Abstract
Ventilation design greatly affects disease transmission by aerosols in healthcare buildings and is necessary to protect patients and healthcare workers against Hospital Acquired Infections (HAI). The rising concerns for antibiotic resistance and the strong push to save energy are motivating an assessment of current situation and are supporting a multidisciplinary effort to use novel approaches and tools. The paper is suggesting a shift to performance-based concepts, made possible by a wider use of IAQ sensors and of CFD simulation tools. The paper highlights the key role of particles and Microbe-Carrying Particles, how they are generated and spread by people and can be controlled by dilution and filtration. The viable and non-viable particle measurement techniques are described and OPC emerge as a widely usable tool to quantitatively assess, monitor and control hospital ventilation. Being people the most relevant indoor particle source, it is shown how aerosol dispersion from people can be reduced using occlusive clothing and how different garments are performing in Test Chamber and in OT. The simulation and experimental study of a high-performance OT ventilation system is used in order to show potential benefits of OPC and CFD tools.
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References
ASHRAE. ASHRAE position document on airborne infectious diseases. Atlanta: ASHRAE; 2014.
Azimi P, Stephens B. HVAC filtration for controlling infectious airborne disease transmission in indoor environments: predicting risk reductions and operational costs. Build Environ. 2013;70:150–160.
CDC (Centers for Disease Control). Guidelines for environmental infection control in healthcare facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Atlanta: U.S. Department of Health and Human Services (HHS) for CDC; 2003. p. 52(No. RR-10).
Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint with special reference to the bacterial content of the operating room. Br J Surg. 1969;56:641–9.
DIN 1946-4. Ventilation and air conditioning—part 4: ventilation in buildings and rooms of health care. DIN; 2008.
FGI (Facility Guidelines Institute). Guidelines for design and construction of health care facilities. FGI 2014 Chicago: American Society of Healthcare Engineering of the American Hospital Association. http://www.fgiguidelines.org.
Kujundzic E, Matalkah F, Howard DJ, Hernandez M, Miller SL. Air cleaners and upper-room air UV germicidal irradiation for controlling airborne bacteria and fungal spores. J Occup Environ Hyg. 2006;3(10):536–46. doi:10.1080/15459620600909799.
Lidwell OM, Lowbury EJL, White W, Blowers R, Stanley SJ, Lowe D. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect. 1983;4:111–31.
Ljungqvist B, Reinmüller B. People dressed as a contamination source: some calculations. Eur J Parenter Pharm Sci. 2004;9:83.
Ljungqvist B, Reinmüller B, Gustén J, Nordenadler J. Performance of clothing systems in the context of operating rooms. Eur J Parenter Pharm Sci. 2014;19(3):95–101.
Ljungqvist B, Reinmüller B, Gustén J, Nordenadler J. Clothing systems in operating rooms. A comparative study. J IEST. 2015;58(Suppl 1):20–3. doi:10.17764/1098-4321.58.1.20.
Miller-Leiden S, Lobascio C, Macher JM, Nazaroff WW. Effectiveness of in room air filtration for tuberculosis control in healthcare settings. J Air Waste Manag Assoc. 1996;46:869–82.
Morawska L. Droplet fate in indoor environments, or can we prevent the spread of infection? Indoor Air. 2006;16(5):335–47. doi:10.1111/j.1600-0668.2006.00432.x.
Romano F, Ljungqvist B, Reinmüller B, Gustén J, Joppolo CM. Dispersal chambers used for evaluation of cleanroom and surgical clothing systems. Examples of performed tests and results. In: Proceedings of 23rd symposium of ICCCS—International Confederation of Contamination Control Societies. 20–23 Sept 2016. São Paulo. Brazil.
Romano F, Gustén J, Joppolo CM, Ljungqvist B, Reinmüller B. Some aspects on the sampling efficiency of microbial impaction air samplers. Particuology. 2015a;20:110–3. doi:10.1016/j.partic.2014.11.008.
Romano F, Marocco L, Gustén J, Joppolo CM. Numerical and experimental analysis of airborne particles control in an operating theater. Build Environ. 2015b;89:369–79. doi:10.1016/j.buildenv.2015.03.003.
Stacey A, Humphreys H, et al. A UK historical perspective in operating theatre ventilation. J Hosp Infect. 2002;52:77–80.
Tang JW, Liebner TJ, Craven BA, Settles GS. A Schlieren optical study of the human cough with and without wearing masks for aerosol infection control. J R Soc Interface. 2009;6(Suppl 6):S727–36. doi:10.1098/rsif.2009.0295.focus.
Tellier R. Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface. 2009;6(Suppl 6):S783–90. doi:10.1098/rsif.2009.0302.focus.
Whyte W, Hejab M. Particle and microbial airborne dispersion from people. Eur J Parenter Pharm Sci. 2007;12(Suppl 2):39–46.
Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect. 1982;3:123–35.
World Health Organization (WHO). Natural ventilation for infection control in health-care settings. Atkinson J, Chartier Y, Pessoa-Silva CL, et al. (eds). Copenhagen: WHO; 2009. http://www.ncbi.nlm.nih.gov/books/NBK143284/.
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Joppolo, C.M., Romano, F. (2017). HVAC System Design in Healthcare Facilities and Control of Aerosol Contaminants: Issues, Tools, and Experiments. In: Capolongo, S., Settimo, G., Gola, M. (eds) Indoor Air Quality in Healthcare Facilities. SpringerBriefs in Public Health. Springer, Cham. https://doi.org/10.1007/978-3-319-49160-8_8
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