Uncovering eco-friendly design in the ancient bronze goose-and-fish lamp: an unnoticeable gap boosts ventilation.

The bronze goose-and-fish lamp exhibited in the national museum of China is a 2,000-y-old artifact once used for indoor lighting by nobility in the Western Han dynasty (206 BCE TO 25 CE). The beauty of this national treasure arises from its elegant shape vividly showing a goose catching fish with beautiful colors painted over the whole body. Beyond the artistic and historical value, what enchants people most is the eco-design concept of this oil-burning lamp. It is widely believed that the smoke generated by burning animal oil can flow into the goose belly through its long neck, then be absorbed by prefilled water in the belly, hence mitigating indoor air pollution. Although different mechanistic hypotheses such as natural convection and even the siphon effect have been proposed to qualitatively rationalize the above-claimed pollution mitigation function, due to the absence of a true scientific analysis, the definitive mechanism remains a mystery. By rigorous modeling of the nonisothermal fluid flow coupled with convection-diffusion of pollutant within and out of the lamp, we discover that it is the unnoticeable gap between goose body and lamp tray (i.e., an intrinsic feature of the multicompartmental design) that can offer definitive ventilation in the lamp. The ventilation is facilitated by natural convection due to oil burning. Adequate ventilation plays a key role in enabling pollution mitigation, as it allows pollutant to reach the goose belly, travel over and be absorbed by the water.

How much natural ventilation rate can suppress COVID-19 transmission in occupancy zones?

Background: Previous research has emphasized the importance of efficient ventilation in suppressing COVID-19 transmission in indoor spaces, yet suitable ventilation rates have not been suggested. Materials and Methods: This study investigated the impacts of mechanical, natural, single-sided, cross-ventilation, and three mask types (homemade, surgical, N95) on COVID-19 spread across eight common indoor settings. Viral exposure was quantified using a mass balance calculation of inhaled viral particles, accounting for initial viral load, removal via ventilation, and mask filtration efficiency. Results: Results demonstrated that natural cross-ventilation significantly reduced viral load, decreasing from 10,000 to 0 viruses over 15 minutes in a 100 m2 space by providing ~1325 m3/h of outdoor air via two 0.6 m2 openings at 1.5 m/s wind speed. In contrast, single-sided ventilation only halved viral load at best. Conclusion: Natural cross-ventilation with masks effectively suppressed airborne viruses, lowering potential infections and disease transmission. The study recommends suitable ventilation rates to reduce COVID-19 infection risks in indoor spaces.

A multi-layered strategy for COVID-19 infection prophylaxis in schools: A review of the evidence for masks, distancing, and ventilation.

Implications for the academic and interpersonal development of children and adolescents underpin a global political consensus to maintain in-classroom teaching during the ongoing COVID-19 pandemic. In support of this aim, the WHO and UNICEF have called for schools around the globe to be made safer from the risk of COVID-19 transmission. Detailed guidance is needed on how this goal can be successfully implemented in a wide variety of educational settings in order to effectively mitigate impacts on the health of students, staff, their families, and society. This review provides a comprehensive synthesis of current scientific evidence and emerging standards in relation to the use of layered prevention strategies (involving masks, distancing, and ventilation), setting out the basis for their implementation in the school environment. In the presence of increasingly infectious SARS-Cov-2 variants, in-classroom teaching can only be safely maintained through a layered strategy combining multiple protective measures. The precise measures that are needed at any point in time depend upon a number of dynamic factors, including the specific threat-level posed by the circulating variant, the level of community infection, and the political acceptability of the resultant risk. By consistently implementing appropriate prophylaxis measures, evidence shows that the risk of infection from in-classroom teaching can be dramatically reduced. Current studies indicate that wearing high-quality masks and regular testing are amongst the most important measures in preventing infection transmission; whilst effective natural and mechanical ventilation systems have been shown to reduce infection risks in classrooms by over 80%.

Investigating the gender differences in indoor thermal comfort perception for summer and winter seasons and comparison of comfort temperature prediction methods.

Formulation of indoor thermal comfort guidelines is challenging task considering the fact that these guidelines are supposed to address both, the expectations of the building occupants' regarding indoor thermal comfort, and optimize building energy use, under aggravating conditions of outdoor climate and availability and price volatility of energy. Therefore, a field survey was conducted to assess indoor thermal comfort in two female and three male dormitory buildings. Afterwards, a comparative analysis of three comfort temperature prediction models (linear, cubic and logistic) was conducted. In total, 971 survey forms were collected during the two seasons (summer and winter). Two-third of the data was used to develop the models, while remaining one-third was used to test the accuracies. Although thermal sensation votes of both genders were statistically different, no statistical difference in indoor comfort temperature between the two genders was observed. Comfort temperatures were calculated as 26.4 °C and 27.8 °C during summer and 22.7 °C and 22.4 °C during winters for female and male occupants respectively, using liner regression method. Following the Griffth's method mean operative comfort temperatures were calculated as 26.8 ± 1.5 °C and 27.6 ± 1.7 °C during summer and 22.7 ± 2.3 °C and 22.3 ± 2.0 °C during winter for female and male occupants respectively. Percentage accuracies of three prediction methods under study showed better performance of logistic regression.

Ventilating aged-care center based on solar chimney: Design and theoretical analysis.

Natural ventilation is considered the first suggestion for COVID-19 prevention in buildings by the World Health Organization (WHO). Solar chimney's viability in aged care centers or similar facilities was analyzed numerically and theoretically. A new solar chimney design was proposed to reduce the cross-infection risk of COVID-19 based on an airflow path through window, ceiling vent, attic, and then chimney cavity. Solar chimney performance, quantified by the natural ventilation rate, presented power function with window area, ceiling vent area, cavity height, and solar radiation. The ceiling vent is suggested to be closer to the corridor to enhance the performance and ventilation coverage of the room. A cavity gap of 1.0 m is recommended to balance the ventilation performance and construction cost. A theoretical model was also developed for aged care centers with multiple rooms and a joint attic. Its predictions obey reasonably well with the numerical results. Solar chimney's viability in aged care center is confirmed as a 7.22 air change per hour (ACH) ventilation can be achieved even under a low solar radiation intensity of 200 W/m2, where its performance fulfills the minimal ventilation requirement (i.e., 6 ACH) suggested by the WHO for airborne infection isolation rooms. This study offers a new design and a guideline for the future implementation of solar chimney in aged care centers or similar facilities.

A new method for air exchange efficiency assessment including natural and mixed mode ventilation.

The COVID-19 health crisis highlighted the correlation between air exchange efficiency and virus airborne transmission. Air exchange efficiency is a performance index able to characterize ventilation effectiveness in buildings. Some standards, such as ASHRAE 129, clearly define assessment procedures of air exchange efficiency for mechanical ventilation, adopting tracer gas techniques. However, standardized procedures are based on measurements at the exhaust and cannot be adopted for natural and mixed mode ventilation strategies. In the '80s, Sandberg suggested that tracer gas decay technique enables to measure simultaneously the nominal time constant (through air change rate measurements) and the mean age of air in several points of the ventilated zone. This paper aims to present practical issues and uncertainty analysis related to the implementation of this approach, in a new commissioning protocol. For this purpose, we compare the new procedure, based on Sandberg's observation, with the ASHRAE 129 protocol for mechanical ventilation. Results coming from field campaigns show that the difference between air exchange efficiency values obtained using ASHRAE 129 protocol (51.8%) and the new procedure (47.4%) are usually negligible in low airflow rate, considering an average uncertainty of ± 7.0%. Results show that the procedure is robust and that it is technically possible to implement it to natural and mixed-mode ventilation.

Evaluation of aerosol transmission risk during home quarantine under different operating scenarios: A pilot study.

SARS-CoV-2 has been recognized to be airborne transmissible. With the large number of reported positive cases in the community, home quarantine is recommended for the infectors who are not severely ill. However, the risks of household aerosol transmission associated with the quarantine room operating methods are under-explored. We used tracer gas technique to simulate the exhaled virus laden aerosols from a patient under home quarantine situation inside a residential testbed. The Sulphur hexafluoride (SF6) concentration was measured both inside and outside the quarantine room under different operating settings including, air-conditioning and natural ventilation, presence of an exhaust fan, and the air movement generated by ceiling or pedestal fan. We calculated the outside-to-inside SF6 concentration to indicate potential exposure of occupants in the same household. In-room concentration with air-conditioning was 4 times higher than in natural ventilation settings. Exhaust fan operation substantially reduced in-room SF6 concentration and leakage rate in most of the ventilation scenarios, except for natural ventilation setting with ceiling fan. The exception is attributable to the different airflow patterns between ceiling fan (recirculates air vertically) and pedestal fan (moves air horizontally). These airflow variations also led to differences in SF6 concentration at two sampling heights (0.1 m and 1.7 m) and SF6 leakage rates when the quarantine room door was opened momentarily. Use of natural ventilation rather than air-conditioning, and operating exhaust fan when using air-conditioning are recommended to lower exposure risk for home quarantine. A more holistic experiment will be conducted to address the limitations reflected in this study.

Airborne infection risk of inter-unit dispersion through semi-shaded openings: A case study of a multi-storey building with external louvers.

Building design for natural ventilation and indoor air quality have become increasingly important during the past decades. Investigating airflow routes of airborne transmission and evaluating the potential infection risk in the multi-storey building is helpful to the reduction of airborne transmission. Therefore, this study applies computational fluid dynamics simulations to investigate the inter-unit dispersion pattern of gaseous pollutant between different units through semi-shaded openings. The airflow exchange and pollutant dispersion in a multi-storey building is driven by wind-induced natural ventilation. External shading louvers, which are widely used in building facades to reduce heat gain from solar radiation, are chosen to establish the semi-shaded environment. Experimental validation is performed to make sure the accuracy of numerical settings in airflow investigation of semi-shaded openings. The airflow characteristics around semi-shaded openings is analyzed in the numerical simulations. The re-entry ratio of tracer gas and the airborne infection risk of COVID-19 is investigated in the cases with different louvers' locations and source units. The results show that the airflow is commonly slower in the semi-shaded space between louvers and openings. But the ventilation rate is not always consistent with the airflow speed because of the diversion effect from louver slats. The inter-unit infectious risk in the worst unit rises from 7.82% to 26.17% for windward shading, while it rises from 7.89% to 22.52% for leeward shading. These results are helpful to the further understanding of inter-unit transmission of infectious respiratory aerosols through external openings with complex structures.

Associations between ventilation and children's asthma and allergy in naturally ventilated Chinese homes.

Building ventilation is important for occupants' health. There are few studies of associations between home ventilation and occupant's health in China. During 2013-2016, we measured ventilation in 399 homes in Tianjin and Cangzhou, China, and surveyed the health history of children. Ventilation rates were measured using mass balance of occupant generated CO2 . The associations of home ventilation with children's asthma and allergy were analyzed in different strata of time and space. A low bedroom ventilation at night was significantly associated with an increased proportion of rhinitis among children (rhinitis current, adjusted odds ratio (AOR): 1.59; 95% confidence interval (CI): 1.01-2.49; diagnosed rhinitis, AOR: 3.02 (1.16-7.89)). Our findings suggest a dose-response relationship between ventilation rate at night in children's bedrooms and rhinitis current. The night-time ventilation rate in bedrooms has a greater association with rhinitis than the whole home ventilation rate during daytime.

Estimating long-term time-resolved indoor PM2.5 of outdoor and indoor origin using easily obtainable inputs.

To evaluate the separate impacts on human health and establish effective control strategies, it is crucial to estimate the contribution of outdoor infiltration and indoor emission to indoor PM2.5 in buildings. This study used an algorithm to automatically estimate the long-term time-resolved indoor PM2.5 of outdoor and indoor origin in real apartments with natural ventilation. The inputs for the algorithm were only the time-resolved indoor/outdoor PM2.5 concentrations and occupants' window actions, which were easily obtained from the low-cost sensors. This study first applied the algorithm in an apartment in Tianjin, China. The indoor/outdoor contribution to the gross indoor exposure and time-resolved infiltration factor were automatically estimated using the algorithm. The influence of outdoor PM2.5 data source and algorithm parameters on the estimated results was analyzed. The algorithm was then applied in four other apartments located in Chongqing, Shenyang, Xi'an, and Urumqi to further demonstrate its feasibility. The results provided indirect evidence, such as the plausible explanations for seasonal and spatial variation, to partially support the success of the algorithm used in real apartments. Through the analysis, this study also identified several further development directions to facilitate the practical applications of the algorithm, such as robust long-term outdoor PM2.5  monitoring using low-cost light-scattering sensors.

Monitoring and Assessment of Indoor Environmental Conditions after the Implementation of COVID-19-Based Ventilation Strategies in an Educational Building in Southern Spain.

Since students and teachers spend much of their time in educational buildings, it is critical to provide good levels of indoor environmental quality (IEQ). The current COVID-19 pandemic has shown that maintaining a good indoor air quality level is an effective measure to control the transmission of the SARS-CoV-2 virus. This study used sensors to monitor key IEQ factors and assess several natural ventilation scenarios in a classroom of the University of Granada. Subsequently, the IEQ factors (temperature, relative humidity, CO2 concentration, acoustic environment, and air velocity) were evaluated for the selected ventilation scenarios in the occupied classroom, and the field monitoring was carried out in two different assessment periods, winter and summer. The obtained results show that the CO2 concentration levels were well below the recommended limits. However, the maintenance of the recommended thermal and acoustic IEQ factors was significantly affected by the natural ventilation strategies (temperature and relative humidity values were very close to the outside values, and the background sound pressure level was over 35 dBA during the entire assessment). The proper measurements and careful selection of the appropriate ventilation scenarios become of utmost importance to ensure that the ventilation rates required by the health authorities are achieved.

BIM and Data-Driven Predictive Analysis of Optimum Thermal Comfort for Indoor Environment.

Mechanical ventilation comprises a significant proportion of the total energy consumed in buildings. Sufficient natural ventilation in buildings is critical in reducing the energy consumption of mechanical ventilation while maintaining a comfortable indoor environment for occupants. In this paper, a new computerized framework based on building information modelling (BIM) and machine learning data-driven models is presented to analyze the optimum thermal comfort for indoor environments with the effect of natural ventilation. BIM provides geometrical and semantic information of the built environment, which are leveraged for setting the computational domain and boundary conditions of computational fluid dynamics (CFD) simulation. CFD modelling is conducted to obtain the flow field and temperature distribution, the results of which determine the thermal comfort index in a ventilated environment. BIM-CFD provides spatial data, boundary conditions, indoor environmental parameters, and the thermal comfort index for machine learning to construct robust data-driven models to empower the predictive analysis. In the neural network, the adjacency matrix in the field of graph theory is used to represent the spatial features (such as zone adjacency and connectivity) and incorporate the potential impact of interzonal airflow in thermal comfort analysis. The results of a case study indicate that utilizing natural ventilation can save cooling power consumption, but it may not be sufficient to fulfil all the thermal comfort criteria. The performance of natural ventilation at different seasons should be considered to identify the period when both air conditioning energy use and indoor thermal comfort are achieved. With the proposed new framework, thermal comfort prediction can be examined more efficiently to study different design options, operating scenarios, and changeover strategies between various ventilation modes, such as better spatial HVAC system designs, specific room-based real-time HVAC control, and other potential applications to maximize indoor thermal comfort.

Analysis of Impact of Natural Ventilation Strategies in Ventilation Rates and Indoor Environmental Acoustics Using Sensor Measurement Data in Educational Buildings.

Indoor environmental conditions can significantly affect occupants' health and comfort. These conditions are especially important in educational buildings, where students, teachers and staff spend long periods of the day and are vulnerable to these factors. Recently, indoor air quality has been a focus of attention to ensure that disease transmission in these spaces is minimised. In order to increase the knowledge in this field, experimental tests have been carried out to characterise the impact of natural ventilation strategies on indoor air quality and the acoustic environment. This study has evaluated three ventilation scenarios in four different classrooms in buildings of the University of Granada, considering different window and door opening configurations. Ventilation rates were estimated using the CO2 Decay Method, and background noise recordings were made in each classroom for acoustic tests. Results show that specific natural ventilation strategies have a relevant impact that is worth considering on the background noise in indoor spaces. In this sense ventilation rates provided by the different configurations varied between 3.7 and 39.8 air changes per hour (ACH) and the acoustic tests show a background noise ranging from 43 to 54 dBA in these scenarios. Consequently, managers and teachers should take into account not only the ACH, but also other collateral impacts on the indoor environmental conditions such as the thermal comfort or the acoustic environment.

A fresh (air) look at ventilation for COVID-19: Estimating the global energy savings potential of coupling natural ventilation with novel radiant cooling strategies.

Radiant cooling-assisted natural ventilation is an innovative technical approach that combines new radiant cooling technology with natural ventilation to increase fresh air delivery into buildings year-round with minimal energy cost and improvment of air quality. Currently, the standard paradigm for HVAC (heating, ventilation and air conditioning) is based on central air systems that tie the delivery of heating and cooling to the delivery of fresh air. To prevent heat loss, the delivery of fresh air must be tightly controlled and is often limited through recirculation of already heated or cooled air. Buildings are designed with airtight envelopes, which do not allow for natural ventilation, and depend on energy-intensive central-air systems. As closed environments, buildings have become sites of rapid COVID-19 transmission. In this research, we demonstrate the energy cost of increasing outdoor air supply with standard systems per COVID-19 recommendations and introduce an alternative HVAC paradigm that maximizes the decoupling of ventilation and thermal control. We first consider a novel analysis of the energy costs of increasing the amount of conditioned fresh air using standard HVAC systems to address COVID-19 concerns. We then present an alternative that includes a novel membrane-assisted radiant system we have studied for cooling in humid climates, in place of an air conditioning system. The proposed system can work in conjunction with natural ventilation and thus decreases the risk of indoor spread of infectious diseases and significantly lowers energy consumption in buildings. Our results for modeling HVAC energy in different climates show that increasing outdoor air in standard systems can double cooling costs, while increasing natural ventilation with radiant systems can halve costs. More specifically, it is possible to add up to 100 days' worth of natural ventilation while saving energy when coupling natural ventilation and radiant systems. This combination decreases energy costs by 10-45% in 60 major cities globally, while increasing fresh air intake.

Emission of harmful gases from animal production in Poland.

The aim of the study was to present the scale of greenhouse gas emissions from animal production, and to provide test results from different housing systems. In three free stall buildings, two with slurry in deep channels and one with cattle in cubicles staying on shallow litter concentration of ammonia and carbon dioxide were measured in summer season by using dedicated equipment from Industrial Scientific Research. Air exchange was calculated on the base of balance carbon dioxide method. This method was used in order to estimate the air flow rate. Concentrations of ammonia and CO2 were measured as the base for air exchange and ammonia emission rates. Ammonia emissions were product of ammonia concentration and air exchange rate. Temperature and relative humidity were measured to establish microclimate conditions in buildings tested to show the overall microclimatic situation in buildings. Differences between ammonia emission rates were observed in both housing systems. The highest ammonia emission rate was equal to 2.75 g·h-1·LU-1 in well-ventilated cattle barn with the largest herd size.

Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge.

Among the various strategies for the prevention of airborne transmission, engineering measures are placed high in the hierarchy of control. Modern hospitals in high-income countries have mechanical systems of building ventilation also called HVAC (heating, ventilation, and air-conditioning) but installation and maintenance of such systems is a challenging and resource-intensive task. Even when the state-of-the-art technology was used to build airborne infection isolation rooms (AIIRs), recommended standards were often not met in field studies. The current coronavirus disease-2019 pandemic has highlighted the need to find cost-effective and less resource-intensive engineering solutions. Moreover, there is a need for the involvement of interdisciplinary teams to find innovative infection control solutions and doctors are frequently lacking in their understanding of building ventilation-related problems as well as their possible solutions. The current article describes building ventilation strategies (natural ventilation and hybrid ventilation) for hospitals where HVAC systems are either lacking or do not meet the recommended standards. Other measures like the use of portable air cleaning technologies and temporary negative-pressure rooms can be used as supplementary strategies in situations of demand surge. It can be easily understood that thermal comfort is compromised in buildings that are not mechanically fitted with HVAC systems, therefore the given building ventilation strategies are more helpful when climatic conditions are moderate or other measures are combined to maintain thermal comfort. HOW TO CITE THIS ARTICLE: Zia H, Singh R, Seth M, Ahmed A, Azim A. Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge. Indian J Crit Care Med 2021;25(4):453-460.

Analysing natural ventilation to reduce the cooling energy consumption and the fuel poverty of social dwellings in coastal zones.

In southern European countries, summer temperatures could contribute to a high cooling energy consumption. Family units with fewer economic resources living in social dwellings could suffer from fuel poverty if they want to use air conditioning systems. Otherwise, they could face discomfort hours because of a natural ventilation without clear control criteria. This study analyses quantitatively and qualitatively the possibilities of natural ventilation through mixed-mode and the possibility of reducing fuel poverty for family units living in social dwellings. For this purpose, the application of a natural ventilation approach was analysed through an adaptive behaviour based on EN 16798-1: 2019. A case study of 51 social dwellings was analysed by using various operation hypothesis between 2015 and 2019. The results showed the potential of using mixed-mode approaches based on the categories from EN 16798-1:2019 to achieve savings in the energy consumption and to remove cases of fuel poverty in low-income families. Likewise, surveys in which families living in these cities participated reflected the great awareness of the natural ventilation use, although there is not a clear criterion of the need of this ventilation for thermal comfort, as well as the need of a supportive use of air conditioning systems. Finally, the similarity of the climate conditions of the city analysed and the coastal cities from various countries in the south of Europe shows the possibility of using ventilation strategies as energy saving measures in other regions.

Numerical investigation of gaseous pollutant cross-transmission for single-sided natural ventilation driven by buoyancy and wind.

Single-sided natural ventilation was numerically investigated to determine the impact of buoyancy and wind on the cross-transmission of pollution by considering six window types commonly found in multistory buildings. The goal of this study was to predict the gaseous pollutant transmission using computational fluid dynamics based on the Reynolds-averaged Navier-Stokes equations and baseline k-ω turbulence equations. The results indicated that ventilation rates generally increased with increasing wind speeds if the effects of buoyancy and wind were not suppressed; however, the re-entry ratio representing the proportion of expelled air re-entering other floors and the corresponding risk of infection decreased. If the source of the virus was on a central floor, the risk of infection was the highest on the floors closest to the source. Different window types were also considered for determining their effectiveness in controlling cross-transmission and infection risk, depending on the source location and driving force (e.g., buoyancy and wind).

Evaluating the potential of adaptive comfort approach using historic data to reduce energy consumption in buildings in southern Spain.

The application of adaptive comfort models is among the determinant factors to reduce greenhouse gas emissions in the building sector. This research studies the region of Andalusia (south of Spain). A cluster analysis is applied to 786 Andalusian municipalities, and 4 groups are established according to the potential of adaptive strategies. A town is chosen from each group, and an hourly specific study is conducted for the last 20 years, as well as a daily study of the old time series by using an artificial neural network based on the existing climate data. The possibility of application of the EN 16798-1:2019 standard during the days of the year is analysed, as well as the possibilities of using natural ventilation and the possibility of using adaptive setpoint temperatures in comparison with both 3 fixed heating temperatures and 3 fixed cooling temperatures by considering the energy saving. The results to apply the standard ranged 69.0 and 100% of the days of each year. The possibilities of natural ventilation considered were greater than 10% of the hours of the year in all the assumptions. The energy saving of cooling degrees reveals a greater potential in the area studied than that of heating degrees; this tendency is supported by the study of old temporary series which are part of the climate variation predicted throughout the 21st century.

Improving natural ventilation in hospital waiting and consulting rooms to reduce nosocomial tuberculosis transmission risk in a low resource setting.

BACKGROUND: TB transmission in healthcare facilities is an important public health problem, especially in the often-overcrowded settings of HIV treatment scale-up. The problem is compounded by the emergence of drug resistant TB. Natural ventilation is a low-cost environmental control measure for TB infection control where climate permits that is suited to many different areas in healthcare facilities. There are no published data on the effect of simple structural modifications to existing hospital infrastructure to improve natural ventilation and reduce the risk of nosocomial TB transmission. The purpose of this study was to measure the effect of simple architectural modifications to existing hospital waiting and consulting rooms in a low resource setting on (a) improving natural ventilation and (b) reducing modelled TB transmission risk. METHODS: Room ventilation was measured pre- and post-modification using a carbon dioxide tracer-gas technique in four waiting rooms and two consulting rooms in two hospitals in Lima, Peru. Modifications included additional windows for cross-ventilation (n = 2 rooms); removing glass from unopenable windows (n = 2); creation of an open skylight (n = 1); re-building a waiting-room in the open air (n = 1). Changes in TB transmission risk for waiting patients, or healthcare workers in consulting rooms, were estimated using mathematical modelling. RESULTS: As a result of the infrastructure modifications, room ventilation in the four waiting rooms increased from mean 5.5 to 15; 11 to 16; 10 to 17; and 9 to 66 air-changes/hour respectively; and in the two consulting rooms from mean 3.6 to 17; and 2.7 to 12 air-changes/hour respectively. There was a median 72% reduction (inter-quartile range 51-82%) in calculated TB transmission risk for healthcare workers or waiting patients. The modifications cost