Dissertations / Theses on the topic 'Airborne infection'

A mathematical model which estimates spatial infection risk as a function of pulmonary rate and deposition region has been developed based on the does-response model. It is specifically designed for enclosed space with consideration of pathogen bio-properties, such as viability and infectivity. Firstly, eleven cases of Tuberculosis (TB) outbreaks in aircraft are studied to develop the optimal parameters set. It is then used to perform model validation and investigation of sample inpatient room spatial infection risk. Secondly, infection risk for eleven TB outbreaks are compared with modeling and Wells-Riley estimations. As a result, modeling results are within the calculated range of Wells-Riley prediction. To determine the importance of viability and ventilation rate regarding HVAC system design for health facilities, infection risks are calculated at different viability and ventilation rates. Based on the observation, ventilation rate or particle concentration in the space dominate the infection risk distribution, except when viability decays extreme rapidly. Thirdly, the spatial infection risk is investigated for TB in a typical 60 m³ inpatient room with displacement and well-mixed ventilation systems. Two room settings, a nurse standing close to the patient’s bed versus a visitor standing far away from the bed, and two coughing directions, horizontal versus vertical, are studied. The results show that for coughing horizontally, when the nurse stands beside the patient's bed, his/her breathing zone is the highest risk zone for displacement ventilation. Under displacement ventilation, the infection risk is lower when visitor stands away from the bed compared to stand close to the bed if the visitor is the only person present in the room besides the patient. The infection risk of the breathing zones in the two cases with horizontal coughing are both higher than 25%. However, when a patient coughs vertically, the displacement ventilation significantly reduces the infection risk. With 24 hours exposure, the infection risk for the nurse and the visitor are both less than 5%.

This research has arisen from the need to understand the air patterns within isolation rooms and how they can affect the transmission of airborne diseases to staff or visitors who are inside the room with an infectious patient. Similarly, when it is the patient who needs protection from airborne infection, the ventilation patterns inside the room need to be understood in order to protect the patient. At times staff are very close to a patient and the risk of infection during these activities needs to be quantified. This study analyses the risk of infection in these cases, with different ventilation regimes. Differential pressures between an isolation room and adjacent spaces and airtightness levels also aid in preventing the transmission of infectious diseases, The existence of many different international guidelines with regards to ventilation flow rates, air changes per hour and differential pressures between rooms make the selection complicated for designers. This study investigates the effect that pressure differentials and airtightness have in infection control and how higher differential pressures, which are more difficult to achieve and maintain, impact on the protection. With the recent Ebola infection breakouts and fear of biological attacks, a new model for an isolation room for this type of pathogens (category 4) has been studied. The design intended to remove a patient's containment Trexler tent, in order to provide better access and care to the patient. Several changes to the original design have been studied in order to improve the ventilation in the isolation room. The risk of infection to staff in all variations of the design has been studied. Finally, engineering methods quantify airborne infection using tracer gas techniques, such as carbon dioxide or nitrous oxide, however little research has been done to compare the gas tracer techniques with the behavior of real bacteria

The existence, probability and control measures of airborne infections have been widely discussed for centuries. Although public belief regarding airborne infection kept on altering throughout the entire history of medicine and is still controversial, many airborne transmission experiments and airborne infection outbreak analyses have been carried out. Different airborne transmission models have been built and various airborne control measures have been evaluated. One of the major knowledge gaps obstructing applications of some airborne control measures in clinical practices and public applications is that there is a lack of evidence in proving the effectiveness of such measures. Ventilation as an important airborne infection control method can be achieved by opening windows, or increasing the outdoor air supply rate in mechanical ventilation systems or indirectly by using filters and ultraviolet equipments. However the applications of ventilation in infection control were largely restricted to isolation rooms rather than regarded as a public control measure. In this study we focus on evaluating the effectiveness of ventilation as a community measure. Results, therefore, can provide evidence for using ventilation as a public health measure for controlling respiratory diseases transmitted by the airborne route or multi-routes. Two mathematical modeling approaches (deterministic model and social network model) are adopted to estimate different airborne diseases outbreaks with a focus on ventilation and a corresponding analysis of their relative effectiveness compared with other public health measures. A comprehensive understanding of detailed control strategies (including both engineering and public health control) will be achieved through gradually complicated and realistic models. It’s commonly believed that many respiratory infections are transmitted through multiple routes including airborne, droplet-borne and contact routes. Hence the effectiveness of airborne control measures was doubted when the airborne route was not dominant. Therefore, we developed a model to simulate partially airborne transmitted diseases outbreaks and evaluated the relative effectiveness of ventilation when the role of airborne transmission altered. Knowing the complex transmission mechanisms of respiratory transmission and the role of the airborne route in the transmission process is essential in determining the effectiveness of airborne control measures. Hence in this study we also tested the virus exposures dose to infectious patients at different distances when patients were carrying out different respiratory activities. A complex model considering transmission mechanisms of respiratory infections was also built to evaluate the influence of the transmission route in large scale outbreak simulations. The results showed that increasing ventilation rate especially in homes, offices and classrooms is an effective control method for controlling airborne and partially airborne transmitted infections. Combining isolation and increasing ventilation rate can reach similar or even better control effect compared with other general public health interventions such as vaccination. This finding suggested the important role of ventilation in airborne infectious disease prevention and intervention. The ventilation rate required by existing ventilation standards such as ASHRAE 62 might be too low for the purpose of controlling possible airborne outbreaks.
published_or_final_version
Mechanical Engineering
Doctoral
Doctor of Philosophy

Airborne infection control (AIC) measures are used extensively in healthcare settings to curtail the spread of airborne infectious diseases; these measures include administrative, architectural, engineering (e.g. ventilation) and personal protective interventions, serving either to reduce the concentration of airborne infectious particles or to protect individuals from direct exposure to airborne infection. Few such measures are applied in public congregate spaces outside of health facilities, such as those associated with public transport. Limited literature is available on existing AIC measures in the context of public transport modalities. This study explores the role of ventilation as an AIC measure in minibus taxis in Cape Town, South Africa, to determine its potential role in reducing airborne infectious disease transmission. The minibus taxi model chosen for the study was the Toyota Quantum Ses’fikile, which is commonly used in the Cape Town metropole. The Ses’fikile taxi has 6 windows, 2 at the front, 2 in line with the main passenger door and 2 towards the rear of the taxi. Ultrasonic anemometers were placed at key positions throughout the taxi-interior to measure and log airflow patterns, under different widow-open/close configurations and at different taxi speeds. To determine ventilation rates, the configurations were tested in an occupied taxi, with occupants comprising the driver, a researcher, and 14 volunteer participants. This study analysed TB transmission risk using the Issarow equation, a dose-response model. Airflows created by different window configurations produced patterns in airflow direction and velocity. A linear regression model fit to the ventilation data revealed that increasing taxi speed increased ventilation. Ventilation rates were found to depend on interior airflow as a result of the window configuration, as well as on the number of open windows, although the ventilation rate was not highest with the highest number of open windows. The best ventilation rates were found with four open windows, which included the front windows on both sides of the vehicle, and either the middle windows on both sides or the rear windows on both sides. The ventilation rates produced by these configurations at all tested taxi speeds (40 km/h, 80 km/h and 100 km/h) ranged from 108 to 316 L/s and exceeded the World Health Organization recommendation for new healthcare facilities, airborne precaution rooms, and general wards and outpatient departments. TB transmission probabilities in a taxi were dependent on ventilation, occupancy, number of infectors and duration of exposure. The risk of transmission was shown to increase substantially when ventilation rates fell below 50 L/s. In conclusion, minibus taxis were found to provide an effective range of ventilation rates that reduce the risk of TB transmission at varying speeds, however when natural ventilation is not used and with typical high occupancies, the risk posed to all occupants is high. Alternative AIC interventions may have to be considered.

Thesis (M.S.)--West Virginia University, 2009.
Title from document title page. Document formatted into pages; contains x, 83 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 79-83).

As the world observes a new pandemic with COVID-19, it is clear that pathogens can spread rapidly and without recognition of borders. Outbreaks will continue to occur, and so the diseases’ transmission method must be thoroughly understood in order to minimize their impact. Some infections, such as influenza, tuberculosis and measles are known to be spread through droplets in the air. In a confined space the concentration can grow as more droplets are released. This study examined a simulated confined space modelled as a hospital waiting area, where people who could have underlying conditions congregate and mix with potentially infectious individuals. It further investigated the impact of the volume of the waiting area, the number of people in the room, the placement of them as well as their weight. The simulation is an agent-based model (ABM), a computational model with the purpose of analysing a system through the actions and cumulative consequences of autonomous agents. The presented ABM features embodied agents with differing body weights that can move, breathe and cough in a ventilated room. An investigation into current epidemiological models lead to the hypothesis that one may be implemented as a corresponding ABM, where it could possibly also be improved upon. In this paper, it is shown that all parameters of the Gammaitoni and Nucci model can be taken into account in an ABM via the MASON library. In addition, proof is produced to suggest that some flaws of the epidemiological model can be mended in the ABM. It is demonstrated that the constructed model can account for proximity between susceptible people and infectors, an expressed limitation of the original model.
När världen observerar en ny pandemi, COVID-19, är det tydligt att patogener kan spridas fort och utan hänsyn till landsgränser. Utbrott kommer att fortsätta ske och därför måste sjukdomarnas överföringsmetod förstås, så att deras påverkan kan minimeras. Det är känt att vissa infektioner, såsom influensa, tuberkulos och mässling kan spridas via droppkärnor i luften. I ett begränsat utrymme kan koncentrationen växa när fler droppar tillförs. Denna studie utvärderar ett simulerat begränsat utrymme modellerat som ett väntrum på ett sjukhus, där människor som kan ha underliggande sjukdomar samlas och beblandar sig med potentiellt smittsamma individer. Inverkan av volymen av väntrummet, antalet personer i rummet, var de var placerade i rummet samt deras vikt undersöktes också. Simuleringen är en agent-baserad modell (ABM), en beräkningsmodell med syftet att analysera ett system genom handlingarna och kumulativa konsekvenserna av självstyrande agenter. Personer med olika kroppsvikt som kan röra sig, andas och hosta i ett ventilerat rum simuleras i denna ABM. Efterforskning av aktuella epidemiologiska modeller leder till hypotesen att en sådan skulle kunna implementeras som en motsvarande ABM, där den möjligtvis också kan förbättras. I denna rapport kommer det att uppvisas att alla parametrar av Gammaitonioch Nucci-modellen kan tas hänsyn till i en ABM via MASON biblioteket. Därtill produceras bevis som pekar på att vissa brister i den epidemiologiska modellen kan hämmas i denna ABM. Det demonstreras att den konstruerade modellen kan beakta distansen mellan mottagliga personer och smittsamma, vilket är en känd begränsning i originalmodellen.

Interpersonal transport of expiratory droplets and droplet nuclei constitutes a prerequisite for the transmission of pathogens as well as the transmission of respiratory diseases. This study modeled the physical process of interpersonal transport of droplets and droplet nuclei in a ventilated room. The impacts of a number of parameters in three length scales and three corresponding physical processes were analyzed, including dispersion and evaporation of droplets/droplet nuclei at 1 to 100 μm, human exhalation flows and body plumes at 0.1 to 1 m, and the indoor environment at 1 to 10 m. The strong hygroscopicity of the solutes in the droplet is capable of keeping the droplet with an equilibrium size in humid air, larger than that of a dried particle. Mathematical models were developed to predict the droplet nucleus size in both dry air and humid air, by simplifying the composition of one expiratory droplet to NaCl solution and suspended spherical particles. For a droplet with an initial diameter of 100 μm, initial NaCl concentration of 0.9%, and initial solids ratio of 1.8%, the droplet nucleus size was estimated to be 42 μm in an ambient relative humidity of 90% (25°C), which is 30% larger than it was in a relative humidity of 30% (25°C). A numerical model was also developed to predict droplet evaporation and dispersion in a constant turbulent buoyant jet. Droplets with initial sizes larger than 80 μm were predicted to deposit on the floor at a distance of ~1.25 m (~1.7 m for 60 μm) away from the mouth, while droplets with initial sizes less than 40 μm travelled to the end of the jet. A series of experiments was conducted to assess the characteristics of human exhalation airflows and thermal plume, using a full-scale test room and a breathing thermal manikin. The impacts of the ventilation system were illustrated by comparing the velocity distribution of the exhalation airflows and airflows induced by thermal plume. Further experiments employing two breathing thermal manikins were carried out to evaluate the interpersonal transport of the expiratory contaminants that were simulated by tracer gas. When the two manikins with the same heights were standing face to face at a mutual distance of 0.8 m, the exhalation airflows from the mouth of the source manikin could directly travel into the breathing region of the susceptible manikin, resulting in a high exposure. The high exposure decreased sharply with an increase in the mutual distance from 0.5 m to 1.0 m. Between 1.0 m to 3.0 m, the exposure by the susceptible manikin remained at a low and constant level. Numerical simulations considering droplet evaporation and droplet nucleus sizes were carried out; and the impacts of the parameters of droplet initial size, humidity, vicinity, ventilation conditions and synchronization of exhalation were evaluated. Fine droplets and droplet nuclei were predicted to travel toward the upper part of the test room, whereas large droplets tend to be deposited on the floor. With a high relative humidity, 95%, most of the droplets were deposited on the floor within 16 seconds. Meanwhile, all of the droplets evaporated to droplet nuclei and remained suspended in the air when the relative humidity was 35%. Mixing ventilation that supplied fresh air with a ventilation rate of 5.6 h-1 resulted in drafts and strong turbulence, which made droplets and droplet nuclei dispersed in the room. The average vertical position was higher than that when the ventilation rate was 3.0 h-1. Displacement ventilation led to the vertical temperature stratification in the room. The vertical temperature gradient could neutralize the buoyancy force and weaken body plumes and the vertical dispersion of droplets and droplet nuclei. The inhalation of the droplets and droplet nuclei by the susceptible person and the deposition of the droplets and droplet nuclei on the body surface of the susceptible person were investigated at mutual distances of 0.5, 1.0, 1.5 and 3.0 m. For one breath from the source person, 1,600 droplets were released. Three and 9 droplet nuclei were inhaled by the susceptible person at a mutual distance of 0.5 and 1.0 m, respectively. No droplet nuclei were inhaled at 1.5 and 3.0 m.
published_or_final_version
Mechanical Engineering
Doctoral
Doctor of Philosophy

Thesis (MScAgric)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: The evaluation of fungicide efficacy in commercial vineyards can be influenced by the sporadic occurrence of Botrytis cinerea at various positions on vines, differences in bunch structure during bunch development and the phenomenon that symptom expression in shoots and bunches is governed by the resistance reaction of the various shoot and bunch parts. It has been postulated that, following air and water dispersal, infection by solitary conidia should playa prominent role in the epidemiology of B. cinerea on grapevine. The aim of this study was to determine (i) infection and (ii) fungicide efficacy at specific sites on shoots of vinelets and bunches (table grape cultivar Dauphine and the wine grape cultivar Merlot) inoculated with dry, airborne conidia of B. cinerea. Vinelets, prepared from cuttings, and bunches obtained from the vineyards at full bloom, pea size, bunch closure, véraison and harvest stages, were sprayed in a spray chamber at the recommended dosages with iprodione, pyrimethanil, cyprodinil/fludioxonil and fenhexamid or were left unsprayed. After 24 h the vinelets or bunches were dusted with dry conidia of Botrytis cinerea in a settling tower and incubated for 24 h at a high relative humidity (±93%). Following incubation, both the vinelets or bunches were divided into three groups. Vinelets and bunches of the one group were surface-sterilised, the others were left unsterile. Vinelets and bunches of one unsterile group were placed in dry chambers, kept for 14 days at 22°C with a 12 h photoperiod daily and monitored for symptom expression and the development of B. cinerea. Vinelets and bunches of the sterile group, and from one unsterile group were used for isolation. From each of these vinelets leaf blades, leaf petioles, shoots and inflorescences were removed. Sites used for isolation in bunch parts were rachises, laterals and pedicels, and sites on berries were the pedicel-end, cheek and style-end. The different parts and segments were placed in Petri dishes on Kerssies' B. cinerea selective medium, or on water agar medium supplemented with paraquat and incubated for 14 days at 22°C with a 12 h photoperiod daily. Infection and fungicide efficacy was determined by observing intact vinelets and bunches for symptom expression, and by estimating the amount of B. cinerea at the various sites on the vinelets and bunches with isolation studies. No symptoms of B. cinerea decay developed on sprayed and unsprayed vinelets that were kept in dry chambers during the 2 wk observation period. The isolation and incubation studies showed that the different fungicides were highly and nearly equally efficient in reducing superficial B. cinerea inoculum and latent infection. .In the case of leaf blades, which showed a high amount of B. cinerea on unsprayed vinelets under the two sterility regimes, decay was significantly reduced by each fungicide on both cultivars. This was not the case for the other parts, which yielded B. cinerea at low incidences under the two sterility regimes. The study with bunches showed that dry, airborne conidia, and the fungicide sprays, penetrated loose and tight clustered bunches from bloom to harvest and evenly landed on the various bunch parts. At full bloom, the amount of B. cinerea in unsprayed bunches was high on the laterals and pedicels, but low on the embryos. Unsprayed intact bunches at full bloom were highly susceptible to B. cinerea and developed symptoms of grey mould. The fungicides inhibited symptom expression at full bloom, but could not prevent infection. Unsprayed bunches inoculated at the other stages remained asymptomatic. The amount of B. cinerea was generally high in the rachises and laterals at pea size and bunch closure stages, and in the pedicel end of berries at harvest. Infection was constantly low in the berry cheek. The fungicides had a differential effect on infection at the various sites. In the case of rachises, the amount of B. cinerea was at each growth stage drastically reduced by each fungicide. In laterals, it was effectively reduced at pea size and bunch closure. However, at these two sites, significant differences were found between the fungicides in efficacy at stages when the amount of B. cinerea was high. This study showed that if these fungicides are applied properly to vine in commercial vineyards between budding and prebloom, during flowering, and at bunch closure, they should effectively prevent infection and symptom expression and thus the development of B. cinerea epiphytotics.
AFRIKAANSE OPSOMMING: INFEKSIE DEUR DROË, LUGGEDRAAGDE BOTRYTIS CINEREA KONIDIA EN DIE EFFEK VAN FUNGISlEDE OP VERSKILLENDE SETELS BINNE WINGERDTROSSE EN OP LOTE: Evaluering van fungisieddoeltreffendheid in kommersiële wingerde word beïnvloed deur die sporadiese voorkoms van Botrytis cinerea op verskeie posisies van wingerddele, verskille in trosstruktuur tydens trosontwikkeling, en die feit dat simptoomuitdrukking in lote en trosse deur die weerstandsaksie van die verskillende morfologiese dele van lote en trosse beheer word. In die natuur speel infeksie deur enkel konidia 'n prominente rol in die epidemiologie van B. cinerea van wingerd. Die doel van hierdie studie was om (i) infeksie en (ii) die effek van fungisiede op verskillende posisies op lote en trosse (tafeldruif kultivar Dauphine, wyndruif kultivar Merlot), wat met droë, luggedraagde konidia van B. cinerea geïnokuleer is, te bepaal. Lote, verkry vanaf steggies, en trosse versamel vanuit die wingerde tydens blom-, ertjiekorrel-, trostoemaak-, deurslaan- en oesstadium, is teen aanbevole dosisse met iprodione, pyrimethanil, cyprodinillfludioxonil of fenhexamid in 'n spuitkas bespuit, of is onbehandeld gelaat. Na 24 h is die lote en trosse met droë konidia van B. cinerea in 'n inokulasietoring geïnokuleer en daarna vir 24 h onder hoë humiditeit [±93% RH] geïnkubeer. Na inkubasie is die lote en trosse in drie groepe verdeel. Die een groep lote en trosse is oppervlakkig gesteriliseer om die patogeen op die oppervlakte te elimineer, en die ander twee groepe is onbehandeld gelaat. Die lote en trosse van een nie-steriele groep is vir 14 dae in droë voghokke by 22°C met 'n 12 uur daaglikse fotoperiode geplaas, en daagliks vir siekteuitdrukking en die ontwikkeling van B. cinerea gemonitor. Lote en trosse van die ander twee groepe is vir isolasiestudies gebruik. Vanaf elke loot is blaarskywe, blaarstele, internodes en ongeopende blomtrossies verwyder. Vanaftrosse is ragisse, laterale en korreisteie verwyder, en vanaf korrels is skilsegmente aangrensend aan die korrelsteel, die stempel-end, en die wang verwyder. Die dele en segmente is op B. cinerea selektiewe medium, en op paraquat medium in Petri bakkies geplaas en vir 14 dae by 22°C met 'n 12 uur daaglikse fotoperiode geïnkubeer. Infeksie en die fungisiedeffek is bepaal deur die intakte lote en trosse vir siekte- uitdrukking te monitor, en deur die hoeveelheid B. cinerea op verskeie posisies op lote en trosse te bepaal. Geen simptome het op enige posisie op bespuite en onbespuite lote, wat in droë hokke gehou is, ontwikkel nie. Die isolasie- en inkubasiestudies het getoon dat die verskillende fungisiede hoogs effektief op lote was, en inokulumvlakke van die patogeen doeltreffend verlaag het. In die geval van blaarskywe, wat hoë vlakke van B. cinerea op onbespuite steggies onder die twee steriliteitskondisies getoon het, is verrotting op beide kultivars betekenisvol deur die fungisiedes verlaag. Dit het egter nie vir die ander dele, waarop daar 'n lae voorkoms van B. cinerea onder die twee steriliteitskondisies was, gegeld me. Die studie met trosse het getoon dat droë, luggedraagde konidia en fungisiednewels beide oop en kompakte trosse vanaf blomstadium tot oes penetreer en eweredig op die verskillende dele land. Met blomstadium was die hoeveelheid B. cinerea in onbespuite trosse hoog op laterale en korrelstele, maar laag op die embrios. Onbespuite, intakte trosse was hoogs vatbaar vir B. cinerea by blomstadium en het simptome van vaalvrot ontwikkel. Die fungisiede het siekte-uitdrukking by blomstadium voorkom, maar kon nie infeksie voorkom me. Onbespuite trosse wat op ander stadia geïnokuleer is, het geen siekte-uitdrukking getoon me. Die hoeveelheid B. cinerea was hoër in die ragi, asook in laterale by ertjiekorrel- en trostoemaak stadium, en hoër in korreisteie by oesstadium. Infeksie was konstant laag in die korrelskil. Die fungisiede het 'n differensiële effek op infeksie by die verskillende posisies gehad. In die geval van ragi was die hoeveelheid B. cinerea drasties deur elke fungisied by alle groeistadia verlaag. In laterale was dit effektief by ertjiekorrel- en trostoemaakstadium verminder. By hierdie twee posisies waar die hoeveelheid B. cinerea hoog was, is daar egter betekenisvolle verskille in die doeltreffendheid van fungisiedes gevind. Hierdie studie toon dat as fungisiede behoorlik in kommersiële wingerde tussen botvorming en blomstadium, en tydens blom- en trostoemaakstadium toegedien word, infeksie en siekte-uitdrukking, en dus ook die epifitotiese ontwikkeling van B. cinerea, voorkom behoort te word.

Thesis (M. Tech. (Environmental health: Food safety )) - Central university of Technology, Free State, 2013
Food processing plants and agricultural environments have a long-standing history of being known to provide a conducive environment for the prevalence and distribution of microorganisms which emanate as a consequence of activities undertaken in such premises. Microorganisms in the aforementioned environments may be found in the atmosphere (airborne), and/or on food contact surfaces. Airborne microorganisms from food handlers and in food products and raw materials (as part of bioaerosols) have in the past been implicated as having a potential to cause adverse health effects (especially in indoor environments) and therefore also to have economic implications. Recently their effect on food safety has received increased interest. The recent international interest in bioaerosols in the food industry has played a role in rapidly providing increased understanding of bioaerosols and their effects in different food processing environments. However, there is still a lack of research on the actual impact of bioaerosols over time in most of the food premises especially in Southern Africa and other developing countries. The overall purpose of this dissertation was to assess possible microbial contaminants and the role of selected environmental parameters on these microbes at a dairy farm plant in central South Africa. In relation to the purpose of the study, the objectives of this dissertation were to investigate and establish the food handler’s food safety knowledge, attitude, behaviour and practices. The sub-objective was to investigate the prevalence and distribution of microbial contaminants (both airborne and food contact surface populations), and concomitant environmental parameters. The microbe isolates from both investigations (i.e. air samples and food contact surfaces) were identified to strain level using matrix-assisted laser desorption ionization – time of flight mass spectrometry (MALDI-TOF MS). The findings of this study in relation to food handlers’ food safety knowledge, attitude, behaviour and practices indicated a dire need for training of employees as well as improved health and hygiene measures as emphasised by some of the identified strains. The environmental parameters (both indoor and outdoor) were similar, with no relationship established between airborne microbes’ prevalence and environmental parameters. The samples of the airborne microbial populations in both indoor and outdoor environments were similar. Airborne microbial counts at the dairy farm plant over the entire duration of the study ranged between 1.50 x 101cfu.m-3and 1.62 x 102cfu.m-3. Microbial counts on food contact surfaces ranged between 2.50 x 102 cfu.cm-2 and 1.10 x 105 cfu.cm-2 over the entire duration of the study. A wide variety of microorganisms (from air and food contact surfaces) such as the Gram-positive bacteria, Gram-negative bacteria, as well as fungi were present at the dairy farm plant. A number of the isolated genera have previously been associated with agricultural environments whilst others are associated with hospital environments. The positively identified strains were from genera such as Aeromonas, Arthrobacter, Candida, Pseudomonas, Pantoea, Citrobacter, Staphylococcus, Bacillus, Escherichia, Rhodococcus and Rhodotorula, amongst others. The isolation of microorganisms associated with food spoilage and foodborne disease outbreaks, which are known as indicator organisms such as Escherichia coli, Staphylococcus and Bacillus from both air and surface samples, signified possible faecal contamination and could be attributed to poor health and hygiene practices at the dairy farm plant. Despite the isolation of microorganisms associated with food spoilage and foodborne disease outbreaks, the isolation of microorganisms not usually associated with the food processing industry (usually associated with hospital environments) was an enormous and serious concern which suggested a need for further investigations at dairy farm plants as the implications of these pathogenic microorganisms in food is not known. The isolation of similar microorganisms from both the air samples and surface swabs suggests that airborne microbes have a potential of settling on food contact surfaces, therefore having a potential to contaminate dairy products which are known to be more prone to contamination and which, because of their nutritional status, serve as a good substrate for the growth of microorganisms.

A presente pesquisa tem como objetivo avaliar a eficiência de diferentes sistemas de ventilação no controle da transmissão aérea de agentes infecciosos em sala cirúrgica e em quarto de isolamento hospitalar. Para isso, foram desenvolvidos estudos experimentais e numéricos a partir de dados gerados em um hospital brasileiro de referência no tratamento de doenças respiratórias. Em uma sala cirúrgica, comparou-se o sistema de climatização existente (sistema de ventilação unidirecional) com um sistema split, adaptado na sala especialmente para este estudo. Em um quarto de isolamento compararam-se diferentes arranjos com ventilação natural (porta e janelas) e/ou mecânica (ventilador axial e unidade de descontaminação - filtro e exaustor). Em ambos os ambientes foram medidos parâmetros ambientais (velocidade do ar, temperatura do ar e intensidade de turbulência) e se realizou um estudo da concentração de partículas, mediante o uso de um gerador de partículas monodisperso. A partir dos dados gerados por meio desses procedimentos experimentais, para a sala cirúrgica, obteve-se o fator de proteção e, para o quarto de isolamento, a probabilidade de infecção utilizando o equacionamento proposto por Wells e Riley, bem como a taxa de decaimento de partículas. Os resultados experimentais subsidiaram a realização de um estudo numérico, que consistiu na avaliação dos campos de velocidade, temperatura e intensidade de turbulência do ar para os diferentes tipos de ventilação estudados e no estudo da dinâmica de partículas nos dois ambientes. Embora o sistema unidirecional seja, teoricamente, mais eficiente no controle das partículas, a metodologia de análise adotada evidenciou ineficiência do sistema na remoção de partículas devido a problemas na instalação e operação. Quanto ao sistema split, o presente estudo, como outros assemelhados, evidenciou a inadequação de seu uso em salas cirúrgicas. No quarto de isolamento a ventilação natural mostrou-se o método mais eficiente para a remoção de partículas e, consequentemente, o que mais reduz o risco de contaminação cruzada, conforme o equacionamento original de Wells-Riley. Para a sala cirúrgica foram obtidos valores experimentais do fator de proteção variando entre 0,10 e 0,52 e de -0,9 a +2,5 na análise numérica. Para o quarto de isolamento foram obtidos experimentalmente riscos de infecção entre 0,25 e 2,65%. Finalizando, este trabalho visa contribuir na proposição de uma metodologia experimental e numérica para a avaliação da dinâmica das partículas e, consequentemente, do risco de infecção por via aérea em ambientes hospitalares.
This research aims to evaluate the efficiency of different ventilation systems to control airborne transmission of infectious agents in a hospital operating room and isolation room. Experimental and numerical studies were carried out based on data generated in a Brazilian reference hospital for the treatment of respiratory diseases. In an operating room, an existing unidirectional air conditioning system (i. e., laminar air flow - LAF) was compared to a split system, adapted in the room especially for this study. In a respiratory isolation room, comparisons were drawn between different arrangements with natural ventilation (door and window) and/or mechanical ventilation (axial fan and decontamination unit - filter plus exhaust fan). In both rooms, environmental parameters (air speed, air temperature and turbulence intensity) were measured, and a study of particle concentration was developed employing a monodisperse aerosol generator. The data generated by these experimental procedures were used to calculate the protection factor for the operating room and the probability of infection for the isolation room, using the equation proposed by Wells and Riley, as well as the rate of particle decay. The experimental results were then used in a numerical study, which included evaluation of the fields of air velocity, temperature and turbulence intensity for different types of ventilation under study, as well as the analysis of particle dynamics in both environments. Although the unidirectional system is theoretically more effective for particle control, the methodology of analysis adopted revealed an inefficiency of this system in removing particles, due to installation and operation problems. Concerning the split system, this research - similarly to analogous studies - emphasizes the inadequacy of its use in operating rooms. In the isolation room, natural ventilation proved the most effective method for removing particles and, consequently, the one which reduces the most the risk of cross-contamination, according to the original Wells-Riley modeling. In the operating room were obtained experimental data for the protection factor ranging from 0.10 to 0.52 and from -0.9 to +2.5 in the numerical analysis. In the isolation room were obtained probabilities of infection between 0.25 and 2.65%. Finally, this work aims to contribute in proposing an experimental and numerical methodology for assessing the dynamics of particles and hence risk of airborne infection in hospital settings.

Tuberculosis (TB), one of the world's greatest killers, is predominantly spread by the airborne route. Drug-resistant M. tuberculosis has emerged as a global public health threat despite effective drugs and disease control strategies. Little is known about M. tuberculosis transmission and the efficacy of necessary environmental (engineering) interventions for infection control; particularly in light of the global HIV/Aids epidemic. This thesis covers the development, validation and calibration of the unique Airborne Infection Research (AIR) facility (apparatus) that utilises a biological model to sample airborne M. tuberculosis by transporting infectious air from patient wards to animal exposure chambers housing guinea pigs. This capability, hitherto a universal limitation due to the unique characteristics of the tubercle bacili, will now allow a collaboration of researchers horn around the world to undertake scientific studies to answer fundamental questions about the infectiousness of drug-resistant M. tuberculosis and the efficacy of various engineering interventions to minimise the spread of airborne disease. These experiments will provide the scientific blue-prints for design of safer health care facilities and the development of improved building and construction standards. The AIR facility, recently completed as pan of this study, was the culmination of a five year research project by a collaborative research team From the SA Medical Research Council, the Council for Scientific and Industrial Research, the Centers for Disease Control, Atlanta, USA; and Harvard University, Boston, USA; made possible with initial finding provided by the US Agency for International Development (USAID) and private sector donors which included the South African National Tuberculosis Association (SANTA). The author, as the engineering research member of the collaborating research team, was responsible for all architectural engineering aspects of the research behind the design, development, operation and, in part, the bioaerosol sampling techniques; and had to develop an in depth appreciation and understanding of M tuberculosis generation, risk and control in order to anticipate what was needed from the apparatus to support the various research projects that are to be undertaken. The various engineering interventions necessary to curtail transmission of infection, such as ultraviolet germicidal irradiation (UVGI) and other electro/mechanical interventions can now be tested and evaluated. The facility, as an apparatus, is capable of supporting the experiments intended for the study of these interventions in that the effects of varying ventilation rates and environmental conditions, such as temperature and humidity on the transmission dynamics of aerosolized infectious particles, are possible. The thesis discusses the hypothesis, aims, results and conclusions of the apparatus development, validation and calibration experiments of the unique state-of-the-art facility. The effectiveness and airtightness (leakage factor) of the air distribution from the wards, the transporting capacity of gram-positive and negative aerosolized bacteria and the efficacy of the in-line UVGI units to the animal infection chambers were conclusively proven via validation experiments. The results presented indicate that from the validated operational parameters of the apparatus the losses were less than 5% for non-biological substances and less than 12% for endospores (Serratia marcescens). No significant losses were noted across the transfer axial fan. A 100% efficacy was achieved across the in-he ultraviolet germicidal irradiation units as no Serratia marcescens were detected in the animal room. The calibration experiment, conducted to calibrate the exposure apparatus of the AIR facility in meeting its purpose to effectively transfer infectious airborne particles from patient wards (clinical unit) to the animal exposure chambers, concluded from the rate of guinea pig infections observed that the AIR facility is a highly effective way to quantify the infectiousness of TB patients. The high rate of observed infections among the guinea pig infections proves conclusively that the AIR facility will serve its purpose to effectively evaluate infectiousness of the ward air and to test the efficacy of engineering interventions to minimize the spread of the disease. The AIR facility now provides unique opportunity to evaluate the efficacy of novel engineering interventions for infection control, particularly in light of the global HIV/Aids epidemic. Future studies that are planned are also discussed.
Thesis (Ph.D. (Mechanical Engineering))--North-West University, Potchefstroom Campus, 2007.

Microbial pathogens commonly transmitted through the aerosol route to surfaces, equipment, and hands in the clinical setting leads to costly and life threatening hospital-acquired infections (HAIs). Even with improved hand hygiene and surface disinfection, HAIs continue to persist in healthcare environments, warranting consideration of novel interventions to reduce the transmission risk of HAIs. This study quantitated the efficacy of ion generating passive air treatment (PAT) against viruses (MS2), bacteria (Escherichia coli), and bacterial spores (Bacillus thuringiensis) in a controlled environmental setting. Microorganisms were seeded into a 2.72 m3 chamber using a positive pressure nebulizing device to generate aerosolized droplets. The PAT unit was then turned on and seeded organisms were collected at various time points using impingers to concentrate the organisms into sterile aqueous solution. The microorganisms were enumerated using approved standard protocols developed in the Environment, Exposure Science, and Risk Assessment Center's laboratory at The University of Arizona. Three experiments were conducted to challenge the PAT unit. Experiment one evaluated the efficacy of the PAT unit over a single 10-minute period on microbial inactivation from the airborne environment following a single seeding; additionally, experiment one aimed to determine the efficacy of the PAT unit against viruses, bacteria, and bacterial spores on environmental surfaces; experiment two evaluated the efficacy of the PAT unit running continuously over a period of 6 hours following a single seeding; and experiment three evaluated the efficacy of the PAT unit running two continuously over a period of 5.25 hours following two seeding events. Bacterial spores from pre- and post-treatment with the PAT unit were collected and analyzed by scanning electron microscopy to assess structural differences. After a single seeding and 10 minutes of continuous treatment of the PAT unit, normalized average microbial log10 reductions of post-treatment compared to pre-treatment air concentrations were 1.67, 0.59, and 1.04 for MS2, B. thuringiensis spores, and E. coli, respectively. Differences in average log10 reductions between the control unit and the PAT unit were statistically significant for MS2 (p=0.009) and B. thuringiensis (p=0.0455), but not for E. coli (p=0.0565). The geometric mean log10 surface concentrations of MS2, B. thuringiensis, and E. coli after a single seeding and 10 minutes of continuous treatment of the PAT unit were 7.30 PFU/100 cm2, 5.90 CFU/100 cm2, and 2.74 CFU/100 cm2, respectively, compared to exposure of the control unit, 8.59 PFU/100 cm2, 6.03 CFU/100 cm2, and 4.96 CFU/100 cm2, respectively. There was a statistically significant difference between the mean log10 surface concentrations following 10 minutes of treatment with the control unit compared to the PAT unit for E. coli (p=0.002), but not for MS2 (p=0.3358) or B. thuringiensis (p=0.0866). After a single seeding and 6-hours of continuous treatment of the PAT unit, normalized average microbial log10 reductions of MS2 and B. thuringiensis were 1.43 and 1.32, respectively. The difference in average log10 reduction of all post-treatment samples between the control unit and the PAT unit was statistically significant for B. thuringiensis (p=0.0008) but not for MS2 (p=0.2568). After two seedings and 5.25 hours of continuous treatment of the PAT unit, normalized average microbial log10 reductions of MS2 and B. thuringiensis were 1.59 and 1.26, respectively. There was a statistically significant difference in the average log10 reductions between the control unit and the PAT unit for MS2 (p=0.002) and B. thuringiensis (p=0.0003). Scanning electron microscopy analysis identified visual modification to B. thuringiensis spores following treatment with the PAT unit. In this study, the tested ion generating PAT unit was effectively able to reduce airborne microbial concentrations between 1-2 log10 in a controlled chamber environment within 10 minutes and up to 6 hours of treatment. The implications of this study suggest that ion producing PAT systems may represent a beneficial supplement to cleaning and disinfection practices in the reduction of pathogen contamination from the airborne and fomite-airborne routes.

Background: Tuberculosis (TB) is a major healthcare problem worldwide and is endemic to Cape Town, South Africa. Health Care Workers in Emergency Centers (ECs) are at high risk of nosocomial TB infection. The aim of this study was to determine whether the isolation rooms (IRs)in emergency centers, for patients with diagnosed or suspected TB, comply with set National Core Standards. Methods: This was a cross-sectional descriptive study of ECs in the Cape Town Metropolitan area. .The characteristics of IRs with regards to air changes per hour (ACH), negative pressure ventilation with relation to the surrounding areas and appropriate discharge of air outdoors or via filters before recirculation was measured using standard objective engineering methods. Results: 19 IRs in 8 ECs were evaluated, none of which complied with the National Core Standard's ideal requirements for IRs. Five complied with minimal requirements . Eleven (57,9%) IRs were designed to have negative pressure; and 8 (42,1%) rooms were not designed for isolation purposes, . IR volumes ranged from 15,5 m³ to 67,2 m³ (median 35,6 m³). Five (26,3%) IRs were under negative pressure; 7 (36,8%) had erratic air flow; and 7 (36,8%) showed positive airflow from the IR into adjacent clinical areas. Fifteen (78,9%) IRs had central provision of air via a ventilation system; 6 (31,6%) had central air extraction; 6 (31,6%) had local extraction; and 7 (36,8%) used natural ventilation only. Four local extraction units had zero flow rate. Airflow in naturally ventilated IRs was significantly lower than flow with other systems (p = 0,0002). The ACH ranged from 0 (n=4) to 112.37 (median 11,9); and was significantly greater in rooms ventilated with central extraction compared to other systems (p = 0,00002). Discussion: The ventilation aspects of airborne infectious disease control are generally poorly implemented. This may contribute to, and fail to mitigate, the high risk of nosocomial transmission of airborne infectious diseases to staff and other patients utilising emergency facilities in the TB endemic areas of Cape Town. Conclusion: Existing ECs should improve adherence to standards of airborne infectious disease transmission prevention in order to protect patients and staff from nosocomial airborne transmitted diseases, such as TB. New Hospitals should place a high priority on the amount, positioning and maintenance of IRs when planning their facility.

The history of surgery is nearly as old as the human race. Control of wound infection has always been an essential part of any surgical procedure, and is still an important challenge in hospital operating rooms today. For patients undergoing surgery there is always a risk that they will develop some kind of postoperative complication. It is widely accepted that airborne bacteria reaching a surgical site are mainly staphylococci released from the skin flora of the surgical staff in the operating room and that even a small fraction of those particles can initiate a severe infection at the surgical site.  Wound infections not only impose a tremendous burden on healthcare resources but also pose a major threat to the patient. Hospital-acquired infection ranks amongst the leading causes of death within the surgical patient population. A broad knowledge and understanding of sources and transport mechanisms of infectious particles may provide valuable possibilities to control and minimize postoperative infections. This thesis contributes to finding solutions, through analysis of such mechanisms for a range of ventilation designs together with investigation of other factors that can influence spread of infection in hospitals, particularly in operating rooms. The aim of this work is to apply the techniques of computational fluid dynamics in order to provide better understanding of air distribution strategies that may contribute to infection control in operating room and ward environments of hospitals, so that levels of bacteria-carrying particles in the air can be reduced while thermal comfort and air quality are improved.  A range of airflow ventilation principles including fully mixed, laminar and hybrid strategies were studied. Airflow, particle and tracer gas simulations were performed to examine contaminant removal and air change effectiveness. A number of further influential parameters on the performance of airflow ventilation systems in operating rooms were examined and relevant measures for improvement were identified. It was found that airflow patterns within operating room environments ranged from laminar to transitional to turbulent flows. Regardless of ventilation system used, a combination of all airflow regimes under transient conditions could exist within the operating room area. This showed that applying a general model to map airflow field and contaminant distribution may result in substantial error and should be avoided. It was also shown that the amount of bacteria generated in an operating room could be minimized by reducing the number of personnel present. Infection-prone surgeries should be performed with as few personnel as possible. The initial source strength (amount of colony forming units that a person emits per unit time) of staff members can also be substantially reduced, by using clothing systems with high protective capacity. Results indicated that horizontal laminar airflow could be a good alternative to the frequently used vertical system. The horizontal airflow system is less sensitive to thermal plumes, easy to install and maintain, relatively cost-efficient and does not require modification of existing lighting systems. Above all, horizontal laminar airflow ventilation does not hinder surgeons who need to bend over the surgical site to get a good view of the operative field. The addition of a mobile ultra-clean exponential laminar airflow screen was also investigated as a complement to the main ventilation system in the operating room. It was concluded that this system could reduce the count of airborne particles carrying microorganisms if proper work practices were maintained by the surgical staff. A close collaboration and mutual understanding between ventilation experts and surgical staff would be a key factor in reducing infection rates. In addition, effective and frequent evaluation of bacteria levels for both new and existing ventilation systems would also be important.
Tidigt i mänsklighetens utveckling har kirurgin funnits med i bilden. Hantering av infektioner har genom tiderna varit en oundviklig del av alla kirurgiska ingrepp, och finns kvar ännu idag som en viktig utmaning i operationssalar på sjukhus. För patienter som genomgår kirurgi finns alltid en risk att de efter ingreppet utvecklar någon behandlingsrelaterad komplikation. Allmänt accepterat är att de luftburna bakterier som når operationsområdet huvudsakligen består av stafylokocker frigjorda från hudfloran av operationspersonalen i operationssalen, och att endast en liten del av dessa partiklar behövs för att initiera en allvarlig infektion i det behandlade området. Sårinfektioner innebär inte bara en enorm börda för hälso- och sjukvårdsresurser, utan utgör också en betydande risk för patienten. På sjukhus förvärvad infektion finns bland de främsta dödsorsakerna i kirurgiska patientgrupper.. En bred kunskap och förståelse av spridningsmekanismer och källor till infektionsspridande partiklar kan ge värdefulla möjligheter att kontrollera och minimera postoperativa infektioner. Denna avhandling bidrar till lösningar genom analys av en rad olika ventilationssystem tillsammans med undersökning av andra faktörer som kan påverka infektionsspridningen på sjukhus, främst i operationssalar. Syftet med arbetet är att med hjälp av CFD-teknik (Computational Fluid Dynamics) få bättre förståelse för olika luftspridningsmekanismers betydelse vid ventilation av operationssalar och vårdinrättningar på sjukhus, så att halten av bacteriebärande partiklar i luften kan minskas samtidigt som termisk komfort och luftkvalité förbättras.  Flera luftflödesprinciper för ventilation inklusive omblandade strömning, riktad (laminär) strömning och hybridstrategier har studerats. Simuleringar av luft-, partikel- och spårgasflöden gjordes för alla fallstudier för att undersöka partikelevakuering och luftomsättning i rummet. Flera viktiga parametrar som påverkar detta undersöktes och relevanta förbättringar  föreslås i samarbete med industrin. Av resultaten framgår att mängden genererade bakterier i en operationssal  kan begränsas genom att minska antalet personer i operationsteamet. Infektionsbenägna operationer skall utföras med så lite personal som möjligt. Den initiala källstyrkan (mängden kolonibildande enheter som en person avger per tidsenhet) från operationsteamet kan avsevärt minskas om högskyddande kläder används. Av resultaten framgår också att ett horisontellt (laminärt) luftflöde kan vara ett bra alternativ till det ofta använda vertikala luftflödet. Ett horisontellt luftflöde är mindre känsligt för termisk påverkan från omgivningen, enkelt att installera och underhålla, relativt kostnadseffektivt och kräver vanligen ingen förändring av befintlig belysningsarmatur. Framför allt begränsar inte denna ventilationsprincip kirurgernas rörelsemönster. De kan luta kroppen över operationsområdet utan att hindra luftflödet. En flyttbar flexibel skärm för horisontell spridning av ultraren ventilationsluft i tillägg till ordinarie ventilation undersöktes också. Man fann att denna typ av tilläggsventilation kan minska antalet luftburna partiklar som bär mikroorganismer om operationspersonalen följer en strikt arbetsordning. Bra samarbete och förståelse mellan ventilationsexperter och operationsteamet på sjukhuset är nyckeln till att få ner infektionsfrekvensen. Det är också viktigt med effektiva och frekventa utvarderingar av bakteriehalten i luften, för såväl nya  som befintliga ventilationssystem.

QC 20160129

Les spores fongiques sont à l'origine d'infections nosocomiales affectant le pronostic vital de patients immunodéprimés, et peuvent se transmettre par l'air. C'est pourquoi nous nous sommes intéressé à la déposition et au réenvol de spores d'"Aspergillus", responsables de pathologies gravissimes comme l'aspergillose pulmonaire invasive. Nous avons lors de nos expérimentations utilisé deux méthodes d'aérosolisation : le nébuliseur Collison standard, nécessitant la mise en solution des spores, ainsi qu'un prototype permettant de souffler directement sur les cultures fongiques Ceci nous a permis de mesurer la vitesse de sédimentation des spores, et d'évaluer l'efficacité et la rémanence de traitements fongicides en utilisant un protocole original mettant en œuvre des conditions réalistes.Un dispositif expérimental a été mis au point afin de soumettre des spores déposées sur une surface à un flux d'air tangentiel, et de filmer leur réenvol ( http://tinyurl.com/bla9ynz ), et un critère prédictif théorique de détachement a été exhibé. Des simulations numériques de l'écoulement autour de sphères idéales ont complété cette étude en nous donnant accès à des paramètres critiques inaccessibles expérimentalement.Nous avons finalement appliqué les résultats de nos investigations à la problématique des infections nosocomiales aérotransmises, et découvert que les ventilateurs de refroidissement d'appareils électroniques sont un réservoir de pathogènes et une source de contamination croisée potentielle. Des expériences en milieu contrôlé associées à une campagne de prélèvements en milieu hospitalier ont mis à jour ce nouveau et important risque de contamination.

碩士
國立宜蘭大學
土木工程學系碩士班
104
In recent years, the type and intensity of airborne infection disease is gradually increased in the world, and results in serious threat to human’s health and safety. The duration of people’s indoor activity is beyond 90% of all day. The outbreak of airborne infection will occur if infectors stay in indoor space. In order to predict the risk of airborne infection disease, epidemiology scholars have established infection numerical model to assess the risk of airborne infections. Wells-Riley equation is commonly used to assess risk of airborne infection in research. Wells-Riley equation has two assumptions that indoor air is uniformly mixed and is steady-state. The assumptions are difficult to correspond with reality. Therefore, the integrated model combined computer fluid dynamics (CFD) and Wells-Riley equation to predict the risk of airborne infection is conducted. But the CFD method is difficult to analyze the pollutant concentration in multi-zone space during a long time and the inhaled dose of susceptible persons. The integrated model combined the multi-zone airflow model and the Wells-Riley equation to predict the airborne infection risk is suggested by literature. This study investigate the feasibility of integrated model combined the multi-zone airflow model and the Wells-Riley equation to assess the risk of airborne infection, and propose to assess risk of airborne infection by carbon dioxide exposure. The study includes two parts, part one is to verify the accuracy of simulating pollutant concentration by using CONTAM. The carbon dioxide concentration monitored in Engineering Building 203 and Construction Management Laboratory is compared with the simulated value from CONTAM. The results of the coefficient of determination between measured data and simulated data in the experiments of Engineering Building 203 and Construction Management Laboratory are 0.96 and 0.99 separately. It indicates that the CONTAM has high accuracy to simulate pollutant concentration in indoor space. Part two is to use the integrated model to analyze the risk of airborne infection and compared with the infectors from the actual results of the literature. The first case is an outbreak of measles in elementary school. The results of the first case show that the predicted infectors of simulation and of investigation are 28 and 21 in first generation. The predicted infectors of simulation and of investigation are 31 and 24 in second generation. The predicted infectors of simulation and of investigation are 59 and 46 in combining the first and the second generation. Error rate is 26.2%, 24.1%, and 22.7%in above three scenarios separately. The second case is an outbreak of measles in a pediatric clinic. The simulation of CONTAM results in the criteria exposure of infection according to the reality of infection. The results indicate that a susceptible person will be infected if the exposure is above 156.75 min·ppm.

According to recommendations from the Facility Guidelines Institute (FGI) of the American Institute of Architects (AIA), World Health Organization (WHO) and Center for Disease Control and Prevention (CDC), a common engineering approach to isolation room design is to maintain the air ventilation rate at a minimum of 12 air changes per hour (ACH) for mixing and dilution, and a negative pressure in the room to direct airflow inwards, instead of leaking outwards.
In collaborations with physicians in the Respiratory Division and the Intensive Care Unit (ICU) at the Chinese University of Hong Kong (CUHK), a series of experiments were carried out to verify the ventilation performance of an All room at the Princess Margaret Hospital (PMH). Experiments investigated the effects of ACH, the control of airflow direction, the air tightness of the automatic swing door and the application of positive pressure ventilation procedures, such as high flow rate oxygen masks, jet nebulizers and NPPV. These were extensively tested in two different isolation rooms of the Prince of Wales Hospital (PWH) and PMH, under common clinical circumstances and environmental conditions.
Many patients with severe respiratory infection require supportive therapy for respiratory failure. Common interventions involve supplemental oxygen to improve tissue oxygenation. In the worst scenario, mechanical ventilation via non-invasive positive pressure ventilation (NPPV) may be required. Since a large amount of aerosols is generated during these interventions, there is a great risk of spreading infectious aerosols from the respiratory tract of the patient to the surrounding environment.
The aerodynamic data in this thesis infonns architects and engineers on how to improve the hospital ward ventilation design so as to avoid aerosol and ventilation leakage. Ultimately, it is hoped that this work may play a role in preventing devastating nosocomial outbreaks in the future.
The design of airborne infection isolation (AII) room has become one of the major research domains following the emergence of the global concern of acute respiratory diseases in this century. These include severe acute respiratory syndrome (SARS) in 2003, H5N1 avian influenza, and pandemic influenza H1N1 in 2009. All of which have claimed thousands of lives. Even with the current stringent design and practice guidelines, nosocomial infection of healthcare workers (HCWs) and inpatients continues to occur. This implies that there might be limitations in current isolation ward designs.
The experiments implemented a high-fidelity human patient simulator (HPS) which could be programmed with different lung breathing conditions and oxygen flow rate settings. The patient exhaled air dispersion distances and airflow patterns were captured in detail with a non-intrusive, laser light sheet, smoke particle scattering technique, designed for this thesis. Thin laser light sheets were generated by a high energy YAG laser with custom cylindrical optics. Smoke concentration in the patient exhaled air and leakage jets was estimated from the intensity of light scattered, which was then expressed as nonnalized particle concentration contours using computer programs developed for this study.
The study quantitatively revealed the distinctive patient exhaled airflow patterns and the extent of bioaerosol, generated directly from the patient source with the application of different oxygen delivery interventions for different patient lung conditions and oxygen flow rates. It was found that contamination was more critical during the administration of oxygen therapies, which is common in clinical circumstances. Source control is therefore the most efficient and effective approach to the reduction and even elimination of patient exhaled bioaerosol contaminants. Thus, when working in an isolation room environment, full preventive measure should be taken and it is essential to consider the location of mechanical vents and the patient exhaled airflow patterns. It has also been shown in experiment that applications of bacterial viral filter could be a solution to the problem.
Chow, Ka Ming.
Advisers: Puay Peng Ho; Jin Yeu Tsou.
Source: Dissertation Abstracts International, Volume: 73-09(E), Section: A.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 115-147).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.

碩士
中華醫事科技大學
生物安全衛生研究所
98
Negative pressure and air-tightness are required for airborne infection isolation room (AIIR) to prevent the escape of microorganisms. The effect of unexpected leakage in AIIR on decreasing negative pressure differential need to be investigated. In this research, a volume-adjustable chamber with independent supply and exhaust ventilation system which simulate airborne infection isolation room without anteroom was adopted to study the pressure differential caused by doorway and leakage. The ventilation system provides 20% greater exhaust flow-rate than supply air to meet 4, 8, 12 and 16 air change per hour (ACH) of the chamber with the volume ranging between 28.47 m^3 and 45.38 m^3. By changing the adjustable height (0.2 ~ 1.2 cm) of doorway which has 100 cm width, the value of negative pressure was measured to develop the correlation of doorway size and pressure differential. Similar experiment was also conducted under three different designed leakage areas (4, 25 and 100 cm^2) to study the effect of leakage area on pressure differential.It was found that pressure differential increases as ACH increases, but decreases with decreasing height of doorway and leakage area for different chamber volumes. No significant pressure differential was observed for different leakage positions. For ACH equals to 4, the pressure differential can not reach the recommended standard of pressure differential (≧8 Pa) when leakage area is greater than 25 cm^2. By using the experimental data, a predicting model was developed to estimate pressure differential based on the information of flow-rate, doorway and leakage area. It provides diagnosis of leakage sources and ensures operational effectiveness of AIIR.

No
The effectiveness of any ultraviolet germicidal irradiation (UVGI) system is governed by the passage of airborne microorganisms through the UV field. This paper describes a new method for evaluating the performance of UVGI devices using computational fluid dynamic (CFD) simulations. A microorganism inactivation equation is combined with a scalar transport equation to describe the concentration of airborne microorganisms in the presence of a UV field. The solution of this equation, in conjunction with the momentum and turbulent energy equations, allows the effect of both the airflow and the UV field on the microorganism distribution to be examined. Solutions are shown for the airflow and microorganism concentration through a bench scale flow apparatus, at five different UV intensities. The results from the CFD model are validated against the experimental data, obtained from the flow apparatus, for aerosolised Pseudomonas aeruginosa microorganisms. Good comparisons are seen, giving confidence in the application of the technique to other situations.

博士
國立陽明大學
公共衛生研究所
98
Nosocomial infection is one of the most important indicators of medical quality, because it would increase the staffs’ work loading, medical resource waste and medical malpractice. Compared with the urinary and blood infection, the respiratory infection controlling is the most important managerial target of hospitals. This study aimed to explore the noscomial infection issues, and was conducted by examining two phases in two studies. Firstly, we started from investigating indoor air microorganisms in the hospital. The purposes were to determine the levels and species of their air microorganisms in order to contribute some effective suggestions of the indoor air quality improving. Secondly, we focused on the Legionella noscomial infection issue, which was the new key point of hospital environmental management. According to the findings obtained from investigation, we would like to understand the situations of the air microorganisms’ environmental distribution and noscomial infection. The studies used 1-stage Andersen microbial particle sizing sampler (AMS) for the sampling tool. In the first study, we used it to measure the indoor air microorganisms in a hospital’s five special units?oER, RCW, ICU, BR and DR. There are two sampling phases in this study. First, we measured the levels, species of bacteria and fungi in the air, and recorded their levels of CO2, relative humidity, temperature of indoor air. In the second phase, we chose the highest microbial amount unit from the above, which was the focus investigated place in this phase. We sampled and analyzed its indoor microorganisms, and recorded the situations of personal actions. We found the average bacteria level of RCW was higher than that in the other units, and that the whole daytime level exceeded the low bacteria standard?o200 cfu/m3. The peak level was 934 cfu/m3; it appeared at 13:00-15:00 time period. The total bacterial counts were related to relative humidity and the level of CO2 (p＜0.05). Coagulase negative staphylococci (CNS) and Staphylococcus aureus were commonly detected in the indoor air of our study, and the dominant fungi species were Penicillium and Aspergillus. The second study focused on the Legionella noscomial infection issue of RCW and ICU. It investigated the positive rates of Legionella pneumophila (L. pneumophila) including the water samples of cooling tower, indoor environmental samples and inpatients’ sputum/blood specimens of six hospitals in Taiwan. There were 180 water samples from 30 hospitals’ cooling towers and 548 environmental samples from the RCW and ICU which were performed and cultured to identify the existence of L. pneumophila by buffered charcoal yeast extract (BCYEα) agar. We also measured the characteristics of water quality from the cooling towers at the same time. Venous blood and sputum specimens of 325 inpatients in these RCW and ICU were collected. They were cultured by BCYEα agar after acid-treatment and sero-typing with DFA and LAX tests. And the inpatient whose serum single titer (IFA test) exceeded 1:256 was the suggestive case of Legionnaires' disease (LD). The results showed that almost 30.0% (9/30) of cooling towers in these hospitals were contaminated by L. pneumophila, and most of them belonged to L. pneumophila serotype 1 (Lp-1). The concentration of free residual chlorine in the cooling tower water samples was related with L. pneumophila (p＜0.05). But few of the indoor environmental samples (0.5%) were isolated from L. pneumophila. After examining these inpatients’ medical records, four of them were confirmed with L. pneumophila infection, and one of these four inpatients was the nosocomial infection case. We suggest the hospitals should periodically monitor the air microorganisms. High efficiency particulate air filter can be used in the hospital’s special units, especially RCW or ICU. The appropriate temperature and relative humidity should be maintained, and controlling the visitors’ actions to avoid the nosocomial infection by the air transmittal. And the periodic environmental surveys, effective water disinfectant methods could prevent the outbreak of the L. pneumophila infection events, too.

Magister Pharmaceuticae - MPharm
Dioxy MP 14 is a locally developed form of stabilized chlorine dioxide in an aqueous medium. It has all the sanitizing properties of chlorine dioxide gas, a neutral compound of chlorine in the +IV oxidation state, which has been used extensively as a non-toxic sterilizing agent with various applications. In this study, Dioxy MP14 was tested in a commercial chicken pen to determine its effectiveness as an environmental sanitizing agent. Control of environmental microbes in a chicken pen is important to ensure healthy birds and optimum egg production. The biocide was introduced via an overhead misting system with a variable dosing pump at various daily frequencies.The effectiveness of environmental microorganism control was determined with air settle plates. The health and performance of the chickens were evaluated and compared to chickens in a control pen.The results show a decrease in airborne microbial load in the treated pen. Better egg production and lower mortality of the chickens in the treated pen compared to the control pen, indicate effective environmental microbial control was achieved with a residual 7.46 ppm Dioxy MP 14 at a daily dose given for 5 minutes every 2 hours.This study was a pilot study, with encouraging results, for an extended study to investigate the feasibility of introducing Dioxy MP 14 through a misting system in a clinical environment (clinics and hospitals) to control airborne pathogens like Mycobacterium tuberculosis thereby reducing the infection risks for clinical workers and medical staff.