air, on surfaces and on participants—associated with seven common healthcare activities. The seven activities studied were bathing, central venous access, intravenous access, intubation, physical examination, suctioning and vital signs assessment. HCWs with experience in one or more activities were recruited to participate and performed one to two activities in the laboratory using task trainers that contained or were contaminated with fluorescein-containing simulated bodily fluid. Fluorescein was quantitatively measured in the air and on seven environmental surfaces. Fluorescein was quantitatively and qualitatively measured on the personal protective equipment (PPE) worn by participants. A total of 39 participants performed 74 experiments, involving 10–12 experimental trials for each healthcare activity. Healthcare activities resulted in diverse patterns and levels of contamination in the environment and on PPE that are consistent with the nature of the activity. Glove and gown contamination were ubiquitous, affirming the value of wearing these pieces of PPE to protect HCW’s clothing and skin. Though intubation and suctioning are considered aerosol-generating procedures, fluorescein was detected less frequently in air and at lower levels on face shields and facemasks than other activities, which suggests that the definition of aerosol-generating procedure may need to be revised. Face shields may protect the face and facemask from splashes and sprays of bodily fluids and should be used for more healthcare activities.
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Affiliation(s)
- Rachel T Weber
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Linh T Phan
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Rachael M Jones
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Rule AM, Apau O, Ahrenholz SH, Brueck SE, Lindsley WG, de Perio MA, Noti JD, Shaffer RE, Rothman R, Grigorovitch A, Noorbakhsh B, Beezhold DH, Yorio PL, Perl TM, Fisher EM. Healthcare personnel exposure in an emergency department during influenza season. PLoS One 2018; 13:e0203223. [PMID: 30169507 PMCID: PMC6118374 DOI: 10.1371/journal.pone.0203223] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Healthcare personnel are at high risk for exposure to influenza by direct and indirect contact, droplets and aerosols, and by aerosol generating procedures. Information on air and surface influenza contamination is needed to assist in developing guidance for proper prevention and control strategies. To understand the vulnerabilities of healthcare personnel, we measured influenza in the breathing zone of healthcare personnel, in air and on surfaces within a healthcare setting, and on filtering facepiece respirators worn by healthcare personnel when conducting patient care. Methods Thirty participants were recruited from an adult emergency department during the 2015 influenza season. Participants wore personal bioaerosol samplers for six hours of their work shift, submitted used filtering facepiece respirators and medical masks and completed questionnaires to assess frequency and types of interactions with potentially infected patients. Room air samples were collected using bioaerosol samplers, and surface swabs were collected from high-contact surfaces within the adult emergency department. Personal and room bioaerosol samples, surface swabs, and filtering facepiece respirators were analyzed for influenza A by polymerase chain reaction. Results Influenza was identified in 42% (53/125) of personal bioaerosol samples, 43% (28/ 96) of room bioaerosol samples, 76% (23/30) of pooled surface samples, and 25% (3/12) of the filtering facepiece respirators analyzed. Influenza copy numbers were greater in personal bioaerosol samples (17 to 631 copies) compared to room bioaerosol samples (16 to 323 copies). Regression analysis suggested that the amount of influenza in personal samples was approximately 2.3 times the amount in room samples (Wald χ2 = 16.21, p<0.001). Conclusions Healthcare personnel may encounter increased concentrations of influenza virus when in close proximity to patients. Occupations that require contact with patients are at an increased risk for influenza exposure, which may occur throughout the influenza season. Filtering facepiece respirators may become contaminated with influenza when used during patient care.
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Affiliation(s)
- Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Otis Apau
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Steven H. Ahrenholz
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - Scott E. Brueck
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - William G. Lindsley
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Marie A. de Perio
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - John D. Noti
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Ronald E. Shaffer
- National Personal Protective Technology Lab (NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of America
| | - Richard Rothman
- Johns Hopkins Hospital, Adult Emergency Department, Baltimore, Maryland, United States of America
| | - Alina Grigorovitch
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bahar Noorbakhsh
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Donald H. Beezhold
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Patrick L. Yorio
- National Personal Protective Technology Lab (NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of America
| | - Trish M. Perl
- Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Edward M. Fisher
- National Personal Protective Technology Lab (NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Tang JW, Hoyle E, Moran S, Pareek M. Near-Patient Sampling to Assist Infection Control-A Case Report and Discussion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E238. [PMID: 29385031 PMCID: PMC5858307 DOI: 10.3390/ijerph15020238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 01/08/2023]
Abstract
Air sampling as an aid to infection control is still in an experimental stage, as there is no consensus about which air samplers and pathogen detection methods should be used, and what thresholds of specific pathogens in specific exposed populations (staff, patients, or visitors) constitutes a true clinical risk. This case report used a button sampler, worn or held by staff or left free-standing in a fixed location, for environmental sampling around a child who was chronically infected by a respiratory adenovirus, to determine whether there was any risk of secondary adenovirus infection to the staff managing the patient. Despite multiple air samples taken on difference days, coinciding with high levels of adenovirus detectable in the child's nasopharyngeal aspirates (NPAs), none of the air samples contained any detectable adenovirus DNA using a clinically validated diagnostic polymerase chain reaction (PCR) assay. Although highly sensitive, in-house PCR assays have been developed to detect airborne pathogen RNA/DNA, it is still unclear what level of specific pathogen RNA/DNA constitutes a true clinical risk. In this case, the absence of detectable airborne adenovirus DNA using a conventional diagnostic assay removed the requirement for staff to wear surgical masks and face visors when they entered the child's room. No subsequent staff infections or outbreaks of adenovirus have so far been identified.
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Affiliation(s)
- Julian W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
- Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Elizabeth Hoyle
- Infection Prevention and Control, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
| | - Sammy Moran
- Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
| | - Manish Pareek
- Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
- Infectious Diseases Unit, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
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Jones RM, Xia Y. Occupational exposures to influenza among healthcare workers in the United States. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2016; 13:213-222. [PMID: 26556672 DOI: 10.1080/15459624.2015.1096363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study is to estimate the annual number of occupational exposures to influenza among healthcare workers that result from providing direct and supportive care to influenza patients in acute care, home care and long-term care settings. Literature review was used to identify healthcare utilization for influenza, and worker activity patterns. This information was used, with Monte Carlo simulation, to tabulate the mean annual number of occupational exposures. Given a medium-sized epidemic with a 6% annual symptomatic influenza incidence proportion, the mean number of occupational exposures was estimated to be 81.8 million annually. Among the approximately 14 million healthcare workers, this corresponds to 5.8 exposures per worker annually, on average. Exposures, however, are likely concentrated among subsets of healthcare workers. Occupational exposures were most numerous in ambulatory care settings (38%), followed by long-term care facilities (30%) and home care settings (21%). The annual number of occupational exposures to influenza is high, but not every occupational exposure will result in infection. Some infection control activities, like patient isolation, can reduce the number of occupational exposures.
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Affiliation(s)
- Rachael M Jones
- a Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago , Chicago , Illinois
| | - Yulin Xia
- a Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago , Chicago , Illinois
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