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De Roos AJ, Senter JP, Schinasi LH, Huang W, Moore K, Maltenfort M, Forrest C, Henrickson SE, Kenyon CC. Outdoor aeroallergen impacts on asthma exacerbation among sensitized and nonsensitized Philadelphia children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100248. [PMID: 38645670 PMCID: PMC11024998 DOI: 10.1016/j.jacig.2024.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/30/2023] [Accepted: 01/27/2024] [Indexed: 04/23/2024]
Abstract
Background Outdoor aeroallergens, such as pollens and molds, are known triggers of asthma exacerbation; however, few studies have examined children's aeroallergen response based on sensitization. Objective Our aim was to compare the relative impact of aeroallergen levels on asthma exacerbation between pediatric patients with asthma who tested positive or negative for sensitization to particular allergens. Methods A case-crossover design study was conducted to examine associations between outdoor aeroallergen levels and asthma exacerbation events among children living in Philadelphia, Pennsylvania, who were treated within a large pediatric care network. Sensitization to common allergens was characterized in a subset of patients with asthma exacerbation who had undergone skin prick testing (5.5%). Odds ratios (ORs) and 95% CIs were estimated in all patients with asthma exacerbation and in those sensitized or not sensitized to aeroallergens. Results Children who were sensitized to a particular allergen had higher odds of asthma exacerbation with exposure to the allergen (ie, early-season tree pollen, oak tree pollen, early-season weed pollen, and late-season molds) than did all patients with asthma or nonsensitized patients. For example, the association between early-season tree pollen and asthma exacerbation among sensitized children (>90th percentile vs ≤25th, OR = 2.28 [95% CI = 1.23-4.22]) was considerably stronger than that estimated among all patients (OR = 1.34 [95% CI = 1.19-1.50]), and it was also substantially different from the lack of association seen among nonsensitized children (OR = 0.89 [95% CI = 0.51-1.55] [P value for heterogeneity = .03]). Conclusion More prevalent allergy testing may be useful for prevention of asthma exacerbation by informing interventions targeted to sensitized children and tailored for particular aeroallergens.
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Affiliation(s)
- Anneclaire J. De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pa
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pa
| | - James P. Senter
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Leah H. Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pa
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pa
| | - Wanyu Huang
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pa
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pa
| | - Mitchell Maltenfort
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Christopher Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Sarah E. Henrickson
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chén C. Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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Somorin YM, O'Connor GM. Assessment of microbial contamination in laser materials processing laboratories used for prototyping of biomedical devices. Access Microbiol 2023; 5:000494.v3. [PMID: 38188238 PMCID: PMC10765054 DOI: 10.1099/acmi.0.000494.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/02/2023] [Indexed: 01/09/2024] Open
Abstract
Microbial contamination of medical devices during pilot production can be a significant barrier as the laboratory environment is a source of contamination. There is limited information on microbial contaminants in laser laboratories and environments involved in the pilot production of medical devices. This study aimed to determine the bioburden and microbial contaminants present in three laser laboratories - an ISO class 7 clean room, a pilot line facility and a standard laser laboratory. Microbiological air sampling was by passive air sampling using settle plates and the identity of isolates was confirmed by DNA sequencing. Particulate matter was analysed using a portable optical particle counter. Twenty bacterial and 16 fungal genera were isolated, with the genera Staphylococcus and Micrococcus being predominant. Most isolates are associated with skin, mouth, or upper respiratory tract. There was no significant correlation between microbial count and PM2.5 concentration in the three laboratories. There were low levels but diverse microbial population in the laser-processing environments. Pathogenic bacteria such as Acinetobacter baumannii and Candida parapsilosis were isolated in those environments. These results provide data that will be useful for developing a contamination control plan for controlling microbial contamination and facilitating advanced manufacturing of laser-based pilot production of medical devices.
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Affiliation(s)
- Yinka M. Somorin
- National Centre for Laser Applications (NCLA), School of Natural Sciences, University of Galway, Galway, Ireland
- Irish Photonic Integration Centre (IPIC), Tyndall National Institute, Cork, Ireland
| | - Gerard M. O'Connor
- National Centre for Laser Applications (NCLA), School of Natural Sciences, University of Galway, Galway, Ireland
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Marek A, Meijer EFJ, Tartari E, Zakhour J, Chowdhary A, Voss A, Kanj SS, Bal AM. Environmental monitoring for filamentous fungal pathogens in hematopoietic cell transplant units. Med Mycol 2023; 61:myad103. [PMID: 37793805 DOI: 10.1093/mmy/myad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023] Open
Abstract
The incidence of invasive fungal disease (IFD) is on the rise due to increasing numbers of highly immunocompromized patients. Nosocomial IFD remains common despite our better understanding of its risk factors and pathophysiology. High-efficiency particulate air filtration with or without laminar air flow, frequent air exchanges, a positive pressure care environment, and environmental hygiene, amongst other measures, have been shown to reduce the mould burden in the patient environment. Environmental monitoring for moulds in areas where high-risk patients are cared for, such as hematopoietic cell transplant units, has been considered an adjunct to other routine environmental precautions. As a collaborative effort between authors affiliated to the Infection Prevention and Control Working Group and the Fungal Infection Working Group of the International Society of Antimicrobial Chemotherapy (ISAC), we reviewed the English language literature and international guidance to describe the evidence behind the need for environmental monitoring for filamentous fungi as a quality assurance approach with an emphasis on required additional precautions during periods of construction. Many different clinical sampling approaches have been described for air, water, and surface sampling with significant variation in laboratory methodologies between reports. Importantly, there are no agreed-upon thresholds that correlate with an increase in the clinical risk of mould infections. We highlight important areas for future research to assure a safe environment for highly immunocompromized patients.
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Affiliation(s)
- Aleksandra Marek
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Eelco F J Meijer
- Canisius-Wilhelmina Hospital (CWZ), Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Johnny Zakhour
- Division of Infectious Diseases, Department of Internal Medicine and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Abhijit M Bal
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
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Górzyńska A, Grzech A, Mierzwiak P, Ussowicz M, Biernat M, Nawrot U. Quantitative and Qualitative Airborne Mycobiota Surveillance in High-Risk Hospital Environment. Microorganisms 2023; 11:microorganisms11041031. [PMID: 37110454 PMCID: PMC10147027 DOI: 10.3390/microorganisms11041031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: The primary aim of the presented study was to assess the prevalence of fungi in the indoor air of selected hospital wards, and the additional goal was to evaluate the susceptibility of cultured isolates of Aspergillus fumigatus to triazoles. (2) Methods: Three hematology departments and a hospital for lung diseases were surveyed in 2015 and/or 2019. Air samples were taken with a MicroBio MB1 air sampler on Sabouraud agar. The susceptibility of Aspergillus fumigatus isolates to voriconazole, posaconazole and itraconazole was tested with a microdilution method, according to EUCAST. (3) Results: The amount of fungi cultured from rooms equipped with sterile air circulation, as well as flow devices for air disinfection, was significantly lower compared to that from unprotected rooms. The areas most contaminated with fungi were corridors and bathrooms. The dominant species were Cladosporium and Penicillium. A. fumigatus was rare in hematological departments (6/61, 9.8% examinations performed in 2014 and 2/40, 5% in 2019), whereas in the hospital for lung diseases an outbreak of A. fumigatus spores with up to 300 CFU/m3 was noted in March 2015. No triazole-resistant A. fumigatus isolate was detected. (4) Conclusions: Regular microbiological testing of the hospital environment can contribute to the detection of spore outbreaks, and thus enable the implementation of corrective procedures (e.g., additional disinfection, changing of HEPA filters).
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Affiliation(s)
- Aleksandra Górzyńska
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 213a, 50-556 Wroclaw, Poland
| | - Aneta Grzech
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 213a, 50-556 Wroclaw, Poland
| | - Paulina Mierzwiak
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 213a, 50-556 Wroclaw, Poland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Supraregional Centre of Paediatric Oncology "Cape of Hope", 50-556 Wrocław, Poland
| | - Monika Biernat
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Urszula Nawrot
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 213a, 50-556 Wroclaw, Poland
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Larson ER, Crandall SG. Recovery of the soil fungal microbiome after steam disinfection to manage the plant pathogen Fusarium solani. FRONTIERS IN PLANT SCIENCE 2023; 14:1128518. [PMID: 37152156 PMCID: PMC10161934 DOI: 10.3389/fpls.2023.1128518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/22/2023] [Indexed: 05/09/2023]
Abstract
Soil disinfection using high temperatures via steam is a promising approach to manage plant pathogens, pests, and weeds. Soil steaming is a viable option for growers who are moving away from dependence on chemical soil fumigants, especially in plant nursery or high tunnel environments. However, there are few studies that investigate how soil steaming causes substantial disturbance to the soil by killing both target pathogens and other soil biota. Steaming treatments also change the trajectory of the soil microbiome as it reassembles over time. Growers are interested in the health of soils after using steam-disinfection, especially if a virulent pathogen colonizes the soil and then flourishes in a situation where there are very few microbes to suppress its growth. Should recruitment of a virulent pathogen occur in the soil, this could have devasting effects on seed germination, seedling establishment and survival. Beneficial microbes are often used to prevent the colonization of plant pathogens, especially after a soil-steaming event. Here, we experimentally test how soil fungal communities assemble after steaming disinfection. We introduce to steam-treated soil Fusarium solani, an important fungal pathogen of soybean and Trichoderma harzianum, a known beneficial fungus used for soilborne pathogen suppression. Results show that F. solani significantly affects the relative abundance and diversity of the soil fungal microbiome, however, T. harzianum does not mitigate the amount of F. solani in the steam treated soil. Within the T. harzianum microbial addition, the soil fungal communities were similar to the control (steaming only). This result suggests inoculating the soil with T. harzianum does not drastically alter the assembly trajectory of the soil fungal microbiome. Other soil amendments such as a combination of Trichoderma spp. or other genera could suppress F. solani growth and shift soil microbiome composition and function post-steaming, however, more experimental research is needed.
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Affiliation(s)
- Eric R. Larson
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA, United States
- Microbiome Center, Penn State Institutes of the Life Sciences, University Park, PA, United States
- *Correspondence: Eric R. Larson,
| | - Sharifa G. Crandall
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA, United States
- Microbiome Center, Penn State Institutes of the Life Sciences, University Park, PA, United States
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Sofia Paulino Mendes A, Rutgersson A, Paulsson M. Outdoor Environmental Effects on Cleanrooms - A Study from a Swedish Hospital Pharmacy Compounding Unit. Eur J Pharm Biopharm 2022; 177:100-106. [PMID: 35750108 DOI: 10.1016/j.ejpb.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
In this study we examined how outdoor climate affects indoor conditions of a cleanroom used for the preparation of radiopharmaceuticals in the Uppsala university hospital pharmacy, Sweden. Further objectives were to identify associated risk factors to ensure a consistent extemporaneous manufacturing process. Data for two years from the facility monitoring system (with one minute resolution for temperature, relative humidity, differential pressure) were compared with meteorological outdoor data from Uppsala (Swedish Meteorological and Hydrological Institute, 60-minute mean data for temperature, relative humidity (%RH), wind speed and air pressure). The findings of this study indicate a linear relationship between indoor and outdoor temperature for the autumn, winter and spring seasons. The typical summer outdoor diurnal pattern is also seen for indoor temperature. During the study period, the minimum outdoor temperature was -17.5°C and the maximum 31.4°C. This wide temperature range also entails a wide range of air humidity from 10%RH to 100%RH indoors. Cleanroom temperature and %RH are factors that may affect the quality of medications, especially the risk of microbiological growth in aseptic processes, stability of medications during storage but also may affect handling of for example uncoated tablets or weighing of powder, especially at high %RH for hygroscopic drugs or at low %RH due to static electricity. Further the risk of damage on electrical equipment from electrostatic discharge at low %RH is discussed with a focus on the need for humidity control of cleanrooms and/or systems for mitigation of electrostatic discharge in climates with outdoor temperature in the wintertime below freezing point.
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Affiliation(s)
- Ana Sofia Paulino Mendes
- Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira n. 228 4050-313 Porto, Portugal
| | - Anna Rutgersson
- Department of Earth Sciences, Uppsala University, Villavägen 16 SE-752 36 Uppsala, Sweden
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden.
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Comprehensive health risk assessment of microbial indoor air quality in microenvironments. PLoS One 2022; 17:e0264226. [PMID: 35213573 PMCID: PMC8880710 DOI: 10.1371/journal.pone.0264226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
The higher airborne microbial concentration in indoor areas might be responsible for the adverse indoor air quality, which relates well with poor respiratory and general health effects in the form of Sick building syndromes. The current study aimed to isolate and characterize the seasonal (winter and spring) levels of culturable bio-aerosols from indoor air, implicating human health by using an epidemiological health survey. Microorganisms were identified by standard macro and microbiological methods, followed by biochemical testing and molecular techniques. Sampling results revealed the bacterial and fungal aerosol concentrations ranging between (300–3650 CFU/m3) and (300–4150 CFU/m3) respectively, in different microenvironments during the winter season (December-February). However, in spring (March-May), bacterial and fungal aerosol concentrations were monitored, ranging between (450–5150 CFU/m3) and (350–5070 CFU/m3) respectively. Interestingly, Aspergillus and Cladosporium were the majorly recorded fungi whereas, Staphylococcus, Streptobacillus, and Micrococcus found predominant bacterial genera among all the sites. Taken together, the elevated levels of bioaerosols are the foremost risk factor that can lead to various respiratory and general health issues in additional analysis, the questionnaire survey indicated the headache (28%) and allergy (20%) were significant indoor health concerns. This type of approach will serve as a foundation for assisting residents in taking preventative measures to avoid exposure to dangerous bioaerosols.
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Abstract
Fungal spores make up a significant portion of Primary Biological Aerosol Particles (PBAPs) with large quantities of such particles noted in the air. Fungal particles are of interest because of their potential to affect the health of both plants and humans. They are omnipresent in the atmosphere year-round, with concentrations varying due to meteorological parameters and location. Equally, differences between indoor and outdoor fungal spore concentrations and dispersal play an important role in occupational health. This review attempts to summarise the different spore sampling methods, identify the most important spore types in terms of negative effects on crops and the public, the factors affecting their growth/dispersal, and different methods of predicting fungal spore concentrations currently in use.
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Indoor Air Quality in Healthcare Units—A Systematic Literature Review Focusing Recent Research. SUSTAINABILITY 2022. [DOI: 10.3390/su14020967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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A systematic review and meta-analysis of indoor bioaerosols in hospitals: The influence of heating, ventilation, and air conditioning. PLoS One 2021; 16:e0259996. [PMID: 34941879 PMCID: PMC8699671 DOI: 10.1371/journal.pone.0259996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate (1) the relationship between heating, ventilation, and air conditioning (HVAC) systems and bioaerosol concentrations in hospital rooms, and (2) the effectiveness of laminar air flow (LAF) and high efficiency particulate air (HEPA) according to the indoor bioaerosol concentrations. METHODS Databases of Embase, PubMed, Cochrane Library, MEDLINE, and Web of Science were searched from 1st January 2000 to 31st December 2020. Two reviewers independently extracted data and assessed the quality of the studies. The samples obtained from different areas of hospitals were grouped and described statistically. Furthermore, the meta-analysis of LAF and HEPA were performed using random-effects models. The methodological quality of the studies included in the meta-analysis was assessed using the checklist recommended by the Agency for Healthcare Research and Quality. RESULTS The mean CFU/m3 of the conventional HVAC rooms and enhanced HVAC rooms was lower than that of rooms without HVAC systems. Furthermore, the use of the HEPA filter reduced bacteria by 113.13 (95% CI: -197.89, -28.38) CFU/m3 and fungi by 6.53 (95% CI: -10.50, -2.55) CFU/m3. Meanwhile, the indoor bacterial concentration of LAF systems decreased by 40.05 (95% CI: -55.52, -24.58) CFU/m3 compared to that of conventional HVAC systems. CONCLUSIONS The HVAC systems in hospitals can effectively remove bioaerosols. Further, the use of HEPA filters is an effective option for areas that are under-ventilated and require additional protection. However, other components of the LAF system other than the HEPA filter are not conducive to removing airborne bacteria and fungi. LIMITATION OF STUDY Although our study analysed the overall trend of indoor bioaerosols, the conclusions cannot be extrapolated to rare, hard-to-culture, and highly pathogenic species, as well as species complexes. These species require specific culture conditions or different sampling requirements. Investigating the effects of HVAC systems on these species via conventional culture counting methods is challenging and further analysis that includes combining molecular identification methods is necessary. STRENGTH OF THE STUDY Our study was the first meta-analysis to evaluate the effect of HVAC systems on indoor bioaerosols through microbial incubation count. Our study demonstrated that HVAC systems could effectively reduce overall bioaerosol concentrations to maintain better indoor air quality. Moreover, our study provided further evidence that other components of the LAF system other than the HEPA filter are not conducive to removing airborne bacteria and fungi. PRACTICAL IMPLICATION Our research showed that HEPA filters are more effective at removing bioaerosols in HVAC systems than the current LAF system. Therefore, instead of opting for the more costly LAF system, a filter with a higher filtration rate would be a better choice for indoor environments that require higher air quality; this is valuable for operating room construction and maintenance budget allocation.
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Arıkan I, Genç Ö, Uyar C, Tokur ME, Balcı C, Perçin Renders D. Effectiveness of air purifiers in intensive care units: an interventional study. J Hosp Infect 2021; 120:14-22. [PMID: 34688796 DOI: 10.1016/j.jhin.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/22/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Effective design and operation of Intensive Care Unit (ICU) ventilation systems is important to prevent hospital-acquired infections. Air purifiers may contribute to that. AIM In this study we aimed at detecting the number and types of microorganisms present in the air and on the high touch surfaces in the ICU; evaluating the effectiveness of the air purifying device in reducing the microbial load and thus the rate of nosocomial infections in the ICU. METHOD This interventional study was conducted in two similar ICUs between December 2019 and May 2020. Novaerus brand air purifiers were located in the "intervention ICU" for two months. Routine cleaning procedures and HEPA filtered ventilation continued in "control ICU" as well as in the "Intervention ICU". After two months the units were moved to the other ICU for the next two months to reduce any possible bias in the results. Air and surface samples were evaluated. FINDINGS The evaluation of the change in the interventional ICU over time revealed a significantly lower colony concentration in the air and on surfaces on Day 60 compared to Day 1 (pair<0.001 and psurface<0.001). There was a significant positive correlation between the number of colonies detected and the rate of hospital-acquired infections in the interventional ICU (r:0.406, p:0.049) and in the control ICU (r:0.698, p:0.001). CONCLUSION Using air purifiers in addition to the hospital HVAC systems might be an effective way to reduce the microbial load in the air and surfaces and thus hospital-acquired infections.
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Affiliation(s)
- I Arıkan
- Department of Public Health, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ö Genç
- Department of Medical Microbiology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - C Uyar
- Department of Infectious Diseases, Kutahya Health Sciences University, Evliya Celebi Education and Research Hospital, Kutahya, Turkey
| | - M E Tokur
- Department of Anaesthesiology and Reanimation, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - C Balcı
- Department of Anaesthesiology and Reanimation, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - D Perçin Renders
- Department of Medical Microbiology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey.
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Abstract
Almost all hospitals are equipped with air-conditioning systems to provide a comfortable environment for patients and staff. However, the accumulation of dust and moisture within these systems increases the risk of transmission of microbes and have on occasion been associated with outbreaks of infection. Nevertheless, the impact of air-conditioning on the transmission of microorganisms leading to infection remains largely uncertain. We conducted a scoping review to screen systematically the evidence for such an association in the face of the coronavirus disease 2019 epidemic. PubMed, Embase and Web of Science databases were explored for relevant studies addressing microbial contamination of the air, their transmission and association with infectious diseases. The review process yielded 21 publications, 17 of which were cross-sectional studies, three were cohort studies and one case−control study. Our analysis showed that, compared with naturally ventilated areas, microbial loads were significantly lower in air-conditioned areas, but the incidence of infections increased if not properly managed. The use of high-efficiency particulate air (HEPA) filtration not only decreased transmission of airborne bioaerosols and various microorganisms, but also reduced the risk of infections. By contrast, contaminated air-conditioning systems in hospital rooms were associated with a higher risk of patient infection. Cleaning and maintenance of such systems to recommended standards should be performed regularly and where appropriate, the installation of HEPA filters can effectively mitigate microbial contamination in the public areas of hospitals.
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13
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Kumar P, Kausar MA, Singh AB, Singh R. Biological contaminants in the indoor air environment and their impacts on human health. AIR QUALITY, ATMOSPHERE, & HEALTH 2021; 14:1723-1736. [PMID: 34394766 PMCID: PMC8346343 DOI: 10.1007/s11869-021-00978-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/04/2021] [Indexed: 05/25/2023]
Abstract
Indoor air environment contains a complex mixture of biological contaminants such as bacteria, fungi, viruses, algae, insects, and their by-products such as endotoxins, mycotoxins, volatile organic compounds, etc. Biological contaminants have been categorized according to whether they are allergenic, infectious, capable of inducing toxic or inflammatory responses in human beings. At present, there is a lack of awareness about biological contamination in the indoor environment and their potential sources for the spreading of various infections. Therefore, this review article examines the association of biological contaminants with human health, and it will also provide in-depth knowledge of various biological contaminants present in different places such as residential areas, hospitals, offices, schools, etc. Moreover, qualitative and quantitative data of bio-contaminants in various indoor environments such as schools, hospitals, residential houses, etc. have also been derived from the recent literature survey.
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Affiliation(s)
- Pradeep Kumar
- Department of Environmental Studies, Satyawati College, University of Delhi, Ashok Vihar III, Delhi-52, India
| | - Mohd. Adnan Kausar
- Department of Biochemistry, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - A. B. Singh
- CSIR- Institute of Genomics and Integrative Biology (IGIB), Delhi University Campus, Delhi-07, India
| | - Rajeev Singh
- Department of Environmental Studies, Satyawati College, University of Delhi, Ashok Vihar III, Delhi-52, India
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Pollen and Fungal Spores Evaluation in Relation to Occupants and Microclimate in Indoor Workplaces. SUSTAINABILITY 2021. [DOI: 10.3390/su13063154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Indoor air quality depends on many internal or external factors mutually interacting in a dynamic and complex system, which also includes indoor workplaces, where subjects are exposed to many pollutants, including biocontaminants such as pollen and fungal spores. In this context, the occupants interact actively with their environment through actions, modifying indoor environmental conditions to achieve their own thermal comfort. Actions such as opening/closing doors and windows and turning on/off air conditioning could have effects on workers’ health. The present study explored the contribution of human occupants to pollen and fungal spore levels in indoor workplaces, combining aerobiological, microclimate, and worker monitoring during summer and winter campaigns. We evaluated the overall time spent by the workers in the office, the workers’ actions regarding non-working days and working days, and non-working hours and working hours, during two campaigns of pollen and fungal spore monitoring. Our results showed that the biocontaminant values depend on many mutually interacting factors; hence, the role of all of the factors involved should be investigated. In this regard, aerobiological monitoring should be a valid tool for the management of occupational allergies, providing additional information to improve occupational health protection strategies.
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Does a mobile dust-containment cart reduce the risk of healthcare-associated fungal infections during above-ceiling work? Infect Control Hosp Epidemiol 2020; 42:477-479. [PMID: 33032667 DOI: 10.1017/ice.2020.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Immunocompromised patients are at risk for infections due to above-ceiling activities in hospitals. Mobile dust-containment carts are available as environmental controls, but no published data support their efficacy. Using microbial air sampling and particle counts, we provide evidence of reduced risk of fungal exposure during open ceiling activities.
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Development of multiplex real-time PCR for rapid identification and quantitative analysis of Aspergillus species. PLoS One 2020; 15:e0229561. [PMID: 32150555 PMCID: PMC7062252 DOI: 10.1371/journal.pone.0229561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
The identification of Aspergillus species and azole resistance is highly important for the treatment of invasive aspergillosis (IA), which requires improvements in current fungal diagnostic methods. We aimed to develop multiplex real-time PCR to identify major Aspergillus section and azole resistance. BenA and cyp51A genes were used to design primers, probes, and control DNA for multiplex PCR. Qualitative and quantitative analysis was conducted for 71 Aspergillus and 47 non-Aspergillus isolates. Further, the limit of detection (LOD) and limit of quantitation (LOQ) from hyphae or conidia were determined according to the culture time. Newly developed real-time PCR showed 100% specificity to each Aspergillus section (Fumigati, Nigri, Flavi, and Terrei), without cross-reaction between different sections. In quantitative analysis of sensitivity measurements, LOD and LOQ were 40 fg and 400 fg, respectively. Melting temperature analysis of the cyp51A promoter to identify azole resistance showed temperatures of 83.0 ± 0.3°C and 85.6 ± 0.6°C for susceptible A. fumigatus and resistant isolates with TR34 mutation, respectively. The minimum culture time and fungal colony size required for successful detection were 24 h and 0.4 cm in diameter, respectively. The developed multiplex real-time PCR can identify common Aspergillus sections quantitatively and detect presence of the TR34 mutation. Further, this method shows high sensitivity and specificity, allowing successful detection of early-stage fungal colonies within a day of incubation. These results can provide a template for rapid and accurate diagnosis of IA.
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Park JH, Ryu SH, Lee JY, Kim HJ, Kwak SH, Jung J, Lee J, Sung H, Kim SH. Airborne fungal spores and invasive aspergillosis in hematologic units in a tertiary hospital during construction: a prospective cohort study. Antimicrob Resist Infect Control 2019; 8:88. [PMID: 31161035 PMCID: PMC6542016 DOI: 10.1186/s13756-019-0543-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Invasive aspergillosis (IA) is an opportunistic fungal infection that mostly occurs in immunocompromised patients, such as those having hematologic malignancy or receiving hematopoietic stem cell transplantation. Inhalation of Aspergillus spores is the main transmission route of IA in immunocompromised patients. Construction work in hospitals is a risk factor for environmental fungal contamination. We measured airborne fungal contamination and the incidence of IA among immunocompromised patients, and evaluated their correlation with different types of construction works. Methods Our tertiary hospital in Seoul, Korea underwent facility construction from September 2017 to February 2018. We divided the entire construction period into period 1 (heavier works: demolition and excavation) and period 2 (lighter works: framing, interior designing, plumbing, and finishing). We conducted monthly air sampling for environmental spore surveillance in three hematologic wards. We evaluated the incidence of IA among all immunocompromised patients hospitalized in the three hematologic wards (2 adult wards and 1 pediatric ward) during this period. IA was categorized into proven, probable, and possible aspergillosis based on the revised European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Results A total of 15 patients was diagnosed with proven (1 case), probable (8 cases), or possible (6 cases) hospital-acquired IA during period 1. In period 2, 14 patients were diagnosed with either proven (1 case), probable (10 cases), or possible (3 cases) hospital-acquired IA. Total mold and Aspergillus spp. spore levels in the air tended to be higher in period 1 (p = 0.06 and 0.48, respectively). The incidence rate of all IA by the EORTC/MSG criteria was significantly higher in period 1 than in period 2 (1.891 vs. 0.930 per 1000 person-days, p = 0.05). Conclusions Airborne fungal spore levels tended to be higher during the period with heavier construction works involving demolition and excavation, during which the incidence of IA was significantly higher as well. We recommend monitoring airborne fungal spore levels during construction periods in hospitals with immunocompromised patients. Subsequently, the effect of airborne fungal spore level monitoring in reducing hospital-acquired IA should be evaluated. Electronic supplementary material The online version of this article (10.1186/s13756-019-0543-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joung Ha Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505 Republic of Korea
| | - Seung Hee Ryu
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Young Lee
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeon Jeong Kim
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Hee Kwak
- 2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505 Republic of Korea.,2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jina Lee
- 3Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heungsup Sung
- 4Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505 Republic of Korea.,2Office for Infection Control, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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