The protective effect of tight-fitting powered air-purifying respirators during chest compressions.

BACKGROUND: Airborne personal protective equipment is required for healthcare workers when performing aerosol-generating procedures on patients with infectious diseases. Chest compressions, one of the main components of cardiopulmonary resuscitation, require intense and dynamic movements of the upper body. We aimed to investigate the protective effect of tight-fitting powered air-purifying respirators (PAPRs) during chest compressions. METHODS: This single-center simulation study was performed from February 2021 to March 2021. The simulated workplace protection factor (SWPF) is the concentration ratio of ambient particles and particles inside the PAPR mask; this value indicates the level of protection provided by a respirator when subjected to a simulated work environment. Participants performed continuous chest compressions three times for 2 min each time, with a 4-min break between each session. We measured the SWPF of the tight-fitting PAPR during chest compression in real-time mode. The primary outcome was the ratio of any failure of protection (SWPF <500) during the chest compression sessions. RESULTS: Fifty-four participants completed the simulation. Overall, 78% (n = 42) of the participants failed (the measured SWPF value was less than 500) at least one of the three sessions of chest compressions. The median value and interquartile range of the SWPF was 4304 (685-16,191). There were no reports of slipping down of the respirator or mechanical failure during chest compressions. CONCLUSIONS: Although the median SWPF value was high during chest compressions, the tight-fitting PAPR did not provide adequate protection.

Recomendaciones para calefacción, ventilación y aire acondicionado en establecimientos de salud, octubre del 2020 / Recommendations for Heating, Ventilation, and Air Conditioning in Healthcare Facilities, October 2020

Proporcionar condiciones térmicas y sistemas de ventilación adecuados que eviten la dispersión de patógenos es fundamental para proteger la salud de los pacientes, de los profesionales médicos y de enfermería, y del resto del personal, así como para el funcionamiento general de los equipos sensibles. Esta segunda versión presenta recomendaciones generales para evitar la transmisión del SARS-CoV-2 a través de sistemas de calefacción, ventilación y aire acondicionado en establecimientos de salud.

Providing adequate thermal conditions and ventilation systems that prevent the dispersion of pathogens, is fundamental to protect the health of patients, caregivers and staff, and to the overall operation of sensitive equipment. This technical note presents general recommendations to prevent the transmission of SARS-CoV-2 through heating, ventilation, and air conditioning systems in ​health care facilities.

Containment of procedure-associated aerosols by an extractor tent: effect on nebulized drug particle dispersal.

BACKGROUND: Several medical procedures involving the respiratory tract are considered as 'aerosol-generating procedures'. Aerosols from these procedures may be inhaled by bystanders, and there are consequent concerns regarding the transmission of infection or, specific to nebulized therapy, secondary drug exposure. AIM: To assess the efficacy of a proprietary high-efficiency-particulate-air-filtering extractor tent on reducing the aerosol dispersal of nebulized bronchodilator drugs. METHODS: The study was conducted in an unoccupied outpatient room at St. James's Hospital, Dublin, Ireland. A novel real-time, fluorescent particle counter, the Wideband Integrated Bioaerosol Sensor (WIBS), monitored room air continuously for 3 h. Baseline airborne particle count and count during nebulization of bronchodilator drug solutions were recorded. FINDINGS: Nebulization within the tent prevented any increase over background level. Nebulization directly into room air resulted in mean fluorescent particle counts of 4.75 x 105/m3 and 4.21 x 105/m3 for Ventolin and Ipramol, respectively, representing more than 400-fold increases over mean background level. More than 99.3% of drug particles were <2 µm in diameter and therefore small enough to enter the lower respiratory tract. CONCLUSION: The extractor tent was completely effective for the prevention of airborne spread of drug particles of respirable size from nebulized therapy. This suggests that extractor tents of this type would be efficacious for the prevention of airborne infection from aerosol-generating procedures during the COVID-19 pandemic.

Reusable Filters Augmented with Heating Microfibers for Antibacterial and Antiviral Sterilization.

Numerous threats to human health and ecosystems on earth exist due to air pollution and the spread of fatal diseases. Airborne pollutants and particulate matter (PM) pose serious public health risks. In addition, the emergence and spread of bacterial and viral diseases constantly threaten public health and safety. Although various approaches have been implemented thus far to protect humans from air pollution and exposure to diseases, several challenges remain to be addressed. In this study, we developed a hybrid air filter consisting of filtration, heating, and thermal insulation layers. The air filtration layer can effectively capture airborne PM1 particles (less than 1.0 µm in diameter). Furthermore, the heating layer enables the hybrid air filter to generate temperatures above 100 °C, and the insulation layer prevents the heat from being transferred to the other side (e.g., the human skin, if the hybrid air filter is used in a facemask). Since several bacteria and viruses are incapacitated under high temperatures, this hybrid air filter holds great promise for antibacterial and antiviral protection.

[Reuse process of positive pressure powered air-filter protective hoods].

OBJECTIVE: To establish reuse process of positive pressure powered air-filter protective hoods during coronavirus disease 2019 (COVID-19) epidemic. METHODS: The procedure of pretreatment, storage, recovery, cleaning, disinfection and sterilization process of positive pressure powered air-filter protective hoods, which were used in the treatment of COVID-19 infection patients was established in Central Sterile Supply Department of the hospital. The cleaning and disinfection effects of the protective hoods after treatment were examined by magnifying glass method, residual protein detection method, real-time PCR, and agar pour plate method. RESULTS: Twenty five used protective hoods underwent totally 135 times of washing, disinfecting and sterilizing procedures. After washing, all the protein residue tests and COVID-19 nucleic acid tests showed negative results. After sterilizing, all the protective hoods met sterility requirement. All the tested protective hoods were undamaged after reprocessing. CONCLUSIONS: The established reuse procedures for used positive pressure powered air-filter protective hoods are safe.

Measurement of filtration efficiencies of healthcare and consumer materials using modified respirator fit tester setup.

During the current SARS-CoV-2 pandemic there is unprecedented demand for personal protective equipment (PPE), especially N95 respirators and surgical masks. The ability of SARS-CoV-2 to be transmitted via respiratory droplets from asymptomatic individuals has necessitated increased usage of both N95 respirators in the healthcare setting and masks (both surgical and homemade) in public spaces. These precautions rely on two fundamental principles of transmission prevention: particle filtration and droplet containment. The former is the focus of NIOSH N95 testing guidelines, and the latter is an FDA guideline for respirators and surgical masks. While studies have investigated droplet containment to provide guidance for homemade mask production, limited work has been done to characterize the filtration efficiency (FE) of materials used in home mask making. In this work, we demonstrate the low-cost (<$300) conversion of standard equipment used to fit-test respirators in hospital and industrial settings into a setup that measures quantitative FEs of materials based on NIOSH N95 guidelines, and subsequently measure FEs of materials found in healthcare and consumer spaces. These materials demonstrate significant variability in filtration characteristics, even for visually similar materials. We demonstrate a FE of 96.49% and pressure drop of 25.4 mmH20 for a double-layer of sterilization wrap used in surgical suites and a FE of 90.37% for a combination of consumer-grade materials. The excellent filtration characteristics of the former demonstrate potential utility for emergent situations when N95 respirators are not available, while those of the latter demonstrate that a high FE can be achieved using publicly available materials.

COVID-19​ and safe indoor spaces live Q&A with Maria Neira and Luca Fontana. Ask WHO​ 22 Sept. 2020

#AskWHO​ series: This was the live discussion about the COVID-19 pandemic of 16 September 2020 with Dr Mike Ryan, Executive Director of WHO Health Emergencies Programme, and Dr Maria Van Kerkhove, WHO Technical Lead on COVID-19. Questions from the audience were taken.

Conducting an evaluation of CBRN canister protection capabilities against emerging chemical and radiological hazards.

In the event of a chemical, biological, radiological, or nuclear (CBRN) hazard release, emergency responders rely on respiratory protection to prevent inhalation of these hazards. The National Institute for Occupational Safety and Health's (NIOSH) CBRN Statement of Standard calls for CBRN respirator canisters to be challenged with 11 different chemical test representative agents (TRAs) during certification testing, which represent hazards from 7 distinct Chemical Families; these 11 TRAs were identified during the original 2001 CBRN hazard assessment. CBRN hazards are constantly evolving in type, intent of use, and ways of dissemination. Thus, new and emerging hazards must be identified to ensure CBRN canisters continue to provide protection to emergency responders against all hazards that would most likely be used in an intentional or unintentional event. The objectives are to: (1) update the CBRN list of hazards to ensure NIOSH-approved CBRN canisters continue to provide adequate protection capabilities from newly emerging chemical and radiological hazards and (2) identify the need to update NIOSH TRAs to ensure testing conditions represent relevant hazards. These objectives were accomplished by reviewing recent hazard assessments to identify a list of chemical and radiological respiratory hazards, evaluate chemical/physical properties and filtration behavior for these hazards, group the hazards based on NIOSH's current Chemical Families, and finally compare the hazards to the current TRAs based on anticipated filtration behavior, among other criteria. Upon completion of the evaluation process, 237 hazards were identified and compared to NIOSH's current CBRN TRAs. Of these 237 hazards, 203 were able to be categorized into one of NIOSH's current seven Chemical Families. Five were identified for further evaluation. Based on reviewing key chemical/physical properties of each hazard, NIOSH's current 11 TRAs remain representative of the identified respiratory CBRN hazards to emergency responders and should continue to be used during NIOSH certification testing. Thus, NIOSH's CBRN Statement of Standard remains unchanged. The process developed standardizes a methodology for future hazard evaluations.

Recomendaciones para calefacción, ventilación y aire acondicionado en establecimientos de salud, 21 de mayo del 2020 / Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities, 21 May 2020

Esta ficha técnica presenta recomendaciones generales para evitar la transmisión del SARS-CoV-2 por medio de sistemas de calefacción, ventilación y aire acondicionado en establecimientos de salud.

This technical note presents general recommendations to prevent the transmission of SARS-CoV-2 through heating, ventilation, and air conditioning systems in ​health care facilities.

Air filters for indoor environments: Interlaboratory evaluation of the new international filter testing standard ISO 16890.

Electret filters are widely used in HVAC systems to decrease particulate matter in indoor environments. The previous standard in Europe for testing air filters for general ventilation was EN 779. In July 2018, it was replaced by the new international standard ISO 16890. One major change is the discharging process: It is now performed by treating the filters with saturated isopropyl alcohol (IPA) vapor. The process is intended to simulate a worst-case scenario of the filtration efficiency due to the reduction of the electret effect. These minimal efficiencies are a principal part of the filter classification. Therefore, two round robin tests with different filter classes (F9 and F7 according to EN 779) and up to eleven participants were carried out to evaluate the new test method by comparing the filtration efficiencies and pressure drops before and after the IPA treatment. Pressure drop measurements showed no mechanical altering of the material due to the discharging process. The calculated filter classes had a maximum deviation of 5%. Even with different equipment, the results indicate that the new ISO 16890 seems to be a viable test standard and a decent replacement for previous national standards.

Copper Tannic Acid Coordination Nanosheet: A Potent Nanozyme for Scavenging ROS from Cigarette Smoke.

The global tobacco epidemic is still a devastating threat to public health. Toxic reactive oxygen species (ROS) in the cigarette smoke cannot be efficiently eliminated by currently available cigarette filters. The resultant oxidative stress causes severe lung injury and further diseases. To tackle this challenge, herein, a novel copper tannic acid coordination (CuTA) nanozyme is reported as a highly active and thermostable ROS scavenger. The CuTA nanozyme exhibits intrinsic superoxide dismutase-like activity, catalase-like activity, and hydroxyl radical elimination capacity. These synergistic antioxidant abilities make the CuTA nanozyme a promising candidate for the improvement of commercial cigarette filters. Mouse model results show that commercial cigarettes loaded with CuTA nanozyme efficiently scavenge ROS in the cigarette smoke, reduce oxidative stress-induced lung inflammation, and minimize the resultant acute lung injury. The developed CuTA nanozyme offers an efficient ROS scavenger with multiple antioxidant ability and opens up new opportunities for the modification of cigarette filters to reduce the toxic effects of cigarette smoke.

Practical Applications of Biofluorescent Particle Counting in Environmental Monitoring Investigations.

Investigations into environmental monitoring (EM) excursions can be prolonged and do not always result in clear root causes or corrective and preventative actions. This article outlines how biofluorescent particle counting (BFPC) can be used in investigations to eliminate the inherent delays of culture-based methods. The application for investigations supplements routine EM, acting as a risk-reduction tool enabling real-time detection of viable microorganisms in air samples and supporting root cause analysis and remedial actions. The article includes guidance on how to use the technology, a real case study involving a mold excursion, and examples of business benefits achieved by various companies.

Assessment of air purifier on efficient removal of airborne bacteria, Staphylococcus epidermidis, using single-chamber method.

We evaluated the efficiency of an air purifier using the single-chamber method for the effective removal of airborne Staphylococcus epidermidis, a nosocomial infection-causing bacterium. In this experiment, the bacterial strain S. epidermidis was injected using a nebulizer into the test chamber, which was similar to a consumer living space (60 m3). The microbial sampling was conducted via the air sampler method, and the reduction in S. epidermidis growth was monitored by performing three consecutive tests. Initially, a blank test was conducted to determine the natural decay rate and calibrate the experimental setup. After injecting the bacterial strain from 1240 to 11180 CFU per unit volume (m3), the natural decay rate showed a maximum deviation of 3.1% with a sampling error of 1.1% p at a confidence level of 95%. In addition, the particle size distribution in the test chamber was found to range from 0.3 to 5.0 µm, and a subsequent decrease in large-sized particles was observed with the operation of the air purifier, which is the size similar to that of suspended airborne bacteria. This can be used to assess the performance of the air purifier by calibrating the natural reduction value to the reduced operation value. Thus, the single-chamber technique is a promising approach for analyzing the removal efficacy of airborne bacteria from indoor air.

Fine and ultrafine particle removal efficiency of new residential HVAC filters.

Particle air filters used in central residential forced-air systems are most commonly evaluated for their size-resolved removal efficiency for particles 0.3-10 µm using laboratory tests. Little information exists on the removal efficiency of commercially available residential filters for particles smaller than 0.3 µm or for integral measures of mass-based aerosol concentrations (eg, PM2.5 ) or total number concentrations (eg, ultrafine particles, or UFPs) that are commonly used in regulatory monitoring and building measurements. Here, we measure the size-resolved removal efficiency of 50 new commercially available residential HVAC filters installed in a recirculating central air-handling unit in an unoccupied apartment unit using alternating upstream/downstream measurements with incense and NaCl as particle sources. Size-resolved removal efficiencies are then used to estimate integral measures of PM2.5 and total UFP removal efficiency for the filters assuming they are challenged by 201 residential indoor particle size distributions (PSDs) gathered from the literature. Total UFP and PM2.5 removal efficiencies generally increased with manufacturer-reported filter ratings and with filter thickness, albeit with numerous exceptions. PM2.5 removal efficiencies were more influenced by the assumption for indoor PSD than total UFP removal efficiencies. Filters with the same ratings but from different manufacturers often had different removal efficiencies for PM2.5 and total UFPs.

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.

Measuring airflow through the portable high-efficiency air filtration (PHEAF) device to assess reliability of instrument and sample location.

The portable high-efficiency air filtration (PHEAF) device is an engineering control common to the environmental remediation industry. Damage to the high-efficiency particulate air (HEPA) filter (e.g., filtration media, gasket), improper installation of the filter into the mounting frame, or defects in the filtration housing affect the capture efficiency of the device. PHEAF devices operating at less than marketed efficiencies justify periodic leak testing of the PHEAF device, especially when the filtered air is exhausted into occupied spaces. A leak test is accomplished by injecting a known concentration of aerosol upstream of the HEPA filter and measuring the percentage of aerosol penetrating through the filtration system. The test protocol scripted for stationary systems (i.e., biological safety cabinets) states that upstream concentrations can be empirically determined using the aerosol photometer to measure particulate matter (PM) in the airstream. This practice requires a homogenous mixture of the aerosol challenge agent within the airstream. However, design of the PHEAF device does not include a validated induction point for the aerosol. Absent of an acceptable means to achieve a homogenous mixture for upstream measurement, the aerosol concentration is mathematically derived based on the measured air volume passing through the PHEAF equipment. In this study, intake volume and exhaust volume for each PHEAF device were measured by either the balometer or the hot wire anemometer. Variability of measurements was examined by instrument and sample location (intake vs. exhaust) to understand which combination would be most consistent for measuring airflow volume. From this study, the authors conclude that the balometer is preferred compared with the hot wire anemometer for measuring airflow through the PHEAF device. Exhaust measurement by balometer seems more reliable than intake measurements by hot wire anemometer. Implications: Although testing of PHEAF devices is recommended by various public health authorities, no nationally recognized test protocol has been published in the United States. In support of measuring the performance of the PHEAF device in a field setting, this study evaluated the hot wire anemometer and balometer techniques and sample locations (intake vs. exhaust) to reliably measure airflow through the PHEAF device. Since accuracy of the particle measurement is associated with airflow volume, it is essential to obtain a true airflow reading. This study suggests that the balometer was more consistent in measuring airflow through the PHEAF device.