Aerobiological engineering

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Aerobiological engineering is the science of designing buildings and systems to control airborne pathogens and allergens in indoor environments. The most-common environments include commercial buildings, residences and hospitals. This field of study is important because controlled indoor climates generally tend to favor the survival and transmission of contagious human pathogens as well as certain kinds of fungi and bacteria.

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Aerobiological engineering in healthcare facilities

Since healthcare facilities can house a number of different types of patients who potentially have weakened immune systems, aerobiological engineering is of significant importance to engineers of hospitals. The aerobiology that concerns designers of hospitals includes viruses, bacteria, fungi, and other microbiological products such as endotoxins, mycotoxins, and microbial volatile organic compounds (MVOC's). Bacteria and viruses, because of their small size, readily become airborne as bacterial aerosols and can remain suspended in the air for hours. Because of this, adequate precautions and mitigation techniques need to be taken with indoor air quality in hospitals dealing with infectious diseases.

Ventilation systems

At a minimum, ventilation systems provide dilution and removal of airborne contaminants, which in general leads to improved indoor air quality and happier occupants. If filters are checked and replaced as needed, they can form an integral component of an immune building system designed to prevent the spread of diseases by airborne routes. They can also be used for pressurization of areas within buildings to provide contamination control.

Biocontamination in ventilation systems

Ventilation systems can contribute to the microbial loading of indoor environment by drawing in microbes from outdoor air and by creating conditions for growth. When microbes land on a wet filter that has been collecting dust, they have the perfect medium on which to grow, and if they grow through the filter they have the potential to be aerosolized and carried throughout the building via the HVAC control system.

Dilution rates

Bacteria in hospitals can be aerosolized when sick patients cough and sneeze and because of the large number of germs produced it is necessary that the number of air changes per hour (ACH) remain high in treatment and operating rooms. The American Society of Heating, Refrigerating and Air-Conditioning Engineers typically recommends 12-25 ACH in treatment and operating rooms and 4-6 ACH in intensive-care rooms. For rooms containing tuberculosis patients, the Centers for Disease Control and Prevention recommends an ACH of 6 to 12, with exhaust air being sent through high-efficiency-particulate-air (HEPA) filters before being sent outside.

Pressurized isolation rooms

In order to keep patients safe, hospitals use a range of technologies to combat airborne pathogens. Isolation rooms can be designed to feature positive or negative air-pressure flows. Positive-pressure rooms are used when there are patients who are extremely susceptible to disease, such as HIV patients. For these patients, it is paramount to prevent the ingress of any microorganisms, including common fungi and bacteria that may be harmless to healthy people. These systems filter the air before delivery with a HEPA filter and then pump it into the isolation room at high pressure, which forces air from the isolation room out into the hallway. In a negative-pressure system, the focus is on keeping infectious diseases isolated by controlling the airflow and directing harmful aerosols away from health care workers and other occupied areas. Negative pressure isolation rooms keep contaminants and pathogens from reaching external areas. The most common application of these rooms in the health industry today is for isolating tuberculosis patients. To do this, the air is exhausted from the room at a rate greater than that at which it is being delivered. This makes it difficult for airborne disease to go from a contaminated area to a hospital hallway, because air is constantly being drawn into the room rather than escaping from it.

Air sterilization processes

The normal means for filtration in healthcare facilities is low-efficiency air filters outside the air-handling unit followed by the HEPA (High Efficiency Particulate Air) filters placed after the air-handling unit. To be HEPA-certified, filters must remove particles of 0.3 μm diameter, with at least a 99.97-percent efficiency. Air burners sterilize air that is leaving contaminated isolation rooms by heating it to 300 °C (572 °F) for six seconds. Ultraviolet germicidal irradiation (UVGI) is another technique for special-purpose air sterilization. It is defined as electromagnetic radiation in the range of about 200 to 320 nm, that is used to destroy microorganisms. When HEPA filters are used in conjunction with UV sterilization tools, the results can be extremely effective. The filter will remove the bigger, hardier spores, and all that is left are the smaller microbes which are killed more efficiently by the high-intensity UV treatment.

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<span class="mw-page-title-main">Aerobiology</span> Study of airborne organisms

Aerobiology is a branch of biology that studies the passive transport of organic particles, such as bacteria, fungal spores, very small insects, pollen grains and viruses. Aerobiologists have traditionally been involved in the measurement and reporting of airborne pollen and fungal spores as a service to those with allergies. However, aerobiology is a varied field, relating to environmental science, plant science, meteorology, phenology, and climate change.

<span class="mw-page-title-main">Cleanroom</span> Dust-free room for research or production

A cleanroom or clean room is an engineered space, which maintains a very low concentration of airborne particulates. It is well isolated, well-controlled from contamination, and actively cleansed. Such rooms are commonly needed for scientific research, and in industrial production for all nanoscale processes, such as semiconductor manufacturing. A cleanroom is designed to keep everything from dust, to airborne organisms, or vaporised particles, away from it, and so from whatever material is being handled inside it.

<span class="mw-page-title-main">Disinfectant</span> Antimicrobial agent that inactivates or destroys microbes

A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than sterilization, which is an extreme physical or chemical process that kills all types of life. Disinfectants are generally distinguished from other antimicrobial agents such as antibiotics, which destroy microorganisms within the body, and antiseptics, which destroy microorganisms on living tissue. Disinfectants are also different from biocides—the latter are intended to destroy all forms of life, not just microorganisms. Disinfectants work by destroying the cell wall of microbes or interfering with their metabolism. It is also a form of decontamination, and can be defined as the process whereby physical or chemical methods are used to reduce the amount of pathogenic microorganisms on a surface.

<span class="mw-page-title-main">Positive pressure</span> Force applied in a chamber to remove a fluid

Positive pressure is a pressure within a system that is greater than the environment that surrounds that system. Consequently, if there is any leak from the positively pressured system, it will egress into the surrounding environment. This is in contrast to a negative pressure room, where air is sucked in.

<span class="mw-page-title-main">HEPA</span> Efficiency standard of air filters

HEPA filter, also known as high-efficiency particulate absorbing filter and high-efficiency particulate arrestance filter, is an efficiency standard of air filters.

<span class="mw-page-title-main">Hospital-acquired infection</span> Infection that is acquired in a hospital or other health care facility

A hospital-acquired infection, also known as a nosocomial infection, is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare-associated infection. Such an infection can be acquired in hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. A number dynamic processes bring contamination into operating rooms and other areas within nosocomial settings. Infection is spread to the susceptible patient in the clinical setting by various means. Health care staff also spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting. Nosocomial infection tends to lack evidence that it was present when the patient entered the healthcare setting, thus meaning it was acquired post-admission.

An antimicrobial is an agent that kills microorganisms (microbicide) or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals are used against fungi. They can also be classified according to their function. The use of antimicrobial medicines to treat infection is known as antimicrobial chemotherapy, while the use of antimicrobial medicines to prevent infection is known as antimicrobial prophylaxis.

<span class="mw-page-title-main">Air purifier</span> Device which removes contaminants from the air in a room

An air purifier or air cleaner is a device which removes contaminants from the air in a room to improve indoor air quality. These devices are commonly marketed as being beneficial to allergy sufferers and asthmatics, and at reducing or eliminating second-hand tobacco smoke.

Infection prevention & control is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from healthcare into a component in public health, known as "infection protection". It is an essential part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.

<span class="mw-page-title-main">Medical microbiology</span> Branch of medical science

Medical microbiology, the large subset of microbiology that is applied to medicine, is a branch of medical science concerned with the prevention, diagnosis and treatment of infectious diseases. In addition, this field of science studies various clinical applications of microbes for the improvement of health. There are four kinds of microorganisms that cause infectious disease: bacteria, fungi, parasites and viruses, and one type of infectious protein called prion.

<span class="mw-page-title-main">Bioaerosol</span> Airborne particles containing living organisms

Bioaerosols are a subcategory of particles released from terrestrial and marine ecosystems into the atmosphere. They consist of both living and non-living components, such as fungi, pollen, bacteria and viruses. Common sources of bioaerosols include soil, water, and sewage.

<span class="mw-page-title-main">Isolation (health care)</span> Measure taken to prevent contagious diseases from being spread

In health care facilities, isolation represents one of several measures that can be taken to implement in infection control: the prevention of communicable diseases from being transmitted from a patient to other patients, health care workers, and visitors, or from outsiders to a particular patient. Various forms of isolation exist, in some of which contact procedures are modified, and others in which the patient is kept away from all other people. In a system devised, and periodically revised, by the U.S. Centers for Disease Control and Prevention (CDC), various levels of patient isolation comprise application of one or more formally described "precaution".

<span class="mw-page-title-main">Airborne transmission</span> Disease transmission by airborne particles

Airborne transmission or aerosol transmission is transmission of an infectious disease through small particles suspended in the air. Infectious diseases capable of airborne transmission include many of considerable importance both in human and veterinary medicine. The relevant infectious agent may be viruses, bacteria, or fungi, and they may be spread through breathing, talking, coughing, sneezing, raising of dust, spraying of liquids, flushing toilets, or any activities which generate aerosol particles or droplets. This is the transmission of diseases via transmission of an infectious agent, and does not include diseases caused by air pollution.

Indoor bioaerosol is bioaerosol in an indoor environment. Bioaerosols are natural or artificial particles of biological origin suspended in the air. These particles are also referred to as organic dust. Bioaerosols may consist of bacteria, fungi, viruses, microbial toxins, pollen, plant fibers, etc. Size of bioaerosol particles varies from below 1 µm to 100 µm in aerodynamic diameter; viable bioaerosol particles can be suspended in air as single cells or aggregates of microorganism as small as 1–10 µm in size. Since bioaerosols are potentially related to various human health effects and the indoor environment provides a unique exposure situation, concerns about indoor bioaerosols have increased over the last decade.

<span class="mw-page-title-main">Negative room pressure</span> Health care isolation technique wherein some air is forced in to prevent disease spread

Negative room pressure is an isolation technique used in hospitals and medical centers to prevent cross-contamination from room to room. It includes a ventilation that generates negative pressure to allow air to flow into the isolation room but not escape from the room, as air will naturally flow from areas with higher pressure to areas with lower pressure, thereby preventing contaminated air from escaping the room. This technique is used to isolate patients with airborne contagious diseases such as: influenza (flu), measles, chickenpox, tuberculosis (TB), severe acute respiratory syndrome (SARS-CoV), Middle East respiratory syndrome (MERS-CoV), and coronavirus disease 2019 (COVID-19).

Transmission-based precautions are infection-control precautions in health care, in addition to the so-called "standard precautions". They are the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens, which require additional control measures to effectively prevent transmission. Universal precautions are also important to address as far as transmission-based precautions. Universal precautions is the practice of treating all bodily fluids as if it is infected with HIV, HBV, or other blood borne pathogens.

Bioburden is normally defined as the number of bacteria living on a surface that has not been sterilized.

<span class="mw-page-title-main">Respiratory droplet</span> Type of particle formed by breathing

A respiratory droplet is a small aqueous droplet produced by exhalation, consisting of saliva or mucus and other matter derived from respiratory tract surfaces. Respiratory droplets are produced naturally as a result of breathing, speaking, sneezing, coughing, or vomiting, so they are always present in our breath, but speaking and coughing increase their number.

<span class="mw-page-title-main">Powered air-purifying respirator</span>

A powered air-purifying respirator (PAPR) is a type of respirator used to safeguard workers against contaminated air. PAPRs consist of a headgear-and-fan assembly that takes ambient air contaminated with one or more type of pollutant or pathogen, actively removes (filters) a sufficient proportion of these hazards, and then delivers the clean air to the user's face or mouth and nose. They have a higher assigned protection factor than filtering facepiece respirators such as N95 masks. PAPRs are sometimes called positive-pressure masks, blower units, or just blowers.

Air filtration guidelines for operating rooms are determined by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) using a standard known as Minimum Efficiency Reporting Value (MERV). MERV is determined based on the size of particles successfully removed from the air and is used to classify the efficiency of HEPA filters. Ratings range from 1-16 and efficiency increases as the rating increases. ASHRAE groups surgeries into three categories: minor surgical procedures (A); minor or major surgical procedures performed with minor sedation (B); and major surgical procedures performed with general anesthesia or regional block anesthesia (C). Each surgical category is given a minimum MERV rating it must comply with.

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