Exploratory assessment of outdoor and indoor airborne black carbon in different locations of Hanoi, Vietnam.

Black carbon (BC) is a significant component of atmospheric particulate matter, especially in areas affected by combustion emissions. Despite the fact that air pollution is a great concern in Vietnam, there are no studies on the level of BC in the outdoor and indoor environment. In this exploratory study, an assessment of urban BC concentrations was conducted through monitoring of both outdoor and indoor BC concentrations in three households and one working office at different locations across Hanoi. PM2.5 and meteorology data were also obtained for this monitoring period to evaluate the association between them and the outdoor BC concentration. Overall, the mean indoor and mean outdoor BC concentrations by 30 second-logs for the monitoring period were 4.42 µg/m3 and 4.89 µg/m3, respectively. Time-series analysis of paired indoor and outdoor BC concentrations suggested that indoor BC level was usually influenced by outdoor BC level (r = 0.78, p < 0.001). In this study, we observed a significant positive association between outdoor BC and PM2.5 (r = 0.39, p < 0.001) while outdoor BC negatively correlated with wind speed (r = -0.34, p < 0.001). The level of outdoor BC in Hanoi measured in this study is relatively high and should be confirmed by further studies.

Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

BACKGROUND: Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. METHODS: We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. RESULTS: Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p < 0.01 for all). This was also true for all VARI (p < 0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75-3.33, p = 0.23; VARI without VAP HR 0.40, 95% CI 0.14-1.17, p = 0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806-7824) vs 3131 USD (IQR 2108-7551), p = 0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75-6.75, p = 0.15). CONCLUSIONS: VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed.

Exploratory assessment of indoor and outdoor particle number concentrations in Hanoi households.

No studies have been conducted in Vietnam to understand the levels of atmospheric ultrafine particles, despite having adverse health effects. Information about indoor air quality in Vietnam is also limited. Hence we aimed to conduct the first assessment of ultrafine particle concentrations in terms of particle number (PN) in Hanoi, by simultaneously measuring indoor and outdoor PN concentrations from six households at different locations across the city in January 2016. We also acquired PM2.5 data for this monitoring period from an air quality monitoring station located at the US Embassy in Hanoi, to compare the general trends between PN and PM2.5 concentrations. The mean daily indoor and outdoor PN concentrations for the monitoring period were 1.9×104p/cm3 and 3.3×104p/cm3, respectively, with an increase during rush hour traffic. It was concluded that traffic was the main contributor to outdoor PN concentrations, with agricultural burning having a small influence at one study location. The mean ratio of indoor to outdoor PN concentrations for all six sites was 0.66±0.26, which points to outdoor air as the main driver of indoor PN concentrations, rather than indoor sources. These PN concentrations and I/O ratios are similar to those reported for a number of cities in developed countries. However, in contrast to PN, ambient mean PM2.5 concentrations in Hanoi (60-70µg/m3) were significantly higher than those typically recorded in developed countries. These findings demonstrate that urban particle mass (PM2.5) concentrations are not indicative of the PN concentrations, which can be explained by different sources contributing to PN and PM, and that direct measurements of PN are necessary to provide information about population exposure to ultrafine particles and for management of air quality.