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.

"You can feel the fresh air " Rural Alaska Native household perceptions of home air purifiers and health.

Alaska Native and American Indian children experience frequent respiratory illness. Indoor air quality is associated with the severity and frequency of respiratory infections in children. High efficiency particulate air (HEPA) purifiers effectively improve indoor air quality and may protect respiratory health. In 2019, the Yukon-Kuskokwim Health Corporation implemented a pilot programme that provided education and HEPA purifiers to households of children with chronic lung conditions. The team evaluated HEPA purifier acceptability and use by interviewing representatives from 11 households that participated in the pilot programme. All interviewees reported improvement in their child's health, and some believed that the health of other household members was also improved because of the HEPA purifier. Interviewees reported that the HEPA purifiers were easy to use, quiet, and not expensive to run. Five of 11 households were still using the HEPA purifier at the time of the interview, which was about three years after receipt of the unit. The most common reasons for discontinuing use were equipment failure and lack of replacement filter, suggesting that programme support could increase sustainability. Our evaluation suggests that HEPA purifiers are acceptable and feasible for use in rural Alaska Native households.

Sunlight-Driven Self-Cleaning Ultrafine Particulate Matter Filter with Antibacterial Activity.

Air pollution by particulate matter (PM) and airborne pathogens causes severe health problems in the human body. Presently, popular disposable air filters yield huge waste and have a fatal impact on the environment. Postuse cleaning of air filters also leads to secondary air and water pollution. Here, we report a sunlight-driven self-cleaning PM filter by coupling a full-solar-spectrum-active photocatalyst comprising up-conversion nanoparticles (UCNPs) decorated with semiconductor iron(III) oxide (UCNP@α-Fe2O3) shells stabilized upon graphene functionalized borosilicate fibrous membrane (rGO-BF). While rGO-BF ensures high PM adsorption, UCNP@α-Fe2O3 (NP) enables self-photodegradation of adsorbed PM under abundant sunlight and subsequent membrane regeneration, while preventing secondary air or water pollution. Rational surface chemistry and optimal microstructure enable our filters to remove >99% of PM2.5 under deplorable air-quality conditions. Moreover, our filter shows excellent antibacterial activity toward E. coli and S. aureus, demonstrating its potential for practical utilization in face masks, air filtering devices, and protective medical wear. This work successfully suggests an intriguing design platform for self-sustainable zero-waste air filter membranes.

Tribo-charge enhanced and cellulose based biodegradable nanofibrous membranes with highly fluffy structure for air filtration and self-powered respiration monitoring systems.

Recently, the demand for healthcare products especially wearable smart masks is increasing. The biosafety and degradability of smart masks are crucial for human health and environmental protection. However, the development of biodegradable and biocompatible fibrous membranes with high filtration efficiency and low pressure drop is still a challenge. How to realize the collaborative improvement between air filtration efficiency and pressure drop of the nanofibrous membrane is still a challenge. Here, a tribo-charge enhanced and biodegradable nanofibrous membranes (TCB NFMs) with highly fluffy structure for air filtration and self-powered respiration monitoring systems is reported for the first time. The filtration efficiency and pressure drop of the prepared membranes for 0.3 µm NaCl particulates is 99.971% and 41.67 Pa. The TCB NFMs based smart mask possesses a series of satisfactory and excellent characteristics, such as self-powered, biodegradable, biocompatible, high filtration efficiency, and low pressure drop, which is highly promising for application in air filtration systems and intelligent wearable respiration monitoring systems.

Virus removal by high-efficiency air (HEPA) filters and filtration capacity enhancement by nanotextiles: a pilot study.

Portable household air purifiers are widely used devices designed to maintain a high-quality level of indoor air. Portable air purifiers equipped with the high-efficiency air (HEPA) filter served 100 h in a household space occupied by two adults without any symptoms of respiratory tract infection. The main objective of the study was to determine microbial contamination on the HEPA filter and to investigate if the selected nanotextile monolayer made of polyamide 6 (PA6) nanofibers can capture potential microorganisms when installed downstream of the HEPA filter as the final filtration medium. Samples were taken from the inlet and outlet surfaces. Samples from the nanotextile were collected in the same manner as from the HEPA filter. QIAStat DX® 1.0 Analyzer using the Respiratory SARS CoV-2 Panel multiplex PCR detection system was selected for microorganism detection. Adenovirus was detected on the inlet surface of the HEPA filter. The outlet surface of the filter contained no viruses included in the Respiratory SARS CoV-2 Panel portfolio. The nanotextile monolayer was replaced twice during the 100 h of operation, so three pieces were used and all contained coronavirus 229 E. Coronavirus 229 E was then detected in the nasopharynx of one of the members of the household as well. It may be assumed that the selected nanotextile is capable of capturing a virus of a small size.

Reduction by air purifier of particulate concentration during orthodontic procedures: a pilot study.

BACKGROUND: The SARS-CoV-2 pandemic has raised awareness of the importance of air quality. This pilot study arose from the need to reduce the concentration of particulate matter in the dental office during orthodontic procedures. To evaluate the efficacy of using an air purifier during orthodontic care in the dental office to reduce the concentration of ambient particulate matter. RESULTS: Significant reductions in particle numbers were obtained for all particle sizes except the largest particles counted (10 µm) through use of the air filter. A marked association between higher humidity levels and higher particle counts was also observed. CONCLUSIONS: Using an air purifier during dental care achieves a significant reduction in the concentration of ambient particles in the dental office. There is a correlation between higher relative humidity and higher particle concentration. The probability of obtaining a maximum particulate concentration level of 0.3 and 0.5 µm is 1000 times lower when using an air purifier.

Exploring the residential exposome: Determination of hazardous flame retardants in air filter dust from HVAC systems.

Dust is a sink for flame retardants, which are added to a myriad of consumer products in residential spaces. Organophosphate esters (OPEs) and brominated flame retardants (BFRs) are two classes of flame retardants that are frequently used in consumer products and consequently found in dust. In this present work, a novel solvent-limited microextraction technique, which we detailed in a companion study, was applied for the determination of four OPEs and two BFRs with limits of quantitation at the ng/g level by gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry from n = 47 air filter dust samples collected from forced air HVAC systems. Levels of the BFRs, including tetrabromobisphenol-A and its derivative tribromobisphenol-A, were found at levels <4 µg/g and not frequently detected. Conversely, all four OPEs were detected in all air filter dust samples. Total OPE load was dominated by tris(2,4-di-tert-butylphenyl) phosphate, T24DtBPP, a novel OPE not widely examined in the literature. Comparison of individual and total OPE concentrations to residential characteristics revealed statistically significant relationships to location of the home and dominant flooring type. Overall, this study motivates future work in examining the whole house exposome using air filter dust as a passive sampling regime with more examination of T24DtBPP loads within other indoor spaces.

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.

Evaluation and risk communication of the effects of alcohol exposure on disposable procedure masks and portable air purifiers in hospital environments.

Electret technology was widely used to prevent the airborne transmission of bioaerosols during the COVID-19 pandemic and improve the filtration efficiency of masks and high-efficiency particulate air (HEPA) filters. As alcohol disinfectants are widely used in medical and welfare institutions, concerns about alcohol exposure inactivating electret exist. However, comprehensive alcohol exposure tests have not been conducted on masks and HEPA filters distributed in Japan. Twenty-five types of masks and five types of HEPA filters were subjected to a discharging process according to ISO 16890 to quantitatively elucidate the resistance to alcohol exposure. Measurements of changes in filtration efficiency and pressure drop before and after discharge show that 17 masks (68%) and four HEPA filters (80%) exhibited a significant decrease in filtration efficiency, confirming their vulnerability to alcohol. In addition, a survey (n = 500 Japanese adults, including 30 healthcare professionals) revealed that ∼90% of the general public were unaware that alcohol exposure could degrade masks and air purifiers. Furthermore, 36% of the surveyed healthcare professionals had sprayed alcohol directly onto their masks. The effectiveness of user warnings through product labels and instructions was investigated from the perspective of ensuring the safety of patients and healthcare professionals. Results revealed that the best approach was to describe the extent and duration of the adverse effects caused by disregarding precautions. Increase in awareness of healthcare professionals and general public by authorities and manufacturers through guidelines and warning labels would reduce the risk of inhaling bioaerosols caused by unintentional electret inactivation.

Antibacterial and Antiviral Activities of Silver Nanocluster/Silica Composite Coatings Deposited onto Air Filters.

The indoor air quality should be better controlled and improved to avoid numerous health issues. Even if different devices are developed for air filtration, the proliferation of microorganisms under certain conditions must be controlled. For this purpose, a silver nanocluster/silica composite coating was deposited via a cosputtering technique onto fiber glass and polymeric based substrates. The aim of this work is focused on the evaluation of the antibacterial and antiviral effects of the developed coating. The preliminary results of the compositional and morphological tests showed an evenly distributed coating on filters surfaces. Several antibacterial tests were performed, confirming strong effect both in qualitative and quantitative methods, against S. epidermidis and E. coli. To understand if the coating can stop the proliferation of bacteria colonies spread on it, simulation of everyday usage of filters was performed, nebulizing bacteria solution with high colonies concentration and evaluating the inhibition of bacteria growth. Additionally, a deep understanding of the virucidal action and mechanism of Ag nanoclusters of the coating was performed. The effect of the coating both in aqueous medium and in dry methods was evaluated, in comparison with analysis on ions release. The virucidal performances are assessed against the human coronavirus OC43 strain (HCoV-OC43).

Highly Efficient Fabrication of Biomimetic Nanoscaled Tendrils for High-Performance PM0.3 Air Filters.

Particulate matter pollution has become a serious public health issue, especially with the outbreak of new infectious diseases. However, most existing air filtration materials face challenges such as being too bulky, having high resistance, and a trade-off between filtration efficiency and air permeability. Here, a unique electro-blown spinning technique is used to prepare an air filter made of biomimetic nanoscaled tendril nonwovens (Nano-TN). The introduction of an airflow field significantly increases the whipping frequency and the strain mismatch of composite jets, achieving large-scale and highly efficient preparation of Nano-TN. The resultant Nano-TN has an ultrahigh porosity (97%) and a small pore size (2.9 µm). At the same filtration level, its air resistance is 37% lower than that of traditional straight nanofibrous nonwovens and has a higher dust-holding capacity. Moreover, compared with traditional three-dimensional air filters, the Nano-TN filter is thinner, offering tremendous application prospects in various environmental purification and personal protection fields.

Advancing Breathability of Respiratory Nanofilter by Optimizing Pore Structure and Alignment in Nanofiber Networks.

Respiratory masks are the primary and most effective means of protecting individuals from airborne hazards such as droplets and particulate matter during public engagements. However, conventional electrostatically charged melt-blown microfiber masks typically require thick and dense membranes to achieve high filtration efficiency, which in turn cause a significant pressure drop and reduce breathability. In this study, we have developed a multielectrospinning system to address this issue by manipulating the pore structure of nanofiber networks, including the use of uniaxially aligned nanofibers created via an electric-field-guided electrospinning apparatus. In contrast to the common randomly collected microfiber membranes, partially aligned dual-nanofiber membranes, which are fabricated via electrospinning of a random 150 nm nanofiber base layer and a uniaxially aligned 450 nm nanofiber spacer layer on a roll-to-roll collector, offer an efficient way to modulate nanofiber membrane pore structures. Notably, the dual-nanofiber configuration with submicron pore structure exhibits increased fiber density and decreased volume density, resulting in an enhanced filtration efficiency of over 97% and a 50% reduction in pressure drop. This leads to the highest quality factor of 0.0781. Moreover, the submicron pore structure within the nanofiber networks introduces an additional sieving filtration mechanism, ensuring superior filtration efficiency under highly humid conditions and even after washing with a 70% ethanol solution. The nanofiber mask provides a sustainable solution for safeguarding the human respiratory system, as it effectively filters and inactivates human coronaviruses while utilizing 130 times fewer polymeric materials than melt-blown filters. This reusability of our filters and their minimum usage of polymeric materials would significantly reduce plastic waste for a sustainable global society.

Sustainable lignocellulose aerogel for air purifier with thermal insulation, flame retardancy, mechanical strength, and its life cycle assessment.

High-performance biomass materials with good thermal insulation, flame retardrancy, and mechanical properties are urgently required for thermal management. Herein, a novel lignocellulose aerogel treated using a recyclable deep eutectic solvent (DES) was physically mixed with tourmaline particles (TPs) to enhance its structural stability, flame retardancy, and mechanical properties. The optimized TPs-modified lignocellulose aerogel (TLA-4) had good comprehensive performances due to the synergistic effect of ammonium sulfate and TPs. Compared with TPs-free lignocellulose aerogel (LA), the total heat release (THR) and heat release rate (HRR) of TLA-4 were reduced by 62.0 % and 66.3 %, respectively, and the limiting oxygen index (LOI) of TLA-4 was drastically enhanced by 74.1 %. TLA-4 also exhibited a low thermal conductivity of 29.67 mW/mK, showing favorable thermal insulation performance. When compressed to 5 %, the mechanical strength of TLA-4 increased by 8.3 times. Meanwhile, the presence of TPs and abundant pores in the aerogel contributed to the release of negative oxygen ions (NOIs), aiding air purification. A life cycle assessment (LCA) indicated that this composite had a minimal environmental impact (EI) in 17 categories compared to other similar aerogels. The proposed strategy for preparing an environment-friendly lignocellulose aerogel offers significant potential for applications in home decoration and building materials.

A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions.

Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.

High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study.

Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 µm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

Personal-level actions to reduce air pollution exposure in the WHO European Region

This report summarizes evidence and information and formulates practical advice on personal-level actions to reduce exposure to ambient air pollution. It covers personal actions such as reducing the amount of time spent in polluted outdoor environments, adjusting the location and timing of physical activity, using air cleaners, wearing face coverings, and mobility options (transport, active transportation, routes, driving style and vehicle settings). Each topic is evaluated according to a uniform set of criteria, ranging from effectiveness to personal costs and social factors. Most of the evidence available to inform the advice derives from western European and North American studies. Although evidence on effectiveness and on health risks/harms can be considered applicable across settings, evidence on economic, social or feasibility factors is less so. Consequently, the applicability of the advice presented in this report should be carefully considered at national level, especially in settings outside western Europe.

Clinical Issues - January 2024.

Off-label medication use and prescribing practices Key words: off-label, licensed prescriber, approved, unapproved, US Food and Drug Administration (FDA). Prophylactic, therapeutic, and empiric use of antimicrobial agents Key words: prophylactic, therapeutic, empiric, infection, antimicrobial. Perioperative RN administration of antineoplastic agents Key words: antineoplastic medication, chemotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), instillation device, perfusionist. Minimum efficiency reporting values, parameters, and testing for air filters in heating, ventilation, and air-conditioning systems Key words: heating, ventilation, and air-conditioning (HVAC); minimum efficiency reporting value (MERV); particle size removal efficiency; air filter; filtration.

Computational analysis of an electrostatic separator design for removal of volatile organic compounds from indoor air.

Concentrations of volatile organic compounds (VOCs) in air can be reduced in electrostatic separators where VOCs are ionized using ion-molecule reactions, extracted using electric fields, and eliminated in a waste flow. Embodiments for such separator technology have been explored in only a few studies, despite the possible advantage of purification without adsorbent filters. In one design, based on ionization of VOCs in positive polarity with hydrated protons as reactant ions, efficiencies for removal were measured as 30-40% . The results were fitted to a one-dimensional convective diffusion model requiring an unexpectedly high production rate of reactant ions to match both the model and data. A realistic rate of reactant ion production was used in finite element method simulations (COMSOL) and demonstrated that low removal efficiency could be attributed to non-uniform patterns of sample flow and to incomplete mixing of VOCs with reactant ions. In analysis of complex systems, such as this model, even limited computational modeling can outperform a pure analytical approach and bring insights into limiting factors or system bottlenecks.Implications: In this work, we applied modern computational methods to understand the performance of an air purifier based on electrostatics and ionized volatile organic compounds (VOCs). These were described in the publication early 2000s. The model presented was one-dimensional and did not account for the effects of flow. In our multiphysics finite element models, the efficiency and operation of the filter is better explained by the patterns of flow and flow influences on ion distributions in electric fields. In general, this work helps using and applying computational modelling to understand and improve the performance bottlenecks in air purification system designs.

Detection of SARS-CoV-2 in high-efficiency particulate air (HEPA) filters of low-cost air purifiers in community-based organizations.

This study aims to investigate the presence of SARS-CoV-2 in public spaces and assess the utility of inexpensive air purifiers equipped with high-efficiency particulate air (HEPA) filters for viral detection. Samples were collected from six community-based organizations in underserved minority neighborhoods in Northwest Miami, Florida, from February to May 2022. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to detect SARS-CoV-2 in air purifier filters and surface swabs. Among 32 filters tested, three yielded positive results, while no positive surface swabs were found. Notably, positive samples were obtained exclusively from child daycare centers. These findings highlight the potential for airborne transmission of SARS-CoV-2 in indoor air, particularly in child daycare centers. Moreover, the study demonstrates the effectiveness of readily available HEPA filters in detecting the virus. Improving indoor ventilation and implementing air filtration systems are crucial in reducing COVID-19 transmission where people gather. Air filtration systems incorporating HEPA filters offer a valuable approach to virus detection and reducing transmission risks. Future research should explore the applicability of this technology for early identification and mitigation of viral outbreaks.