Impact of supplementary air filtration on aerosols and particulate matter in a UK hospital ward: a case study.

BACKGROUND: Aerosol spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a major problem in hospitals, leading to an increase in supplementary high-efficiency particulate air filtration aimed at reducing nosocomial transmission. This article reports a natural experiment that occurred when an air cleaning unit (ACU) on a medicine for older people ward was switched off accidentally while being commissioned. AIM: To assess aerosol transport within the ward and determine whether the ACU reduced airborne particulate matter (PM) levels. METHODS: An ACU was placed in a ward comprising two six-bedded bays plus three single-bed isolation rooms which had previously experienced several outbreaks of coronavirus disease 2019. During commissioning, real-time measurements of key indoor air quality parameters (PM1-10, CO2, temperature and humidity) were collected from multiple sensors over 2 days. During this period, the ACU was switched off accidentally for approximately 7 h, allowing the impact of the intervention on PM to be assessed. FINDINGS: The ACU reduced the PM counts considerably (e.g. PM1 65.5-78.2%) throughout the ward (P<0.001 all sizes), with positive correlation found for all PM fractions and CO2 (r=0.343-0.817; all P<0.001). PM counts rose/fell simultaneously when the ACU was off, with correlation of PM signals from multiple locations (e.g. r=0.343-0.868; all P<0.001) for particulates <1 µm). CONCLUSION: Aerosols migrated rapidly between the various ward subcompartments, suggesting that social distancing alone cannot prevent nosocomial transmission of SARS-CoV-2 as this fails to mitigate longer-range (>2 m) transmission. The ACU reduced PM levels considerably throughout the ward space, indicating its potential as an effective intervention to reduce the risk posed by infectious airborne particles.

Comparative evaluation of the hygienic efficacy of an ultra-rapid hand dryer vs conventional warm air hand dryers.

AIMS: To compare an ultra-rapid hand dryer against warm air dryers, with regard to: (A) bacterial transfer after drying and (B) the impact on bacterial numbers of rubbing hands during dryer use. METHODS AND RESULTS: The Airblade™ dryer (Dyson Ltd) uses two air 'knives' to strip water from still hands, whereas conventional dryers use warm air to evaporate moisture whilst hands are rubbed together. These approaches were compared using 14 volunteers; the Airblade™ and two types of warm air dryer. In study (A), hands were contaminated by handling meat and then washed in a standardized manner. After dryer use, fingers were pressed onto foil and transfer of residual bacteria enumerated. Transfers of 0-10(7) CFU per five fingers were observed. For a drying time of 10 s, the Airblade™ led to significantly less bacterial transfer than the other dryers (P < 0·05; range 0·0003-0·0015). When the latter were used for 30-35 s, the trend was for the Airblade to still perform better, but differences were not significant (P > 0·05, range 0·1317-0·4099). In study (B), drying was performed ± hand rubbing. Contact plates enumerated bacteria transferred from palms, fingers and fingertips before and after drying. When keeping hands still, there was no statistical difference between dryers, and reduction in the numbers released was almost as high as with paper towels. Rubbing when using the warm air dryers inhibited an overall reduction in bacterial numbers on the skin (P < 0·05). CONCLUSIONS: Effective hand drying is important for reducing transfer of commensals or remaining contaminants to surfaces. Rubbing hands during warm air drying can counteract the reduction in bacterial numbers accrued during handwashing. SIGNIFICANCE AND IMPACT OF THE STUDY: The Airblade™ was superior to the warm air dryers for reducing bacterial transfer. Its short, 10 s drying time should encourage greater compliance with hand drying and thus help reduce the spread of infectious agents via hands.

An aerobiological model of aerosol survival of different strains of Pseudomonas aeruginosa isolated from people with cystic fibrosis.

Pseudomonas aeruginosa is a common and important pathogen in people with cystic fibrosis (CF). Recently epidemic strains of P. aeruginosa associated with increased morbidity, have been identified. The method of transmission is not clear, but there is evidence of a potential airborne route. The aim of this study was to determine whether different strains of P. aeruginosa isolated from people with CF were able to survive within artificially generated aerosols in an aerobiological chamber. Viable P. aeruginosa could still be detected up to 45min after halting generation of the aerosols. All of the strains of P. aeruginosa expressing a non-mucoid phenotype isolated from people with CF had a reduced ability to survive within aerosols compared to an environmental strain. Expression of a mucoid phenotype by the strains of P. aeruginosa isolated from people with CF promoted survival in the aerosol model compared to strains expressing a non-mucoid phenotype.

A new tool for the management of infection in patients with febrile neutropenia.

BACKGROUND: We describe a novel analytical technique for determining instantaneous trends in body temperature data, which may assist clinicians in optimizing antimicrobial therapy in patients with febrile neutropenia. The paper presents a new algorithm, based on a modified second backward difference (M2BD) matrix filter for monitoring temperature response to anti-microbial chemotherapies in neutropenic patients and develops techniques for extracting accurate, instantaneous trend data from clinical time series data. Such an algorithm is needed because it is difficult to assess patient wellbeing in those who are neutropenic. Temperature data, a key indicator of response to antimicrobial therapy, are typically very noisy, with many fluctuations, making it very difficult to identify underlying trends in real time. Clinicians are therefore forced to make important decisions concerning drug therapy on imperfect data. METHODS: In order to determine the underlying temperature trend, analysis of synthetic time series data (with a known underlying trend) was undertaken using both the CUSUM technique and the M2BD matrix filter. The CUSUM analysis was undertaken using four reference temperatures, 37.5 degrees C, 38.0 degrees C, 38.5 degrees C and 39.0 degrees C. A validation study was also undertaken using four sets of noisy synthetic temperature data to evaluate the performance of the M2BD filter. The M2BD filter was then used to analyse anonymized serial temperature data from a neutropenic patient undergoing chemotherapy. RESULTS: For all four reference temperatures the CUSUM analysis failed to predict the underlying temperature trend. By comparison, the M2BD filter extracted, in real time, the underlying temperature trend with great accuracy and no time lag. In the validation study, the M2BD filter accurately extracted the underlying temperature trend for all four of the synthetic datasets. With regard to the anonymized patient data, the M2BD filter again performed well, accurately determining the underlying trend. CONCLUSION: The study demonstrated that the M2BD filter is capable of instantaneously extracting underlying trends from clinical time series data. This finding suggests that this algorithm has great potential as a tool for assisting clinicians in the management of patients with febrile neutropenia.

Amino acid partitioning using a Fiedler vector model.

This paper presents a new Fiedler vector model for categorising amino acids, which is based on the Miyazawa-Jernigan matrix. The model splits the amino acid residues into two hydrophobic groups (LFI) and (MVWCY) and two polar groups (HATGP) and (RQSNEDK). In so doing, it independently confirms the findings of Wang and Wang and Cieplak et al. and demonstrates the validity of using eigenvectors to partition amino acid groups.

Modelling the transmission of airborne infections in enclosed spaces.

The Wells-Riley equation for modelling airborne infection in indoor environments is incorporated into an SEIR epidemic model with a short incubation period to simulate the transmission dynamics of airborne infectious diseases in ventilated rooms. The model enables the effect of environmental factors such as the ventilation rate and the room occupancy to be examined, and allows the long-term impact of infection control measures to be assessed. A theoretical parametric study is carried out to demonstrate how changes to both the physical environment and infection control procedures may potentially limit the spread of short-incubation-period airborne infections in indoor environments such as hospitals.

The transmission of tuberculosis in confined spaces: an analytical review of alternative epidemiological models.

Tuberculosis (TB) is a disease that is closely associated with poverty, with transmission occurring in situations where infected persons are in close contact with others in confined spaces. While it is well recognised that overcrowding increases the risk of transmission, this increased risk has not been quantified and the relationship between overcrowding and duration of exposure is not well understood. This paper analyses three epidemiological models that have been used to predict the transmission of airborne disease in confined spaces: the Mass Action model, Riley, Murphy and Riley's model and Gammaitoni and Nucci's model. A study is presented to demonstrate the range of applicability of each model and show how they can be applied to the transmission of both TB and diseases with short incubation periods such as measles. Gammiatoni and Nucci's generalised formulation is shown to be the most suitable for modelling airborne transmission in ventilated spaces, and it is subsequently used in a parametric study to evaluate the effect of physical and environmental factors on the rate of disease transmission. The paper also presents reported quanta production data for several TB outbreaks and demonstrates that the greatest risk of TB infection is during clinical procedures that produce large quantities of aerosol, such as bronchoscopy or intubation.

Susceptibility of Burkholderia cepacia and other pathogens of importance in cystic fibrosis to u.v. light.

To investigate the potential usefulness of u.v. germicidal irradiation (UVGI) in preventing the spread of Burkholderia cepacia, an important pathogen in cystic fibrosis (CF), the in-vitro susceptibility of B. cepacia to UVGI was determined. Five strains were exposed to UVGI from a 7.2-W source. Burkholderia cepacia was less susceptible to UVGI than other important CF-related pathogens, namely Staphylococcus aureus and Pseudomonas aeruginosa, but was more susceptible than Stenotrophomonas maltophilia. No strain of B. cepacia survived longer than an 8 s exposure to UVGI, with doses required to achieve 1 log reduction in bacterial numbers ranging from 28.3 to 57.5 J m(-2).

The resurgence of tuberculosis in the tropics. An engineering approach to the control of Mycobacterium tuberculosis and other airborne pathogens: a UK hospital based pilot study.

The world-wide occurrence of tuberculosis (TB) is very high, and in many parts of the world prevalence has reached epidemic proportions. While the WHO's global 'directly observed therapy short-course' (DOTS) programme has yielded some notable successes, it has reached only 12% of the world's TB cases (1996 data). This suggests that the use of drug therapy alone is not enough to solve the global TB problem and that prevention using public health engineering techniques may provide a complementary solution. There are a number of engineering control strategies, such as the use of ultraviolet germicidal irradiation (UVGI) and advanced ventilation techniques, which can be used to combat the spread of Mycobacterium tuberculosis and other airborne pathogens. This paper describes a pilot study currently being undertaken at the Leeds General Infirmary in the UK, which is investigating the use of UVGI to disinfect air in ward spaces.