Low-cost interventions to improve ventilation in long-term care facilities.

Residents of long-term care facilities are particularly vulnerable to communicable diseases. Low-cost interventions to increase air exchange rates (AERs) may be useful in reducing the transmission of airborne communicable diseases between long-term care residents and staff. In this study, carbon dioxide gas was used as a tracer to evaluate the AER associated with the implementation of low-cost ventilation interventions. Under baseline conditions with the room's door closed, the mean AER was 0.67 ACH; while baseline conditions with the door open had a significantly higher mean AER of 3.87 ACH (p < 0.001). Subsequently opening a window with the door open increased mean AER by 1.49 ACH (p = 0.012) and adding a fan in the window further increased mean AER by 1.87 ACH (p < 0.001). Regression analyses indicated that the flow rate of air entering through the window, both passively and through the use of a fan, was significantly associated with an increase in AER (p < 0.001). These results indicate that low-cost interventions that pull outside air into resident rooms were effective in improving the air exchange rates in these facilities. While implementation of these interventions is dependent on facility rules and isolation requirements of residents with airborne communicable diseases, these interventions remain viable options for long-term care facilities to improve resident room ventilation without requiring costly ventilation system upgrades.

Assessment of university classroom ventilation during the COVID-19 pandemic.

Ventilation plays an important role in mitigating the risk of airborne virus transmission in university classrooms. During the early phase of the COVID-19 pandemic, methods to assess classrooms for ventilation adequacy were needed. The aim of this paper was to compare the adequacy of classroom ventilation determined through an easily accessible, simple, quantitative measure of air changes per hour (ACH) to that determined through qualitative "expert judgment" and recommendations from the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), and the American Conference of Governmental Industrial Hygienists (ACGIH)®. Two experts, ventilation engineers from facilities maintenance, qualitatively ranked buildings with classrooms on campus with regard to having "acceptable classroom ventilation." Twelve lecture classrooms were selected for further testing, including a mix of perceived adequate/inadequate ventilation. Total air change per hour (ACH) was measured to quantitatively assess ventilation through the decay of carbon dioxide in the front and rear of these classrooms. The outdoor ACH was calculated by multiplying the total ACH by the outdoor air fraction. The classrooms in a building designed to the highest ASHRAE standards (62.1 2004) did not meet ACGIH COVID-19 recommendations. Four of the classrooms met the ASHRAE criteria. However, a classroom that was anticipated to fail based on expert knowledge met the ASHRAE and ACGIH criteria. Only two classrooms passed stringent ACGIH recommendations (outdoor ACH > 6). None of the classrooms that passed ACGIH criteria were originally expected to pass. There was no significant difference in ACH measured in the front and back of classrooms, suggesting that all classrooms were well mixed with no dead zones. From these results, schools should assess classroom ventilation considering a combination of classroom design criteria, expert knowledge, and ACH measurements.

Preventing carbon monoxide poisoning in the Hudson River Tunnel in 1921: recounting history.

The New York Bridge and Tunnel Commission began planning for a tunnel beneath the lower Hudson river to connect Manhattan to New Jersey in 1919. At 8,300 feet, it would be the longest tunnel for passenger vehicles in the world. A team of engineers and physiologists at the Yale University Bureau of Mines Experiment Station was tasked with calculating the ventilation requirements that would provide safety from exposure to automobile exhaust carbon monoxide (CO) while balancing the cost of providing ventilation. As the level of ambient CO which was comfortably tolerated was not precisely defined, they performed human exposures breathing from 100 to 1,000 ppm CO, first on themselves and subsequently on Yale medical students. Their findings continue to provide a basis for carbon monoxide alarm requirements a century later.

Welfare assessment in intensive and semi-intensive dairy cattle management system in Sicily.

The present study aimed to compare the welfare of dairy cows kept in two traditional husbandry systems (semi-intensive and intensive farming) in south-eastern Sicily. A total of 18 dairy farms (nine semi-intensive and nine intensive) were evaluated with a multicriteria system adapted for Sicilian conditions and obtained simplifying the model of the European Food Safety Authority (EFSA). Values of welfare measures, collected by inspections of the farms (general well-being indicators, ventilation system, resting areas [cubicles or bedding], flooring, milking parlours and waiting area, manger and watering equipment), and those of health categories (cases of abortions, hypocalcemia, displacement of abomasum, acidosis/ketosis, enteritis, hoof problems, and mastitis) obtained through the farm records, were compared using Mann-Whitney and Chi-squared tests, respectively. Data showed significant differences (p ≤ .05) about the variables related to welfare categories such as housing ventilation system, resting area, manger, and water equipment that were better in the semi-intensive system than the intensive system. No significant differences were observed about the variables related to health indicators. The results demonstrated that in Sicily the semi-intensive farm is better than the intensive to satisfy the conditions of animal welfare.

Protocolo de acompanhamento das condições de saúde para organizações privadas / Protocol for monitoring health conditions for private organizations

Este documento visa orientar os gestores das organizações privadas quanto à prevenção e acompanhamento das condições de saúde de seus colaboradores, visando prevenir a disseminação da Covid-19 nos ambientes de trabalho. Neste protocolo são apresentadas diretrizes para a realização de ações de prevenção, triagem, testagem, conduta e comunicação de casos suspeitos. As ações de acompanhamento das condições de saúde por parte das organizações privadas devem estar vinculadas às diretrizes e recomendações do Sistema Público de Vigilância em Saúde.

Simultaneous assessment of central and peripheral chemoreflex regulation of muscle sympathetic nerve activity and ventilation in healthy young men.

KEY POINTS: Central chemoreceptor stimulation, by hypercapnia (acidosis), and peripheral, by hypoxia plus hypercapnia, evoke reflex increases in ventilation and sympathetic outflow. The assumption that central or peripheral chemoreceptor-mediated sympathetic activation elicited when PCO2 increases parallels concurrent ventilatory responses is unproven. Applying a modified rebreathing protocol that equilibrates central and peripheral chemoreceptor PCO2 whilst clamping O2 tension at either hypoxic or hyperoxic concentrations, the independent ventilatory and muscle sympathetic stimulus-response properties of the central and peripheral chemoreflexes were quantified and compared in young men. The novel findings were that ventilatory and sympathetic responses to central and peripheral chemoreflex stimulation are initiated at similar PCO2 recruitment thresholds but individual specific sympathetic responsiveness cannot be predicted from the ventilatory sensitivities of either chemoreceptor reflex. Such findings in young men, if replicated in heart failure or hypertension, should temper present enthusiasm for trials targeting the peripheral chemoreflex based solely on ventilatory responsiveness to non-specific chemoreceptor stimulation. ABSTRACT: In humans, stimulation of peripheral or central chemoreceptor reflexes is assumed to evoke equivalent ventilatory and sympathetic responses. We evaluated whether central or peripheral chemoreceptor-mediated sympathetic activation elicited by increases in CO2 tension ( PCO2 ) parallels concurrent ventilatory responses. Twelve healthy young men performed a modified rebreathing protocol designed to equilibrate central and peripheral chemoreceptor PCO2 tensions with end-tidal PCO2 ( PETCO2 ) at two isoxic end-tidal PO2 ( PETO2 ) such that central responses can be segregated, by hyperoxia, from the net response (hypoxia minus hyperoxia). Ventilation and muscle sympathetic nerve activity (MSNA) were recorded continuously during rebreathing at isoxic PETO2 of 150 and 50 mmHg. During rebreathing, the PETCO2 values at which ventilation (L min-1 ) and total MSNA (units) began to rise were identified ( PETCO2 recruitment thresholds) and their slopes above the recruitment threshold were determined (sensitivity). The central chemoreflex recruitment threshold for ventilation (46 ± 3 mmHg) and MSNA (45 ± 4 mmHg) did not differ (P = 0.55) and slopes were 2.3 ± 0.9 L min-1  mmHg-1 and 2.1 ± 1.5 units mmHg-1 , respectively. The peripheral chemoreflex recruitment thresholds, at 41 ± 3 mmHg for both ventilation and MSNA were lower (P < 0.05) compared to the central chemoreflex recruitment thresholds. Peripheral chemoreflex sensitivity was 1.7 ± 0.1 L min-1  mmHg-1 for ventilation and 2.9 ± 2.6 units mmHg-1 for MSNA. There was no relationship between the ventilatory and MSNA sensitivity for either the central (r2  = 0.01, P = 0.76) or peripheral (r2  = 0.01, P = 0.73) chemoreflex. In healthy young men, ventilatory and sympathetic responses to central and peripheral chemoreceptor reflex stimulation are initiated at similar PETCO2 recruitment thresholds but individual ventilatory responsiveness does not predict sympathetic sensitivities of either chemoreflex.

Assessment of displacement ventilation systems in airborne infection risk in hospital rooms.

Efficient ventilation in hospital airborne isolation rooms is important vis-à-vis decreasing the risk of cross infection and reducing energy consumption. This paper analyses the suitability of using a displacement ventilation strategy in airborne infection isolation rooms, focusing on health care worker exposure to pathogens exhaled by infected patients. The analysis is mainly based on numerical simulation results obtained with the support of a 3-D transient numerical model validated using experimental data. A thermal breathing manikin lying on a bed represents the source patient and another thermal breathing manikin represents the exposed individual standing beside the bed and facing the patient. A radiant wall represents an external wall exposed to solar radiation. The air change efficiency index and contaminant removal effectiveness indices and inhalation by the health care worker of contaminants exhaled by the patient are considered in a typical airborne infection isolation room set up with three air renewal rates (6 h-1, 9 h-1 and 12 h-1), two exhaust opening positions and two health care worker positions. Results show that the radiant wall significantly affects the air flow pattern and contaminant dispersion. The lockup phenomenon occurs at the inhalation height of the standing manikin. Displacement ventilation renews the air of the airborne isolation room and eliminates the exhaled pollutants efficiently, but is at a disadvantage compared to other ventilation strategies when the risk of exposure is taken into account.

Assessment of carbon monoxide exposure in roadside food-vending shanties using coal cookstoves in Kolkata, India.

Roadside food-vending shanties using coal cookstoves may be an important source of carbon monoxide (CO) exposure in megacities in India. The shanties are often small, congested and poorly ventilated, and very little is known about the level of human exposure to CO. Here, we assessed the level of exposure to CO in 25 roadside food-vending shanties using coal cookstoves in Kolkata, India. Portable electrochemical CO monitors were used to measure CO concentrations during peak and non-peak customer-periods in closed (blocked from three sides) and semi-closed (blocked from two sides) shanties. Measurements were taken where customers sit indoor about 5-7 ft away from the cookstoves. The shanties' ventilation rates were measured using tracer gas concentration-decay technique. Levels of blood carboxyhaemoglobin (COHb) and exhaled CO were estimated using regression models. The 1-hr time weighted average (TWA) indoor CO exposure levels ranged from 7.8 to 18.1 ppm during peak-periods, and 0.7-3.1 ppm during non-peak-periods. The exposure levels during peak-periods exceeded the USEPA's reference limit of 9 ppm in all cases in the closed shanties, and in 71% of cases in the semi-closed shanties. The ventilation rates ranged from 5.5 to 23.4 and 14.8 to 32.5 cubic feet per minute (cfm) per person for the closed and semi-closed shanties, respectively, indicating poor ventilation in some shanties. There was significant variation (p = 0.01) in the level of indoor CO exposure between peak and non-peak periods, and between shanty types. The estimated levels of blood COHb during peak and non-peak hours were 0.78 ±â€¯0.7% and 0.35 ±â€¯0.07%, respectively, that were within the normal physiological values in non-smokers.

Dispersion Characteristics of Hazardous Gas and Exposure Risk Assessment in a Multiroom Building Environment.

The leakage of hazardous chemicals during storage and transport processes is a kind of commonly occurring accident that can pose a serious threat to people's lives and property. This paper aims to investigate the airflow and dispersion characteristics of hazardous gas around a multiroom building, and evaluate the corresponding exposure risks. The effects on indoor air quality (IAQ) when polluted air enters a room under different indoor and external conditions were examined by using a computational fluid dynamics technique. First, the numerical model established herein was verified by the available wind-tunnel experimental data, and acceptable agreement was found between the predicted and measured velocities. Subsequently, the effects of different natural ventilation paths, wall porosities and outdoor pollutant source characteristics on the airflow and contaminant distribution were evaluated. The study not only reveals the airflow pattern and concentration distribution in indoor spaces under different natural ventilation conditions but also quantitatively analyzes the relationship between the probability of death and the corresponding source strength under the circumstance of pollutant leakage near a building. The results can be useful for the prevention and control of hazardous chemical gas leakages and provide some guidance on evacuation after an accidental or routine leakage.

Modeled construction and operating costs of different ventilation systems for lactating dairy cows.

The objectives were to compare capital costs of building and installation of 7 ventilation systems for adult lactating dairy cow housing and evaluate the energy use and operating cost between systems. A cost model comprising stochastic and parametric modules was created to estimate the number of fans operating each day based on temperature set points; annual profiles of daily maximum, minimum, and average temperatures; ramping functions to transition between seasons; and weather data from 7 locations in the United States. Costs were described as US$ per stall per year and operating costs as US$ (kW·h) per stall per year. Building costs amoritized over 10 yr ranged from $246 to $318, where a 16-row cross-ventilated design had the minimum cost and a hybrid design incorporating elements of tunnel and natural ventilation had the maximum cost. Lowering the summer temperature set point from 22.2 to 18.0°C to potentially improve heat abatement for high-producing cows increased cost by $10.10 (101.0 kW·h). On average, an exponential ramping function for transitioning between seasons cost $55.40 (554 kW·h) compared with $61.40 (614 kW·h) for a linear function. A tunnel barn ranged from $79.40 (794 kW·h) to $212.30 (2123 kW·h), and a natural design ranged from $32.60 (326 kW·h) to $81.80 (818 kW·h) in operating costs due to fan selection alone. Cross-ventilated barns benefitted from economies of scale and had similar operating costs as naturally ventilated barns in larger facilities. On average, mechanical systems cost twice as much to operate as natural systems, and operating costs in hotter US climates were approximately double those in milder climates. Selecting a fan with low energy efficiency can increase the operating cost of any ventilation system approximately 2-fold, making fan choice a critical design element.

Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India.

BACKGROUND: One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. OBJECTIVE: The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. METHODS: It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. RESULTS: About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. CONCLUSION: The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Characteristics and mortality risk of children with life-threatening influenza infection admitted to paediatric intensive care in England 2003-2015.

BACKGROUND: Information is lacking about the severity of complications in children with influenza admitted to paediatric intensive care units (PICU) in the UK. In this study, we report risk factors for mortality, invasive ventilation and use of vasoactive drugs for children admitted to PICU with influenza. METHODS: We evaluated all admissions to PICUs in England for resident children with a recorded influenza diagnosis between September 2003 and March 2015. We used the Paediatric Intensive Care Audit Network (PICANet) database linked to hospital admission records to identify influenza cases, and high-risk comorbidities among admitted children. We used mixed effects logistic regression models to determine risk factors for mortality, use of invasive ventilation and vasoactive drugs. RESULTS: We identified 1961 influenza-related PICU admissions in 1778 children. Children with high-risk conditions accounted for 1540 admissions (78.5%). The odds of mortality were significantly higher for girls than boys (adjusted odds ratio 1.91; 95% confidence interval 1.31, 2.79), children from Asian/Asian British (2.70; 1.74, 4.20) or other minority ethnic groups (3.95; 1.65, 9.42) compared to white British children, and significantly increased before and during the A(H1N1)pdm 2009 pandemic compared to the post-pandemic period. Children required invasive ventilation in 1588 admissions (81.0%), and received vasoactive drugs in 586 admissions (29.9%). CONCLUSIONS: Nearly four fifths of influenza-related PICU admissions occurred in children with high-risk conditions, highlighting the burden of severe influenza in this vulnerable population Further research is required to explain sex and ethnic group differences in PICU mortality among children admitted with influenza.

Characterization and health risk assessment of airborne pollutants in commercial restaurants in northwestern China: Under a low ventilation condition in wintertime.

Impacts on indoor air quality of dining areas from cooking activities were investigated in eight categories of commercial restaurants including Szechwan Hotpot, Hunan, Shaanxi Noodle, Chinese Barbecue, Chinese Vegetarian, Korean Barbecue, Italian, and Indian, in Northwestern China during December 2011 to January 2012. Chemical characterization and health risk assessment for airborne carbonyls, and particulate-bound polycyclic aromatic hydrocarbons (PAHs) and heavy metals were conducted under low ventilation conditions in wintertime. The highest total quantified carbonyls (Σcarbonyls) concentration of 313.6µgm-3 was found in the Chinese Barbecue, followed by the Szechwan Hotpot (222.6µgm-3) and Indian (221.9µgm-3) restaurants. However, the highest Σcarbonyls per capita was found at the Indian restaurant (4500µgcapita-1), suggesting that cooking methods such as stir-fly and bake for spices ingredients released more carbonyls from thermal cooking processes. Formaldehyde, acetaldehyde, and acetone were the three most abundant species, totally accounting for >60% of mass concentrations of the Σcarbonyls. Phenanthrene, chrysene, and benzo[a]anthracene were the three most abundant PAHs. Low molecular weight fraction (ΣPAHs≤178) had the highest contributions accounting for 40.6%-65.7%, much greater than their heaver counterparts. Diagnostic PAHs ratios suggest that cooking fuel and environmental tobacco smoke (ETS) contribute to the indoor PAHs profiles. Lead was the most abundant heavy metal in all sampled restaurants. High quantity of nickel was also found in samples due to the emissions from stainless-steel made kitchen utensils and cookware and ETS. Cancer risk assessments on the toxic substances demonstrate that the working environment of dining areas were hazard to health. Formation of reactive organic species (ROS) from the cooking activities was evidenced by measurement of hydroxyl radical (OH) formed from simulating particulate matter (PM) react with surrogate lung fluid. The highest OH concentration of 294.4ngm-3 was detected in Chinese Barbecue. In addition, the elevation of the concentrations of PM and OH after non-dining periods implies that the significance of formation of oxidizing-active species indoor at poor ventilation environments.

Solvent Transfer-Efficiency of Risk Management Measures.

A series of laboratory simulations were conducted in order to determine the airborne protection that might be afforded by different combinations of workplace exposure controls typically encountered when handling volatile solvents (e.g. solvent transfer). These conditions, referred to as risk management measures (RMMs) under the Registration, Evaluation and Authorisation of Chemicals Regulation (REACH), are typically described using standard phrases in safety data sheets [and specifically those of the European Phrase Catalogue (EUPhraC)]. Ethanol was used as a model compound and its emissions were monitored continuously with a portable IR spectrometer at 3000 cm-1. The average emission reduction performance of the investigated RMMs (e.g. containment, extract ventilation, drum pump) exceeded 90%. They present suitable ways to reduce airborne solvent exposure in a workplace and confirmed the initial expectations derived at by the European Solvents Industry Group (ESIG) and the European Centre For Ecotoxicology and toxicology of Chemicals (ECETOC) Targeted Risk Assessment (TRA) model.

Nano-metal oxides: Exposure and engineering control assessment.

In January 2007, the National Institute for Occupational Safety and Health (NIOSH) conducted a field study to evaluate process specific emissions during the production of ENMs. This study was performed using the nanoparticle emission assessment technique (NEAT). During this study, it was determined that ENMs were released during production and cleaning of the process reactor. Airborne concentrations of silver, nickel, and iron were found both in the employee's personal breathing zone and area samples during reactor cleaning. At the completion of this initial survey, it was suggested that a flanged attachment be added to the local exhaust ventilation system. NIOSH re-evaluated the facility in December 2011 to assess worker exposures following an increase in production rates. This study included a fully comprehensive emissions, exposure, and engineering control evaluation of the entire process. This study made use of the nanoparticle exposure assessment technique (NEAT 2.0). Data obtained from filter-based samples and direct reading instruments indicate that reactor cleanout increased the overall particle concentration in the immediate area. However, it does not appear that these concentrations affect areas outside of the production floor. As the distance between the reactor and the sample location increased, the observed particle number concentration decreased, creating a concentration gradient with respect to the reactor. The results of this study confirm that the flanged attachment on the local exhaust ventilation system served to decrease exposure potential. Given the available toxicological data of the metals evaluated, caution is warranted. One should always keep in mind that occupational exposure levels were not developed specifically for nanoscale particles. With data suggesting that certain nanoparticles may be more toxic than the larger counterparts of the same material; employers should attempt to control emissions of these particles at the source, to limit the potential for exposure.

Validation of Contamination Control in Rapid Transfer Port Chambers for Pharmaceutical Manufacturing Processes.

There is worldwide concern with regard to the adverse effects of drug usage. However, contaminants can gain entry into a drug manufacturing process stream from several sources such as personnel, poor facility design, incoming ventilation air, machinery and other equipment for production, etc. In this validation study, we aimed to determine the impact and evaluate the contamination control in the preparation areas of the rapid transfer port (RTP) chamber during the pharmaceutical manufacturing processes. The RTP chamber is normally tested for airflow velocity, particle counts, pressure decay of leakage, and sterility. The air flow balance of the RTP chamber is affected by the airflow quantity and the height above the platform. It is relatively easy to evaluate the RTP chamber's leakage by the pressure decay, where the system is charged with the air, closed, and the decay of pressure is measured by the time period. We conducted the determination of a vaporized H2O2 of a sufficient concentration to complete decontamination. The performance of the RTP chamber will improve safety and can be completely tested at an ISO Class 5 environment.

A comparison of control banding tools for nanomaterials.

Control banding (CB) is a useful approach to evaluate and control the risk of exposure to nanomaterials (NM) due to uncertainty surrounding their toxicity and challenges associated with their measurement. Four CB tools specifically developed for NMs (NanoSafer, Stoffenmanager-Nano, NanoTool, and the Precautionary matrix) have been evaluated for their changes to differences in hazard and exposure input data. The hazard and exposure classification were also compared with experimental data. The tools provided different hazard and emission/exposure outputs when compared with each other and with experimental data. For some of the tools the information required to estimate the hazard is not always available in the Safety Data Sheet and it requires expert judgement. The tools have the potential to be valuable starting points to assess areas of high priority, although outputs should be interpreted with care. Further work should be done to improve their estimates, especially the inclusion of modifiers that account for the effectiveness of the ventilation and the effect of high temperatures during the process.