Risco de contaminação por aerossóis em consultório odontológico e comparação a procedimentos eletivos / Risk of contamination by aerosols in dental offices and comparison to elective procedures / Riesgo de contaminación por aerosoles en consultorios dentales y comparación con procedimientos electivos

Durante os procedimentos odontológicos, os profissionais devem se preocupar com a disseminação e a formação de aerossóis, sendo essa uma rota de transmissão potencial. O objetivo foi demonstrar o risco de contaminação por aerossóis da cavidade bucal durante o atendimento em consultórios odontológicos e comparar cinco procedimentos eletivos, utilizou-se um marcador (corante alimentício) na água do reservatório do equipamento odontológico para identificar a contaminação por produção de aerossóis. Estabeleceu-se os círculos A, B e C com raios de 50, 100 e 150 cm, respectivamente, a partir do ponto central do encosto da cabeça na cadeira odontológica. Estabeleceu-se um planejamento fatorial e teste de Tukey para comparação das médias dos pontos de contaminação e para os pontos não contáveis de contaminação aplicou-se a Análise de Componentes Principais (ACP). O tipo de procedimento e a interação entre o local e tipo de procedimento não se mostraram estatisticamente significativos, mas verificou-se maior incidência significativa no círculo A (raio de 50 cm). Aplicando a ACP foi possível relacionar a contaminação do tórax do paciente e da ponta do sugador com os procedimentos de Ultrassom e Incisivo Central Superior, assim como a relação da contaminação do jaleco do cirurgião dentista e da ponta da caneta de alta rotação com os procedimentos de Primeiro Molar Superior, Primeiro Molar Inferior e Incisivo Central Inferior. Precauções para minimizar a contaminação e o espalhamento dos aerossóis devem ser utilizadas nos atendimentos odontológicos para diminuir os riscos de contaminação da equipe profissional, dos pacientes e do ambiente.

During dental procedures, professionals should be concerned with the spread and formation of aerosols, as this is a potential transmission route. The objective was to demonstrate the risk of contamination by aerosols in the oral cavity during care in dental offices and to compare five elective procedures. Circles A, B and C were established with radii of 50, 100 and 150 cm, respectively, from the central point of the headrest on the dental chair. A factorial design and Tukey's test were established to compare the averages of the contamination points and for the non-countable points of contamination, Principal Component Analysis (PCA) was applied. The type of procedure and the interaction between the location and the type of procedure were not statistically significant, but there was a significant higher incidence in circle A (50 cm radius). Applying PCA, it was possible to relate the contamination of the patient's thorax and the tip of the sucker with the Ultrasound and Upper Central Incisor procedures, as well as the relationship of contamination of the dentist's coat and the tip of the high-speed pen with the procedures of Upper First Molar, Lower First Molar and Lower Central Incisor. Precautions to minimize contamination and the spread of aerosols must be used in dental care to reduce the risk of contamination of the professional team, patients and the environment.

Durante los procedimientos dentales, los profesionales deben preocuparse por la propagación y formación de aerosoles, ya que esta es una ruta potencial de transmisión. El objetivo fue demostrar el riesgo de contaminación por aerosoles en la cavidad bucal durante la atención en los consultorios odontológicos y comparar cinco procedimientos electivos. Se establecieron círculos A, B y C con radios de 50, 100 y 150 cm, respectivamente, desde el punto central del reposacabezas del sillón dental. Se estableció un diseño factorial y la prueba de Tukey para comparar los promedios de los puntos de contaminación y para los puntos de contaminación no contables se aplicó el Análisis de Componentes Principales (PCA). El tipo de procedimiento y la interacción entre la ubicación y el tipo de procedimiento no fueron estadísticamente significativos, pero hubo una incidencia significativamente mayor en el círculo A (50 cm de radio). Aplicando PCA se logró relacionar la contaminación del tórax del paciente y la punta de la ventosa con los procedimientos de Ultrasonido e Incisivo Central Superior, así como la relación de la contaminación de la bata del odontólogo y la punta del bolígrafo de alta velocidad con los procedimientos de Primer Molar Superior, Primer Molar Inferior e Incisivo Central Inferior. Precauciones para minimizar la contaminación y la propagación de aerosoles deben ser utilizados en la atención odontológica para reducir el riesgo de contaminación del equipo profesional, los pacientes y el medio ambiente.

Prevalencia del síndrome del edificio enfermo en trabajadores de la industria manufacturera / Prevalence of sick building syndrome in manufacturing industry workers

El síndrome del edificio enfermo, se refiere a un conjunto de síntomas generales en mucosa (ocular y/o respiratoria) y piel que presentan los ocupantes de edificaciones con calidad ambiental deficientes, exponiendo a sus ocupantes a factores de riesgos físicos, mecánicos, químicos, biológicos y psicosociales, que puede afectar negativamente la salud y productividad de las personas. Con el propósito de determinar la frecuencia de los síntomas de los ocupantes de una industria manufacturera del Perú, se realizó estudio transversal aplicándose a 237 trabajadores, estratificados por áreas laborales, el cuestionario sugerido por el Instituto Nacional de Higiene y Seguridad en el Trabajo, además de evaluar la condición ambiental mediante la determinación de bioaerosoles cultivables y contables. Los resultados mostraron prevalencia superior al 20% en síntomas como: sequedad en ojos y garganta, picor en garganta congestión nasal, dolor de cabeza y debilidad general. Se tomaron, cuantificaron y caracterizaron 164 muestras de bioaerosoles, los microrganismos encontrados con mayor porcentaje fueron, Aspergillus sp. 54,68% (68) en el área administrativa, mientras que en las áreas de producción y almacén predomino Penicillium sp. con 87,10% (108) y 62,21% (77) respectivamente. Otros géneros encontrados en mayor porcentajes, en las tres áreas fueron: Trichoderma, Acremonium, Monilia, Cladosporium, entre otros. Los hallazgos se correlacionan con lo reportado en diversas investigaciones, la presencia de mencionados hongos, sugiere que existe una inadecuada calidad ambiental y aunada a la prevalencia obtenida en cuanto a sintomatología, se puede clasificar la edificación objeto de estudio con el Síndrome del edificio enfermo(AU)

Sick building syndrome refers to a set of general mucosal (ocular and/or respiratory) and skin symptoms presented by occupants of buildings with poor environmental quality, exposing their occupants to physical, mechanical, chemical, biological and psychosocial, which can negatively affect the health and productivity of people. In order to determine the frequency of the symptoms of the occupants of a manufacturing industry in Peru, a cross-sectional study was carried out, applying to 237 workers, stratified by work areas, the questionnaire suggested by the National Institute of Hygiene and Safety at Work, in addition to to evaluate the environmental condition by determining cultivable and countable bioaerosols. The results showed a prevalence greater than 20% in symptoms such as: dry eyes and throat, itchy throat, nasal congestion, headache and general weakness. 164 samples of bioaerosols were taken, quantified and characterized, the microorganisms found with the highest percentage were Aspergillus sp. 54.68% (68) in the administrative area, while in the production and storage areas, Penicillium sp. with 87.10% (108) and 62.21% (77) respectively. Other genera found in higher percentages in the three areas were: Trichoderma, Acremonium, Monilia, Cladosporium, among others. The findings correlate with what has been reported in various investigations, the presence of these fungi suggests that there is an inadequate environmental quality and, together with the prevalence obtained in terms of symptoms, the building under study can be classified with the Sick Building Syndrome(AU)

Droplets and aerosols in dental clinics and prevention and control measures of infection / 中华口腔医学杂志

Spraying during dental practices can generate quantity of droplets, which transform into droplet nuclei and suspend in the air of clinic in the form of aerosol. Either droplets or aerosols may carry microorganisms and cause air contamination in the hospital, posing potential threat to the health of clinical healthcare staff and patients. The present article summarizes some basic concepts involved in bio-aerosol research and reviews literatures on intervention measures of dental clinic droplet/aerosols to clarify whether there is experimental evidence of aerosol-carrying bacteria in the existing literatures. The aim of this article is to provide evidence for the formulation of guidelines for infection control in dental healthcare practices during the epidemic period of infectious diseases, as well as to provide reference and scientific basis for the management and implementation of infection control measures in daily dental clinical work.

Association of airborne particles, protein, and endotoxin with emergency department visits for asthma in Kyoto, Japan

BACKGROUND@#The health effects of biological aerosols on the respiratory system are unclear. The purpose of this study was to clarify the association of airborne particle, protein, and endotoxin with emergency department visits for asthma in Kyoto City, Japan.@*METHODS@#We collected data on emergency department visits at a hospital in Kyoto from September 2014 to May 2016. Fine (aerodynamic diameter ≤ 2.5 μm) and coarse (≥ 2.5 μm) particles were collected in Kyoto, and protein and endotoxin levels were analyzed. The association of the levels of particles, protein, endotoxin, and meteorological factors (temperature, relative humidity, wind speed, and air pressure) with emergency department visits for asthma was estimated.@*RESULTS@#There were 1 to 15 emergency department visits for asthma per week, and the numbers of visits increased in the autumn and spring, namely many weeks in September, October, and April. Weekly concentration of protein in fine particles was markedly higher than that in coarse particles, and protein concentration in fine particles was high in spring months. Weekly endotoxin concentrations in fine and coarse particles were high in autumn months, including September 2014 and 2015. Even after adjusting for meteorological factors, the concentrations of coarse particles and endotoxin in both particles were significant factors on emergency department visits for asthma.@*CONCLUSIONS@#Our results suggest that atmospheric coarse particles and endotoxin are significantly associated with an increased risk of asthma exacerbation.

Respiratory Disorders Among Workers in Slaughterhouses

BACKGROUND: Workers in slaughterhouses are exposed to a wide range of biological contaminants, such as bacteria and fungi, due to their working environment. This study aimed to assess the prevalence of respiratory disorders among workers in slaughterhouses. METHODS: This study was conducted on 81 workers in slaughterhouses and 81 healthy office workers as a reference group. The American Thoracic Society standard respiratory symptoms questionnaire was used to determine the prevalence of respiratory disorders. Besides, lung function tests were conducted using a calibrated spirometer at the beginning (preshift) and at the end (postshift) of the 1st working day. Single-stage Anderson sampler was used to measure the concentration of bioaerosols in different parts of slaughterhouses. RESULTS: The prevalence of respiratory disorders, such as cough, productive cough, breathlessness, phlegm, and wheezing, was 3.17, 4.02, 3.07, 4.66, and 3.94 times, respectively, higher among workers in slaughterhouses compared with the reference group. CONCLUSION: The prevalence of respiratory disorders was significantly higher among workers in slaughterhouses. Thus, the significant reduction in the percentage predicted lung function among workers in slaughterhouses might be associated with exposure to bioaerosols in their work environment.

Bioaerosol Contamination In Dental Clinic : A Potential Health Hazard.

Dental clinics are potential hazardous areas as large amount of bio-aerosols are produced here. Bioaerosols are microorganisms or particles, gases, vapors, or fragments of biological origin (i.e., alive or released from a living organism) that are in the air. Many sources of bioaerosols exist within and outside the dental clinic. The concentration of aerosols and splatters appears to be highest during dental procedures, especially those generated by some procedures such as ultrasonic scaling, or using a high speed drill. Bioaerosols may reach up to 12-16 feet from the source during patient care and may stay suspended in the air for hours if there is inadequate ventilation of air exchanges. Therefore, several infectious diseases could be transmitted to staff and patients by airborne bacterial and other contaminants in the dental clinic. Dental staff should use personal protective measures, which reduce contact with bacterial aerosols and splatters in the dental clinic.

Evaluación de bioaerosoles en ambientes de centros de salud de la ciudad de Valencia, Venezuela / Evaluation of bioaerosoles in health center environments in the city of Valencia, Venezuela

Los establecimientos de atención en salud son entornos donde se congregan pacientes que en menor o mayor grado presentan compromisos inmunológicos. En este contexto, el ambiente hospitalario resulta un espacio donde podrían adquirir infecciones nosocomiales con el consiguiente deterioro del cuadro clínico preexistente. En el presente estudio se realizaron evaluaciones en ambientes hospitalarios de centros de salud ubicados en la ciudad de Valencia, Venezuela, tomando en cuenta áreas críticas como quirófanos. Para la captación de las muestras se tomó en cuenta las metodologías establecidas en las Normas Técnicas Españolas. La captación del aire sobre los medios de cultivo Nutritivoy Sabouraud se incubaron a 37°C de 24-72 horas, para determinar UFC/m3 de aire. Conjuntamente se midió la temperatura y humedad relativa. La identificación microbiológica se realizó utilizando galerias bioquímicas automatizadas (API). De los 6 centros hospitalarios evaluados, 5 quirófanos presentaron más de 10 UFC/m3 de aerobios mesófilos y más de 20 UFC/m3 de población fúngica, cuyo rango debería ser menor a 10UFC/m3. Los microorganismos identificados con mayor frecuencia fueron: Staphylococcus spp, Pseudomonas aeruginosa, Bacillus spp., Acinetobacter lowfii, Aspergillus nidulans, A. terreus y Geotrichum candidum. Las medidas de temperatura fueron mayores a 20°C y la humedad relativa mayor a 45%, siendo el rango establecido por la NTP 409 para la temperatura entre 15-18°C, y 50-70% en cuanto a la humedad relativa. Se infiere que existe poco compromiso en aplicar las medidas correctas para cumplir a cabalidad con las normas de manipulación de pacientes en áreas críticas, lo que propicia un entorno favorable para el desarrollo microbiano, además de factores como temperatura, humedad relativa, sistemas de climatización, que no cumplen con lo indicado según las normas técnicas Internacionales

Health center facilities are areas where patients who have a greater or lesser degree of immunological compromise congregate. In this context, the hospital environment is a space where nosocomial diseases could be acquired causing deterioration of the preexistent clinical condition. This study carried out evaluations in hospital environments at health centers in the city of Valencia, Venezuela, taking into account critical areas such as operating theatres. For sample collection, methodologies established by the Spanish Technical Standards were taken into account. The air samples taken over Nutritivo and Sabouraud cultivation media were incubated at 37°C for 24-72 hours, to determine the UFC/m3 for the air. Following a 24-hour incubation at 37°C, the bacterial charges (UFC/m3) were determined. Additionally, temperature and relative humidity were measured. Taxonomical identification was achieved through a computerized biochemical test (API galleries). Five out of the six health centers evidenced more than 10UFC/m3 and 20 UFC/m3 for the bacterial and fungal charges, respectively. These values are higher than those allowed by official legislation. The most frequently detected microorganisms were Staphylococcus spp, Pseudomonas aeruginosa, Bacillus spp., Acinetobacter lowfii, Aspergillus nidulans, A. terreus and Geotrichum candidum. The temperature and relative humidity were always higher than 20°C and 45%, whereas ranges established by the NTP 409 norm are 15-18ºC and 50-70%, respectively. It seems there is little commitment to applying correct measures to comply fully with standards for patient handling in critical areas, favoring an environment conducive to microbial development, as well as factors such as temperature, relative humidity and air conditioning systems, which do not comply with what is indicated in international technical standards

Microbial Exposure Assessment in Sawmill, Livestock Feed Industry, and Metal Working Fluids Handling Industry

OBJECTIVES: The objective of this study is to investigate the distribution patterns and exposure concentrations of bioaerosols in industries suspected to have high levels of bioaerosol exposure. METHODS: We selected 11 plants including 3 livestock feed plants (LF industry), 3 metal working fluids handling plants (MWFs industry), and 5 sawmills and measured total airborne bacteria, fungi, endotoxins, as well as dust. Airborne bacteria and fungi were measured with one stage impactor, six stage cascade impactor, and gelatin filters. Endotoxins were measured with polycarbonate filters. RESULTS: The geometric means (GM) of the airborne concentrations of bacteria, fungi, and endotoxins were 1,864, 2,252 CFU/m3, and 31.5 EU/m3, respectively at the sawmills, followed by the LF industry (535, 585 CFU/m3, and 22.0 EU/m3) and MWFs industry (258, 331 CFU/m3, and 8.7 EU/m3). These concentrations by industry type were significantly statistically different (p < 0.01). The ratio of indoor to outdoor concentration was 6.2, 1.9, 3.2, and 3.2 for bacteria, fungi, endotoxins, and dust in the LF industry, 5.0, 0.9, 2.3, and 12.5 in the MWFs industry, and 3.7, 4.1, 3.3, and 9.7 in sawmills. The respiratory fractions of bioaerosols were differentiated by bioaerosol types and industry types: the respiratory fraction of bacteria in the LF industry, MWF industry, and sawmills was 59.4%, 72.0%, and 57.7%, respectively, and that of fungi was 77.3%, 89.5%, and 83.7% in the same order. CONCLUSION: We found that bioaerosol concentration was the highest in sawmills, followed by LF industry facilities and MWFs industry facilities. The indoor/outdoor ratio of microorganisms was larger than 1 and respiratory fraction of microorganisms was more than 50% of the total microorganism concentrations which might penetrate respiratory tract easily. All these findings suggest that bioaerosol in the surveyed industries should be controlled to prevent worker respiratory diseases.