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.

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.

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.