Direct and quantitative capture of viable bacteriophages from experimentally contaminated indoor air: A model for the study of airborne vertebrate viruses including SARS-CoV-2.

AIM: The air indoors has profound health implications as it can expose us to pathogens, allergens and particulates either directly or via contaminated surfaces. There is, therefore, an upsurge in marketing of air decontamination technologies, but with no proper validation of their claims. We addressed the gap through the construction and use of a versatile room-sized (25 m3 ) chamber to study airborne pathogen survival and inactivation. METHODS AND RESULTS: Here, we report on the quantitative recovery and detection of an enveloped (Phi6) and a non-enveloped bacteriophage (MS2). The two phages, respectively, acted as surrogates for airborne human pathogenic enveloped (e.g., influenza, Ebola and coronavirus SARS-CoV-2) and non-enveloped (e.g., norovirus) viruses from indoor air deposited directly on the lawns of their respective host bacteria using a programmable slit-to-agar air sampler. Using this technique, two different devices based on HEPA filtration and UV light were tested for their ability to decontaminate indoor air. This safe, relatively simple and inexpensive procedure augments the use of phages as surrogates for the study of airborne human and animal pathogenic viruses. CONCLUSIONS: This simple, safe and relatively inexpensive method of direct recovery and quantitative detection of viable airborne phage particles can greatly enhance their applicattion as surrogates for the study of vertebrate virus survival in indoor air and assessment of technologies for their decontamination. SIGNIFICANCE AND IMPACT OF THE STUDY: The safe, economical and simple technique reported here can be applied widely to investigate the role of indoor air for virus survival and transmission and also to assess the potential of air decontaminating technologies.

A quantitative method to assess the role of indoor air decontamination to simultaneously reduce contamination of environmental surfaces: testing with vegetative and spore-forming bacteria.

Indoor air can spread pathogens, which can be removed/inactivated by a variety of means in healthcare and other settings. We quantitatively assessed if air decontamination could also simultaneously reduce environmental surface contamination in the same setting. Two types of vegetative bacteria (Staphylococcus aureus and Acinetobacter baumannii), and a bacterial spore-former (Geobacillus stearothermophilus) were tested as representative airborne bacteria. They were separately aerosolized with a Collison nebulizer into a 24-m3 aerobiology chamber and air samples collected with a programmable slit-to-agar sampler. Settling airborne particles were collected on culture plates placed at, and collected from, five different locations on the floor of the chamber with a custom-built remote plate-placement and -retriever system. Experimentally contaminated air in the chamber was decontaminated for 45 min with a device based on HEPA filtration and UV light. The plates were incubated and CFU counted. The device reduced the viability levels of all tested bacteria in the air by >3 log10 (>99·9%) in 45 min. Based on two separate tests, the average reductions in surface contamination for S. aureus, A. baumannii and G. stearothermophilus were respectively, 97, 87 and 97%. We thus showed that air decontamination could substantially and simultaneously reduce the levels of surface contamination in the same setting irrespective of the type of pathogen present. SIGNIFICANCE AND IMPACT OF THE STUDY: The innovative and generic test protocol described can quantitatively assess the reduction in environmental surface contamination from microbial decontamination of indoor air in the same setting. This added advantage from air decontamination has implications for infection prevention and control in healthcare and other settings without the need for additional expense or effort. Continuous operation of an air decontamination device, such as the one tested here, can lead to ongoing reductions in pathogens in air and on environmental surfaces.

The Impact of Supplemental Intraoperative Air Decontamination on the Outcome of Total Joint Arthroplasty: A Pilot Analysis.

BACKGROUND: During the early era of arthroplasty, the concept of ultraclean operating room (OR) was introduced based on the principle that the number of airborne particles in the OR directly influences incidence of device-related infections. The hypothesis of this pilot study was that use of an innovative UV-C air decontamination technology would lead to a reduction in the incidence of periprosthetic joint infection (PJI) following total joint arthroplasty. METHODS: A retrospective, observational, surveillance study was conducted with a consecutive series of patients who underwent total joint arthroplasty (n = 496) between January 2016 and August 2017. All perioperative and postoperative care protocols were identical for both groups, only study variable was that in 231 arthroplasty patients (OR B), an innovative supplemental UV-C air decontamination technology was used, whereas in the remaining 265 patients, arthroplasty was performed with standard turbulent HVAC (OR A). RESULTS: There was no significant difference between patient groups regarding age, body mass index, diabetes diagnosis, smoking status, length of surgery, or revision status. The rate of PJI was documented to be 1.9% in the turbulent air group, and no infections were documented in the cohorts operated under UV-C air decontamination, which was statistically significant (P < .044). CONCLUSION: While PJI is multifactorial in nature, the present retrospective pilot study suggests that use of an intraoperative supplemental air decontamination significantly reduced the overall risk of PJI. The findings of this study are encouraging and should be examined in a larger-scale, prospective, multicenter study.

Airborne Pathogens inside Automobiles for Domestic Use: Assessing In-Car Air Decontamination Devices Using Staphylococcus aureus as the Challenge Bacterium.

Family cars represent ∼74% of the yearly global output of motorized vehicles. With a life expectancy of ∼8 decades in many countries, the average person spends >100 min daily inside the confined and often shared space of the car, with exposure to a mix of potentially harmful microbes. Can commercial in-car microbial air decontamination devices mitigate the risk? Three such devices (designated devices 1 to 3) with HEPA filters were tested in the modified passenger cabin (3.25 m3) of a four-door sedan housed within a biosafety level 3 containment facility. Staphylococcus aureus (ATCC 6538) was suspended in a soil load to simulate the presence of body fluids and aerosolized into the car's cabin with a 6-jet Collison nebulizer. A muffin fan (80 mm by 80 mm, with an output of 0.17 m3/min) circulated the air inside. Plates (150 mm diameter) of Trypticase soy agar (TSA), placed inside a programmable slit-to-agar sampler, were held at 36 ± 1°C for 18 to 24 h and examined for CFU. The input dose of the test bacterium, its rate of biological decay, and the log10 reductions by the test devices were analyzed. The arbitrarily set performance criterion was the time in hours a device took for a 3-log10 reduction in the level of airborne challenge bacterium. On average, the level of S. aureus challenge in the air varied between 4.2 log10 CFU/m3 and 5.5 log10 CFU/m3, and its rate of biological decay was -0.0213 ± 0.0021 log10 CFU/m3/min. Devices 1 to 3 took 2.3, 1.5, and 9.7 h, respectively, to meet the performance criterion. While the experimental setup was tested using S. aureus as an archetypical airborne pathogen, it can be readily adapted to test other types of pathogens and technologies.IMPORTANCE This study was designed to test the survival of airborne pathogens in the confined and shared space of a family automobile as well as to assess claims of devices marketed for in-car air decontamination. The basic experimental setup and the test protocols reported are versatile enough for work with all major types of airborne human pathogens and for testing a wide variety of air decontamination technologies. This study could also lay the foundation for a standardized test protocol for use by device makers as well as regulators for the registration of such devices.

Optimal Fast Integral Decontamination of Bacillus thuringiensis Aerosols and Fast Disinfection of Contaminated Surfaces.

Aerosolized anthrax (Bacillus anthracis) spores are of extreme health concern and can remain airborne for hours and contaminate all kinds of surfaces, constituting reservoirs from which resuspension is easily produced. The assessment of decontamination techniques must therefore consider both air and surfaces. In the present study, several kinds of disinfecting fogs were experimentally tested against Bacillus thuringiensis spores, which served as a surrogate for Bacillus anthracis, both as aerosols released into the air and spread on porous and non-porous surfaces with different positions and orientations. This technology removed Bacillus thuringiensis spores from the air in 20 min with just a 1 min application of fog. The dynamics and characteristics of the fog, related to aerosol and surface interactions, proved to be critical for optimal performance and decontamination. An optimal configuration could provide effective disinfection even on indirectly reached surfaces. In all cases, 8% hydrogen peroxide (H2O2) provided a higher disinfection rate than 2% glutaraldehyde.

Metal-organic framework-derived NaMxOy adsorbents for low-temperature SO2 removal.

This work reported the fabrication of NaMxOy-type adsorbents from air calcination of (Na, M)-trimesate metal-organic frameworks. NaMnxOy (NMO) crystallized as disc-shaped microsheets, whereas NaCoxOy (NCO) crystallized as smooth microsheets with surface deposition of polyhedral nanoparticles. The oxides have a surface area of 1.90-2.56 m2 g-1. The synthesized adsorbents were studied for low-temperature SO2 removal in breakthrough studies. The maximum adsorption capacity of 46.8 mg g-1 was recorded for NMO at 70 °C. The adsorption capacity increased with the increasing temperature due to the chemisorptive nature of the adsorption process. The capacity increased with the increasing bed loading and decreasing flow rate due to the improved SO2 retention time. The elemental mapping confirmed the uniform distribution of sulfur species over the oxide surface. X-ray diffraction showed the absence of metal sulfate nanoparticles in the SO2-exposed samples. The X-ray photoelectron analysis confirmed the formation of surface sulfate and bisulfate. The formation of oxidized sulfur species was mediated by hydroxyl groups over NMO and lattice oxygen over NCO. Thus, the work demonstrated here is the first such report on the use of NaMxOy-type materials for SO2 mineralization.

Assessment of multiple environmental factors on the adsorptive and photocatalytic removal of gaseous formaldehyde by a nano-TiO2 colloid: Experimental and simulation studies.

Environmental factors affecting the photocatalytic oxidation of volatile organic compounds (VOCs) have previously been studied experimentally, but there are few theoretical studies, especially those on surface intermolecular forces. Because of this, it is unclear how multiple coexisting factors impact photocatalytic processes. Herein, comprehensive multi-factorial impact mechanisms of the photocatalytic oxidation of formaldehyde were assessed using experiments and density functional theory simulations. The influence of humidity, concentration, and intermediate formate was investigated using a nano-TiO2 colloid, followed by adsorption and photocatalytic simulations. The maximum photocatalytic reaction rate and degradation efficiency occurred at 50% humidity due to the initially enhanced and then weakened adsorption and photocatalysis of formaldehyde. This stemmed from the increased number of water molecules and the narrower TiO2 band gap at low humidities, as well as the competitive adsorption between formaldehyde and excess water molecules at high humidities. Upon increasing the formaldehyde concentration, its photocatalytic oxidation rate increased due to enhanced adsorption, but weakened photocatalysis decreased the photocatalytic efficiency. The intermediate formate enhanced the adsorption and inhibited photocatalysis and did not significantly change the photocatalytic oxidation rate of formaldehyde upon changing the irradiation time. These findings provide guidance for the photocatalytic oxidation of VOCs produced by industrial air pollution.

Effectiveness of a novel, non-intrusive, continuous-use air decontamination technology to reduce microbial contamination in clinical settings: a multi-centric study.

BACKGROUND: Despite rigorous disinfection and fumigation, healthcare-associated infection (HAI) remains a significant concern in healthcare settings. We have developed a novel airborne-microbicidal technology 'ZeBox' which clears >99.999% of airborne microbial load under controlled laboratory conditions. AIM: To evaluate the clinical performance of ZeBox in reducing airborne and surface microbial load. METHODS: The study was conducted in single-bed and multi-bed intensive care units (ICUs) of two hospitals. Airborne and surface microbial loads were sampled pre and post deployment of ZeBox at pre-determined sites. Statistical significance of the reduction was determined using the Mann-Whitney U-test. FINDINGS: ZeBox brought statistically significant reduction of both airborne and surface bacterial and fungal load. In both hospital ICUs, airborne and surface bacterial load decreased by 90% and 75% on average respectively, providing a low bioburden zone of 10-15 feet diameter around the unit. The reduced microbial level was maintained during ZeBox's operation over several weeks. Most clinical bacterial isolates recovered from one of the hospitals were antibiotic resistant, highlighting ZeBox's ability to eliminate antimicrobial-resistant bacteria among others. CONCLUSION: ZeBox significantly reduces airborne and surface microbial burden in clinical settings. It thereby serves an unmet need for reducing the incidence of HAI.

Photocatalytic Activity of Cu2S/WO3 and Cu2S/SnO2 Heterostructures for Indoor Air Treatment.

Volatile organic compounds (VOCs) are commonly found in indoor spaces (e.g., homes or offices) and are often related to various illnesses, some of them with carcinogenic potential. The origins of VOC release in the indoor environment are in office products, building materials, electronics, cleaning products, furniture, and maintenance products. VOC removal can be done based on two types of technologies: adsorption in specific materials and decomposition via oxidative processes. The present article reports the development and photocatalytic activity of two heterostructures (Cu2S/WO3 and Cu2S/SnO2) used for indoor air decontamination. The acetaldehyde removal rate is discussed in correlation with the S-scheme mechanisms established between the heterostructure components but also comparatively with the bare catalysts' activity. Acetaldehyde was considered as a VOC reference because it was found by the International Agency for Research on Cancer to be one of the most frequent air toxins with potential carcinogenic effects. The samples contained monoclinic WO3, tetragonal SnO2, and orthorhombic Cu2S crystalline structures. The Cu2S crystallite size in the heterostructure varied from 75.9 to 82.4 Å, depending on the metal oxide substrate. The highest photocatalytic efficiency (75.7%) corresponded to Cu2S/SnO2, with a constant rate of 0.106 s-1 (which was three times faster than WO3 or SnO2 and seven and a half times faster than Cu2S).

Efficiency of an air circulation decontamination device for micro-organisms using ultraviolet radiation.

BACKGROUND: The concern with environmental security to avoid contamination of individuals was intensified with the crisis established by SARS-CoV-2. The COVID-19 pandemic has shown the necessity to create systems and devices capable of clearing the air in an environment of micro-organisms more efficiently. The development of systems that allow the removal of micro-droplets mainly originating from breathing or talking from the air was the motivation of this study. AIM: This article describes a portable and easy-to-operate system that helps to eliminate the droplets or aerosols present in the environment by circulating air through an ultraviolet-C (UV-C) reactor. METHODS: An air circulation device was developed, and a proof-of-principle study was performed using the device against bacteria in simulated and natural environments. The microbiological analysis was carried out by the simple sedimentation technique. In order to compare the experimental results and the expected results for other micro-organisms, the reduction rate values for bacteria and viruses were calculated and compared with the experimental results based on technical parameters (clean air delivery rate (CADR) and air changes per hour (ACH)). FINDINGS: Results showed that the micro-organisms were eliminated with high efficiency by the air circulation decontamination device, with reductions of 99.9% in the proof-of-principle study, and 84-97% in the hospital environments study, contributing to reducing contamination of individuals in environments considered to present risk. CONCLUSION: This study resulted in a low-cost and relatively simple device, which was shown to be effective and safe, and could be replicated, especially in low-income countries, respecting the standards for air disinfection using UV-C technologies.

Enhancing the Photocatalytic Activity of SnO2-TiO2 and ZnO-TiO2 Tandem Structures Toward Indoor Air Decontamination.

ZnO-TiO2 and SnO2-TiO2 tandem structures were developed using the doctor blade technique. It was found that by employing organic hydrophilic and hydrophobic as additives into the precursor it is possible to tailor the film density and morphology with direct consequences on the photocatalytic activity of the tandem structures. The highest photocatalytic efficiency corresponds to ZnO-TiO2 and can reach 74.04% photocatalytic efficiency toward acetaldehyde when a hydrophilic additive is used and 70.93% when a hydrophobic additive is employed. The snO2-TiO2 tandem structure presents lower photocatalytic properties (61.35 % when the hydrophilic additive is used) with a constant rate reaction of 0.07771 min-1.

Efficiencies Evaluation of Photocatalytic Paints Under Indoor and Outdoor Air Conditions.

The removal of indoor and outdoor air pollutants is crucial to prevent environmental and health issues. Photocatalytic building materials are an energy-sustainable technology that can completely oxidize pollutants, improving in situ the air quality of contaminated sites. In this work, different photoactive TiO2 catalysts (anatase or modified anatase) and amounts were used to formulate photocatalytic paints in replacement of the normally used TiO2 (rutile) pigment. These paints were tested in two different experimental systems simulating indoor and outdoor environments. In one, indoor illumination conditions were used in the photoreactor for the oxidation of acetaldehyde achieving conversions between 37 and 55%. The other sets of experiments were performed under simulated outdoor radiation for the degradation of nitric oxide, resulting in conversions between 13 and 35%. This wide range of conversions made it difficult to directly compare the paints. Thus, absorption, photonic, and quantum efficiencies were calculated to account for the paints photocatalytic performance. It was found that the formulations containing carbon-doped TiO2 presented the best efficiencies. The paint with the maximum amount of this photocatalyst showed the highest absorption and photonic efficiencies. On the other hand, the paint with the lowest amount of carbon-doped TiO2 presented the highest value of quantum efficiency, thus becoming the optimal formulation in terms of energy use.

Ozonation and ozone-enhanced photocatalysis for VOC removal from air streams: Process optimization, synergy and mechanism assessment.

The present work evaluates ozone driven processes (O3, O3/UVC, O3/TiO2/UVA) in the NETmix mili-photoreactor, as a cost-effective alternative for the removal of volatile organic compounds (VOCs) from air streams, using n-decane as a model pollutant. The network of channels and chambers of the mili-photoreactor was coated with a TiO2-P25 thin film, resulting in a catalyst coated surface per reactor volume of 990 m2 m-3. Ozone and n-decane streams were fed to alternate chambers of the mili-photoreactor, promoting a good contact between O3/n-decane/catalyst. Initially, direct reaction between n-decane and ozone (ozonation) was assessed for different O3/n-decane (O3/dec) feed molar ratios and total feed flow rates. Under the best conditions, ozonation process achieved total n-decane conversion (below the limit of detection), yielding a reaction rate (rdec) of 6.8 µmol min-1 or 6.7 mmol m-3reactor s-1. However, the low reactivity of ozone with the degradation by-products resulted in a quite poor mineralization (~10%). For the O3/UVC system, an increase on relative humidity from 7 to 40% slight improved the n-decane oxidation rate, mainly associated with the generation of HO from the reaction of active oxygen radicals (O) and water molecules. A strong synergistic effect was observed when coupling TiO2/UVA photocatalysis with ozonation (O3/TiO2/UVA), enhancing substantially the mineralization of n-decane molecules up to 100% under O3/dec feed molar ratio of 15, photonic flux of 2.67 ±â€¯0.03 J s-1 and a residence time of 2.0 s. Different reaction intermediates were detected for O3, TiO2/UVA and O3/TiO2/UVA oxidative systems, indicating the participation of different oxidant species (O3, HO, O, etc.).

Indoor air as a vehicle for human pathogens: Introduction, objectives, and expectation of outcome.

Airborne spread of pathogens can be rapid, widespread, and difficult to prevent. In this international workshop, a panel of 6 experts will expound on the following: (1) the potential for indoor air to spread a wide range of human pathogens, plus engineering controls to reduce the risk for exposure to airborne infectious agents; (2) the behavior of aerosolized infectious agents indoors and the use of emerging air decontamination technologies; (3) a survey of quantitative methods to recover infectious agents and their surrogates from indoor air with regard to survival and inactivation of airborne pathogens; (4) mathematical models to predict the movement of pathogens indoors and the use of such information to optimize the benefits of air decontamination technologies; and (5) synergy between different infectious agents, such as legionellae and fungi, in the built environment predisposing to possible transmission-related health impacts of aerosolized biofilm-based opportunistic pathogens. After the presentations, the panel will address a set of preformulated questions on selection criteria for surrogate microbes to study the survival and inactivation of airborne human pathogens, desirable features of technologies for microbial decontamination of indoor air, knowledge gaps, and research needs. It is anticipated that the deliberations of the workshop will provide the attendees with an update on the significance of indoor air as a vehicle for transmitting human pathogens with a brief on what is currently being done to mitigate the risks from airborne infectious agents.

Decontamination of indoor air to reduce the risk of airborne infections: Studies on survival and inactivation of airborne pathogens using an aerobiology chamber.

BACKGROUND: Although indoor air can spread many pathogens, information on the airborne survival and inactivation of such pathogens remains sparse. METHODS: Staphylococcus aureus and Klebsiella pneumoniae were nebulized separately into an aerobiology chamber (24.0 m3). The chamber's relative humidity and air temperature were at 50% ± 5% and 20°C ± 2°C, respectively. The air was sampled with a slit-to-agar sampler. Between tests, filtered air purged the chamber of any residual airborne microbes. RESULTS: The challenge in the air varied between 4.2 log10 colony forming units (CFU)/m3 and 5.0 log10 CFU/m3, sufficient to show a ≥3 log10 (≥99.9%) reduction in microbial viability in air over a given contact time by the technologies tested. The rates of biologic decay of S aureus and K pneumoniae were 0.0064 ± 0.00015 and 0.0244 ± 0.009 log10 CFU/m3/min, respectively. Three commercial devices, with ultraviolet light and HEPA (high-efficiency particulate air) filtration, met the product efficacy criterion in 45-210 minutes; these rates were statistically significant compared with the corresponding rates of biologic decay of the bacteria. One device was also tested with repeated challenges with aerosolized S aureus to simulate ongoing fluctuations in indoor air quality; it could reduce each such recontamination to an undetectable level in approximately 40 minutes. CONCLUSIONS: The setup described is suitable for work with all major classes of pathogens and also complies with the U.S. Environmental Protection Agency's guidelines (2012) for testing air decontamination technologies.

Assessing microbial decontamination of indoor air with particular focus on human pathogenic viruses.

Transmission of bacterial, fungal, and viral pathogens is of primary importance in public and occupational health and infection control. Although several standardized protocols have been proposed to target microbes on fomites through surface decontamination, use of microbicidal agents, and cleaning processes, only limited guidance is available on microbial decontamination of indoor air to reduce the risk of pathogen transmission between individuals. This article reviews the salient aspects of airborne transmission of infectious agents, exposure assessment, in vitro assessment of microbicidal agents, and processes for air decontamination for infection prevention and control. Laboratory-scale testing (eg, rotating chambers, wind tunnels) and promising field-scale methodologies to decontaminate indoor air are also presented. The potential of bacteriophages as potential surrogates for the study of airborne human pathogenic viruses is also discussed.

Generic aspects of the airborne spread of human pathogens indoors and emerging air decontamination technologies.

Indoor air can be an important vehicle for a variety of human pathogens. This review provides examples of airborne transmission of infectious agents from experimental and field studies and discusses how airborne pathogens can contaminate other parts of the environment to give rise to secondary vehicles leading air-surface-air nexus with possible transmission to susceptible hosts. The following groups of human pathogens are covered because of their known or potential airborne spread: vegetative bacteria (staphylococci and legionellae), fungi (Aspergillus, Penicillium, and Cladosporium spp and Stachybotrys chartarum), enteric viruses (noro- and rotaviruses), respiratory viruses (influenza and coronaviruses), mycobacteria (tuberculous and nontuberculous), and bacterial spore formers (Clostridium difficile and Bacillus anthracis). An overview of methods for experimentally generating and recovering airborne human pathogens is included, along with a discussion of factors that influence microbial survival in indoor air. Available guidelines from the U.S. Environmental Protection Agency and other global regulatory bodies for the study of airborne pathogens are critically reviewed with particular reference to microbial surrogates that are recommended. Recent developments in experimental facilities to contaminate indoor air with microbial aerosols are presented, along with emerging technologies to decontaminate indoor air under field-relevant conditions. Furthermore, the role that air decontamination may play in reducing the contamination of environmental surfaces and its combined impact on interrupting the risk of pathogen spread in both domestic and institutional settings is discussed.