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Use of portable air cleaners to reduce aerosol transmission on a hospital coronavirus disease 2019 (COVID-19) ward

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  24 June 2021

Kristy L. Buising Open the ORCID record for Kristy L. Buising [Opens in a new window] ,
Robyn Schofield ,
Louis Irving ,
Melita Keywood ,
Ashley Stevens ,
Nick Keogh ,
Grant Skidmore ,
Imogen Wadlow ,
Kevin Kevin  and
Behzad Rismanchi
...Show all authors
Kristy L. Buising*
Affiliation:
Victorian Infectious Diseases Service Royal Melbourne Hospital, Melbourne, Victoria, Australia
Robyn Schofield
Affiliation:
Environmental Science Hub, University of Melbourne, Melbourne, Victoria, Australia
Louis Irving
Affiliation:
Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Melita Keywood
Affiliation:
Oceans and Atmosphere, Commonwealth Scientific and Industrial Research Organization, Melbourne, Victoria, Australia
Ashley Stevens
Affiliation:
Hospital Engineering, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Nick Keogh
Affiliation:
Hospital Engineering, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Grant Skidmore
Affiliation:
Department of Mechanical Engineering, University of Melbourne, Melbourne, Victoria, Australia
Imogen Wadlow
Affiliation:
University of Melbourne, Melbourne, Victoria, Australia
Kevin Kevin
Affiliation:
University of Melbourne, Melbourne, Victoria, Australia
Behzad Rismanchi
Affiliation:
Department of Infrastructure Engineering, University of Melbourne, Melbourne, Victoria, Australia
Amanda J. Wheeler
Affiliation:
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
Ruhi S. Humphries
Affiliation:
Oceans and Atmosphere, Commonwealth Scientific and Industrial Research Organization, Melbourne, Victoria, Australia
Marion Kainer
Affiliation:
Infection Prevention Western Health, Melbourne, Victoria, Australia
Jason Monty
Affiliation:
Department of Mechanical Engineering, University of Melbourne, Melbourne, Victoria, Australia
Forbes McGain
Affiliation:
Intensive Care, Western Health, Melbourne, Victoria, Australia
Caroline Marshall
Affiliation:
Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
*
Author for correspondence: Prof Kirsty Buising, E-mail: kirsty.buising@mh.org.au
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Abstract

Objective:

To study the airflow, transmission, and clearance of aerosols in the clinical spaces of a hospital ward that had been used to care for patients with coronavirus disease 2019 (COVID-19) and to examine the impact of portable air cleaners on aerosol clearance.

Design:

Observational study.

Setting:

A single ward of a tertiary-care public hospital in Melbourne, Australia.

Intervention:

Glycerin-based aerosol was used as a surrogate for respiratory aerosols. The transmission of aerosols from a single patient room into corridors and a nurses’ station in the ward was measured. The rate of clearance of aerosols was measured over time from the patient room, nurses’ station and ward corridors with and without air cleaners [ie, portable high-efficiency particulate air (HEPA) filters].

Results:

Aerosols rapidly travelled from the patient room into other parts of the ward. Air cleaners were effective in increasing the clearance of aerosols from the air in clinical spaces and reducing their spread to other areas. With 2 small domestic air cleaners in a single patient room of a hospital ward, 99% of aerosols could be cleared within 5.5 minutes.

Conclusions:

Air cleaners may be useful in clinical spaces to help reduce the risk of acquisition of respiratory viruses that are transmitted via aerosols. They are easy to deploy and are likely to be cost-effective in a variety of healthcare settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 8 , August 2022 , pp. 987 - 992
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Transmission of SARS-CoV-2: implications for infection prevention precautions. World Health Organization website. https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions. Accessed March 27, 2021.Google Scholar
Shiu, EY, Leung, NH, Cowling, BJ. Controversy around airborne versus droplet transmission of respiratory viruses: implication for infection prevention. Curr Op Infect Dis 2019;32:372–379.CrossRefGoogle ScholarPubMed
Morawska, L, Cao, J. Airborne transmission of SARS-CoV-2: the world should face the reality. Environ Intern 2020;139:105730.CrossRefGoogle ScholarPubMed
Tang, S, Mao, Y, Jones, RM, et al. Aerosol transmission of SARS-CoV-2? Evidence, prevention, and control. Environ Intern 2020;144:106039.CrossRefGoogle Scholar
Dancer, SJ, Tang, JW, Marr, LC, Miller, S, Morawska, L, Jimenez, JL. Putting a balance on the aerosolization debate around SARS-CoV-2. J Hosp Infect 2020;105:569–570.CrossRefGoogle ScholarPubMed
Tang, JW, Bahnfleth, WP, Bluyssen, PM, et al. Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus (SARS-CoV-2). J Hosp Infect 2021;110:89–96.Google Scholar
Asadi, S, Bouvier, N, Wexler, AS, Ristenpart, WD. The coronavirus pandemic and aerosols: Does COVID-19 transmit via expiratory particles? Aerosol Sci Technol 2020. doi: 10.1080/02786826.2020.1749229.CrossRefGoogle ScholarPubMed
Morawska, L, Milton, DK. It is time to address airborne transmission of coronavirus disease 2019 (COVID-19). Clin Infect Dis 2020;71:2311–2313.Google Scholar
Fennelly, KP. Particle sizes of infectious aerosols: implications for infection control. Lancet Resp Med 2020;8:914–924.CrossRefGoogle ScholarPubMed
Somsen, GA, van Rijn, C, Kooij, S, Bem, RA, Bonn, D. Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission. Lancet Resp Med 2020;8:658–659.Google ScholarPubMed
Bahl, P, de Silva, C, Bhattacharjee, S, et al. Droplets and aerosols generated by singing and the risk of coronavirus disease 2019 for choirs. Clin Infect Dis 2020;ciaa1241.Google Scholar
Meyerowitz, EA, Richterman, A, Gandhi, RT, Sax, PE. Transmission of SARS-CoV-2: a review of viral, host, and environmental factors. Ann Intern Med 2021;174:69–79.CrossRefGoogle ScholarPubMed
Edwards, DA, Ausiello, D, Langer, R, et al. Exhaled aerosol increases with COVID-19 infection, and risk factors of disease symptom severity. Proc Nat Acad Sci 2021;118:e2021830118.CrossRefGoogle Scholar
Mürbe, D, Kriegel, M, Lange, J, Schumann, L, Hartmann, A, Fleischer, M. Aerosol emission of adolescents voices during speaking, singing and shouting. Plos One 2021;16:e0246819.CrossRefGoogle ScholarPubMed
Echternach, M, Gantner, S, Peters, G, et al. Impulse dispersion of aerosols during singing and speaking: a potential COVID-19 transmission pathway. Am J Resp Crit Care Med 2020;202:1584–1587.CrossRefGoogle ScholarPubMed
Morawska, L, Johnson, G, Ristovski, Z, et al. Size distribution and sites of origin of droplets expelled from the human respiratory tract during expiratory activities. J Aero Sci 2009;40:256–269.Google Scholar
Bourouiba, L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA 2020;323:1837–1838.Google ScholarPubMed
Hamner, L. High SARS-CoV-2 attack rate following exposure at a choir practice—Skagit County, Washington, March 2020. Morbid Mortal Wkly Rept 2020;69:606–610.CrossRefGoogle Scholar
Morawska, L, Tang, JW, Bahnfleth, W, et al. How can airborne transmission of COVID-19 indoors be minimised? Environ Int 2020;142:105832.CrossRefGoogle ScholarPubMed
Buising, KL, Williamson, D, Cowie, BC, et al. A hospital-wide response to multiple outbreaks of COVID-19 in health care workers: lessons learned from the field. Med J Aust 2021;214:101–104.CrossRefGoogle ScholarPubMed
Islam, MS, Rahman, KM, Sun, Y, et al. Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: a global analysis. Infect Cont Hosp Epi 2020;41:1196–1206.CrossRefGoogle ScholarPubMed
Goldman, E. Exaggerated risk of transmission of COVID-19 by fomites. Lancet Infect Dis 2020;20:892–893.CrossRefGoogle ScholarPubMed
Liu, Y, Ning, Z, Chen, Y, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature 2020;582:557–560.CrossRefGoogle ScholarPubMed
Setti, L, Passarini, F, De Gennaro, G, et al. Airborne transmission route of COVID-19: why 2 meters/6 feet of interpersonal distance could not be enough. Int J Env Res Pub Health 2020;17:2932.CrossRefGoogle Scholar
Sommerstein, R, Fux, CA, Vuichard-Gysin, D, et al. Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19. Antimicr Resist Infect Cont 2020;9:100.CrossRefGoogle ScholarPubMed
Guo, Z-D, Wang, Z-Y, Zhang, S-F, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020; 26:1586.Google ScholarPubMed
Chia, PY, Coleman, KK, Tan, YK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nature Comm 2020;11:1–7.CrossRefGoogle ScholarPubMed
Santarpia, JL, Rivera, DN, Herrera, VL, et al. Aerosol and surface contamination of SARS-CoV-2 observed in quarantine and isolation care. Scient Rep 2020;10:12732.CrossRefGoogle ScholarPubMed
Lednicky, JA, Lauzard, M, Fan, ZH, et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. Int J Infect Dis 2020;100:476–482.CrossRefGoogle ScholarPubMed
Birgand, G, Peiffer-Smadja, N, Fournier, S, Kerneis, S, Lescure, F-X, Lucet, J-C. Assessment of air contamination by SARS-CoV-2 in hospital settings. JAMA Network Open 2020;3:e2033232-e.CrossRefGoogle ScholarPubMed
Healthcare Infection Control Practices Advisory Committee (HICPAC): Guidelines for environmental infection control in healthcare facilities, 2003. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf Publishrd 2003. Accessed March 26, 2021.Google Scholar
Design guidelines for hospitals and day procedure centres. Part E - Building services and environmental design. 2004. The Victorian Department of Health and Human Services website. http://www.healthdesign.com.au/vic.dghdp/. Accessed March 20, 2021.Google Scholar
Cook, T, Harrop-Griffiths, W. Aerosol clearance times to better communicate safety after aerosol-generating procedures. Anaesthesia 2020;75:1122–1123.CrossRefGoogle ScholarPubMed
Cook, T, El-Boghdadly, K, McGuire, B, McNarry, A, Patel, A, Higgs, A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia 2020;75:785–799.CrossRefGoogle ScholarPubMed
Zhou, L, Yao, M, Zhang, X, et al. Breath-, air-, and surface-borne SARS-CoV-2 in hospitals. J Aerosol Sci 2021;152:105693.CrossRefGoogle ScholarPubMed
Memarzadeh, F. Literature review of the effect of temperature and humidity on viruses. ASHRAE Transact 2012;118:1049–1060.Google Scholar
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