Airborne Infection Risk Research Articles

Predicting Airborne Infection Risk: Association Between Personal Ambient Carbon Dioxide Level Monitoring and Incidence of Tuberculosis Infection in South African Health Workers.

BackgroundHigh rates of tuberculosis (TB) transmission occur in hospitals in high-incidence countries, yet there is no validated way to evaluate the impact of hospital design and function on airborne infection risk. We hypothesized that personal ambient carbon dioxide (CO2) monitoring could serve as a surrogate measure of rebreathed air exposure associated with TB infection risk in health workers (HWs).MethodsWe analyzed baseline and repeat (12-month) interferon-γ release assay (IGRA) results in 138 HWs in Cape Town, South Africa. A random subset of HWs with a baseline negative QuantiFERON Plus (QFT-Plus) underwent personal ambient CO2 monitoring.ResultsAnnual incidence of TB infection (IGRA conversion) was high (34%). Junior doctors were less likely to have a positive baseline IGRA than other HWs (OR, 0.26; P = .005) but had similar IGRA conversion risk. IGRA converters experienced higher median CO2 levels compared to IGRA nonconverters using quantitative QFT-Plus thresholds of ≥0.35 IU/mL (P < .02) or ≥1 IU/mL (P < .01). Median CO2 levels were predictive of IGRA conversion (odds ratio [OR], 2.04; P = .04, ≥1 IU/mL threshold). Ordinal logistic regression demonstrated that the odds of a higher repeat quantitative IGRA result increased by almost 2-fold (OR, 1.81; P = .01) per 100 ppm unit increase in median CO2 levels, suggesting a dose-dependent response.ConclusionsHWs face high occupational TB risk. Increasing median CO2 levels (indicative of poor ventilation and/or high occupancy) were associated with higher likelihood of HW TB infection. Personal ambient CO2 monitoring may help target interventions to decrease TB transmission in healthcare facilities and help HWs self-monitor occupational risk, with implications for other airborne infections including coronavirus disease 2019.

Airborne infection risk of nearby passengers in a cabin environment and implications for infection control

BackgroundExpiratory droplets cause high infection risk to nearby passengers via airborne route. Methods: We built a two-row four-seat setup to simulate a public transport cabin. A cough generator and a nebulizer were used to simulate the cough and talk processes respectively. Exposure and infection risk of nearby passengers was studied. The effect of gasper jet and backrest on risk mitigation was investigated. ResultsFor the activity of coughing, the front passenger has much higher infection risk, which was around four times of that of other passengers, because of the concentration surge in the inhalation zone. For talking, the nearby passengers have similar infection risk because nearby passengers were all exposed to concentration surges with similar peak value. Gasper jet of the infected passenger and higher backrest can extinguish or reduce the concentration surge of front passengers and reduce the infection risk due to coughing and talking droplets. ConclusionThe passengers near the infected passenger have very high infection risk. The overhead gasper and a higher backrest can reduce the exposure and mitigate the risk of infection. It is believed that the control measures to protect nearby passengers are urgently needed in public transport cabins.

Airborne infection risk assessment of COVID-19 in an inpatient department through on-site occupant behavior surveys

Airborne transmission is a possible infection route of the coronavirus disease 2019 (COVID-19). This investigation focuses on the airborne infection risk of COVID-19 in a nursing unit in an inpatient building in Shenzhen, China. On-site measurements and questionnaire surveys were conducted to obtain the air change rates and occupant trajectories, respectively. The aerosol transport and dose–response models were applied to evaluate the infection risk. The average outdoor air change rate measured in the wards was 1.1 h−1, which is below the minimum limit of 2.0 h−1 required by ASHRAE 170–2021. Considering the surveyed occupant behavior during one week, the patients and their attendants spent an average of 19.4 h/d and 15.1 h/d, respectively, in the wards, whereas the nurses primarily worked in the nurse station (3.0 h/d) and wards (2.4 h/d). The doctors primarily worked in their offices (2.6 h/d) and wards (1.1 h/d). Assuming one undetected COVID-19 infector emitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the nursing unit, we calculated the accumulated viral dose and infection probabilities of the occupants. After one week, the cumulative infection risks of the patients and attendants were almost equal (0.002), and were higher than those of the nurses (0.0013) and doctors (0.0004). Proper protection measures, such as reducing the number of attendants, increasing the air change rate, and wearing masks, were found to reduce the infection risk. It should be noted that the reported results are based on several assumptions, such as the speculated virological properties of SARS-CoV-2 and the particular trajectories of occupants. Moreover, only second generations of transmission were taken into consideration, whereas in reality, the week-long exposure may cause third generation of transmission or worse.

The Impact of the COVID-19 Pandemic on Dentistry and Dental Education: A Narrative Review.

Dentists and dental staff have an increased risk of airborne infection with pathogens such as SARS-CoV-2 since they are exposed to high levels of droplets and aerosols produced during specific dental procedures. Hence, new guidelines such as patient screening and temperature control, air purification, space, surface and hand sanitizing and the use of protective equipment and physical barriers have been successfully implemented. In addition, the use of teledentistry has expanded considerably in pediatric dentistry, orthodontics, oral medicine and periodontics in order to address oral and dental health issues during the COVID-19 pandemic while minimizing virus transmission. Thus, teleconsultation, telediagnosis, teletriage, teletreatment and telemonitoring have emerged as valuable tools not only in the delivery of care, but also in the academic and research training of dental health professionals. This narrative review summarizes the current literature on the impact of the pandemic on dental care, dental staff and dental education, with an emphasis on how newly emerging protocols and technologies can be successfully utilized as integral parts of various branches of the dental practice and their future implications without compromising patient care.

Particle Size Analysis in Aerosol-Generating Dental Procedures Using Laser Diffraction Technique.

The global outbreak of coronavirus disease 2019 (COVID-19) has raised concerns about the risk of airborne infection during dental treatment. Aerosol-generating dental procedures (AGDP) produce droplets and aerosols, but the details of the risks of COVID-19 transmission in AGDP are not well-understood. By discriminating between droplets and aerosols, we devised a method to measure particle size using laser diffraction analysis and evaluated aerosols generated from dental devices for providing a basis for proper infection control procedures. The droplets and aerosols generated from dental devices were characterized by multimodal properties and a wide range of droplet sizes, with the majority of droplets larger than 50 μm. AGDP emitted few aerosols smaller than 5 μm, which are of concern for pulmonary infections due to airborne transmission. In addition, the use of extraoral suction was found to prevent the spread of aerosols from high-speed dental engines. This study suggests that the risk of aerosol infections is considerably limited in regular dental practice and that current standard precautions, such as mainly focusing on protection against droplet and contact infections, are sufficient. While several cases of airborne transmission of COVID-19 in general clinics and emergency hospitals have been reported, cluster outbreaks in dental clinics have not yet been reported, which may indicate that AGDP does not pose a significant threat in contributing to the spread of SARS-CoV-2.

Reducing airborne infection risk of COVID-19 by locating air cleaners at proper positions indoor: Analysis with a simple model

Portable air cleaners (PACs) can remove airborne SARS-CoV-2 exhaled by COVID-19 infectors indoor. However, effectively locating PAC to reduce the infection risk is still poorly understood. Here, we propose a simple model by regressing an equation of seven similarity criteria based on CFD-modeled results of a scenario matrix of 128 cases for office rooms. The model can calculate the mean droplet nucleus concentration with very low computing costs. Combining this model with the Wells–Riley equation, we estimate the airborne infection risk when a PAC is located in different positions. The two similarity criteria, Bp+ and Gp+, are critical for characterizing the effect of the position and airflow rate of PAC on the infection risk. An infection probability of less than 10% requires Bp + to be larger than 144 and Gp + to be larger than 0.001. These criteria imply that locating PAC in the center of the room is optimal under the premise that the airflow rate of PAC is greater than a certain level. The model provides an easy-to-use approach for real-time risk control strategy decisions. Furthermore, the placement strategies offer timely guidelines for precautions against the prolonged COVID-19 pandemic and common infectious respiratory diseases.

Intervention of personalized ventilation on interpersonal airborne disease transmission

Personalized ventilation (PV) has been integrated to reduce the risk of interpersonal infection exposure in the office environment. Some studies showed that PV systems may increase occupants’ risk of airborne infection. Therefore, the aim of this study is to investigate the intervention of PV on interpersonal airborne disease transmission in office environment. A three-dimensional computational fluid dynamics model (CFD) was developed and experimentally validated in a clean chamber. Then the validated CFD model was used to calculate the diffusion of exhaled droplets under different particle size. Results showed at the size of 0.7μm particles, compared to pure mixing ventilation, the personal ventilation of 6L/s reduced the inhalation fraction （IF）from 0.121% to 0.092%，and the reduction ratio of IF is 23.96%. As of 5μm, the IF also decreased from 0.165% to 0.102%, and the reduction ratio of IF is 38.18%. The percentage of 50μm particles deposited on the ground rises from 6.29% to 43.22% of exhaled particles. Therefore, the personalized ventilation can reduce the risk of inhalation in exposed person, and for large size particles, the number of particles falling on the floor increased greatly, which lead to the risk of resuspension increases. The results may be helpful for maximizing the effect of PV in interpersonal airborne disease control.

Exploring the potentials of micro-environment ventilation in mitigating airborne transmission risk

In the background of COVID-19, new requirements are occurring in the novel ventilation systems to mitigate airborne transmission risk in indoor environments. In this study, two micro-environment ventilation systems: personalized ventilation combined with radiant panel system (PVRP) and low velocity unit combined with radiant panel system (LVRP) were studied to explore the potential of reducing the airborne infection risk. In a simulated double layout office, the droplets generated by a thermal breathing manikin were used to simulate the breathing process of an infected person. Opposite the manikin, a heated dummy was as an exposed person. During the 102-minute measurement, the results show that the infection risk at the inhaled air with micro-environment systems is lowest. The heat gain levels do have much effect on infection risk with the PVRP system, but higher heat gain will increase the risk slightly with the LVRP system.

A spatiotemporally resolved infection risk model for airborne transmission of COVID-19 variants in indoor spaces

The classic Wells-Riley model is widely used for estimation of the transmission risk of airborne pathogens in indoor spaces. However, the predictive capability of this zero-dimensional model is limited as it does not resolve the highly heterogeneous spatiotemporal distribution of airborne pathogens, and the infection risk is poorly quantified for many pathogens. In this study we address these shortcomings by developing a novel spatiotemporally resolved Wells-Riley model for prediction of the transmission risk of different COVID-19 variants in indoor environments. This modelling framework properly accounts for airborne infection risk by incorporating the latest clinical data regarding viral shedding by COVID-19 patients and SARS-CoV-2 infecting human cells. The spatiotemporal distribution of airborne pathogens is determined via computational fluid dynamics (CFD) simulations of airflow and aerosol transport, leading to an integrated model of infection risk associated with the exposure to SARS-CoV-2, which can produce quantitative 3D infection risk map for a specific SARS-CoV-2 variant in a given indoor space. Application of this model to airborne COVID-19 transmission within a hospital ward demonstrates the impact of different virus variants and respiratory PPE upon transmission risk. With the emergence of highly contagious SARS-CoV-2 variants such as the Delta and Omicron strains, respiratory PPE alone may not provide effective protection. These findings suggest a combination of optimal ventilation and respiratory PPE must be developed to effectively control the transmission of COVID-19 in healthcare settings and indoor spaces in general. This generalised risk estimation framework has the flexibility to incorporate further clinical data as such becomes available, and can be readily applied to consider a wide range of factors that impact transmission risk, including location and movement of infectious persons, virus variant and stage of infection, level of PPE and vaccination of infectious and susceptible individuals, impacts of coughing, sneezing, talking and breathing, and natural and mechanised ventilation and filtration.

SOCIAL AND ERGONOMIC EVALUATION OF MOTORCYCLE PROTECTIVE ISOLATION SHIELD FOR REDUCING COMMUNITY SPREAD OF COVID-19

Coronavirus (COVID-19) pandemic have rapidly evolved into a situation with profound effects on lifestyle and travel worldwide, ranging from a dramatic decrease in the patronage of formal public transport modes to an unprecedented increase in the usage of informal public transport modes. It is the main goal of this study to adapt a Motorcycle Protective Isolation Shield (MPIS) on a motorcycle for the reduction of community spread of COVID-19. MPIS was designed according to the anthropometry data obtained from motorcycle riders and passengers; and was fabricated using locally available materials. Anthropometry data used for the MPIS frame were sitting height (SH) and popliteal height (PH) of both motorcycle riders and passengers while seat depth (SD) of motorcycle riders and buttock knee length (BKL) of motorcycle passengers were used to locate the position of the MPIS mounted on the motorcycle. The 50% of the anthropometry data used for the design of MPIS is SH=800.00 mm, PH=500.00 mm, SD=300.00 mm and BKL=550.00 mm. The uncertainty modelling of motorcycle accident occurrence reveals the effect of higher speeds and the adapted MPIS during riding. The probability of occurrence of fatal crash, major crash and minor crash of motorcycle accident was 36.3%, 35.3% and 28.4%, respectively. The MPIS showed satisfactory post-riding assessment in terms of riding stability; riding, steering, and sitting convenience; and riding comfort for both the riders and passengers. It will be a good protection for motorcycle riders against the risk of COVID-19 and other air-borne infections.

The vaccination threshold for SARS-CoV-2 depends on the indoor setting and room ventilation

BackgroundEffective vaccines are now available for SARS-CoV-2 in the 2nd year of the COVID-19 pandemic, but there remains significant uncertainty surrounding the necessary vaccination rate to safely lift occupancy controls in public buildings and return to pre-pandemic norms. The aim of this paper is to estimate setting-specific vaccination thresholds for SARS-CoV-2 to prevent sustained community transmission using classical principles of airborne contagion modeling. We calculated the airborne infection risk in three settings, a classroom, prison cell block, and restaurant, at typical ventilation rates, and then the expected number of infections resulting from this risk at varying percentages of occupant immunity.ResultsWe estimate the setting-specific immunity threshold for control of wild-type SARS-CoV-2 to range from a low of 40% for a mechanically ventilation classroom to a high of 85% for a naturally ventilated restaurant.ConclusionsIf vaccination rates are limited to a theoretical minimum of approximately two-thirds of the population, enhanced ventilation above minimum standards for acceptable air quality is needed to reduce the frequency and severity of SARS-CoV-2 superspreading events in high-risk indoor environments.

Effect of under-floor air distribution system to prevent the spread of airborne pathogens in classrooms

This study investigated the effect of the under-floor air distribution (UFAD) system compared to conventional mixed-mode ventilation system to prevent airborne pathogen spread in elementary school. To analysis airborne pathogen spread pattern, STAR-CCM+ is used. By applying the UFAD system airborne infection risk at region around the exhaust area of conventional ventilation system can be significantly reduced. However, increased infection risks around exhaust area of UFAD system still existed. Thus, it is recommended to install the exhaust vents (outlets) away from the breathing area. In addition, since both of conventional ventilation system and the UFAD systems have a high infection risk at the front of the classroom, novel method to reduce the infection risk from students to teachers should be considered.

Exploring the potentials of personalized ventilation in mitigating airborne infection risk for two closely ranged occupants with different risk assessment models

In the context of COVID-19, new requirements are occurring in ventilation systems to mitigate airborne transmission risk in indoor environment. Personalized ventilation (PV) which directly delivers clean air to the occupant’s breathing zone is considered as a promising solution. To explore the potentials of PV in preventing the spread of infectious aerosols between closely ranged occupants, experiments were conducted with two breathing thermal manikins with three different relative orientations. Nebulized aerosols were used to mimic exhaled droplets transmitted between the occupants. Four risk assessment models were applied to evaluate the exposure or infection risk affected by PV with different operation modes. Results show that PV was effective in reducing the user’s infection risk compared with mixing ventilation alone. Relative orientations and operation modes of PV significantly affected its performance in airborne risk control. The infection risk of SARS-CoV-2 was reduced by 65% with PV of 9 L/s after an exposure duration of 2 h back-to-back as assessed by the dose–response model, indicating effective protection effect of PV against airborne transmission. While the side-by-side orientation was found to be the most critical condition for PV in airborne risk control as it would accelerate diffusion of infectious droplets in lateral diffusion to occupants by side. Optimal designs of PV for closely ranged occupants were hereby discussed. The four risk assessment models were compared and validated by experiments with PV, implying basically consistent rules of the predicted risk with PV among the four models. The relevance and applicability of these models were discussed to provide a basis for risk assessment with non-uniformly distributed pathogens indoor.

Effective ventilation and air disinfection system for reducing coronavirus disease 2019 (COVID-19) infection risk in office buildings.

During the COVID-19 pandemic, an increasing amount of evidence has suggested that the virus can be transmitted through the air inside buildings. The ventilation system used to create the indoor environment would facilitate the transmission of the airborne infectious diseases. However, the existing ventilation systems in most buildings cannot supply sufficient clean outdoor air for diluting the virus concentration. To reduce the airborne infection risk and minimize energy consumption, especially in existing buildings with well-mixed ventilation systems, this investigation used an ultraviolet-C (UV-C) air disinfection device (Rheem's third generation products, RM3) with 99.9% disinfection efficiency to clean air carrying the COVID-19 virus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) which could help promote environmental sustainability and create healthy cities. This investigation assessed the impact of the RM3 UV-C units on the infection risk, the number of RM3 UV-C units required, and the strategy for decreasing the infection risk, with the use of computational-fluid-dynamics (CFD) numerical simulations. An actual office building with a combination of individual offices and workstations was selected as an example for the research. According to the numerical results, the best strategy would be to use a combination of 100% outside air and UV-C in heating, ventilation and air-conditioning (HVAC) ducts with air disinfected by the RM3 UV-C units. The infection risk in the office building could thus be reduced to a negligible level. These findings could provide theoretical basis and engineering application basis for COVID-19 epidemic prevention and control.

Predictive and retrospective modelling of airborne infection risk using monitored carbon dioxide

The risk of long range, herein ‘airborne', infection needs to be better understood and is especially urgent during the COVID-19 pandemic. We present a method to determine the relative risk of airborne transmission that can be readily deployed with either modelled or monitored CO2 data and occupancy levels within an indoor space. For spaces regularly, or consistently, occupied by the same group of people, e.g. an open-plan office or a school classroom, we establish protocols to assess the absolute risk of airborne infection of this regular attendance at work or school. We present a methodology to easily calculate the expected number of secondary infections arising from a regular attendee becoming infectious and remaining pre/asymptomatic within these spaces. We demonstrate our model by calculating risks for both a modelled open-plan office and by using monitored data recorded within a small naturally ventilated office. In addition, by inferring ventilation rates from monitored CO2, we show that estimates of airborne infection can be accurately reconstructed, thereby offering scope for more informed retrospective modelling should outbreaks occur in spaces where CO2 is monitored. Well-ventilated spaces appear unlikely to contribute significantly to airborne infection. However, even moderate changes to the conditions within the office, or new variants of the disease, typically result in more troubling predictions.

Survey of air exchange rates and evaluation of airborne infection risk of COVID-19 on commuter trains.

To identify potential countermeasures for coronavirus disease (COVID-19), we determined the air exchange rates in stationary and moving train cars under various conditions in July, August, and December 2020 in Japan. When the doors were closed, the air exchange rates in both stationary and moving trains increased with increasing area of window-opening (0.23-0.78/h at 0m2, windows closed to 2.1-10/h at 2.86m2, fully open). The air exchange rates were one order of magnitude higher when doors were open than when closed. With doors closed, the air exchange rates were higher when the centralized air conditioning (AC) and crossflow fan systems (fan) were on than when off. The air exchange rates in moving trains increased as train speed increased, from 10/h at 20km/h to 42/h at 57km/h. Air exchange rates did not differ significantly between empty cars and those filled with 230 mannequins representing commuters. The air exchange rates were lower during aboveground operation than during underground. Assuming that 30-300 passengers travel in a train car for 7-60min and that the community infection rate is 0.0050-0.30%, we estimated that commuters' infection risk on trains was reduced by 91-94% when all 12 windows were opened (to a height of 10cm) and the AC/fan was on compared with that when windows were closed and the AC/fan was off.

Airborne infection risks of SARS-CoV-2 in U.S. schools and impacts of different intervention strategies

The potential airborne transmission of SARS-CoV-2 has triggered concerns as schools continue to reopen and resume in-person instruction during the current COVID-19 pandemic. It is critical to understand the risks of airborne SARS-CoV-2 transmission under different epidemiological scenarios and operation strategies for schools to make informed decisions to mitigate infection risk. Through scenario-based analysis, this study estimates the airborne infection risk of SARS-CoV-2 in 111,485 U.S. public and private schools and evaluates the impacts of different intervention strategies, including increased ventilation, air filtration, and hybrid learning. Schools in more than 90% of counties exhibit infection risk of higher than 1%, indicating the significance of implementing intervention strategies. Among the considered strategies, air filtration is found to be most effective: the school average infection risk when applying MERV 13 is over 30% less than the risk levels correlating with the use of increased ventilation and hybrid learning strategies, respectively. For most schools, it is necessary to adopt combined intervention strategies to ensure the infection risk below 1%. The results provide insights into airborne infection risk in schools under various scenarios and may guide schools and policymakers in developing effective operations strategies to maintain environmental health.

Dynamic assessment of the risk of airborne viral infection.

This paper applies the Rudnick and Milton method through the dynamic evaluation of the probability of airborne contagion, redefining all parameters and variables in discretized form. To adapt the calculation of the risk of contagion to real needs, scenarios are used to define the presence of people, infected subjects, the hourly production of the quanta of infection, and the calculation of the concentration of CO2 produced by exhalation in the air. Three case studies are discussed: a school, an office, a commercial activity. Complex scenarios include environmental sanitization, a variable number of people, and the possibility of simulating work shifts. The dynamic evaluation of the quanta of infection is also estimated, not foreseen by the Rudnick and Milton model, and involves updating the average values of the equivalent fraction of the indoor air with an improvement in the accuracy of the calculation due to the reduction of improper peaks of the stationary variables.

Airborne infection risk during open-air cardiopulmonary resuscitation

AimCardiopulmonary resuscitation (CPR) is an emergency procedure where interpersonal distance cannot be maintained. There are and will always be outbreaks of infection from airborne diseases. Our objective was to assess...

Human exposure to respiratory aerosols in a ventilated room: Effects of ventilation condition, emission mode, and social distancing

Airborne transmission of virus via respiratory aerosols plays an important role in the spread of infectious diseases in indoor environments. Ventilation and social distancing are two major control strategies to reduce the indoor airborne infection risk. However, there is a present lack of science-based information on how the human exposure to viral aerosols vary with ventilation condition and social distance. The objective of this study is to explore the transport patterns of respiratory aerosols in occupied spaces and assess the occupant exposure risk under different ventilation strategies, social distances and aerosol emission modes. The study results show that buoyancy-driven flow regime (can be found in many residential settings) can lead to a longer transmission distance and elevated exposure to viral aerosols than the mixing airflow, thereby causing higher cross-infection risk in indoor environments. The results also suggest that a 2 m (6 ft) social distance alone may not ensure control of indoor airborne infections.