Reducing Transmission of Airborne Respiratory Pathogens: A New Beginning as the COVID-19 Emergency Ends.

BACKGROUND: In response to the COVID-19 pandemic, new evidence-based strategies have emerged for reducing transmission of respiratory infections through management of indoor air. OBJECTIVES: This paper reviews critical advances that could reduce the burden of disease from inhaled pathogens and describes challenges in their implementation. DISCUSSION: Proven strategies include assuring sufficient ventilation, air cleaning by filtration, and air disinfection by germicidal ultraviolet (UV) light. Layered intervention strategies are needed to maximize risk reduction. Case studies demonstrate how to implement these tools while also revealing barriers to implementation. Future needs include standards designed with infection resilience and equity in mind, buildings optimized for infection resilience among other drivers, new approaches and technologies to improve ventilation, scientific consensus on the amount of ventilation needed to achieve a desired level of risk, methods for evaluating new air-cleaning technologies, studies of their long-term health effects, workforce training on ventilation systems, easier access to federal funds, demonstration projects in schools, and communication with the public about the importance of indoor air quality and actions people can take to improve it. https://doi.org/10.1289/EHP13878.

A facile cellulose finishing strategy through in-situ growth of sliver-doped manganese dioxide assisted by amine-quinone for improving indoor living quality.

Nowadays, various harmful indoor pollutants especially including bacteria and residual formaldehyde (HCHO) seriously threaten human health and reduce the quality of public life. Herein, a universal substrate-independence finishing approach for efficiently solving these hybrid indoor threats is demonstrated, in which amine-quinone network (AQN) was employed as reduction agent to guide in-situ growth of Ag@MnO2 particles, and also acted as an adhesion interlayer to firmly anchor nanoparticles onto diverse textiles, especially for cotton fabrics. In contrast with traditional hydrothermal or calcine methods, the highly reactive AQN ensures the efficient generation of functional nanoparticles under mild conditions without any additional catalysts. During the AQN-guided reduction, the doping of Ag atoms onto cellulose fiber surface optimized the crystallinity and oxygen vacancy of MnO2, providing cotton efficient antibacterial efficiency over 90 % after 30 min of contact, companying with encouraging UV-shielding and indoor HCHO purification properties. Besides, even after 30 cycles of standard washing, the Ag@MnO2-decorated textiles can effectively degrade HCHO while well-maintaining their inherent properties. In summary, the presented AQN-mediated strategy of efficiently guiding the deposition of functional particles on fibers has broad application prospects in the green and sustainable functionalization of textiles.

A quanta-independent approach for the assessment of strategies to reduce the risk of airborne infection.

The Wells-Riley model is extensively used for retrospective and prospective modelling of the risk of airborne transmission of infection in indoor spaces. It is also used when examining the efficacy of various removal and deactivation methods for airborne infectious aerosols in the indoor environment, which is crucial when selecting the most effective infection control technologies. The problem is that the large variation in viral load between individuals makes the Wells-Riley model output very sensitive to the input parameters and may yield a flawed prediction of risk. The absolute infection risk estimated with this model can range from nearly 0 % to 100 % depending on the viral load, even when all other factors, such as removal mechanisms and room geometry, remain unchanged. We therefore propose a novel method that removes this sensitivity to viral load. We define a quanta-independent maximum absolute before-after difference in infection risk that is independent of quanta factors like viral load, physical activity, or the dose-response relationships. The input data needed for a non-steady-state calculation are just the removal rates, room volume, and occupancy duration. Under steady-state conditions the approach provides an elegant solution that is only dependent on removal mechanisms before and after applying infection control measures. We applied this method to compare the impact of relative humidity, ventilation rate and its effectiveness, filtering efficiency, and the use of ultraviolet germicidal irradiation on the infection risk. The results demonstrate that the method provides a comprehensive understanding of the impact of infection control strategies on the risk of airborne infection, enabling rational decisions to be made regarding the most effective strategies in a specific context. The proposed method thus provides a practical tool for mitigation of airborne infection risk.

The impact of indoor air pollution on children's health and well-being: the experts' consensus.

BACKGROUND: Pollution of the indoor environment represents a concern for human health, mainly in case of prolonged exposure such as in the case of women, children, the elderly, and the chronically ill, who spend most of their time in closed environments. MAIN BODY: The aim of the study is to organize a group of experts in order to evaluate the evidence and discuss the main risk factors concerning indoor air and the impact on human health as well as challenging factors regarding preventive strategies to reduce pollution. The experts highlighted the main risk factors concerning indoor air, including poor ventilation, climatic conditions, chemical substances, and socio-economic status. They discussed the impact on human health in terms of mortality and morbidity, as well as challenging factors regarding preventive strategies to reduce pollution. CONCLUSION: The experts identified strategies that can be reinforced to reduce indoor pollution and prevent negative consequences on human health at national and local levels.

Opportunities and Challenges Associated with the Uptake of Residential Clean Fuel Usage.

PURPOSE OF REVIEW: Almost 3 billion people worldwide use solid fuel for cooking and heating. This review examines (i) household energy practices and infrastructures and their influence on fuel usage in different contexts; (ii) barriers in adoption of household clean energy technologies and uses in diverse settings and population groups and (iii) potential air pollution exposure reduction in homes through using processed fuel. RECENT FINDINGS: Population health burden from solid fuel combustion-derived particulate air pollution has been estimated in several low- and middle-income countries. However, such studies have not been carried out in high income countries (e.g., UK). Irrespective of the region, fuel prices are the most dominant factor influencing the choice of fuel. Laboratory studies suggest processed fuel - pellets and briquettes - reduce particulate matter emissions by 70-80% and can be a promising alternative. Adoption of clean fuels for domestic energy needs facilitates progress towards five of the UN Sustainable Development Goals (SDGs). There is evidence that a variety of factors, including cost savings, encourage and hinder such uptake. These factors include price fluctuations, expenses, and the usage of clean fuels. Due to their distinct development scenarios, more expansive policy frameworks, and political economies of energy, these determinants are localized in character and differ significantly amongst economies. Therefore, in order to create innovative plans for the adoption of clean fuel use, strategies centred on local settings must be developed while keeping broad socio-technical and socio-economic issues in mind. Solid fuel processing - pelletization and briquetting - have the potential to reach Liquefied Petroleum Gas (LPG)-like emissions, and could be a potential strategy to mitigate exposure to household air pollution.

Bronchiolitis recovery and the use of High Efficiency Particulate Air (HEPA) Filters (The BREATHE Study): study protocol for a multi-center, parallel, double-blind, randomized controlled clinical trial.

BACKGROUND: Acute viral bronchiolitis is the most common reason for hospitalization of infants in the USA. Infants hospitalized for bronchiolitis are at high risk for recurrent respiratory symptoms and wheeze in the subsequent year, and longer-term adverse respiratory outcomes such as persistent childhood asthma. There are no effective secondary prevention strategies. Multiple factors, including air pollutant exposure, contribute to risk of adverse respiratory outcomes in these infants. Improvement in indoor air quality following hospitalization for bronchiolitis may be a prevention opportunity to reduce symptom burden. Use of stand-alone high efficiency particulate air (HEPA) filtration units is a simple method to reduce particulate matter ≤ 2.5 µm in diameter (PM2.5), a common component of household air pollution that is strongly linked to health effects. METHODS: BREATHE is a multi-center, parallel, double-blind, randomized controlled clinical trial. Two hundred twenty-eight children < 12 months of age hospitalized for the first time with bronchiolitis will participate. Children will be randomized 1:1 to receive a 24-week home intervention with filtration units containing HEPA and carbon filters (in the child's sleep space and a common room) or to a control group with units that do not contain HEPA and carbon filters. The primary objective is to determine if use of HEPA filtration units reduces respiratory symptom burden for 24 weeks compared to use of control units. Secondary objectives are to assess the efficacy of the HEPA intervention relative to control on (1) number of unscheduled healthcare visits for respiratory complaints, (2) child quality of life, and (3) average PM2.5 levels in the home. DISCUSSION: We propose to test the use of HEPA filtration to improve indoor air quality as a strategy to reduce post-bronchiolitis respiratory symptom burden in at-risk infants with severe bronchiolitis. If the intervention proves successful, this trial will support use of HEPA filtration for children with bronchiolitis to reduce respiratory symptom burden following hospitalization. TRIAL REGISTRATION: NCT05615870. Registered on November 14, 2022.

Optimizing the Indoor Air Quality in Historical Buildings: Strategies for Environmental Improvement and Public Health Enhancement.

The endeavor to maintain and enhance the indoor air quality (IAQ) in historical buildings transcends the traditional boundaries of cultural heritage preservation, emerging as a pivotal public health concern [...].

Nonthermal plasma air disinfection for the inactivation of airborne microorganisms in an experimental chamber and indoor air.

AIMS: Airborne transmission of diseases presents a serious threat to human health, so effective air disinfection technology to eliminate microorganisms in indoor air is very important. This study evaluated the effectiveness of a non-thermal plasma (NTP) air disinfector in both laboratory experiments and real environments. METHODS AND RESULTS: An experimental chamber was artificially polluted with a bioaerosol containing bacteria or viruses. Additionally, classroom environments with and without people present were used in field tests. Airborne microbial and particle concentrations were quantified. A 3.0 log10 reduction in the initial load was achieved when a virus-containing aerosol was disinfected for 60 min and a bacteria-containing aerosol was disinfected for 90 min. In the field test, when no people were present in the room, NTP disinfection decreased the airborne microbial and particle concentrations (P < 0.05). When people were present in the room, their constant activity continuously contaminated the indoor air, but all airborne indicators decreased (P < 0.05) except for planktonic bacteria (P = 0.094). CONCLUSIONS: NTP effectively inactivated microorganisms and particles in indoor air.

Indoor Air Sources of Outdoor Air Pollution: Health Consequences, Policy, and Recommendations: An Official American Thoracic Society Workshop Report.

Indoor sources of air pollution worsen indoor and outdoor air quality. Thus, identifying and reducing indoor pollutant sources would decrease both indoor and outdoor air pollution, benefit public health, and help address the climate crisis. As outdoor sources come under regulatory control, unregulated indoor sources become a rising percentage of the problem. This American Thoracic Society workshop was convened in 2022 to evaluate this increasing proportion of indoor contributions to outdoor air quality. The workshop was conducted by physicians and scientists, including atmospheric and aerosol scientists, environmental engineers, toxicologists, epidemiologists, regulatory policy experts, and pediatric and adult pulmonologists. Presentations and discussion sessions were centered on 1) the generation and migration of pollutants from indoors to outdoors, 2) the sources and circumstances representing the greatest threat, and 3) effective remedies to reduce the health burden of indoor sources of air pollution. The scope of the workshop was residential and commercial sources of indoor air pollution in the United States. Topics included wood burning, natural gas, cooking, evaporative volatile organic compounds, source apportionment, and regulatory policy. The workshop concluded that indoor sources of air pollution are significant contributors to outdoor air quality and that source control and filtration are the most effective measures to reduce indoor contributions to outdoor air. Interventions should prioritize environmental justice: Households of lower socioeconomic status have higher concentrations of indoor air pollutants from both indoor and outdoor sources. We identify research priorities, potential health benefits, and mitigation actions to consider (e.g., switching from natural gas to electric stoves and transitioning to scent-free consumer products). The workshop committee emphasizes the benefits of combustion-free homes and businesses and recommends economic, legislative, and education strategies aimed at achieving this goal.

Zonal demand-controlled ventilation strategy to minimize infection probability and energy consumption: A coordinated control based on occupant detection.

Due to the outbreak of COVID-19, an increased risk of airborne transmission has been experienced in buildings, particularly in confined public places. The need for ventilation as a means of infection prevention has become more pronounced given that some basic precautions (like wearing masks) are no longer mandatory. However, ventilating the space as a whole (e.g., using a unified ventilation rate) may lead to situations where there is either insufficient or excessive ventilation in localized areas, potentially resulting in localized virus accumulation or large energy consumption. It is of urgent need to investigate real-time control of ventilation systems based on local demands of the occupants to strike a balance between infection risk and energy saving. In this work, a zonal demand-controlled ventilation (ZDCV) strategy was proposed to optimize the ventilation rates in sub-zones. A camera-based occupant detection method was developed to detect occupants (with eight possible locations in sub-zones denoted as 'A' to 'H'). Linear ventilation model (LVM), dimension reduction, and artificial neural network (ANN) were integrated for rapid prediction of pollutant concentrations in sub-zones with the identified occupants and ventilation rates as inputs. Coordinated ventilation effects between sub-zones were optimized to improve infection prevention and energy savings. Results showed that rapid prediction models achieved an average prediction error of 6 ppm for CO2 concentration fields compared with the simulation under different occupant scenarios (i.e., occupant locations at ABH, ABCFH, and ABCDEFH). ZDCV largely reduced the infection risk to 2.8% while improved energy-saving efficiency by 34% compared with the system using constant ventilation rate. This work can contribute to the development of building environmental control systems in terms of pollutant removal, infection prevention, and energy sustainability.

Effects of long-term indoor air purification intervention on cardiovascular health in elderly: a parallel, double-blinded randomized controlled trial in Hong Kong.

Ambient fine particulate matter (PM2.5) is a leading environmental risk factor globally, and over half of the associated disease burden are caused by cardiovascular disease. Numerous randomized controlled trials (RCT) have investigated the short-term cardiovascular benefits of indoor air purifiers (IAPs), but major knowledge gaps remain on their longer-term benefits. In this 1-year, randomized, double-blinded, parallel controlled trial of 47 elderly (ntrue-purification = 24; nsham-purification = 23) aged ≥70 years, true-purification reduced household PM2.5 levels by 28% and maintained lower exposure throughout the year compared to the sham-purification group. After 12 months of intervention, a significant reduction of diastolic blood pressure was found in the true-purification versus sham-purification group (-4.62 [95% CI: -7.28, -1.96] mmHg) compared to baseline measurement prior to the intervention, whereas systolic blood pressure showed directionally consistent but statistically non-significant effect (-2.49 [95% CI: -9.25, 4.28] mmHg). Qualitatively similar patterns of associations were observed for pulse pressure (-2.30 [95% CI: -6.57, 1.96] mmHg) and carotid intima-media thickness (-10.0% [95% CI: -24.8%, 4.7%]), but these were not statistically significant. Overall, we found suggestive evidence of cardiovascular benefits of long-term IAPs use, particularly on diastolic blood pressure. Evidence on other longer-term cardiovascular traits is less clear. Further trials with larger sample sizes and long-term follow-up are needed across diverse populations to evaluate the cardiovascular benefits of IAPs.

Bauen mit Holz ­ Empfehlungen für eine gute Raumluftqualität : Mitteilung der Kommission Innenraumlufthygiene (IRK).

Wood is a sustainable and widely applicable building material. Wood products emit gaseous substances into the indoor air, which is why they should meet the same indoor air quality requirements as any other building product used indoors. The Commission on Indoor Air Hygiene (IRK) provides advice on how to ensure healthy indoor living conditions in the presence of wood products. Important requirements are the selection of low-emission woods and wood-based materials, compliance with health-related assessment standards, and a ventilation concept that is tailored to the usage and emission sources in the building. When considering these guidelines, wood and wood-based materials can be successfully used both in existing buildings and in newly constructed, airtight buildings with low energy requirements.

Mitigation strategies to reduce particulate matter concentrations in civil engineering laboratories.

In the departments of civil engineering, many experiments are conducted in laboratories for educational and research purposes. Varying degrees of respirable dust are generated as the outcome of these experiments, which could cause harm to instructors' and students' health. This study is devised to highlight the importance of indoor air quality in university laboratories. As part of the research, four different particulate matter (PM) sizes (PM1.0, PM2.5, PM4.0, and PM10) were measured during specific experiments-sieve analysis, preparation of the concrete mixture, crushing aggregate by jaw crusher, dynamic triaxial compression test, sieve analysis of silt specimen, cleaning sieve by an air compressor, and proctor compaction test-being conducted periodically in the laboratories of civil engineering departments. The measured values are mainly high compared to indoor air quality standards. Mitigation strategies were applied to reduce indoor air PM levels in the three experiments that contained the highest PM levels. The results have shown that mitigation strategies applied as control measures could make a remarkable difference in protecting instructors and civil engineering students.

Effect of spraying air freshener on particulate and volatile organic compounds in vehicles.

People in these days spend approximately 6 % of their time in a means of transport. Air fresheners are frequently used in vehicles to mask odors; however, they can cause adverse health effects such as cardiovascular disease, systemic inflammation and autonomic dysfunction. This study aimed to identify the effects of air fresheners on the concentrations of particulate and volatile organic compounds (VOCs) in different vehicle cabins. Scanning mobility and optical particle sizers were used for the particle measurements. VOCs (e.g., BTEX and d-limonene) were collected using a Tenax TA. The products were sprayed for less than a minute. The study assessed three spray products (all trigger types), vehicle size (small, medium, and large), cabin temperature (10 °C, 20 °C, and 25 °C), and in-vehicle ventilation mode (all-off, recirculation, and external inflow modes). The particle concentration increased rapidly during the 1-min spraying of the products. The proportion of nanoparticles in the front seat (67.2 % ± 2.2 %) was 11.1 % ± 2.2 % lower than that in the rear seat (75.6 % ± 2.1 %). The spray product and vehicle size did not significantly affect the particle or VOC concentrations. With an increase in the temperature of the front seat, the proportion of nanoparticles increased by 25.3 % ± 3.2 %. Moreover, the maximum total VOC concentrations (front seat: 364.3 µg/m3; back seat: 241.3 µg/m3) were observed at 20 °C. Under in-vehicle ventilation, recirculation effectively reduced the overall particle concentration within the cabin; however, the generated VOCs circulated. The external inflow proved effective in cabin air purification by reducing the total VOC concentration to 56.0-57.2 % compared with other ventilation modes. These findings provide substantial insight into the persistence of particles and the dynamics of their dispersion, thereby enabling informed decision-making for particle-related risk management.

Indoor air pollution prevention practices and associated factors among household mothers in Olenchiti town, Oromia, Ethiopia.

INTRODUCTION: Most households in low- and middle-income countries still cook using solid fuels in poorly ventilated dwellings. Indoor air pollution causes various health problems, like pneumonia, lung cancer, stillbirth, low birth weight, impaired cognitive development, and cataracts. Nevertheless, a few evidences are available in Africa, including Ethiopia. Therefore, this study aimed to assess the level of indoor air pollution prevention practices and associated factors among household mothers in Olenchiti town, Oromia, Ethiopia. METHODS: A community-based cross-sectional study was conducted. Four hundred twenty mothers were randomly selected by systematic random sampling. Data was collected through an interview and observation checklist. The collected data entered into Epi-Info version 7.2.5 was cleaned, edited, and then exported to SPSS version 23 for analysis. Descriptive statistics were used to describe the findings. Binary logistic regression was computed to analyze the effect of each variable on the outcome variable. Model adequacy fitness was checked with the Hosmer-Lemeshow test. The multicollinearity of independent variables was checked with the variance inflation factor. Adjusted odds ratio with 95% confidence interval and P -value <0.05 was used as cutoff points to declare significance in the final model. RESULTS: The overall good practices of mothers towards the prevention of indoor air pollution was 188 (45.0%). Mothers who had under-five children (AOR = 0.49, 95%CI (0.31-0.76), mothers in grade 9-12 (AOR = 0.51, 95%CI (0.28-0.92)) were significantly associated with indoor air pollution prevention practices. CONCLUSION: The overall good practices of mothers towards indoor air pollution were low compared to different findings. Under-five children and educational status were significantly associated with indoor air pollution prevention practices in the final model. Therefore, the high school curriculums should include indoor air pollution topics.

Evaluating portable air cleaner effectiveness in residential settings to reduce exposures to biomass smoke resulting from prescribed burns.

AIM: Prescribed burning is the most common method employed to reduce fuel loads in flammable landscapes. This practice is designed to reduce the hazard associated with uncontrolled bushfires. Prescribed burns are frequently conducted close to residential areas, and the associated smoke impacts can adversely affect community health. Particulate matter is the predominant pollutant within the smoke and is strongly and consistently linked with adverse health effects. Outdoor smoke readily infiltrates buildings and reduces the quality of indoor air. Portable air cleaners containing high-efficiency particulate air (HEPA) filters are a promising indoor air quality intervention for reducing outdoor smoke exposure. METHODS: We provided 10 homes from semirural regions of Victoria, Australia, with HEPA cleaners and conducted continuous monitoring of indoor and outdoor fine particulate matter (PM2.5) for 2-4 weeks during prescribed burning periods. We calculated the potential improvements to indoor air quality when operating a HEPA cleaner during a smoke episode. Ventilation measures were conducted to identify points of smoke ingress and housing characteristics that could lead to higher infiltration rates. RESULTS: Depending on the house, the use of HEPA cleaners resulted in a reduction in indoor PM2.5 concentrations of 30-74%. CONCLUSIONS: HEPA cleaners have the potential to substantially improve indoor air quality during episodic smoke episodes.

Holistic understanding of ventilation rate in occupational health risk control.

Throughout the history of occupational health risk control, ventilation has been implemented widely as a tried-and-true method to reduce exposure intensity to airborne contaminants. Proper determination of the ventilation rate merits careful consideration when addressing concerns directed toward occupational health and indoor air quality in commercial buildings, albeit this does not translate well among the current engineering and scientific community. This article aims to facilitate a better understanding and proper determination of ventilation rates as a countermeasure for occupational health risk control. To that end, guidance is provided to select the appropriate ventilation rate for nonpandemic versus pandemic scenarios in terms of pertinent regulatory/professional codes and mathematical modeling tools. Limitations and assumptions of the models are summarized to facilitate proper application. Furthermore, the emerging DNA-based aerosol tracing technology, which helps to verify ventilation efficacy, is discussed.

Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis.

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.

Indoor air quality improvement with filtration and UV-C on mitigation of particulate matter and airborne bacteria: Monitoring and modeling.

Indoor air, especially with suspended particulate matter (PM), can be a carrier of airborne infectious pathogens. Without sufficient ventilation, airborne infectious diseases can be transmitted from one person to another. Indoor air quality (IAQ) significantly impacts people's daily lives as people spend 90% of their time indoors. An industrial-grade air cleaner prototype (filtration + ultraviolet light) was previously upgraded to clean indoor air to improve IAQ on two metrics: particulate matter (PM) and viable airborne bacteria. Previous experiments were conducted to test its removal efficiency on PM and airborne bacteria between the inlet and treated air. However, the longer-term improvement on IAQ would be more informative. Therefore, this research focused on quantifying longer-term improvement in a testing environment (poultry facility) loaded with high and variable PM and airborne bacteria concentrations. A 25-day experiment was conducted to treat indoor air using an air cleaner prototype with intermittent ON and OFF days in which PM and viable airborne bacteria were measured to quantify the treatment effect. The results showed an average of 55% reduction of total suspended particulate (TSP) concentration between OFF days (110 µg/m3) and ON days (49 µg/m3). An average of 47% reduction of total airborne viable bacteria concentrations was achieved between OFF days (∼3200 CFU/m3) and ON days (∼2000 CFU/m3). A cross-validation (CV) model was established to predict PM concentrations with five input variables, including the status of the air cleaner, time (h), ambient temperature, indoor relative humidity, and day of the week to help simulate the air-cleaning effect of this prototype. The model can approximately predict the air quality trend, and future improvements may be made to improve its accuracy.