Impact of air-handling system exhaust failure on dissemination pattern of simulant pathogen particles in a clinical biocontainment unit

Indoor Air

Volumn 29, Issue 1, 2019, Pages 143-155

  Therkorn, Jennifer ^a   Drewry III, David ^a   Pilholski, Thomas ^a   Shaw Saliba, Kathryn ^b,c   Bova, Gregory ^d   Maragakis, Lisa L ^b,c,d   Garibaldi, Brian ^b   Sauer, Lauren ^b,c  

^a JOHNS HOPKINS UNIVERSITY APPLIED PHYSICS LABORATORY   (United States)

^b JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^d JOHNS HOPKINS UNIVERSITY   (United States)

Author keywords

air conditioning; clinical biocontainment unit; exhaust failure; fluorescent aerosol tracer; heating; isolation unit; pathogen transmission; ventilation

Indexed keywords

HVAC; SUSPENSIONS (FLUIDS);

CLINICAL BIOCONTAINMENT UNIT; EXHAUST FAILURES; FLUORESCENT AEROSOL TRACER; FLUORESCENT TRACERS; HEATING VENTILATION; ISOLATION UNIT; NEGATIVE PRESSURES; PATHOGEN TRANSMISSION; TRACER PARTICLE; VENTILATION AIRS;

FLUORESCENCE;

AEROSOL; AIR; AIR CONDITIONING; ENVIRONMENTAL MONITORING; HAZARDOUS WASTE; HEALTH CARE FACILITY; HUMAN; INDOOR AIR POLLUTION; MARYLAND; MICROBIOLOGY; MICROCLIMATE; PROCEDURES;

AEROSOLS; AIR MICROBIOLOGY; AIR MOVEMENTS; AIR POLLUTION, INDOOR; CONTAINMENT OF BIOHAZARDS; ENVIRONMENT, CONTROLLED; ENVIRONMENTAL MONITORING; HUMANS; MARYLAND; PATIENTS' ROOMS; VENTILATION;

EID: 85054508870     PISSN: 09056947     EISSN: 16000668     Source Type: Journal    
DOI: 10.1111/ina.12506     Document Type: Article

References (51)

1. Sundell J. On the history of indoor air quality and health. Indoor Air. 2004;14:51-58
2. Li Y, Leung GM, Tang JW, et al. Role of ventilation in airborne transmission of infectious agents in the built environment – a multidisciplinary systematic review. Indoor Air. 2007;17:2-18
3. Neiderud C-J. How urbanization affects the epidemiology of emerging infectious diseases. Infect Ecol Epidemiol. 2015;5:27060
4. Bogoch II, Creatore MI, Cetron MS, et al. Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 West African outbreak. Lancet. 2015;385:29-35
5. Semenza JC, Menne B. Climate change and infectious diseases in Europe. Lancet Infect Dis. 2009;9:365-375
6. Oboho IK, Tomczyk SM, Al-Asmari AM, et al. 2014 MERS-CoV outbreak in Jeddah–a link to health care facilities. N Engl J Med. 2015;372:846-854
7. Chan P, Chan M. Tracing the SARS-coronavirus. J Thorac Dis. 2013;5:S118-S121
8. Schilling S, Fusco FM, De Iaco G, et al. Isolation facilities for highly infectious diseases in Europe – A cross-sectional analysis in 16 countries. PLoS ONE. 2014;9:e100401
9. Walker JT, Hoffman P, Bennett AM, et al. Hospital and community acquired infection and the built environment – design and testing of infection control rooms. J Hosp Infect. 2007;65:43-49
10. Mannheim JK. Isolation precautions. [MedlinePlus Website]. April 5, 2018. https://medlineplus.gov/ency/patientinstructions/000446.htm. Accessed December 12, 2017
11. Siegel JD, Rhinehart E, Jackson M, et al. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. 2007 [CDC Website]. December 2007. http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed December 20, 2017
12. Beggs CB. The airborne transmission of infection in hospital buildings: fact or fiction? Indoor Built Environ. 2003;12:9-18
13. Gralton J, Tovey E, McLaws M-L, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: a review. J Infect. 2011;62:1-13
14. World Health Organization (WHO). Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. [WHO Guidelines]. April 2014. http://www.who.int/csr/bioriskreduction/infection_control/publication/en/. Accessed December 5, 2017
15. Tang JW, Li Y, Eames I, et al. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect. 2006;64:100-114
16. Xiao S, Li Y, Sung M, et al. A study of the probable transmission routes of MERS-CoV during the first hospital outbreak in the Republic of Korea. Indoor Air. 2018;28:51-63
17. Li Y, Huang X, Yu ITS, et al. Role of air distribution in SARS transmission during the largest nosocomial outbreak in Hong Kong. Indoor Air. 2005;15:83-95
18. Garibaldi BT, Kelen GD, Brower RG, et al. The creation of a biocontainment unit at a tertiary care hospital. The Johns Hopkins Medicine experience. Ann Am Thorac Soc. 2016;13:600-608
19. The White House. Fact sheet: Progress in our Ebola response at home and abroad. [The White House Archives]. February 11, 2015. https://obamawhitehouse.archives.gov/the-press-office/2015/02/11/fact-sheet-progress-our-ebola-response-home-and-abroad. Accessed December 21, 2017
20. Centers for Disease Control and Prevention (CDC). Hospital preparedness: A tiered approach. Interim guidance for preparing Ebola treatment centers. [CDC Website]. 2014. https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html. Accessed December 21, 2017
21. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). ASHRAE position document on airborne infectious diseases. February 2017. https://www.ashrae.org/about-ashrae/position-documents. Accessed December 20, 2017
22. Smith PW, Anderson AO, Christopher GW, et al. Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement. Biosecur Bioterror. 2006;4:351-365
23. Herstein JJ, Biddinger PD, Kraft CS, et al. Current capabilities and capacity of Ebola treatment centers in the United States. Infect Control Hosp Epidemiol. 2016;37:313-318
24. Drewry D, Sauer L, Shaw-Saliba K, et al. A novel approach to identify potential provider and environmental contamination on a clinical biocontainment unit using aerosolized pathogen simulants. Health Secur. 2017;16:83-91
25. Centers for Disease Control and Prevention (CDC). Guidelines for environmental infection control in health-care facilities. [CDC Website]. 2005. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/air.html. Accessed December 21, 2017
26. Foord N, Lidwell OM. The control by ventilation of airborne bacterial transfer between hospital patients, and its assessment by means of a particle tracer: I. An airborne-particle tracer for cross-infection studies. J Hyg. 1972;70(279-286):271
27. Qian H, Li Y. Removal of exhaled particles by ventilation and deposition in a multibed airborne infection isolation room. Indoor Air. 2010;20:284-297
28. Hambraeus A, Sanderson HF. The control by ventilation of airborne bacterial transfer between hospital patients and its assessment by means of a particle tracer: III. Studies with an airborne-particle tracer in an isolation ward for burned patients. J Hyg. 1972;70:299-312
29. Pavelchak N, DePersis RP, London M, et al. Identification of factors that disrupt negative air pressurization of respiratory isolation rooms. Infect Control Hosp Epidemiol. 2015;21:191-195
30. Nates JL. Combined external and internal hospital disaster: impact and response in a Houston trauma center intensive care unit. Crit Care Med. 2004;32:686-690
31. Powell T, Hanfling D, Gostin LO. Emergency preparedness and public health: the lessons of hurricane sandy. JAMA. 2012;308:2569-2570
32. United States Department of Homeland Security (USDHS). Environmental assessment of proposed tracer particle and biological releases for the hazards of dynamic outdoor release (HODOR) project. Washington, DC: Department of Homeland Security Science and Technology Directorate; 2017
33. Ratnesar-Shumate S, Wagner ML, Kerechanin C, et al. Improved method for the evaluation of real-time biological aerosol detection technologies. Aerosol Sci Technol. 2011;45:635-644
34. Xie X, Li Y, Chwang ATY, et al. How far droplets can move in indoor environments – revisiting the Wells evaporation–falling curve. Indoor Air. 2007;17:211-225
35. DeFreez R. LIF bio-aerosol threat triggers: then and now. [SPIE Digital Library]. September 17, 2009. https://www.spiedigitallibrary.org/conference-proceedings-of-spie/7484/1/LIF-bio-aerosol-threat-triggers-then-and-now/10.1117/12.835088.full?SSO=1. Accessed December 22, 2017
36. Santarpia JL, Ratnesar-Shumate S, Gilberry JU, Quizon JJ. Relationship between biologically fluorescent aerosol and local meteorological conditions. Aerosol Sci Technol. 2013;47:655-661
37. Pereira ML, Knibbs LD, He C, et al. Sources and dynamics of fluorescent particles in hospitals. Indoor Air. 2017;27:988-1000
38. Licina D, Tian Y, Nazaroff WW. Emission rates and the personal cloud effect associated with particle release from the perihuman environment. Indoor Air. 2017;27:791-802
39. Bhangar S, Adams RI, Pasut W, et al. Chamber bioaerosol study: human emissions of size-resolved fluorescent biological aerosol particles. Indoor Air. 2016;26:193-206
40. Yang S, Lee GW, Chen CM, et al. The size and concentration of droplets generated by coughing in human subjects. J Aerosol Med. 2007;20:484-494
41. Huang J-M, Tsao S-M. The influence of air motion on bacteria removal in negative pressure isolation rooms. HVAC&R Res. 2005;11:563-585
42. King MF, Noakes CJ, Sleigh PA. Modeling environmental contamination in hospital single- and four-bed rooms. Indoor Air. 2015;25:694-707
43. Tang JW, Eames I, Li Y, et al. Door-opening motion can potentially lead to a transient breakdown in negative-pressure isolation conditions: the importance of vorticity and buoyancy airflows. J Hosp Infect. 2005;61:283-286
44. Nicas M, Nazaroff WW, Hubbard A. Toward understanding the risk of secondary airborne infection: emission of respirable pathogens. J Occup Environ Hyg. 2005;2:143-154
45. Nicas M, Hubbard AE, Jones RM, Reingold AL. The infectious dose of Variola (smallpox) virus. Appl Biosaf. 2004;9:118-127
46. CDC. Bioterrorism. https://www.cdc.gov/smallpox/bioterrorism/public/index.html. Accessed July 3, 2018
47. Ducharme J. The FDA approved an anti-bioterrorism drug meant to treat smallpox. [TIME Magazine]. July 14, 2018. http://time.com/5338775/fda-small-pox-approval/. Accessed July 17, 2018
48. Tung Y-C, Shih Y-C, Hu S-C. Numerical study on the dispersion of airborne contaminants from an isolation room in the case of door opening. Appl Therm Eng. 2009;29:1544-1551
49. Lidwell OM. The control by ventilation of airborne bacterial transfer between hospital patients, and its assessment by means of a particle tracer: II. Ventilation in subdivided isolation units. J Hyg. 1972;70:287-297
50. Chen C, Zhao B, Zhou W, et al. A methodology for predicting particle penetration factor through cracks of windows and doors for actual engineering application. Build Environ. 2012;47:339-348
51. Mosley RB, Greenwell DJ, Sparks LE, et al. Penetration of ambient fine particles into the indoor environment. Aerosol Sci Technol. 2001;34:127-136