Room ventilation and the risk of airborne infection transmission in three health care settings within a large teaching hospital

Background: Room ventilation is a key determinant of airborne disease transmission. Despite this, ventilation guidelines in hospitals are not founded on robust scientific evidence related to prevention of airborne transmission. Methods: We sought to assess the effect of ventilation rates on influenza, tuberculosis (TB) and rhinovirus infection risk within three distinct rooms in a major urban hospital; a Lung Function Laboratory, Emergency Department (ED) Negative-pressure Isolation Room and an Outpatient Consultation Room were investigated. Air exchange rate measurements were performed in each room using CO2 as a tracer. Gammaitoni and Nucci’s model was employed to estimate infection risk. Results: Current outdoor air exchange rates in the Lung Function Laboratory and ED Isolation Room limited infection risks to between 0.1 and 3.6%. Influenza risk for individuals entering an Outpatient Consultation Room after an infectious individual departed ranged from 3.6 to 20.7%, depending on the duration for which each person occupied the room. Conclusions: Given the absence of definitive ventilation guidelines for hospitals, air exchange measurements combined with modelling afford a useful means of assessing, on a case-by-case basis, the suitability of room ventilation at preventing airborne disease transmission.

Risk assessment for airborne infectious diseases between natural ventilation and split-system air conditioner in a university classroom

Indoor air quality is a critical factor in the classroom due to high people concentration in a unique space. Indoor air pollutant might increase the chance of both long and short-term health problems among students and staff, reduce the productivity of teachers and degrade the student’s learning environment and comfort. Adequate air distribution strategies may reduce risk of infection in classroom. So, the purpose of air distribution systems in a classroom is not only to maximize conditions for thermal comfort, but also to remove indoor contaminants. Natural ventilation has the potential to play a significant role in achieving improvements in IAQ. The present study compares the risk of airborne infection between Natural Ventilation (opening windows and doors) and a Split-System Air Conditioner in a university classroom. The Wells-Riley model was used to predict the risk of indoor airborne transmission of infectious diseases such as influenza, measles and tuberculosis. For each case, the air exchange rate was measured using a CO2 tracer gas technique. It was found that opening windows and doors provided an air exchange rate of 2.3 air changes/hour (ACH), while with the Split System it was 0.6 ACH. The risk of airborne infection ranged between 4.24 to 30.86 % when using the Natural Ventilation and between 8.99 to 43.19% when using the Split System. The difference of airborne infection risk between the Split System and the Natural Ventilation ranged from 47 to 56%. Opening windows and doors maximize Natural Ventilation so that the risk of airborne contagion is much lower than with Split System.

Ftalato de di-(2-etilexila) (DEHP) em bolsas de PVC para soluções parenterais de grandes volumes

Large volume parenteral solutions (LVPS) are widely used as vehicles for intravenous administration of drugs and polyvinyl chloride (PVC) flexible bags are, nowadays, the plastic containers most commonly used to pack and drip-feed LVPS. An advantage of using bags is that they collapse flat and thus reduce the risk of airborne contamination and embolism caused by air in the bloodstream. They are mainly used in hospitals. This review deals with some important aspects of the PVC packaging containing the plasticizer DEHP, generally used to pack LVPS. The interaction between drug and package is discussed, with an emphasis on the migration of DEHP from the PVC bag to LVPS containing the immunosuppressant cyclosporin, and toxicological aspects are considered.

Mycoplasma-induced minimally conscious state

Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.

Ecological systems approaches to aerobiology, II : development, demonstration and evaluation of models : proceedings of workshop/conference II, National Center for Atmospheric Research, Boulder, Colorado, 12-14 July 1972 /

At head of title: International Biological Program, United States National Committee, Aerobiology Program.

Broadening the perspective on the airborne transmission of respiratory infection

Airborne bioaerosols are becoming increasingly recognized as a potential route of transmission for the spread of bacterial and viral respiratory tract infections.

The risk of airborne influenza transmission in passenger cars

Travel in passenger cars is a ubiquitous aspect of the daily activities of many people. During the 2009 influenza A (H1N1) pandemic a case of probable transmission during car travel was reported in Australia, to which spread via the airborne route may have contributed. However, there are no data to indicate the likely risks of such events, and how they may vary and be mitigated. To address this knowledge gap, we estimated the risk of airborne influenza transmission in two cars (1989 model and 2005 model) by employing ventilation measurements and a variation of the Wells-Riley model. Results suggested that infection risk can be reduced by not recirculating air; however, estimated risk ranged from 59 to 99.9% for a 90 min trip when air was recirculated in the newer vehicle. These results have implications for interrupting in-car transmission of other illnesses spread by the airborne route.

A Method For Producing Airborne Pollen Source Inventories: An Example of Ambrosia (Ragweed) on the Pannonian Plain

We present here a simple methodology for calculating species inventories for allergenic pollen that can be used by atmospheric transport models. Ragweed (Ambrosia) species distribution or infection level on the Pannonian Plain has been used as an example of how the methodology can be used. The Pannonian Plain is one of the three main regions in Europe recognized as being polluted by Ambrosia. The methodology relies on spatial variations in annual Ambrosia pollen counts, knowledge on ragweed ecology and detailed land cover information. The results of this analysis showed that some of the highest mean annual ragweed pollen concentrations were witnessed around Kecskemét in central Hungary and Novi Sad in northern Serbia. These areas are also the areas with the highest density of Ambrosia habitats. The resulting inventory can be entered into atmospheric transport models in combination with other components such as a phenological model and a model for daily pollen release, in order to simulate the movement of ragweed pollen from the Pannonian Plain. The methodology is likely to be generally applicable for creating inventories of species distribution of allergenic plants. The main requirement is availability of: detailed land cover information; pollen indexes; a list of the most important habitats; and a region of interest that is mainly influenced by local sources.

Risk of Exposure to Airborne Ambrosia Pollen from Local and Distant Sources in Europe – an Example from Denmark

Background. Ambrosia artemisiifolia L. is a noxious invasive alien species in Europe. It is an important aeroallergen and millions of people are exposed to its pollen. Objective. The main aim of this study is to show that atmospheric concentrations of Ambrosia pollen recorded in Denmark can be derived from local or more distant sources. Methods. This was achieved by using a combination of pollen measurements, air mass trajectory calculations using the HYPLIT model and mapping all known Ambrosia locations in Denmark and relating them to land cover types. Results. The annual pollen index recorded in Copenhagen during a 15-year period varied from a few pollen grains to more than 100. Since 2005, small quantities of Ambrosia pollen has been observed in the air every year. We have demonstrated, through a combination of Lagrangian back-trajectory calculations and atmospheric pollen measurements, that pollen arrived in Denmark via long-distance transport from centres of Ambrosia infection, such as the Pannonian Plain and Ukraine. Combining observations with results from a local scale dispersion model show that it is possible that Ambrosia pollen could be derived from local sources identified within Denmark. Conclusions. The high allergenic capacity of Ambrosia pollen means that only small amounts of pollen are relevant for allergy sufferers, and just a few plants will be sufficient to produce enough pollen to affect pollen allergy sufferers within a short distance from the source. It is necessary to adopt control measures to restrict Ambrosia numbers. Recommendations for the removal of all Ambrosia plants can effectively reduce the amount of local pollen, as long as the population of Ambrosia plants is small.

Identification of a new cell line permissive to porcine reproductive and respiratory syndrome virus infection and replication which is phenotypically distinct from MARC-145 cell line

Background Airborne transmitted pathogens, such as porcine reproductive and respiratory syndrome virus (PRRSV), need to interact with host cells of the respiratory tract in order to be able to enter and disseminate in the host organism. Pulmonary alveolar macrophages (PAM) and MA104 derived monkey kidney MARC-145 cells are known to be permissive to PRRSV infection and replication and are the most studied cells in the literature. More recently, new cell lines developed to study PRRSV have been genetically modified to make them permissive to the virus. The SJPL cell line origin was initially reported to be epithelial cells of the respiratory tract of swine. Thus, the goal of this study was to determine if SJPL cells could support PRRSV infection and replication in vitro. Results The SJPL cell growth was significantly slower than MARC-145 cell growth. The SJPL cells were found to express the CD151 protein but not the CD163 and neither the sialoadhesin PRRSV receptors. During the course of the present study, the SJPL cells have been reported to be of monkey origin. Nevertheless, SJPL cells were found to be permissive to PRRSV infection and replication even if the development of the cytopathic effect was delayed compared to PRRSV-infected MARC-145 cells. Following PRRSV replication, the amount of infectious viral particles produced in SJPL and MARC-145 infected cells was similar. The SJPL cells allowed the replication of several PRRSV North American strains and were almost efficient as MARC-145 cells for virus isolation. Interestingly, PRRSV is 8 to 16 times more sensitive to IFNα antiviral effect in SJPL cell in comparison to that in MARC-145 cells. PRRSV induced an increase in IFNβ mRNA and no up regulation of IFNα mRNA in both infected cell types. In addition, PRRSV induced an up regulation of IFNγ and TNF-α mRNAs only in infected MARC-145 cells. Conclusions In conclusion, the SJPL cells are permissive to PRRSV. In addition, they are phenotypically different from MARC-145 cells and are an additional tool that could be used to study PRRSV pathogenesis mechanisms in vitro.

The role of seeds and airborne inoculum in the initiation of leaf blotch (Rhynchosporium secalis) epidemics in winter barley

Both airborne spores of Rhynchosporium secalis and seed infection have been implied as major sources of primary inoculum for barley leaf blotch (scald) epidemics in fields without previous history of barley cropping. However, little is known about their relative importance in the onset of disease. Results from both quantitative real-time PCR and visual assessments indicated that seed infection was the main source of inoculum in the field trial conducted in this study. Glasshouse studies established that the pathogen can be transmitted from infected seeds into roots, shoots and leaves without causing symptoms. Plants in the field trial remained symptomless for approximately four months before symptoms were observed in the crop. Covering the crop during part of the growing season was shown to prevent pathogen growth, despite the use of infected seed, indicating that changes in the physiological condition of the plant and/or environmental conditions may trigger disease development. However, once the disease appeared in the field it quickly became uniform throughout the cropping area. Only small amounts of R. secalis DNA were measured in 24 h spore-trap tape samples using PCR. Inoculum levels equivalent to spore concentrations between 30 and 60 spores per m3 of air were only detected on three occasions during the growing season. The temporal pattern and level of detection of R. secalis DNA in spore tape samples indicated that airborne inoculum was limited and most likely represented rain-splashed conidia rather than putative ascospores.

Experimental airborne transmission of Salmonella Agona and Salmonella Typhimurium in weaned pigs

This study tested the hypothesis of airborne transmission of Salmonella Agona (Trial I) and Salmonella Typhimurium (Trial II) in weaned pigs. The trials were performed using stainless-steel/glass isolation cabinets connected by air ducts to permit an unidirectional airflow from cabinet 1 (two control pigs) to cabinet 3 (two sentinel pigs), passing through cabinet 2 (two inoculated pigs). Air samples, pooled faecal samples from the floor and rectal swabs were collected daily and assessed by culture and PCR. A fumigation chamber and rubber gloves coupled to the cabinets allowed sampling without opening the system. Trials I and II lasted 15 and 19 days respectively. The recovery of S. Agona and S. Typhimurium and detection of scroconversion in sentinel pigs indicate that airborne Salmonella transmission in weaned pigs over short distances is possible. Further studies on the role of aerosols in the epidemiology of Salmonella in intensive pig production should be performed.

Viral infections in workers in hospital and research laboratory settings: a comparative review of infection modes and respective biosafety aspects

Objectives: To compare modes and sources of infection and clinical and biosafety aspects of accidental viral infections in hospital workers and research laboratory staff reported in scientific articles. Methods: PubMed, Google Scholar, ISI Web of Knowledge, Scirus, and Scielo were searched (to December 2008) for reports of accidental viral infections, written in English, Portuguese, Spanish, or German; the authors' personal file of scientific articles and references from the articles retrieved in the initial search were also used. Systematic review was carried out with inclusion criteria of presence of accidental viral infection's cases information, and exclusion criteria of absence of information about the viral etiology, and at least probable mode of infection.Results: One hundred and forty-one scientific articles were obtained, 66 of which were included in the analysis. For arboviruses, 84% of the laboratory infections had aerosol as the source; for alphaviruses alone, aerosol exposure accounted for 94% of accidental infections. of laboratory arboviral infections, 15.7% were acquired percutaneously, whereas 41.6% of hospital infections were percutaneous. For airborne viruses, 81% of the infections occurred in laboratories, with hantavirus the leading causative agent. Aerosol inhalation was implicated in 96% of lymphocytic choriomeningitis virus infections, 99% of hantavirus infections, and 50% of coxsackievirus infections, but infective droplet inhalation was the leading mode of infection for severe acute respiratory syndrome coronavirus and the mucocutaneous mode of infection was involved in the case of infection with influenza B. For blood-borne viruses, 92% of infections occurred in hospitals and 93% of these had percutaneous mode of infection, while among laboratory infections 77% were due to infective aerosol inhalation. Among blood-borne virus infections there were six cases of particular note: three cases of acute hepatitis following hepatitis C virus infection with a short period of incubation, one laboratory case of human immunodeficiency virus infection through aerosol inhalation, one case of hepatitis following hepatitis G virus infection, and one case of fulminant hepatitis with hepatitis B virus infection following exposure of the worker's conjunctiva to hepatitis B virus e antigen-negative patient saliva. of the 12 infections with viruses with preferential mucocutaneous transmission, seven occurred percutaneously, aerosol was implicated as a possible source of infection in two cases, and one atypical infection with Macacine herpesvirus 1 with fatal encephalitis as the outcome occurred through a louse bite. One outbreak of norovirus infection among hospital staff had as its probable mode of infection the ingestion of inocula spread in the environment by fomites.Conclusions: The currently accepted and practiced risk analysis of accidental viral infections based on the conventional dynamics of infection of the etiological agents is insufficient to cope with accidental viral infections in laboratories and to a lesser extent in hospitals, where unconventional modes of infection are less frequently present but still have relevant clinical and potential epidemiological consequences. Unconventional modes of infection, atypical clinical development, or extremely severe cases are frequently present together with high viral loads and high virulence of the agents manipulated in laboratories. In hospitals by contrast, the only possible association of atypical cases is with the individual resistance of the worker. Current standard precaution practices are insufficient to prevent most of the unconventional infections in hospitals analyzed in this study; it is recommended that special attention be given to flaviviruses in these settings. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.