High-volume evacuation mitigates viral aerosol spread in dental procedures.

Dental healthcare personnel (DHCP) are subjected to microbe-containing aerosols and splatters in their everyday work. Safer work conditions must be developed to ensure the functioning of the healthcare system. By simulating dental procedures, we aimed to compare the virus-containing aerosol generation of four common dental instruments, and high-volume evacuation (HVE) in their mitigation. Moreover, we combined the detection of infectious viruses with RT-qPCR to form a fuller view of virus-containing aerosol spread in dental procedures. The air-water syringe produced the highest number of aerosols. HVE greatly reduced aerosol concentrations during procedures. The air-water syringe spread infectious virus-containing aerosols throughout the room, while other instruments only did so to close proximity. Additionally, infectious viruses were detected on the face shields of DHCP. Virus genomes were detected throughout the room with all instruments, indicating that more resilient viruses might remain infectious and pose a health hazard. HVE reduced the spread of both infectious viruses and viral genomes, however, it did not fully prevent them. We recommend meticulous use of HVE, a well-fitting mask and face shields in dental procedures. We advise particular caution when operating with the air-water syringe. Due to limited repetitions, this study should be considered a proof-of-concept report.

Cryptosporidium parvum: an emerging occupational zoonosis in Finland.

BACKGROUND: Cryptosporidiosis has increased in recent years in Finland. We aimed to identify risk factors for human cryptosporidiosis and to determine the significance of Cryptosporidium parvum as a causative agent. Based on notifications to the Finnish Infectious Disease Register (FIDR), we conducted a case-control study and genotyped Cryptosporidium species from patient samples from July to December 2019. We also retrieved the occupational cryptosporidiosis cases from 2011 to 2019 from the Finnish Register of Occupational Diseases (FROD). RESULTS: Of 272 patient samples analyzed, 76% were C. parvum and 3% C. hominis. In the multivariable logistic regression analysis of 82 C. parvum cases and 218 controls, cryptosporidiosis was associated with cattle contact (OR 81, 95% confidence interval (CI) 26-251), having a family member with gastroenteritis (OR 34, 95% CI 6.2-186), and spending time at one's own vacation home (OR 15, 95% CI 4.2-54). Of the cases, 65% had regular cattle contact. The most common gp60 subtypes identified were IIaA15G2R1 and IIaA13G2R1. In FROD, 68 recognized occupational cryptosporidiosis cases were registered in 2011-2019. CONCLUSIONS: C. parvum is the most common Cryptosporidium species found in humans in Finland and poses a moderate to high risk of occupational infection for people working with cattle. The number of occupational notifications of cryptosporidiosis increased between 2011 and 2019. Cryptosporidiosis should be recognized as an important occupational disease among persons working with livestock in Finland, criteria to identify occupational cryptosporidiosis need to be created, and occupational safety in cattle-related work should be improved.

Safe use of PHI6 IN the experimental studies.

Surrogate viruses theoretically provide an opportunity to study the viral spread in an indoor environment, a highly needed understanding during the pandemic, in a safe manner to humans and the environment. However, the safety of surrogate viruses for humans as an aerosol at high concentrations has not been established. In this study, Phi6 surrogate was aerosolized at high concentration (Particulate matter2.5: ∼1018 µg m-3) in the studied indoor space. Participants were closely followed for any symptoms. We measured the bacterial endotoxin concentration of the virus solution used for aerosolization as well as the concentration in the room air containing the aerosolized viruses. In addition, we measured how the bacterial endotoxin concentration of the sample was affected by different traditional virus purification procedures. Despite the purification, bacterial endotoxin concentration of the Phi6 was high (350 EU/ml in solution used for aerosols) with both (two) purification protocols. Bacterial endotoxins were also detected in aerosolized form, but below the occupational exposure limit of 90 EU/m3. Despite these concerns, no symptoms were observed in exposed humans when they were using personal protective equipment. In the future, purification protocols should be developed to reduce associated bacterial endotoxin levels in enveloped bacterial virus specimens to ensure even safer research use of surrogate viruses.

Exposure to bacterial and fungal bioaerosols in facilities processing biodegradable waste.

The aim of the study was to determine the exposure of workers within biodegradable waste processing facilities to bacteria and fungi to identify any exposures of potential concern to health. Occupational measurements were performed in six composting and three bioenergy (bioethanol or methane/biogas) producing facilities. Bioaerosols were measured from breathing zones with Button aerosol or open face cassette filter samplers, and swab specimens were taken from the nasal mucous membranes of the workers. Aspergillus fumigatus, Bacillus cereus group, Campylobacter spp., Salmonella spp., Streptomyces spp., and Yersinia spp. were determined by real-time polymerase chain reaction (qPCR). A. fumigatus, and mesophilic and thermophilic actinobacteria were also cultivated from filters. Bacterial airborne endotoxins collected by IOM samplers were analyzed using a Limulus assay. Bioaerosol levels were high, especially in composting compared to bioenergy producing facilities. Endotoxin concentrations in composting often exceeded the occupational exposure value of 90 EU/m3, which may be harmful to the health. In addition to endotoxins, the concentrations of A. fumigatus (up to 2.4 × 105 copies/m3) and actinobacteria/Streptomyces spp. (up to 1.6 × 106 copies/m3) in the air of composting facilities were often high. Microbial and endotoxin concentrations were typically highest in waste reception and pre-treatment, equal or decreased during processing and handling of treated waste, and lowest in wheel loader cabins and control rooms/outdoors. Still, the parameters measured in wheel loader cabins were often higher than in the control sites, which suggests that the use of preventive measures could be improved. B. cereus group, Salmonella spp., and Yersinia spp. were rarely detected in bioaerosols or nasal swabs. Although Campylobacter spp. DNA was rarely detected in air, as a new finding, Campylobacter ureolyticus DNA was frequently detected in the nasal mucous membranes of workers, based on partial 16S rDNA sequencing. Moreover, especially A. fumigatus and C. ureolyticus spp. DNA concentrations in swabs after the work shift were significantly higher than before the shift, which indicates their inhalation or growth during the work shift. Microbial qPCR analysis of bioaerosols and swab samples of nasal mucosa allowed measuring exposure in various work operations and during the work shift, identifying problems for health risk assessment to improve working conditions, and evaluating the effectiveness of preventive measures and personal protection of workers.

Combining Phi6 as a surrogate virus and computational large-eddy simulations to study airborne transmission of SARS-CoV-2 in a restaurant.

COVID-19 has highlighted the need for indoor risk-reduction strategies. Our aim is to provide information about the virus dispersion and attempts to reduce the infection risk. Indoor transmission was studied simulating a dining situation in a restaurant. Aerosolized Phi6 viruses were detected with several methods. The aerosol dispersion was modeled by using the Large-Eddy Simulation (LES) technique. Three risk-reduction strategies were studied: (1) augmenting ventilation with air purifiers, (2) spatial partitioning with dividers, and (3) combination of 1 and 2. In all simulations infectious viruses were detected throughout the space proving the existence long-distance aerosol transmission indoors. Experimental cumulative virus numbers and LES dispersion results were qualitatively similar. The LES results were further utilized to derive the evolution of infection probability. Air purifiers augmenting the effective ventilation rate by 65% reduced the spatially averaged infection probability by 30%-32%. This relative reduction manifests with approximately 15 min lag as aerosol dispersion only gradually reaches the purifier units. Both viral findings and LES results confirm that spatial partitioning has a negligible effect on the mean infection-probability indoors, but may affect the local levels adversely. Exploitation of high-resolution LES jointly with microbiological measurements enables an informative interpretation of the experimental results and facilitates a more complete risk assessment.

SARS-CoV-2 indoor environment contamination with epidemiological and experimental investigations.

SARS-CoV-2 has been detected both in air and on surfaces, but questions remain about the patient-specific and environmental factors affecting virus transmission. Additionally, more detailed information on viral sampling of the air is needed. This prospective cohort study (N = 56) presents results from 258 air and 252 surface samples from the surroundings of 23 hospitalized and eight home-treated COVID-19 index patients between July 2020 and March 2021 and compares the results between the measured environments and patient factors. Additionally, epidemiological and experimental investigations were performed. The proportions of qRT-PCR-positive air (10.7% hospital/17.6% homes) and surface samples (8.8%/12.9%) showed statistical similarity in hospital and homes. Significant SARS-CoV-2 air contamination was observed in a large (655.25 m3 ) mechanically ventilated (1.67 air changes per hour, 32.4-421 L/s/patient) patient hall even with only two patients present. All positive air samples were obtained in the absence of aerosol-generating procedures. In four cases, positive environmental samples were detected after the patients had developed a neutralizing IgG response. SARS-CoV-2 RNA was detected in the following particle sizes: 0.65-4.7 µm, 7.0-12.0 µm, >10 µm, and <100 µm. Appropriate infection control against airborne and surface transmission routes is needed in both environments, even after antibody production has begun.

Large-scale decontamination of disposable FFP2 and FFP3 respirators by hydrogen peroxide vapour, Finland, April to June 2020.

BackgroundThe shortage of FFP2 and FFP3 respirators posed a serious threat to the operation of the healthcare system at the onset of the COVID-19 pandemic.AimOur aim was to develop and validate a large-scale facility that uses hydrogen peroxide vapour for the decontamination of used respirators.MethodsA multidisciplinary and multisectoral ad hoc group of experts representing various organisations was assembled to implement the collection and transport of used FFP2 and FFP3 respirators from hospitals covering 86% of the Finnish population. A large-scale decontamination facility using hydrogen peroxide vapour was designed and constructed. Microbiological tests were used to confirm efficacy of hydrogen peroxide vapour decontamination together with a test to assess the effect of decontamination on the filtering efficacy and fit of respirators. Bacterial and fungal growth in stored respirators was determined by standard methods.ResultsLarge-scale hydrogen peroxide vapour decontamination of a range of FFP2 and FFP3 respirator models effectively reduced the recovery of biological indicators: Geobacillus stearothermophilus and Bacillus atrophaeus spores, as well as model virus bacteriophage MS2. The filtering efficacy and facial fit after hydrogen peroxide vapour decontamination were not affected by the process. Microbial growth in the hydrogen peroxide vapour-treated respirators indicated appropriate microbial cleanliness.ConclusionsLarge-scale hydrogen peroxide vapour decontamination was validated. After effective decontamination, no significant changes in the key properties of the respirators were detected. European Union regulations should incorporate a facilitated pathway to allow reuse of appropriately decontaminated respirators in a severe pandemic when unused respirators are not available.

Review of biological risks associated with the collection of municipal wastes.

In many countries, the management of household waste has recently changed with an increased focus upon waste sorting resulting in lower collection frequency for some waste fractions. A consequence of this is the potential for increased growth of microorganisms in the waste before collection, which can lead to an increased exposure via inhalation for waste collection workers. Through a review of the literature, we aimed to evaluate risks caused by waste collecting workers' exposure to bioaerosols and to illuminate potential measures to reduce the exposure. Across countries and waste types, median exposure to fungi, bacteria, and endotoxin were typically around 104 colony forming units (cfu)/m3, 104 cfu/m3, and 10 EU/m3, respectively. However, some studies found 10-20+ times higher or lower median exposure levels. It was not clear how different types of waste influence the occupational exposure levels. Factors such as high loading, ventilation in and cleaning of drivers' cabs, increased collection frequency, waste in sealed sacks, and use of hand sanitizer reduce exposure. Incidences of gastrointestinal problems, irritation of the eye and skin and symptoms of organic dust toxic syndrome have been reported in workers engaged in waste collection. Several studies reported a correlation between bioaerosol exposure level and reduced lung function as either a short or a long term effect; exposure to fungi and endotoxin is often associated with an inflammatory response in exposed workers. However, a better understanding of the effect of specific microbial species on health outcomes is needed to proceed to more reliable risk assessments. Due to the increasing recycling effort and to the effects of global warming, exposure to biological agents in this working sector is expected to increase. Therefore, it is important to look ahead and plan future measures as well as improve methods to prevent long and short-term health effects.

Peak exposures to main components of ash and gaseous diesel exhausts in closed and open ash loading stations at biomass-fuelled power plants.

Fly and bottom ashes are collected at power plants to reduce the environmental effects of energy production. However, handling the ashes causes health problems for operators, maintenance workers and truck drivers at the power plants. Hence, we evaluated ash loaders' peak inhalation exposures to the chemical components of ash and diesel exhausts in open and closed ash loading stations at biomass-fuelled combined heat and power plants. We also carried out chemical and morphological analyses of the ashes to evaluate their health hazard potential in order to find practical technical measures to reduce workers' exposure. On the basis of X-ray diffraction analyses, the main respirable crystalline ash compounds were SiO2, CaSO4, CaO, Ca2Al2SiO7, NaCl and Ca3Al2O6 in the fly ashes and SiO2, KAlSi3O8, NaAlSi3O8 and Ca2Al2SiO7 in the bottom ashes. The short-term exposure levels of respirable crystalline silica, inhalable inorganic dust, Cr, Mn, Ni and nitric oxide exceeded their Finnish eight hours occupational exposure limit values in the closed ash loading station. According to our observations, more attention should be paid to the ash-moistening process, the use of tank trucks instead of open cassette flatbed trucks, and the sealing of the loading line from the silo to the truck which would prevent spreading the ash into the air. The idling time of diesel trucks should also be limited, and ash loading stations should be equipped with exhaust gas ventilators. If working conditions make it impossible to keep to the OEL values, workers must use respirators and protect their eyes and skin.

The occupant as a source of house dust bacteria.

BACKGROUND: Markers for microbial groups are commonly measured in house dust samples to assess indoor exposure to microbes in studies on asthma and allergy. However, little is known about the sources of different microbes. A better understanding of the nature and origin of microbes present in the immediate environment of human beings is crucial if one wants to elucidate protective as well as adverse effects on human health. OBJECTIVE: To determine the extent to which the bacterial composition of mattress and floor dust reflects the presence of the human body in relation to other environmental sources. METHODS: House dust and skin surface swab samples of occupants in 4 homes were collected and analyzed for their bacterial content, using a culture-independent methodology. Bacterial sequences analyzed from the different house dusts and skin surface swabs represented random samples of bacteria present in a given sample. Highly similar sequences were grouped to assess biodiversity and to draw conclusions about the sources of bacteria. RESULTS: The bacterial flora in the house dust samples was found to be highly diverse and dominated by gram-positive bacteria. To a considerable extent, the presence of different bacterial groups was attributed to human sources. In the individuals' mattress dust samples, 69% to 88% of the bacterial sequences analyzed were associated with human origins. The respective percentages for the individual floor dusts ranged from 45% to 55%. CONCLUSION: Our study indicates that human-derived bacteria account for a large part of the mainly gram-positive bacterial content in house dust.

Predominance of Gram-positive bacteria in house dust in the low-allergy risk Russian Karelia.

Simple living conditions and farming environment have been associated with reduced risk for allergic diseases such as atopy and asthma but the factors responsible for this effect remain unresolved. We examined the bacterial composition of house dusts obtained from Finnish and Russian Karelia, two adjacent areas with high and low occurrence of atopic diseases respectively. Two dust mixes, both composed of 10 randomly selected dust samples from 349 Finnish and 417 Russian Karelian households were studied for bacterial biomarkers (DNA, Limulus-active endotoxin, 3-OH fatty acids, muramic acid) and for 16S rRNA gene sequences. Overall, the DNA cloning revealed more taxons (94 different genera) of dustborne bacteria than seen in any previous study on residential environments. Majority (67%) of the bacterial DNA clones in house dust from the low-allergy Russian Kareliarepresented Gram-positive bacteria (Firmicutes and Actinobacteria), predominantly Staphylococcaceae and Corynebacteriaceae. Russian Karelian dust showed up to 20-fold higher contents of muramic acid (marker of Gram-positive bacteria) and a sevenfold higher number of clones of animal-associated species, whereas in Finnish Karelian dust Gram-negatives (mainly Proteobacteria) predominated. Clones of plant-associated bacterial species and of chloroplast, indicating plant biomass, were more numerous in Finnish than in Russian Karelian dust. In conclusion, this study revealed major disparities between Finnish and Russian house dusts. The higher bacterial content and the predominance of Gram-positive bacteria in Russian dust may have implications for occurrence of atopy.

Variety in dustiness and hygiene quality of peat bedding.

Respiratory exposure to organic dust induces chronic pulmonary diseases both in farmers and horses. The aim of this study was to examine the variation of dustiness and hygiene quality of peat moss bedding. Materials studied were weakly decomposed sphagnum peat (A), weakly decomposed sphagnum peat warmed up in storage (> 30 degrees C) (B) and two more decomposed few-flowered sedge peats (C and D). The geometric mean of mesophilic fungi, thermotolerant fungi and thermophilic actinomycetes were determined from the material. Samples of inhalable dust and endotoxins were collected with IOM samplers and respirable dust with 10M foam samplers when the peat was rotated in a cylinder. The number of particles was detected with an optical particle counter. An LAL assay was used for analysing endotoxins from the filter samples. There were differences in the hygiene quality and dustiness between peat materials (p < 0.01). The geometric mean of fungi was smallest in material A. Warming-up increased the number of fungi in sphagnum peat, but on the other hand, it decreased the content of endotoxin (p < 0.01). Few-flowered peat materials contained thermophilic actinomycetes and material D also contained Aspergillus fumigatus. The concentrations of inhalable dust, respirable dust and the number of particles were smaller in the few-flowered peats (C-D) than in the sphagnum peats (A-B). It is concluded that there are differences in the dustiness and hygiene quality of peat bedding.

Mold-specific immunoglobulin G antibodies in a child population.

The determination of immunoglobulin G (IgG) antibodies to molds has been used as an objective evidence of significant mold exposure. Until present, no data have been published on antibody responses to molds in healthy children living in normal housing conditions. The microbe-specific IgG antibody concentrations of 21 molds and 3 actinobacteria were determined by enzyme-linked immunosorbent assay (ELISA) in 103 1- to 6-year-old children (12.4% of the population of that age), and in 111 7- to 14-year-old school children (12.1%). The international standard sera were available, and the IgG concentrations of the test sera could be expressed in mg/l. On average, IgG concentrations increased in relation to age until the age of 6-7 years. At school age the increase still continued but more slowly. Actinobacteria were the only exceptions; all three tested strains Sreptomyces albus, S. griseus and S. halstedii resulted in rather high concentrations until 3 years of age. If the children lived in a farm, mold-specific IgG concentrations increased at an earlier age than in other children. The results between farmers' children and other children differed significantly before school age for 20 of the 24 microbes tested, the four exceptions being the 3 actinobacteria and the mold Aspergillus versicolor. The reference values must be age related, and separate references are needed for farmers' children before school age.

Control of workers' exposure to airborne endotoxins and formaldehyde during the use of metalworking fluids.

The study evaluated the effects of triazine use and machine enclosure on workers' exposure to bacteria, endotoxins, and formaldehyde in the use of metalworking fluids (MWF). Concentrations of triazine and bacterial contaminants were monitored in bulk samples of MWF from two machines in one workplace. One of the machines was used normally; triazine was added to the other when needed. Air sampling was used to estimate workers' exposure to endotoxins at 18 workplaces near enclosed and open machines. Concentrations of triazine in MWF and formaldehyde in the air were measured. Some recirculating local exhaust ventilation systems were also tested. The endotoxin and bacteria concentrations in the biocide test of MWF rapidly increased when the biocide levels decreased below 500 ppm. Airborne concentrations of endotoxins were substantially lower near enclosed machines than near open ones. Concentrations of airborne formaldehyde were below the Finnish occupational exposure limit at the existing levels of triazine in MWF. Concentrations of triazine in MWF correlated well with those of formaldehyde in the air near the machines (correlation coefficient r=.69). The results showed that the triazine levels in MWF should continuously be kept high enough (>500 ppm) to prevent workers' exposure to endotoxins and bacteria. Overdosing with triazine, however, should be avoided, so that the levels of airborne formaldehyde remain low. Triazine levels in MWF can be followed by the method described in this article. Workers' exposure to contaminants of MWF can be reduced substantially by enclosing the machines and equipping them with local exhausts.

Microbial exposure and mold-specific serum IgG levels among children with respiratory symptoms in 2 school buildings.

In this study, the authors determined the association between serum mold-specific immunoglobulin G (IgG) levels in primary school children (N = 181) with asthma, wheezing, or cough symptoms and exposure to indoor mold in 2 schools, with and without mold damage. Microbial exposure was determined with environmental sampling. Serum IgG antibody concentrations against 24 microbial strains were determined with enzyme-linked immunosorbent assay. Children's microbe-specific IgG levels were often higher in the reference school. There was an association between elevated serum IgG antibody levels to Penicillium notatum and moisture damage in the school. In addition, moisture damage both in school and at home was associated with Penicillium notatum and Eurotium amstelodami IgG levels. These observations comported with microbial findings in the index school. No other positive associations between IgG antibodies and microbial findings for the school buildings were observed. IgG levels in sera of school children did not provide a specific means for assessing the microbial exposure associated with moisture and microbial problems in the school buildings. Thus, IgG analysis cannot be readily suggested as a routine method for the evaluation of these exposures.

Mould-specific immunoglobulin G antibodies in students from moisture- and mould-damaged schools: a 3-year follow-up study.

Immunoglobulin G (IgG) antibodies to moulds have been used as biomarkers of mould exposure, though their role reflecting exposure is not confirmed. The purpose of the present study was to evaluate the changes in mould-specific IgG antibodies in children during a 3-year follow-up in relation to changes in exposure, and to allergic and respiratory morbidity. In 1996, 212 primary school students with asthma, wheezing or prolonged cough participated in a clinical study, including clinical examination, skin-prick tests to 12 moulds and mould-specific IgG determinations to 24 moulds. In 1999, 144 students of the same cohort participated in an identical follow-up study; among them, mould-specific IgG was measured in 121 students. No association was found between IgG antibodies to moulds and exposure to moisture or moulds in schools. Likewise, changes in mould-specific antibodies were only weakly associated with changes in exposure. Mould-specific IgG antibodies had no significant association with asthma, wheezing or cough episodes. IgG antibodies to moulds seem to be poor markers of exposure among children exposed to moisture or moulds at school.

Importance of sampling, extraction and preservation for the quantitation of biologically active endoto.

The influence of filter media, extraction solution and preservation method on detection of biologically active endotoxin in the LAL assay was studied with air samples collected from wastewater treatment plants. The four most common types of filters were used as collection media. The extraction solutions compared were nonpyrogenic water, KH2PO4-triethylamine and Trizma buffers. The effect of preservation on endotoxin air samples was ascertained by storing both the filters without extraction, and samples extracted in the collection day for a few weeks at various temperatures. Samples collected on glass fibre filters showed the highest amounts of detectable endotoxin, while the concentrations of endotoxin were significantly lower when cellulose-mixed esters, polycarbonate or polyvinyl chloride membrane filters were used for air sampling. After collection, the best efficiency for glass fibre filters was attained by extraction with nonpyrogenic water within 8 hours after sampling and storage of the extracts at 4 degrees C until they were analysed. If the filters were stored without extraction, the reduction in endotoxin levels of the sample was about 30% after 1 week preservation and about 70% after 2 weeks. The study shows that the effect of the filter material and preservation practice was significant. These factors play critical roles in assessing exposure to bacterial endotoxins within wastewater aerosols.