Journal of Hospital Infection最新文献

英文中文

In-vitro and in-use efficacy of a rapid, targeted UVC decontamination system 快速、定向紫外线净化系统的体外和使用效果。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.10.019

S. Yui, K. Karia, M. Muzslay, P. Wilson, S. Ali

Background

Ultraviolet C (UVC) decontamination systems are used in healthcare to supplement manual cleaning. Systems typically target whole rooms with fixed, vertical bulbs.

Aim

To evaluate the in-vitro and in-use efficacy of the novel device with emitters on articulating arms designed for rapid, targeted decontamination in a hospital room.

Methods

Isolates of meticillin-resistant Staphylococcus aureus (MRSA) (∼10⁶ colony-forming units (cfu)), Klebsiella pneumoniae (∼10⁶ cfu) and Clostridioides difficile spores (∼10⁵ cfu) were inoculated on to stainless steel biological indicators (BIs) with low (0.3% BSA) and high (10% BSA/synthetic faeces) soiling. Bacteria were recovered from BIs following UVC decontamination, enumerated, and compared with controls. In-use efficacy was assessed by sampling aerobic colony counts (ACC) with contact plates. Sites were further sampled for C. difficile. Samples were taken before cleaning, after manual cleaning, and after UVC decontamination.

Findings

Reductions of 2.97–4.87 and 0.53–3.63 log₁₀ cfu were demonstrated with MRSA and K. pneumoniae with low and high soiling, respectively. Efficacy against C. difficile was only observed in one location (1.12 log₁₀) with low soiling, but not synthetic faeces.

ACC were highest on the bed foot rail (75 cfu/25 cm²) and toilet flush (67 cfu/25 cm²). Bacteria persisted on 50% of surfaces after manual cleaning and 30% after UVC decontamination. C. difficile persisted on one surface.

Conclusion

The system was effective for targeted disinfection and may be used for high-touch surfaces and equipment. The short cycle times allow operation in areas with minimal turnaround time such as operating theatres and anaesthetic rooms.

背景：紫外线 C (UVC) 净化系统用于医疗保健领域，作为人工清洁的补充。该系统通常使用固定的垂直灯泡对整个房间进行净化。目的：评估新型设备在病房中的体外和使用效果：将耐甲氧西林金黄色葡萄球菌（MRSA）（∼106 菌落总数 [CFU]）、肺炎克雷伯氏菌（∼106 CFU）和艰难梭菌孢子（∼105 CFU）的分离菌株接种到低污（0.3% BSA）和高污（10% BSA/合成粪便）的不锈钢生物指示器（BIs）上。经紫外线净化后，从生物指示器中回收细菌，进行计数，并与对照组进行比较。使用接触式平板对需氧菌落计数（ACC）进行采样，以评估使用效果。还进一步对现场进行了艰难梭菌采样。分别在清洗前、人工清洗后和紫外线净化后取样：结果：在低污垢和高污垢情况下，MRSA 和肺炎双球菌分别减少了 2.97-4.87 和 0.53-3.63 Log10 CFU。对艰难梭状芽孢杆菌的抗菌效果仅在一处（1.12 Log10）观察到，但对合成粪便的抗菌效果则没有观察到。床脚栏杆（75 CFU/25cm2）和冲洗马桶（67 CFU/25cm2）上的 ACC 最高。经过人工清洁和紫外线净化后，分别有 50% 和 30% 的表面仍有细菌存在。难辨梭状芽孢杆菌在一个表面上持续存在：该系统对有针对性的消毒很有效，可用于高接触表面和设备。周期短，可在手术室和麻醉室等周转时间最短的区域使用。

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引用次数: 0

Proposal for an updated taxonomy for isolation precautions in healthcare facilities: the term ‘droposol’ 关于更新医疗机构隔离预防措施分类法的建议："Droposol "一词。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.06.023

A.F. Widmer , J. Conly , R. Sommerstein

引用次数: 0

Povidone-iodine and silver nitrate are equally effective in eradicating staphylococcal biofilm grown on a titanium surface: an in-vitro analysis 聚维酮碘和硝酸银对消除钛表面葡萄球菌生物膜同样有效：体外分析

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.11.012

D. Semeshchenko , M.F. Veiga , M. Visus , A. Farinati , I. Huespe , HIBA Hip Surgery Unit , M.A. Buttaro , P.A. Slullitel

Background

There is no consensus on the irrigation solution and concentration that should be used when performing a debridement, antibiotics, and implant retention (DAIR) surgery.

Aim

To determine the minimum biofilm eradication concentration (MBEC) of five antibacterial solutions and to compare their efficacies in eradicating staphylococcal biofilm embedded on a titanium surface.

Methods

Meticillin-sensitive Staphylococcus aureus (MSSA) and meticillin-resistant S. aureus (MRSA) ATCC standard strains were grown over porous Ti–6Al–4V acetabular screw-caps. Antibacterial solutions were povidone-iodine, rifampicin, silver nitrate, copper sulphate, and chlorhexidine. MBEC values were calculated for MSSA and MRSA. After 24 h, screw-caps were exposed for 3 min to each solution. Bacterial separation from each specimen was performed with vortex agitation and footprint on agar plate in triplicate. Colony forming units (cfu) were counted pre- and post-agitation, and the delta of cfu/mL was calculated for each solution. A threefold log reduction in cfu was considered a measure of solution efficacy. Comparison between groups was made with Fisher's test.

Findings

MBEC values for MSSA and MRSA, respectively, were as follows: 8000 μg/mL and 16,000 μg/mL for povidone-iodine; 64 μg/mL and 128 μg/mL for rifampicin; 10,000 μg/mL and 5120 μg/mL for silver nitrate; 900 μg/mL and 900 μg/mL for copper sulphate; 16 μg/mL and 32 μg/mL for chlorhexidine. Rifampicin, copper sulphate and chlorhexidine were ineffective against MSSA and MRSA biofilm compared with povidone-iodine (P<0.01) and silver nitrate (P=0.015) that had a delta cfu reduction >8 log. Povidone-iodine and silver nitrate showed negative footprints without visible MSSA (P=0.005) and MRSA (P=0.014).

Conclusions

Povidone-iodine and silver nitrate were the only irrigating solutions capable of eradicating at least 99.9% of 24-h biofilm.

背景：关于清创、抗生素和种植体固位（DAIR）手术时应使用的冲洗液和浓度，目前尚未达成共识：目的：确定五种抗菌溶液的最小生物膜消除浓度，并比较它们在消除嵌入钛表面的金黄色葡萄球菌生物膜方面的功效：在多孔钛-6Al-4V髋臼螺钉盖上培养甲氧西林敏感金黄色葡萄球菌（MSSA）和甲氧西林耐药金黄色葡萄球菌（MRSA）ATCC标准菌株。抗菌溶液为聚维酮碘、利福平、硝酸银、硫酸铜和洗必泰。计算了 MSSA 和 MRSA 的最小生物膜根除浓度 (MBEC) 值。24 小时后，将螺旋帽暴露在每种溶液中 3 分钟。用涡旋搅拌法从每个试样中分离细菌，并在琼脂平板上留下足迹，一式三份。计数搅拌前后的菌落形成单位（CFU），并计算每种溶液的 CFU/ml delta 值。菌落形成单位减少三倍对数值即为药液的疗效。组间比较采用 Fisher 检验：MSSA 和 MRSA 的 MBEC 值分别如下：聚维酮碘分别为 8000 微克/毫升和 16000 微克/毫升；利福平分别为 64 微克/毫升和 128 微克/毫升；硝酸银分别为 10000 微克/毫升和 5120 微克/毫升；硫酸铜分别为 900 微克/毫升和 900 微克/毫升；洗必泰分别为 16 微克/毫升和 32 微克/毫升。与聚维酮碘相比，利福平、硫酸铜和洗必泰对 MSSA 和 MRSA 生物膜无效（p8 log）。聚维酮碘和硝酸银显示出阴性足印，没有可见的 MSSA（p=0.005）和 MRSA（p=0.014）：结论：聚维酮碘和硝酸银是唯一能够消灭至少 99.9% 的 24 小时生物膜的冲洗溶液。

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引用次数: 0

Risk of carbapenemase acquisition and bacteraemia in patients with carbapenemase-producing Enterobacterales in haematology wards under cohort isolation with different carbapenemase types: a retrospective study 在不同碳青霉烯酶类型的组群隔离下，血液病房中产碳青霉烯酶肠杆菌患者感染碳青霉烯酶和菌血症的风险：一项回顾性研究。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.09.013

J. Jung , H. Lee , S. Park , E.O. Kim , S-H. Kim

引用次数: 0

From the clinic to the wards, the evolution of penicillin allergy testing by non-allergists in a UK hospital 从诊所到病房，英国一家医院由非过敏学家进行青霉素过敏测试的演变。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.09.026

C. Watson , S. Shah , F. Hassan , T. Suri , D. Joseph , G. Gopal Rao , A. McGregor

引用次数: 0

Potential use of Fourier-transform infrared spectroscopy as a rapid screening tool for investigating nosocomial outbreaks of ST-80 vancomycin-resistant Enterococcus faecium 傅立叶变换红外光谱法作为快速筛查工具用于调查 ST-80 耐万古霉素肠球菌爆发的可能性

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.10.005

R.C.W. Wong , I.Y.Y. Cheung , C.K.C. Lai , M.T. Yuk , V.C.Y. Chow , J.S.L. Leung , N.K. Chau , L.K. Konishi , L.K. Lee , I.C.F. Ng , W.Y. Tam , J.H.C. Tong , G.K.H. Siu

Background

Fourier-transform infrared (FT-IR) spectroscopy is a non-genomic, spectrum-based typing technology useful for characterizing outbreaks of multidrug-resistant organisms.

Aim

To assess the performance of FT-IR spectroscopy in characterizing ST-80 vancomycin-resistant Enterococcus faecium (VREf) isolates from a nosocomial outbreak.

Methods

Core-genome single-nucleotide polymorphism phylogeny was used as a reference method to characterize a nosocomial outbreak caused by ST-80 VREf. It identified 22 of 25 epidemiologically related isolates as belonging to an outbreak cluster.

Findings

The use of FT-IR spectroscopy with a cluster-defining cut-off of 0.071 resulted in the correct classification of 21 out of 22 phylogenetically related isolates in a single cluster. It successfully distinguished three phylogenetically unrelated isolates from the outbreak cluster, along with five ST-80-unrelated control isolates, and five isolates from a previous outbreak in May 2023, yielding only one mischaracterized environmental isolate.

Conclusion

These findings support the potential use of FT-IR spectroscopy as a rapid screening tool to assist outbreak investigations. Notably, this study is the first to focus on the performance of FT-IR spectroscopy in the epidemiological analysis of VREf isolates with the same sequence type.

核心基因组单核苷酸多态性系统进化被用于描述由 ST-80 耐万古霉素粪肠球菌（VREf）引起的院内疫情。它确定了 25 个流行病学相关分离物中的 22 个属于疫情集群。使用傅立叶变换红外光谱法（FT-IR），以 0.071 为簇定义临界值，结果正确地将 22 个系统发育相关的分离物中的 21 个归入一个簇。它成功地区分了疫情集群中三个系统发育不相关的分离物、五个 ST-80 不相关的对照分离物以及 2023 年 5 月以前疫情中的五个分离物，只产生了一个定性错误的环境分离物。这些研究结果支持将傅立叶变换红外光谱法作为一种快速筛选工具来协助疫情调查。值得注意的是，本研究首次重点研究了傅立叶变换红外光谱法在对具有相同序列类型的 VREf 分离物进行流行病学分析时的性能。

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引用次数: 0

Response to Kiernan et al.: is detergent-only cleaning paired with chlorine disinfection the best approach for cleaning? 对 Kiernan 等人的回应 - 仅用洗涤剂清洗并用氯消毒是否是最佳的清洗方法？

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.09.025

C. Boswell, J. Scott, L. Ritchie

引用次数: 0

Surgical site infection prevention care bundles in colorectal surgery: a scoping review 结直肠手术中的手术部位感染预防护理捆绑：范围界定综述。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.10.010

T. Cunha , S. Miguel , J. Maciel , C. Zagalo , P. Alves

Background

Surgical site infection (SSI) prevention bundles have been used to reduce infection rates in most types of surgery. Bundles tailored to colorectal surgery have been used with success.

Aim

To identify and review the individual interventions that constitute each SSI prevention care bundle in colorectal surgery, and the reduction in SSI rate associated with their implementation.

Methods

A scoping review was conducted in PubMed, CINAHL, Web of Science Core Collection and Scopus in December 2022.

Results

This review analysed 48 of 164 identified studies on SSI prevention in colorectal surgery from 2011 to 2022. It revealed an average of 11 interventions per study, primarily in the pre-operative [mechanical bowel preparation, oral antibiotic bowel decontamination, hair removal, chlorhexidine gluconate (CHG) shower, normoglycaemia], intra-operative (antibiotic prophylaxis, normothermia, CHG skin preparation, antibiotic prophylaxis re-dosing, gown/glove change) and postoperative (normothermia, normoglycaemia, dressing removal, oxygen optimization, incision cleansing) periods. Despite these interventions, SSI rates remain high, indicating a need for further research to optimize intervention bundles and improve compliance across surgical stages.

Conclusions

The implementation of SSI prevention bundles, tailored to colorectal surgery, has shown a reduction in SSI rates and costs. Grouping interventions according to the peri-operative phase may increase compliance.

背景：手术部位感染预防包已被用于降低大多数类型手术的感染率。目的：确定并回顾构成结直肠手术感染预防护理包的各项干预措施，以及与实施这些措施相关的手术部位感染率降低情况：方法：2022 年 12 月，在 PUBMED、CINAHL、Web of Science Core Collection 和 Scopus 数据库中进行了范围界定综述：本综述分析了 2011 年至 2022 年间 164 项已确定的结直肠手术中手术部位感染 (SSI) 预防研究中的 48 项。结果显示，每项研究平均采取了 11 项干预措施，主要涉及术前（机械肠道准备、口服抗生素肠道净化、脱毛、CHG 淋浴、正常血糖）、术中（抗生素预防、正常体温、CHG 皮肤准备、抗生素预防再用药、更换手术衣/手套）和术后阶段（正常体温、正常血糖、去除敷料、氧气优化、切口清洁）。尽管采取了这些干预措施，但 SSI 感染率仍然很高，这表明有必要进一步开展研究，优化干预措施捆绑，提高各手术阶段的依从性：结论：针对结直肠手术实施的手术部位感染预防捆绑措施已显示出手术部位感染率和成本的降低。根据围手术期进行分组干预可能有助于提高依从率。

{"title":"Surgical site infection prevention care bundles in colorectal surgery: a scoping review","authors":"T. Cunha , S. Miguel , J. Maciel , C. Zagalo , P. Alves","doi":"10.1016/j.jhin.2024.10.010","DOIUrl":"10.1016/j.jhin.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infection (SSI) prevention bundles have been used to reduce infection rates in most types of surgery. Bundles tailored to colorectal surgery have been used with success.</div></div><div><h3>Aim</h3><div>To identify and review the individual interventions that constitute each SSI prevention care bundle in colorectal surgery, and the reduction in SSI rate associated with their implementation.</div></div><div><h3>Methods</h3><div>A scoping review was conducted in PubMed, CINAHL, Web of Science Core Collection and Scopus in December 2022.</div></div><div><h3>Results</h3><div>This review analysed 48 of 164 identified studies on SSI prevention in colorectal surgery from 2011 to 2022. It revealed an average of 11 interventions per study, primarily in the pre-operative [mechanical bowel preparation, oral antibiotic bowel decontamination, hair removal, chlorhexidine gluconate (CHG) shower, normoglycaemia], intra-operative (antibiotic prophylaxis, normothermia, CHG skin preparation, antibiotic prophylaxis re-dosing, gown/glove change) and postoperative (normothermia, normoglycaemia, dressing removal, oxygen optimization, incision cleansing) periods. Despite these interventions, SSI rates remain high, indicating a need for further research to optimize intervention bundles and improve compliance across surgical stages.</div></div><div><h3>Conclusions</h3><div>The implementation of SSI prevention bundles, tailored to colorectal surgery, has shown a reduction in SSI rates and costs. Grouping interventions according to the peri-operative phase may increase compliance.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 221-230"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Disinfection effect of ozonated water on SARS-CoV-2 in the presence of salivary proteins 臭氧水在唾液蛋白存在的情况下对 SARS-CoV-2 的消毒效果。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.11.005

M. Yasugi , K. Gunji , K. Inagaki , M. Kuroda , C. Ii

Background

Ozonated water is expected to be an effective disinfectant for SARS-CoV-2 present on environmental fomites; however, ozone is consumed by organic substances, resulting in attenuation of its effect. SARS-CoV-2 present in saliva can contaminate environmental surfaces; therefore, it is essential to understand the effect of organic substances in saliva on the disinfectant properties of ozonated water.

Aim

To assess organic factors in saliva and the extent to which they diminish the effect of ozonated water on SARS-CoV-2.

Methods

Ozonated water was exposed to salivary organic factors and residual ozone concentrations were measured. SARS-CoV-2 was exposed to a salivary factor and virus inactivation by ozonated water was measured.

Findings

Amylase and mucin consumed ozone in a concentration-dependent manner. Urea did not. Ozonated water appeared to inactivate SARS-CoV-2 within 30 s. The amount of inactivated SARS-CoV-2 decreased as the protein concentration increased. Virus inactivation was stronger by 1.5 mg/L ozonated water than by 0.5 mg/L ozonated water.

Conclusion

This study suggests that the salivary amylase and mucin decay ozone in a concentration-dependent manner, thereby attenuating the disinfection properties of ozonated water for SARS-CoV-2. An increase of the initial amount of ozone can ameliorate the disinfection effect of ozonated water on SARS-CoV-2. Ozone consumption should be taken into consideration for virus infection control. These results provide fundamental information about the effect of ozonated water when used to decontaminate surfaces harbouring SARS-CoV-2 in saliva.

背景：臭氧水可对环境表面的 SARS-CoV-2 有效消毒，但臭氧会被有机物质消耗，导致其效果减弱。唾液中的 SARS-CoV-2 可污染环境表面；因此，了解唾液中的有机物质对臭氧水消毒特性的影响至关重要：方法：将臭氧水与唾液中的有机物接触，并测量臭氧的残留浓度。将 SARS-CoV-2 暴露于唾液因子，测量臭氧水对病毒的灭活作用：结果：淀粉酶和粘蛋白消耗臭氧的方式与浓度有关。尿素不消耗臭氧。臭氧水似乎能在 30 秒内灭活 SARS-CoV-2 病毒。灭活的 SARS-CoV-2 的数量随着蛋白质浓度的增加而减少。1.5 毫克/升臭氧水对病毒的灭活作用强于 0.5 毫克/升臭氧水：这项研究表明，唾液淀粉酶和粘蛋白对臭氧的衰减与浓度有关，从而削弱了臭氧水对 SARS-CoV-2 的消毒作用。增加初始臭氧量可改善臭氧水对 SARS-CoV-2 的消毒效果。在控制病毒感染时应考虑臭氧消耗量。这些结果为臭氧水用于净化唾液中携带 SARS-CoV-2 的表面提供了基本信息。

{"title":"Disinfection effect of ozonated water on SARS-CoV-2 in the presence of salivary proteins","authors":"M. Yasugi , K. Gunji , K. Inagaki , M. Kuroda , C. Ii","doi":"10.1016/j.jhin.2024.11.005","DOIUrl":"10.1016/j.jhin.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Ozonated water is expected to be an effective disinfectant for SARS-CoV-2 present on environmental fomites; however, ozone is consumed by organic substances, resulting in attenuation of its effect. SARS-CoV-2 present in saliva can contaminate environmental surfaces; therefore, it is essential to understand the effect of organic substances in saliva on the disinfectant properties of ozonated water.</div></div><div><h3>Aim</h3><div>To assess organic factors in saliva and the extent to which they diminish the effect of ozonated water on SARS-CoV-2.</div></div><div><h3>Methods</h3><div>Ozonated water was exposed to salivary organic factors and residual ozone concentrations were measured. SARS-CoV-2 was exposed to a salivary factor and virus inactivation by ozonated water was measured.</div></div><div><h3>Findings</h3><div>Amylase and mucin consumed ozone in a concentration-dependent manner. Urea did not. Ozonated water appeared to inactivate SARS-CoV-2 within 30 s. The amount of inactivated SARS-CoV-2 decreased as the protein concentration increased. Virus inactivation was stronger by 1.5 mg/L ozonated water than by 0.5 mg/L ozonated water.</div></div><div><h3>Conclusion</h3><div>This study suggests that the salivary amylase and mucin decay ozone in a concentration-dependent manner, thereby attenuating the disinfection properties of ozonated water for SARS-CoV-2. An increase of the initial amount of ozone can ameliorate the disinfection effect of ozonated water on SARS-CoV-2. Ozone consumption should be taken into consideration for virus infection control. These results provide fundamental information about the effect of ozonated water when used to decontaminate surfaces harbouring SARS-CoV-2 in saliva.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 209-215"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ventilation or aerosol extraction: comparing the efficacy of directional air purifiers, HEPA evacuators and negative-pressure environments 通风还是气溶胶抽吸？比较定向空气净化器、HEPA 抽风机和负压环境的功效。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-01-01 DOI: 10.1016/j.jhin.2024.11.008

T-Y. Hung , S-H. Yu , Y-C. Chen , Y-C. Su , H-L. Chen , B-H. Wu , S-C. Hu , T. Lin

Background

This study evaluated aerosol exposure during various respiratory activities (breathing, tachypnea, coughing, and oxygen therapy) in environments with directional air purifiers (DAPs), HEPA evacuators, and standard negative pressure (SNP) rooms to explore potential alternatives for addressing isolation room shortages.

Methods

Aerosol exposure was measured during various breathing conditions (normal, tachypnea, coughing, and recovery) with non-rebreather masks (NRMs) and nasal cannulas. The study analysed aerosol velocity and concentrations at the head, trunk and feet of a mannequin across settings including DAP, HEPA evacuator, SNP room, their combinations, and a reference group without intervention.

Findings

The DAP, HEPA evacuator and SNP environment all reduced aerosol build-up compared with the control group. The DAP and HEPA evacuator were consistently more effective than the SNP environment, especially during activities that increase expiratory flow. The HEPA evacuator showed higher aerosol concentrations at the head compared with the DAP when used with NRMs or nasal cannulas. Both the DAP and HEPA demonstrated better aerosol clearance than the SNP environment when minute ventilation exceeded 10 L/min.

Conclusions

DAP and HEPA evacuators provide effective aerosol reduction, suggesting their utility as alternatives to SNP isolation rooms during pandemics. While SNP environments continuously ventilate the space, DAP and HEPA evacuators are more efficient in early aerosol removal, preventing accumulation. However, aerosols dispersing in multiple directions during oxygen therapy can challenge the HEPA evacuator's single-point suction, unlike the broader coverage offered by the DAP.

背景：本研究评估了在使用定向空气净化器（DAP）、高效空气过滤器（HEPA）和标准负压室（SNP）的环境中进行各种呼吸活动（呼吸、呼吸急促、咳嗽和氧疗）时的气溶胶暴露情况，以探索解决隔离室短缺问题的潜在替代方法：使用非呼吸面罩（NRM）和鼻插管（NC）测量了各种呼吸条件（正常、呼吸急促、咳嗽和恢复）下的气溶胶暴露量。研究分析了人体模型头部、躯干和脚部在不同环境下的气溶胶速度和浓度，包括 DAP、HEPA 排气口、SNP 室、它们的组合以及无干预的参照组：与对照组相比，DAP、高效空气过滤器和 SNP 环境都减少了气溶胶的积聚。DAP 和 HEPA 抽风机始终比 SNP 环境更有效，尤其是在增加呼气流量的活动中。与 DAP 相比，在使用 NRM 或 NC 时，HEPA 抽风机在头部显示出更高的气溶胶浓度。当分钟通气量超过 10 升/分钟时，DAP 和 HEPA 的气溶胶清除率均高于 SNP 环境：结论：DAP 和 HEPA 排风器可有效减少气溶胶，这表明它们在大流行病期间可替代 SNP 隔离室。虽然 SNP 环境会持续对空间进行通风，但 DAP 和 HEPA 抽风机在早期清除气溶胶、防止气溶胶累积方面更为有效。不过，在氧疗过程中，气溶胶会向多个方向扩散，这对 HEPA 抽真空机的单点抽吸能力提出了挑战，而 DAP 的覆盖范围更广。

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