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Bannan A, Kamal I, Al Makishah NH, Natto ZS. Reducing microbial airborne contamination and particulate matter using different oral suctions in dental clinic: A randomized controlled clinical trial. Saudi Dent J 2024; 36:374-380. [PMID: 38419981 PMCID: PMC10897624 DOI: 10.1016/j.sdentj.2023.11.029] [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: 08/18/2023] [Revised: 11/26/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024] Open
Abstract
Aim This study aimed to assess oral suction devices in declining microbial airborne contamination level and particulate matter. Materials and methods This open-label randomized clinical trial was conducted in an educational hospital with 50 participants above 18 years of age, who had scheduled an appointment at a dental hygienist clinic for scaling procedure. Particulate matter and microbial airborne contamination levels were taken at the beginning for 15 min and during of scaling procedure. Participants were randomized to five groups: low suction, high & low suction, intraoral suction (IOS), extra-oral suction (EOS) & low suction, and IOS & EOS. Repeated measured ANOVA analysis was carried out using STATA version 13. Results Participants had aged 34.4 ± 8.1 years and the average simplified oral hygiene index was 3.5 ± 1.2. Microbial airborne contamination level for each intervention group was different to baseline; low suction, intraoral suction, high & low suction, EOS & low suction, and EOS and intraoral suction were 1089 ± 610, 296.3 ± 321.2, 43.8 ± 52.1, 17.3 ± 7.3 and 14.3 ± 3.9, respectively [P value < 0.05]. Particulate matter shows evidence of no significant difference among oral suctions [P value > 0.05]. Conclusion Low or intraoral suction was not enough to reduce microbial airborne contamination for better infection control, practitioners highly recommended to use combination of suction devices. Clinical relevance Using extra-oral with intra-oral suction, or extra-oral suction with low section, or high & low suction are potentially better in microbial airborne contamination reduction compared with low or intraoral suction only. Trial registration Clinicaltrials.gov (NCT05848245) on April 14, 2023.
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Affiliation(s)
- Abraar Bannan
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Iman Kamal
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Public Health, Faculty of Medicine, AlAzhar University, Egypt
| | - Naief H. Al Makishah
- Department of Environmental Science, Faculty of Environmental Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zuhair S. Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Cao R, Qiu P, Xu B, Lin J, Chu D, Fan Z. Effectiveness of interventions to reduce aerosol generation in dental environments: A systematic review. Prev Med Rep 2023; 35:102383. [PMID: 37680854 PMCID: PMC10480641 DOI: 10.1016/j.pmedr.2023.102383] [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: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
Certain dental procedures produce high levels of aerosols containing pathogenic microorganisms, posing a risk for the transmission of infections in dental settings. This study aimed to assess the effectiveness of various aerosol mitigation interventions during clinical dental procedures in real-world environments. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase for English studies up to March 2023 according to the PRISMA guidelines. Only peer-reviewed controlled clinical trials (CCT) or randomized controlled trials (RCT) studies involving human subjects were included. The risk of bias of selected researches were evaluated by two independent authors using the Cochrane Collaboration tool. The literature search yielded 3491 articles, of which 42 studies met the inclusion criteria and were included in this study. Most studies evaluated bacterial contamination in bio-aerosols, while the viral and fungal contamination was assessed in only three studies. Overall, various approaches have been applied in reducing aerosol contamination in clinical scenarios, including high-volume evacuators (HVE), mouse rinses and rubber dams, air cleaning systems, and high-efficiency particulate air (HEPA) filters. The available evidence suggests that various aerosol mitigation strategies could be implemented to decrease the risk of cross-infection during clinical dental procedures in real-world environments. However, further clinical trials are necessary to establish statistical validity in measuring aerosol contamination and mitigation, as well as to evaluate the risk of infection transmission for viral and fungal contamination.
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Affiliation(s)
- Rongkai Cao
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Piaopiao Qiu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Borui Xu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Jingying Lin
- College of Environmental Science and Engineering, Tongji University, Shanghai 200092, PR China
| | - Danna Chu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Zhen Fan
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
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Glenn K, He J, Rochlin R, Teng S, Hecker JG, Novosselov I. Assessment of aerosol persistence in ICUs via low-cost sensor network and zonal models. Sci Rep 2023; 13:3992. [PMID: 36899063 PMCID: PMC10006437 DOI: 10.1038/s41598-023-30778-7] [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: 11/19/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
The COVID-19 pandemic raised public awareness about airborne particulate matter (PM) due to the spread of infectious diseases via the respiratory route. The persistence of potentially infectious aerosols in public spaces and the spread of nosocomial infections in medical settings deserve careful investigation; however, a systematic approach characterizing the fate of aerosols in clinical environments has not been reported. This paper presents a methodology for mapping aerosol propagation using a low-cost PM sensor network in ICU and adjacent environments and the subsequent development of the data-driven zonal model. Mimicking aerosol generation by a patient, we generated trace NaCl aerosols and monitored their propagation in the environment. In positive (closed door) and neutral-pressure (open door) ICUs, up to 6% or 19%, respectively, of all PM escaped through the door gaps; however, the outside sensors did not register an aerosol spike in negative-pressure ICUs. The K-means clustering analysis of temporospatial aerosol concentration data suggests that ICU can be represented by three distinct zones: (1) near the aerosol source, (2) room periphery, and (3) outside the room. The data suggests two-phase plume behavior: dispersion of the original aerosol spike throughout the room, followed by an evacuation phase where "well-mixed" aerosol concentration decayed uniformly. Decay rates were calculated for positive, neutral, and negative pressure operations, with negative-pressure rooms clearing out nearly twice as fast. These decay trends closely followed the air exchange rates. This research demonstrates the methodology for aerosol monitoring in medical settings. This study is limited by a relatively small data set and is specific to single-occupancy ICU rooms. Future work needs to evaluate medical settings with high risks of infectious disease transmission.
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Affiliation(s)
- K Glenn
- Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - J He
- Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - R Rochlin
- Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - S Teng
- Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - J G Hecker
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - I Novosselov
- Department of Mechanical Engineering, University of Washington, Seattle, USA.
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Demirkol N, Karagozoglu I, Kocer IK. Efficiency of HEPA-filtered extra-oral suction unit on aerosols during prosthetic dental preparation: A pilot study. Clin Oral Investig 2023; 27:1937-1944. [PMID: 36604343 DOI: 10.1007/s00784-022-04850-x] [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: 08/22/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Aerosols formed during dental treatments have a huge risk for the spread of bacteria and viruses. This study is aimed at determining which part of the working area and at what size aerosol is formed and ensuring more effective use of HEPA-filtered devices. MATERIALS AND METHODS Anterior tooth preparation was performed by one dentist with one patient. Particle measurements were made using an airborne particle counter and were taken at four different locations: the chest of the patient, the chest of the dentist, the center of the room, and near the window. Three groups were determined for this study: group 1: measurement in a 24-h ventilated room (before the tooth preparation, empty room), group 2: measurement with the use of saliva ejector (SE), and group 3: measurement with the use of saliva ejector and HEPA-filtered extra-oral suction (HEOS) unit. RESULTS The particles generated during tooth preparation were separated according to their sizes; the concentration in different locations of the room and the efficiency of the HEOS unit were examined. CONCLUSIONS The present study showed that as the particle size increases, the rate of spread away from the dentist's working area decreases. The HEPA-filtered extra-oral suction unit is more effective on particles smaller than 0.5 microns. Therefore, infection control methods should be arranged according to these results. CLINICAL RELEVANCE The effective and accurate use of HEPA-filtered devices in clinics significantly reduces the spread of bacterial and viral infections and cross-infection.
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Affiliation(s)
- Nermin Demirkol
- Department of Prosthodontics, Faculty of Dentistry, Gaziantep University, Şahinbey, 27310, Gaziantep, Turkey
| | - Irem Karagozoglu
- Department of Prosthodontics, Faculty of Dentistry, Gaziantep University, Şahinbey, 27310, Gaziantep, Turkey.
| | - Ipek Kulekci Kocer
- Department of Medical Microbiology, Faculty of Medical, Sanko University, Gaziantep, Turkey
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Tang SGH, Hadi MHH, Arsad SR, Ker PJ, Ramanathan S, Afandi NAM, Afzal MM, Yaw MW, Krishnan PS, Chen CP, Tiong SK. Prerequisite for COVID-19 Prediction: A Review on Factors Affecting the Infection Rate. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12997. [PMID: 36293576 PMCID: PMC9602751 DOI: 10.3390/ijerph192012997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Since the year 2020, coronavirus disease 2019 (COVID-19) has emerged as the dominant topic of discussion in the public and research domains. Intensive research has been carried out on several aspects of COVID-19, including vaccines, its transmission mechanism, detection of COVID-19 infection, and its infection rate and factors. The awareness of the public related to the COVID-19 infection factors enables the public to adhere to the standard operating procedures, while a full elucidation on the correlation of different factors to the infection rate facilitates effective measures to minimize the risk of COVID-19 infection by policy makers and enforcers. Hence, this paper aims to provide a comprehensive and analytical review of different factors affecting the COVID-19 infection rate. Furthermore, this review analyses factors which directly and indirectly affect the COVID-19 infection risk, such as physical distance, ventilation, face masks, meteorological factor, socioeconomic factor, vaccination, host factor, SARS-CoV-2 variants, and the availability of COVID-19 testing. Critical analysis was performed for the different factors by providing quantitative and qualitative studies. Lastly, the challenges of correlating each infection risk factor to the predicted risk of COVID-19 infection are discussed, and recommendations for further research works and interventions are outlined.
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Affiliation(s)
- Shirley Gee Hoon Tang
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Muhamad Haziq Hasnul Hadi
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Siti Rosilah Arsad
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Pin Jern Ker
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Santhi Ramanathan
- Faculty of Business, Multimedia University, Jalan Ayer Keroh Lama, Malacca 75450, Malaysia
| | - Nayli Aliah Mohd Afandi
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Madihah Mohd Afzal
- Center for Toxicology and Health Risk Studies (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Mei Wyin Yaw
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Prajindra Sankar Krishnan
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Chai Phing Chen
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - Sieh Kiong Tiong
- Institute of Sustainable Energy, Department of Electrical & Electronics, Universiti Tenaga Nasional, Kajang 43000, Malaysia
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Zhang Y, Hui FKP, Duffield C, Saeed AM. A review of facilities management interventions to mitigate respiratory infections in existing buildings. BUILDING AND ENVIRONMENT 2022; 221:109347. [PMID: 35782231 PMCID: PMC9238148 DOI: 10.1016/j.buildenv.2022.109347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/01/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
The Covid-19 pandemic reveals that the hazard of the respiratory virus was a secondary consideration in the design, development, construction, and management of public and commercial buildings. Retrofitting such buildings poses a significant challenge for building owners and facilities managers. This article reviews current research and practices in building operations interventions for indoor respiratory infection control from the perspective of facilities managers to assess the effectiveness of available solutions. This review systematically selects and synthesises eighty-six articles identified through the PRISMA process plus supplementary articles identified as part of the review process, that deal with facilities' operations and maintenance (O&M) interventions. The paper reviewed the context, interventions, mechanisms, and outcomes discussed in these articles, concluding that interventions for respiratory virus transmission in existing buildings fall into three categories under the Facilities Management (FM) discipline: Hard services (HVAC and drainage system controls) to prevent aerosol transmissions, Soft Services (cleaning and disinfection) to prevent fomite transmissions, and space management (space planning and occupancy controls) to eliminate droplet transmissions. Additionally, the research emphasised the need for FM intervention studies that examine occupant behaviours with integrated intervention results and guide FM intervention decision-making. This review expands the knowledge of FM for infection control and highlights future research opportunities.
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Affiliation(s)
- Yan Zhang
- Department of Infrastructure Engineering, University of Melbourne, Level 6, Building 290, 700 Swanston Street, Carlton, Victoria, Australia
| | - Felix Kin Peng Hui
- Department of Infrastructure Engineering, University of Melbourne, Australia
| | - Colin Duffield
- Department of Infrastructure Engineering, University of Melbourne, Australia
| | - Ali Mohammed Saeed
- Department of Jobs, Regions and Precincts, Level 13, 1 Spring Street, Melbourne, Victoria, Australia
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Huang CH, He J, Austin E, Seto E, Novosselov I. Assessing the value of complex refractive index and particle density for calibration of low-cost particle matter sensor for size-resolved particle count and PM2.5 measurements. PLoS One 2021; 16:e0259745. [PMID: 34762676 PMCID: PMC8584671 DOI: 10.1371/journal.pone.0259745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022] Open
Abstract
Low-cost optical scattering particulate matter (PM) sensors report total or size-specific particle counts and mass concentrations. The PM concentration and size are estimated by the original equipment manufacturer (OEM) proprietary algorithms, which have inherent limitations since particle scattering depends on particles' properties such as size, shape, and complex index of refraction (CRI) as well as environmental parameters such as temperature and relative humidity (RH). As low-cost PM sensors are not able to resolve individual particles, there is a need to characterize and calibrate sensors' performance under a controlled environment. Here, we present improved calibration algorithms for Plantower PMS A003 sensor for mass indices and size-resolved number concentration. An aerosol chamber experimental protocol was used to evaluate sensor-to-sensor data reproducibility. The calibration was performed using four polydisperse test aerosols. The particle size distribution OEM calibration for PMS A003 sensor did not agree with the reference single particle sizer measurements. For the number concentration calibration, the linear model without adjusting for the aerosol properties and environmental conditions yields an absolute error (NMAE) of ~ 4.0% compared to the reference instrument. The calibration models adjusted for particle CRI and density account for non-linearity in the OEM's mass concentrations estimates with NMAE within 5.0%. The calibration algorithms developed in this study can be used in indoor air quality monitoring, occupational/industrial exposure assessments, or near-source monitoring scenarios where field calibration might be challenging.
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Affiliation(s)
- Ching-Hsuan Huang
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Jiayang He
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, Washington, United States of America
| | - Elena Austin
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Igor Novosselov
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, Washington, United States of America
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Noordien N, Mulder-van Staden S, Mulder R. In Vivo Study of Aerosol, Droplets and Splatter Reduction in Dentistry. Viruses 2021; 13:1928. [PMID: 34696357 PMCID: PMC8539735 DOI: 10.3390/v13101928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Abstract
Oral health care workers (OHCW) are exposed to pathogenic microorganisms during dental aerosol-generating procedures. Technologies aimed at the reduction of aerosol, droplets and splatter are essential. This in vivo study assessed aerosol, droplet and splatter contamination in a simulated clinical scenario. The coolant of the high-speed air turbine was colored with red concentrate. The red aerosol, droplets and splatter contamination on the wrists of the OHCW and chests of the OHCW/volunteer protective gowns, were assessed and quantified in cm2. The efficacy of various evacuation strategies was assessed: low-volume saliva ejector (LV) alone, high-volume evacuator (HV) plus LV and an extra-oral dental aerosol suction device (DASD) plus LV. The Kruskal-Wallis rank-sum test for multiple independent samples with a post-hoc test was used. No significant difference between the LV alone compared to the HV plus LV was demonstrated (p = 0.372059). The DASD combined with LV resulted in a 62% reduction of contamination of the OHCW. The HV plus LV reduced contamination by 53% compared to LV alone (p = 0.019945). The DASD demonstrated a 50% reduction in the contamination of the OHCWs wrists and a 30% reduction in chest contamination compared to HV plus LV. The DASD in conjunction with LV was more effective in reducing aerosol, droplets and splatter than HV plus LV.
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Affiliation(s)
- Naeemah Noordien
- Paediatric Dentistry, The University of the Western Cape, Cape Town 7530, South Africa;
| | - Suné Mulder-van Staden
- Oral Medicine, Periodontology and Implantology Department, The University of the Western Cape, Cape Town 7530, South Africa
| | - Riaan Mulder
- Restorative Dentistry, The University of the Western Cape, Cape Town 7530, South Africa;
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