Study on the interzonal migration of airborne infectious particles in an isolation ward using benign bacteria

The impact of high background particle concentration on the spatiotemporal distribution of Serratia marcescens bioaerosol

Airborne transmission is a well-established mode of dissemination for infectious diseases, particularly in closed environments. However, previous research has often overlooked the potential impact of background particle concentration on bioaerosol characteristics. We compared the spatial and temporal distributions of bioaerosols under two levels of background particle concentration: heavily polluted (150-250 μg/m3) and excellent (0-35 μg/m3) in a typical ward. Serratia marcescens bioaerosol was adopted as a bioaerosol tracer, and the bioaerosol concentrations were quantified using six-stage Andersen cascade impactors. The results showed a significant reduction (over at least 62.9%) in bioaerosol concentration under heavily polluted levels compared to excellent levels at all sampling points. The temporal analysis also revealed that the decay rate of bioaerosols was higher (at least 0.654 min-1) under heavily polluted levels compared to excellent levels. These findings suggest that background particles can facilitate bioaerosol removal, contradicting the assumption made in previous research that background particle has no effect on bioaerosol characteristics. Furthermore, we observed differences in the size distribution of bioaerosols between the two levels of background particle concentration. The average bioaerosols size under heavily polluted levels was found to be higher than that under excellent levels, and the average particle size under heavily polluted levels gradually increased with time. In conclusion, these results highlight the importance of considering background particle concentration in future research on bioaerosol characteristics.

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.

Distribution of droplets/droplet nuclei from coughing and breathing of patients with different postures in a hospital isolation ward

Suspected and confirmed cases of infectious diseases such as COVID-19 are diagnosed and treated in specific hospital isolation wards, posing a challenge to preventing cross-infection between patients and healthcare workers. In this study, the Euler-Lagrange method was used to simulate the evaporation and dispersion of droplets with full-size distribution produced by fluctuating coughing and breathing activities in an isolation ward. The effects of supply air temperature and relative humidity, ventilation rates and patient postures on droplet distribution were investigated. The numerical models were validated by an aerosol experiment with an artificial saliva solution containing E. coli bacteria conducted in a typical isolation ward. The results showed that the small size group of droplets (initial size ≤87.5 μm) exhibited airborne transmission in the isolation ward, while the large size group (initial size ≥112.5 μm) were rapidly deposited by gravitational effects. The ventilation rate had a greater effect on the diffusion of droplet nuclei than the supply air temperature and relative humidity. As the air changes per hour (ACH) increased from 8 to 16, the number fraction of suspended droplet nuclei reduced by 14.2% and 6.4% in the lying and sitting cases, respectively, while the number fraction of escaped droplet nuclei increased by 16.2% and 14.6%. Regardless of whether the patient was lying or sitting, the amount of droplet nuclei deposited on the ceiling was highest at lower ventilation rates. These results may provide some guidance for routine disinfection and ventilation strategies in hospital isolation wards.

Droplet aerosols transportation and deposition for three respiratory behaviors in a typical negative pressure isolation ward

Negative pressure isolation wards could provide safety for health care workers (HCWs) and patients infected with SARS-CoV-2. However, respiratory behavior releases aerosols containing pathogens, resulting in a potential risk of infection for HCWs. In this study, the spatiotemporal distribution of droplet aerosols in a typical negative pressure isolation ward was investigated using a full-scale experiment. In this experiment, artificial saliva was used to simulate the breathing behavior, which can reflect the effect of evaporation on droplet aerosols. Moreover, numerical simulations were used to compare the transport of droplet aerosols released by the three respiratory behaviors (breathing, speaking, and coughing). The results showed that droplet aerosols generated by coughing and speaking can be removed and deposited more quickly. Because reduction in the suspension proportion per unit time was much higher than that in the case of breathing. Under the air supply inlets, there was significant aerosol deposition on the floor, while the breathing area possessed higher aerosol concentrations. The risk of aerosol resuspension and potential infection increased significantly when HCWs moved frequently to these areas. Finally, more than 20% of the droplet aerosols escaped from the ward when the number of suspended aerosols in the aerosol space was 1%.

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.

A tracing method of airborne bacteria transmission across built environments

Disease transmission across built environments has been found to be a serious health risk. Airborne transmission is a vital route of disease infection caused by bacteria and virus. However, tracing methods of airborne bacteria in both lab and field research failed to veritably express the transporting process of microorganism in the air. A new tracing method of airborne bacteria used for airborne transmission was put forward and demonstrated its feasibility by conducting a field evaluation on the basis of genetic modification and bioaerosol technology. A specific gene fragment (pFPV-mCherry fluorescent protein plasmid) was introduced into nonpathogenic E. coli DH5α as tracer bacteria by high-voltage electroporation. Gel electrophoresis and DNA sequencing proved the success of the synthesis. Genetic stability, effect of aerosolization on the survival rate of tracer bacteria, and the application of the tracer bacteria to the airborne bacteria transmission were examined in both lab and field. Both the introduced plasmid stability rates of tracer E. coli in pre-aerosolization and post-aerosolization were above 95% in five test days. Survival rate of tracer E. coli at 97.5% ± 1.2% through aerosolization was obtained by an air-atomizer operated at an air pressure of 30 Psi. In the field experiment, the airborne transmission of E. coli between poultry houses was proved and emitted E. coli was more easily transmitted into self-house than adjacent house due to the ventilation design and weather condition. Our results suggested that the tracing method of airborne bacteria was available for the investigation of airborne microbial transmission across built environments.

Renovation in Hospitals: Pressurization Strategies by Healthcare Contractors in the United States

OBJECTIVE

The objective of the study was to identify current practices utilized by contractors in healthcare renovation projects.

BACKGROUND

Renovation in healthcare facilities comprises nearly half of all healthcare construction. Since a complete shutdown of the healthcare facility during renovation is typically not feasible, efforts must be taken to isolate ongoing functions of the hospital from activities in the construction zone. There are numerous documented cases of morbidity and mortality related to construction activities in the hospital. Hence, guidelines recommend negative pressurization of the construction zone to prevent the migration of dust and potential pathogenic agents into the functioning zone.

METHOD

To accomplish the paper objective, a questionnaire was developed to address pressurization strategies, the use of backup systems and anterooms, and workforce training for healthcare projects. One hundred twenty-nine project managers and superintendents from top healthcare construction companies in the United States participated in the study.

RESULTS

Results show that owners influence pressurization strategy, but contractors typically assume a primary role in establishing pressurization levels, monitoring conformance, and training construction personnel. However, without solid evidence of effectiveness, pressurization levels often vary from Center for Disease Control standards.

CONCLUSION

Further research is needed to establish evidence-based practices and to develop training modules for construction crews to support these best practices. Promoting evidence-based training can improve patient safety and minimize adverse patient outcomes.

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.

Airflow patterns through single hinged and sliding doors in hospital isolation rooms - Effect of ventilation, flow differential and passage

Negative pressure isolation rooms are used to house patients with highly contagious diseases (e.g. with airborne diseases) and to contain emitted pathogens to reduce the risk for cross-infection in hospitals. Airflows induced by door opening motion and healthcare worker passage can, however, transport the potentially pathogen laden air across the doorway. In this study airflow patterns across the isolation room doorway induced by the operation of single hinged and sliding doors with simulated human passage were examined. Smoke visualizations demonstrated that the hinged door opening generated a greater flow across the doorway than the sliding door. Tracer gas measurements showed that the examined ventilation rates (6 and 12 air changes per hour) had only a small effect on the air volume exchange across the doorway with the hinged door. The results were more variable with the sliding door. Supply-exhaust flow rate differential reduced the door motion-induced air transfer significantly with both door types. The experiments showed that the passage induced substantial air volume transport through the doorway with both door types. However, overall, the sliding door performed better in all tested scenarios, because the door-opening motion itself generated relatively smaller air volume exchange across the doorway, and hence should be the preferred choice in the design of isolation rooms.