Heating, ventilation, and air-conditioning systems in healthcare: a scoping review.

Guidelines for heating, ventilation, and air-conditioning systems have been developed for different settings. However, there is a lack of up-to-date evidence providing concrete recommendations for the heating, ventilation, and air-conditioning systems of an isolation room, which is essential to appropriately guide infection control policies. To highlight the guidelines for heating, ventilation, and air-conditioning systems in isolation rooms to inform relevant stakeholders and policymakers. A systematic search was performed based on Joanna Briggs Methodology using five databases (CINAHL, Embase, Joanna Briggs Institute, Medline, and Web of Science) and websites. Eight articles published by government departments were included in this review. Most studies recommended controlled airflow without recirculation, 12 air changes per hour, high-efficiency particulate air filtrate to exhaust contaminated air from the airborne isolation room, humidity ≤60%, and temperature in the range of 18-30 °C. This review provides further evidence that there is a need for interdisciplinary collaborative research to quantify the optimum range for heating, ventilation, and air conditioning system parameters, considering door types, anterooms, and bed management, to effectively reduce the transmission of infection in isolation rooms.

Airborne particles in indoor environment of homes, schools, offices and aged care facilities: The main routes of exposure.

It has been shown that the exposure to airborne particulate matter is one of the most significant environmental risks people face. Since indoor environment is where people spend the majority of time, in order to protect against this risk, the origin of the particles needs to be understood: do they come from indoor, outdoor sources or both? Further, this question needs to be answered separately for each of the PM mass/number size fractions, as they originate from different sources. Numerous studies have been conducted for specific indoor environments or under specific setting. Here our aim was to go beyond the specifics of individual studies, and to explore, based on pooled data from the literature, whether there are generalizable trends in routes of exposure at homes, schools and day cares, offices and aged care facilities. To do this, we quantified the overall 24h and occupancy weighted means of PM10, PM2.5 and PN - particle number concentration. Based on this, we developed a summary of the indoor versus outdoor origin of indoor particles and compared the means to the WHO guidelines (for PM10 and PM2.5) and to the typical levels reported for urban environments (PN). We showed that the main origins of particle metrics differ from one type of indoor environment to another. For homes, outdoor air is the main origin of PM10 and PM2.5 but PN originate from indoor sources; for schools and day cares, outdoor air is the source of PN while PM10 and PM2.5 have indoor sources; and for offices, outdoor air is the source of all three particle size fractions. While each individual building is different, leading to differences in exposure and ideally necessitating its own assessment (which is very rarely done), our findings point to the existence of generalizable trends for the main types of indoor environments where people spend time, and therefore to the type of prevention measures which need to be considered in general for these environments.

An unusual case of hamartomatous polyposis with malignancy complication in a patient with ulcerative colitis treated with golimumab.

We report an unusual case of hamartomatous polyposis with malignant complications in a patient with ulcerative colitis on golimumab and previous thiopurine therapy. This patient was evaluated for iron deficiency anemia and underwent hemicolectomy for extensive right-side predominant inflammatory pseudopolyps. Anemia persisted post-colectomy and subsequent gastroscopy showed a fungating polypoid lesion along with numerous carpet-like strawberry appearing polyps in the stomach extending from the gastro-esophageal junction to the distal part of the antrum, necessitating a gastrectomy. Histology showed extensive hamartomatous-like polyps with adenocarcinoma and nodal metastases. Presence of alopecia totalis and hamartomas in this patient raise the possibility of Cronkhite-Canada Syndrome although this may also represent an undescribed hamartomatous polyposis associated with ulcerative colitis. Even though thiopurine analogue and anti-tumor necrosis factor agents have not been associated with increased risk of solid tumors, immunosuppression in patients with extensive polyposis should be cautiously used due to the potential accelerated malignancy risk. This case also highlights the importance of performing additional imaging of the gastrointestinal tract, in inflammatory bowel disease patients with anemia, particularly if the severity is incongruent with disease activity.

Indoor aerosols: from personal exposure to risk assessment.

Motivated by growing considerations of the scale, severity, and risks associated with human exposure to indoor particulate matter, this work reviewed existing literature to: (i) identify state-of-the-art experimental techniques used for personal exposure assessment; (ii) compare exposure levels reported for domestic/school settings in different countries (excluding exposure to environmental tobacco smoke and particulate matter from biomass cooking in developing countries); (iii) assess the contribution of outdoor background vs indoor sources to personal exposure; and (iv) examine scientific understanding of the risks posed by personal exposure to indoor aerosols. Limited studies assessing integrated daily residential exposure to just one particle size fraction, ultrafine particles, show that the contribution of indoor sources ranged from 19% to 76%. This indicates a strong dependence on resident activities, source events and site specificity, and highlights the importance of indoor sources for total personal exposure. Further, it was assessed that 10-30% of the total burden of disease from particulate matter exposure was due to indoor-generated particles, signifying that indoor environments are likely to be a dominant environmental factor affecting human health. However, due to challenges associated with conducting epidemiological assessments, the role of indoor-generated particles has not been fully acknowledged, and improved exposure/risk assessment methods are still needed, together with a serious focus on exposure control.

Study on the interzonal migration of airborne infectious particles in an isolation ward using benign bacteria.

UNLABELLED: Negative pressure isolation wards are essential infection control facilities against airborne transmissible diseases. Airborne infectious particles are supposed to be contained in the isolation room. However, negative pressure may break down by door-opening action or by human movement. Understanding the interzonal transport of airborne infectious particles in the isolation wards can aid the design and operation strategy of isolation facilities. In this work, the interzonal migration of airborne infectious particles by human movement was studied experimentally in an isolation ward. Artificial saliva solution with benign E. coli bacteria was aerosolized to simulate bacterium-laden infectious particles. The interzonal migration of aerosolized bacteria was characterized by biological air sampling. Less than 1% of airborne infectious particles were transported to the higher pressure zone when door was closed. With human movement, 2.7% of the particles were transported from the anteroom to the corridor. From high-to-low pressure zones, as much as 20.7% of airborne infectious particles were migrated. Only a minimal amount of particles was transported from the corridor to the positive pressure nurses' station. Infection risk of tuberculosis of the healthcare workers and other occupants in the isolation wards were also assessed based on the measured migration ratios. PRACTICAL IMPLICATIONS: Human movement is an important factor governing interzonal migration. It is the main cause of migration of airborne infectious particles to a relatively negative pressure zone. This study provides a set of experimentally obtained particle migration ratios by human movement. Other than serving as empirical data for further studies on the mechanics, these migration ratios can also be used to assess the infection risk for occupants in the isolation ward.

Synthesis of Co3O4 nanowire arrays supported on Ni foam for removal of volatile organic compounds.

Crystalline Co3O4 nanowire arrays freely supported on Ni foam are successfully synthesized using a template-free method. The effects of reaction time, concentration of reactants, and temperature on the morphology of the nanowires are studied. The results indicate that uniform Co3O4 nanowires could be synthesized at 90 degrees C, and a transformation of the samples' morphology from nanoparticles to nanowires to microrods is observed by controlling the concentration of the reactants. The well-ordered nanowires synthesized under the selected reaction conditions are composed of spinel Co3O4 with diameters of 500-580 nm and lengths of 6-8 microm. These nanowires show good catalytic activity for the ozone catalytic oxidation of toluene.

Collagen VI protects against neuronal apoptosis elicited by ultraviolet irradiation via an Akt/phosphatidylinositol 3-kinase signaling pathway.

Collagen VI, one of the extracellular matrix proteins, has been implicated in regulating cell proliferation and reducing apoptosis in several different systems. However, the role of collagen VI in the central nervous system remains unclear. In this manuscript, we demonstrated that upon ultraviolet (UV) irradiation, mouse primary hippocampal neurons specifically up-regulate the expression of Col6a1, Col6a2, and Col6a3 mRNA and secreted collagen VI protein. Augmentation of collagen VI mRNA and protein after UV irradiation may have a neuroprotective role as suggested by the fact that extracellular supplying soluble collagen VI protein, but not other collagen proteins, reduced UV induced DNA damage, mitochondria dysfunction, and neurite shrinkage. We also tried to determine the signaling molecules that mediate the protective effect of collagen VI via Western blot and inhibitor analysis. After collagen VI treatment, UV irradiated neurons increased phosphorylation of Akt and decreased phosphorylation of JNK. Inhibiting Akt/phosphatidylinositol 3-kinases (PI3K) pathway diminished the protective effect of collagen VI. Our study suggested a potential protective mechanism by which neurons up-regulate collagen VI production under stress conditions to activate Akt/PI3K anti-apoptotic signaling pathway.

Review and comparison between the Wells-Riley and dose-response approaches to risk assessment of infectious respiratory diseases.

UNLABELLED: Infection risk assessment is very useful in understanding the transmission dynamics of infectious diseases and in predicting the risk of these diseases to the public. Quantitative infection risk assessment can provide quantitative analysis of disease transmission and the effectiveness of infection control measures. The Wells-Riley model has been extensively used for quantitative infection risk assessment of respiratory infectious diseases in indoor premises. Some newer studies have also proposed the use of dose-response models for such purpose. This study reviews and compares these two approaches to infection risk assessment of respiratory infectious diseases. The Wells-Riley model allows quick assessment and does not require interspecies extrapolation of infectivity. Dose-response models can consider other disease transmission routes in addition to airborne route and can calculate the infectious source strength of an outbreak in terms of the quantity of the pathogen rather than a hypothetical unit. Spatial distribution of airborne pathogens is one of the most important factors in infection risk assessment of respiratory disease. Respiratory deposition of aerosol induces heterogeneous infectivity of intake pathogens and randomness on the intake dose, which are not being well accounted for in current risk models. Some suggestions for further development of the risk assessment models are proposed. PRACTICAL IMPLICATIONS: This review article summarizes the strengths and limitations of the Wells-Riley and the dose-response models for risk assessment of respiratory diseases. Even with many efforts by various investigators to develop and modify the risk assessment models, some limitations still persist. This review serves as a reference for further development of infection risk assessment models of respiratory diseases. The Wells-Riley model and dose-response model offer specific advantages. Risk assessors can select the approach that is suitable to their particular conditions to perform risk assessment.

Fly-ash products from biomass co-combustion for VOC control.

Experiments were conducted in a continuous flow reactor at room temperature to evaluate the elimination of low-concentration toluene in the gas phase to verify if fly-ash products from biomass combustion in an ozonation system could be used in the removal of volatile organic compounds. The fly-ash products from pure biomass combustion (Ash(100)) demonstrated the highest ozonation activities upon the removal of low-concentration toluene (1.5 ppmv), followed by the fly-ash products from co-combustion (Ash(30)) and the coal combustion (Ash(0)). Kinetic experiments showed that the activation energy of the toluene elimination process was substantially reduced with the use of ozone and the reaction intermediates, such as formic acids, aldehydes, etc. Results also showed that the intermediates were reduced with increasing humidity level. The combined use of fly-ash products and zeolite 13X enhanced the removal of toluene to above 90% and suppressed the release of residual ozone and intermediates by holding them in the adsorbed phase.

Lead distribution in blood and organs of mice exposed to lead by vein injection.

To study lead (Pb) distribution in organs and blood in the case of Pb poisoning, mice were firstly exposed to Pb as 0.1 mL or 0.2 mL of lead nitrate solution (0.1 mg/mL) by vein injection every other day. Then, after metabolic absorption, the Pb level in the blood and organs of the mice was measured using flame atomic absorption spectrometry. The resulting data showed that 93% of Pb in blood was accumulated in red cells, but this percentage slightly decreased with increasing exposure time and injection volume. For other target organs, the highest Pb level was in the kidney, followed by the liver, spleen, heart and lung, and was lowest in the brain. Moreover, the Pb level in the heart and brain is in a growth trend at all times for 0.1 mL and 0.2 mL of Pb injection exposure in 15 days, while the growth trend of Pb in other target organs become slow for 0.2 mL of injection after exposure Pb 11 days.

Characterization of expiration air jets and droplet size distributions immediately at the mouth opening.

Size distributions of expiratory droplets expelled during coughing and speaking and the velocities of the expiration air jets of healthy volunteers were measured. Droplet size was measured using the interferometric Mie imaging (IMI) technique while the particle image velocimetry (PIV) technique was used for measuring air velocity. These techniques allowed measurements in close proximity to the mouth and avoided air sampling losses. The average expiration air velocity was 11.7 m/s for coughing and 3.9 m/s for speaking. Under the experimental setting, evaporation and condensation effects had negligible impact on the measured droplet size. The geometric mean diameter of droplets from coughing was 13.5 µm and it was 16.0 µm for speaking (counting 1-100). The estimated total number of droplets expelled ranged from 947 to 2085 per cough and 112-6720 for speaking. The estimated droplet concentrations for coughing ranged from 2.4 to 5.2 cm-3 per cough and 0.004-0.223 cm-3 for speaking.

Catalytic ozonation of toluene using zeolite and MCM-41 materials.

The effects of passing ozone over different zeolite and MCM-41 materials to remove toluene were investigated. Different ozone-to-toluene ratios were used to evaluate the catalytic performance during ozonation. The micro- and meso-porous materials removed about 50% of the toluene via adsorption and another 20-40% was decomposed by ozonation, which was catalytically enhanced by the zeolite and MCM-41 materials. The catalytic reaction portion increased by using a higher ozone inlet concentration and it was further enhanced to around 50% with the use of more adsorbents or with longer residence times. Inside the porous structure of the material, ozone was either decomposed into active atomic oxygen for reactions or converted into oxygen for active site regeneration. The number of Lewis acid sites in the adsorbents for ozone decomposition and byproduct generation during the reactions limit the catalytic activities. Trace amounts of intermediates including aldehydes and organic acids were quantified in the ozonation process. A higher ozone inlet concentration helped to reduce intermediate species formation but it led to more residual ozone in the exhaust. The high adsorption capability of the zeolite and MCM-41 adsorbents could serve as reservoirs for suppressing the release of intermediate species to the exhaust.

Methane emissions abatement by multi-ion-exchanged zeolite A prepared from both commercial-grade zeolite and coal fly ash.

The performance of multimetal-(Cu, Cr, Zn, Ni, and Co)-ion-exchanged zeolite A prepared from both a commercial-grade sample and one produced from coal fly ash in methane emissions abatement was evaluated in this study. The ion-exchange process was used to load the metal ions in zeolite A samples. The methane conversion efficiency by the samples was studied under various parameters including the amount of metal loading (7.3-19.4 wt%), reaction temperature (25-500 degrees C), space velocity (8400-41 900 h(-1)), and methane concentration (0.5-3.2 vol %). At 500 degrees C, the original commercial-grade zeolite A catalyzed 3% of the methane only, whereas the addition of different percentages of metals in the sample enhanced the methane conversion efficiency by 40-85%. Greater methane conversion was observed by increasing the percentage of metals added to the zeolite even though the BET surface area of the zeolite consequently decreased. Higher percentage methane conversion over the multi-ion-exchanged samples was observed at lower space velocities indicating the importance of the mass diffusion of reactants and products in the zeolite. Compared to the multi-ion-exchanged zeolite A prepared from the commercial-grade zeolite, the one produced from coal fly ash demonstrated similar performances in methane emissions abatement, showing the potential use of this low cost recycled material in gaseous pollutant treatment.

A methodology for estimating airborne virus exposures in indoor environments using the spatial distribution of expiratory aerosols and virus viability characteristics.

UNLABELLED: This study investigated the feasibility of using the spatial distribution of expiratory aerosols and the viability functions of airborne viruses to estimate exposures to airborne viruses in an indoor environment under imperfectly mixed condition. A method adopting this approach was tested in an air-conditioned hospital ward. Artificial coughs were produced by aerosolizing a simulated respiratory fluid containing a known concentration of benign bacteriophage. The bacteriophage exposures estimated on the basis of the spatial aerosol distributions and its viability function were in reasonable agreement with those measured directly by biological air sampling and culturing. The ventilation flow and coughing orientation were found to play significant roles in aerosol transport, leading to different spatial distribution patterns in bacteriophage exposure. Bacteriophage exposures decreased with lateral distance from the infector when the infector coughed vertically upward. In contrast, exposures were constant or even increased with distance in the case of lateral coughing. The possibility of incorporating the proposed exposure estimation into a dose-response model for infection risk assessment was discussed. The study has also demonstrated the potential application of viability functions of airborne viral pathogens in exposure assessment and infection risk analysis, which are often unavailable in literature for some important communicable diseases. PRACTICAL IMPLICATIONS: The proposed method makes use of the viability function of the virus and the spatial distribution of the expiratory aerosols for virus exposure estimation. Spatial differences in aerosol distribution and its influences on virus exposure in an air space can be determined. Variations in infectious dose with carrier aerosol size could also be considered. The proposed method may serve as a tool for further investigation of ventilation design and infection control in clinical or other indoor environments.

Transport characteristics of expiratory droplets and droplet nuclei in indoor environments with different ventilation airflow patterns.

Expiratory droplets and droplet nuclei can be pathogen carriers for airborne diseases. Their transport characteristics were studied in detail in two idealized floor-supply-type ventilation flow patterns: Unidirectional-upward and single-side-floor, using a multiphase numerical model. The model was validated by running interferometric Mie imaging experiments using test droplets with nonvolatile content, which formed droplet nuclei, ultimately, in a class-100 clean-room chamber. By comparing the droplet dispersion and removal characteristics with data of two other ceiling-supply ventilation systems collected from a previous work, deviations from the perfectly mixed ventilation condition were found to exist in various cases to different extent. The unidirectional-upward system was found to be more efficient in removing the smallest droplet nuclei (formed from 1.5 mum droplets) by air extraction, but it became less effective for larger droplets and droplet nuclei. Instead, the single-side-floor system was shown to be more favorable in removing these large droplets and droplet nuclei. In the single-side-floor system, the lateral overall dispersion coefficients for the small droplets and nuclei (initial size

Role of ventilation in airborne transmission of infectious agents in the built environment - a multidisciplinary systematic review.

There have been few recent studies demonstrating a definitive association between the transmission of airborne infections and the ventilation of buildings. The severe acute respiratory syndrome (SARS) epidemic in 2003 and current concerns about the risk of an avian influenza (H5N1) pandemic, have made a review of this area timely. We searched the major literature databases between 1960 and 2005, and then screened titles and abstracts, and finally selected 40 original studies based on a set of criteria. We established a review panel comprising medical and engineering experts in the fields of microbiology, medicine, epidemiology, indoor air quality, building ventilation, etc. Most panel members had experience with research into the 2003 SARS epidemic. The panel systematically assessed 40 original studies through both individual assessment and a 2-day face-to-face consensus meeting. Ten of 40 studies reviewed were considered to be conclusive with regard to the association between building ventilation and the transmission of airborne infection. There is strong and sufficient evidence to demonstrate the association between ventilation, air movements in buildings and the transmission/spread of infectious diseases such as measles, tuberculosis, chickenpox, influenza, smallpox and SARS. There is insufficient data to specify and quantify the minimum ventilation requirements in hospitals, schools, offices, homes and isolation rooms in relation to spread of infectious diseases via the airborne route. PRACTICAL IMPLICATION: The strong and sufficient evidence of the association between ventilation, the control of airflow direction in buildings, and the transmission and spread of infectious diseases supports the use of negatively pressurized isolation rooms for patients with these diseases in hospitals, in addition to the use of other engineering control methods. However, the lack of sufficient data on the specification and quantification of the minimum ventilation requirements in hospitals, schools and offices in relation to the spread of airborne infectious diseases, suggest the existence of a knowledge gap. Our study reveals a strong need for a multidisciplinary study in investigating disease outbreaks, and the impact of indoor air environments on the spread of airborne infectious diseases.

Potential use of a combined ozone and zeolite system for gaseous toluene elimination.

This study investigated the performance of a combined ozone and zeolite system in eliminating gaseous toluene which is a major contaminant in many industrial and indoor environments. The hypothesis that the removal of toluene by ozone can be substantially affected by confining the oxidation reaction in a zeolite structure was evaluated. The degradation of toluene seemed to be contributed by the active oxygen atom generated from the decomposition of ozone at the Lewis acid sites in the zeolite 13X. Air containing toluene levels at 1.5, 2 and 3 ppm was injected with ozone in the range of 0-6 ppm before being vented into a fixed amount of 3600 g zeolite 13X with 90 mm bed-length. The experimental results showed that the elimination rate of toluene was significantly enhanced when compared to using zeolite or ozone alone. In particular, over 90% of the 1.5 ppm toluene was removed when 6 ppm ozone was used at 40% relative humidity level. Deactivation of the zeolite 13X after a few hours of reactions under the current experimental conditions was probably due to the adsorbed water, carbon dioxide and the reaction by-products. The residue species left in the zeolite and the intermediate species in the exhaust gas stream were characterized by FT-IR, GC-MS and HP-LC methods, respectively. A distinctive peak of O atom attached to the Lewis acid site at 1380 cm(-1) was found in the FT-IR spectrum and trace amount of aldehydes was found to be the reaction by-products.

A study of the dispersion of expiratory aerosols in unidirectional downward and ceiling-return type airflows using a multiphase approach.

Dispersion characteristics of expiratory aerosols were investigated in an enclosure with two different idealized airflow patterns: the ceiling-return and the unidirectional downward. A multiphase numerical model, which was able to capture the polydispersity and evaporation features of the aerosols, was adopted. Experiments employing optical techniques were conducted in a chamber with downward airflow pattern to measure the dispersion of aerosols. Some of the numerical results were compared with the chamber measurement results. Reasonable agreement was found. Small aerosols (initial size

Synthesis of MCM-41 from coal fly ash by a green approach: influence of synthesis pH.

The present study reports a green synthesis method for preparing pure (free of fly ash) and ordered MCM-41 materials from coal fly ash at room temperature (25 degrees C) during 24 h of reaction. It was shown that the impurities in the coal fly ash were not detrimental to the formation of MCM-41 at the tested conditions. The influence of initial synthesis pH on material properties of calcined MCM-41 samples was investigated by various techniques such as XRF, XPS, XRD, FTIR, DR-UV-vis, solid state NMR, N2 physisorption, TG-DTA, SEM and TEM. The experimental results showed that the amount of trace elements such as Al, Na, Ti and Fe incorporated into the sample increased with synthesis pH value. More aluminum species were incorporated with tetrahedral coordination in the framework under a high pH value. The particle size of the sample decreased with the synthesis pH value. Samples synthesized at high pH values had a larger pore size and were more hydrothermally stable than those at low pH values. From thermal analysis, it was observed that the synthesized MCM-41 samples showed a high thermal stability. These properties made the synthesized MCM-41 suitable for further processing into more useful materials in a wide range of applications.