Microbial Contamination on Used Surgical Masks among Hospital Personnel and Microbial Air Quality in their Working Wards: A Hospital in Bangkok

Wearing face masks as a potential source for inhalation and oral uptake of inanimate toxins - A scoping review

BACKGROUND

From 2020 to 2023 many people around the world were forced to wear masks for large proportions of the day based on mandates and laws. We aimed to study the potential of face masks for the content and release of inanimate toxins.

METHODS

A scoping review of 1003 studies was performed (database search in PubMed/MEDLINE, qualitative and quantitative evaluation).

RESULTS

24 studies were included (experimental time 17 min to 15 days) evaluating content and/or release in 631 masks (273 surgical, 228 textile and 130 N95 masks). Most studies (63%) showed alarming results with high micro- and nanoplastics (MPs and NPs) release and exceedances could also be evidenced for volatile organic compounds (VOCs), xylene, acrolein, per-/polyfluoroalkyl substances (PFAS), phthalates (including di(2-ethylhexyl)-phthalate, DEHP) and for Pb, Cd, Co, Cu, Sb and TiO2.

DISCUSSION

Of course, masks filter larger dirt and plastic particles and fibers from the air we breathe and have specific indications, but according to our data they also carry risks. Depending on the application, a risk-benefit analysis is necessary.

CONCLUSION

Undoubtedly, mask mandates during the SARS-CoV-2 pandemic have been generating an additional source of potentially harmful exposition to toxins with health threatening and carcinogenic properties at population level with almost zero distance to the airways.

Visible-light photoactivated proanthocyanidin and kappa-carrageenan coating with anti-adhesive properties against clinically relevant bacteria

The increase of bacterial resistance to antibiotics is a growing concern worldwide and the search for new therapies could cost billions of dollars and countless lives. Inert surfaces are major sources of contamination due to easier adhesion and formation of bacterial biofilms, hindering the disinfection process. Therefore, the objective of this study was to develop a photoactivatable and anti-adhesive kappa-carrageenan coating using proanthocyanidin as a photosensitizer. The complete reduction (>5-log10 CFU/cm3) of culturable cells of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa pathogens was achieved after 30 min of exposure to visible light (420 nm; 30 mW/cm2) with 5 % (w/v) of the photosensitizer. Cell membrane damage was confirmed by measuring potassium leakage, epifluorescence microscopy and bacterial motility analysis. Overall, visible light irradiation on coated solid surfaces mediated by proanthocyanidin showed no cytotoxicity and inactivated clinically important pathogens through the generation of reactive oxygen species, inhibiting bacterial initial adhesion. The developed coating is a promising alternative for a wide range of applications related to surface disinfection and food biopreservation.

Dental aerosol-producing treatments: Comparison of contamination patterns of face shields and surgical masks

During the COVID-19 pandemic, dental face shields were recommended to protect the eyes. This study aimed to examine to what extent face shield and mask contamination differ when a pre-procedural mouth rinsing with Chlorhexidine (CHX) is conducted before treatment. In this prospective, randomized study, three groups of subjects were formed (rinsing with 0.1% CHX, water, or no rinsing (control) before aerosol-producing treatments). After each of the 301 treatments, the practitioner's face shield was swabbed with eSwab and the mask was brought into contact with agar plates. Sampling was done from the exterior surface only. Samples were cultured for 48 h at 35 °C under aerobic and anaerobic conditions. Bacteria were classified by phenotypic characteristics, biochemical test methods, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Colony-forming units were counted and mean values were compared (WSR, H-test, U-test, p < 0.05). Within each subject group, face shields showed significantly more contamination than surgical masks (control group: 350 CFU, 50 CFU; intervention water: 270 CFU, 40 CFU; intervention CHX: 250 CFU, 30 CFU). Comparison of face shields of the different subject groups did not reveal any statistically significant differences. However, CHX resulted in a statistically significant bacterial reduction on surgical masks compared to the water and control group (control: 50 CFU, intervention water: 40 CFU, intervention CHX: 30 CFU). Contamination of face shields and surgical masks was highest in the control group, followed by the water group, and lowest in the intervention group with CHX. Streptococcus spp. and Staphylococcus spp. dominated, representing the oral and cutaneous flora. Contamination of masks worn with or without face shields did not differ. Presumably, face shields intercept first splashes and droplets, while the masks were mainly exposed to bioaerosol mist. Consequently, face shields protect the facial region and surroundings from splashes and droplets, but not the mask itself. A pre-procedural mouth rinse with CHX had no statistically significant reducing effect on contamination of the face shield, but a statistically significant reducing effect was observed on contamination of the mask.

Indoor air bacterial load and antibiotic susceptibility pattern of isolates at Adare General Hospital in Hawassa, Ethiopia

Background

Air is the agent of pathogenic microbes that cause significant problems in the hospital environment. Multidrug resistance poses a major therapeutic challenge to these airborne microorganisms in hospital indoor environments.

Method and materials

This study was conducted at Adare General Hospital in Hawassa City, Sidama, Ethiopia. A cross-sectional study was conducted. The proportional allocation method was used to select the sampled 50 rooms from the total available rooms in each category of wards and staff offices. A total of 100 indoor air samples were collected using settle plates in all units twice a day, morning (9:00-4:00 a.m.) and afternoon (3:00-4:00 p.m.). The types and number of colonies were determined in the laboratory, and the pathogenic bacteria were isolated by appropriate bacteriological techniques. Antimicrobial susceptibility testing was performed on Mueller-Hinton agar for each potentially pathogenic bacterium isolated. For each bacterium, a total of 12 antibiotics were tested using the Kirby-Bauer disk diffusion method. The test organism was adjusted to McFarland turbidity standards of 0.5. Data were entered and analyzed using the SPSS version 25 window. Descriptive analysis and one-way analysis of variance were performed.

Results

The indoor air bacterial load of Adare General Hospital was found in the range between 210 and 3,224 CFU/m3. The highest indoor air bacterial load was identified from the gynecology ward with a mean of 2,542.5CFU/m3 at p < 0.05. From 100 indoor air samples, a total of 116 bacterial pathogen isolates were obtained. Gram-positive isolates predominated at 72.4%, of which 37.1% were Staphylococcus aureus, 26.7% were coagulase-negative Staphylococci, and the rest 8.6% were Streptococcus pyogenes. The isolation of pathogenic bacteria Staphylococcus aureus and coagulase-negative Staphylococci showed a high level of resistance to ampicillin.

Conclusion

A high bacterial load was found in the study area as compared to different indoor air biological standards. Staphylococcus aureus and coagulase-negative Staphylococci were the isolated predominant bacteria. Attention should be given to preventing and minimizing those environmental factors that favor the multiplication of bacteria in the indoor environment of a hospital for the safe health of patients, visitors, and staff.

Fungal contamination of medical masks among forensic healthcare workers in the COVID19 era

Background

Medical masks are widely used in health care settings to protect healthcare workers from respiratory infections, particularly in the context of the recent Covid-19 disease.

Methods

A cross-sectional study of 52 used masks collected from 52 forensic healthcare practitioners was conducted to culture for fungal isolation and identification. A study of fungal contamination was conducted by making an impression of the mouth mask cut piece on Sabouraud agar for selective isolation; each health worker completed a questionnaire, which included age, sex, type of mask, and duration of mask use.

Results

Twenty five of the 52 used masks tested positive for fungal contamination (48,08%). A total of 44% of the contaminated masks belong to health workers between the ages of 21-30 years. Surgical masks (80%), KN95 (8%), and N95 (4%) were the most contaminated protective devices. Usage duration of 1-2 h was associated with 4% of fungal contamination, while a usage duration of 5-6 h was associated with 36% of fungal contamination. Alternaria sp (32%), Penicillium sp (20%), Aspergillus sp (16%) were the most predominant isolated fungi discovered on the inside areas of the masks.

Conclusion

Because fungi are known to cause allergies and serious adverse health effects following recommendations to properly wear a medical mask is critical to preventing fungal contamination, especially among health care workers who are wearing the same mask for a long period during the pandemic.

The presence of COVID-19 face masks in the largest hypersaline lagoon of South America is predicted by urbanization level

The inadequate disposal of face masks has caused a widespread presence of COVID-19 litter in the environment. We monitored 10 beach arcs along approximately 15 km of the largest hypersaline lagoon of South America looking for face masks during the lockdown (2021) and in the "new normal" (2022) period. Our working hypothesis is that the probability of finding face masks increases with higher urbanization levels, which was estimated by the Human Modification Metric. Approximately 3 × 10^-3 face masks m^-2 were found on nine of 10 beaches (90 %) during the lockdown. However, this reduced to 1 × 10^-4 face masks m^-2 found in eight beaches (80 %) after the lockdown. The probability of finding a face mask was significantly higher as urbanization increased (z = 2.799; p = 0.005). This situation imposes the need for a better waste management and environmental education actions, targeting the reduction of direct littering on coastal ecosystem.

Bacterial contamination on used face masks among nursing home healthcare personnel

Objectives:

Since the beginning of the COVID-19 pandemic, face masks have been worn by many in public areas and for prolonged periods by healthcare workers (HCWs). This may facilitate bacterial contamination and transmission to and from patients in nursing homes where clinical care areas with strict precautions and residential and activity areas are interconnected. We assessed and compared bacterial mask colonization in HCWs belonging to different demographic categories and professions (clinical and nonclinical) and among HCWs who had worn the mask for different periods of time.

Design, setting and participants:

We conducted a point-prevalence study of 69 HCW masks at the end of a typical work shift in a 105-bed nursing home serving postacute care and rehabilitation patients. Information collected about the mask user included profession, age, sex, length of time the mask was worn, and known exposure to patients with colonization.

Results:

In total, 123 distinct bacterial isolates were recovered (1–5 isolates per mask), including Staphylococcus aureus from 11 masks (15.9%) and gram-negative bacteria of clinical importance from 22 masks (31.9%). Antibiotic resistance rates were low. There were no significant differences in the number of clinically important bacteria among masks worn more or less than 6 hours, and there were no significant differences among HCWs with different job functions or exposure to colonized patients.

Conclusions:

Bacterial mask contamination was not associated with HCW profession or exposure and did not increase after 6 hours of mask wearing in our nursing home setting. Bacteria contaminating HCW masks may differ from those colonizing patients.

Unraveling the potential human health risks from used disposable face mask-derived micro/nanoplastics during the COVID-19 pandemic scenario: A critical review

With the global spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), disposable face masks (DFMs) have caused negative environmental impacts. DFMs will release microplastics (MPs) and nanoplastics (NPs) during environmental degradation. However, few studies reveal the release process of MPs/NPs from masks in the natural environment. This review presents the current knowledge on the abiotic and biotic degradation of DFMs. Though MPs and NPs have raised serious concerns about their potentially detrimental effects on human health, little attention was paid to their impacts on human health from DFM-derived MPs and NPs. The potential toxicity of mask-derived MPs/NPs, such as gastrointestinal toxicity, pneumotoxicity, neurotoxicity, hepatotoxicity, reproductive and transgenerational toxicity, and the underlying mechanism will be discussed in the present study. MPs/NPs serve as carriers of toxic chemicals and pathogens, leading to their bioaccumulation and adverse effects of biomagnification by food chains. Given human experiments are facing ethical issues and animal studies cannot completely reveal human characteristics, advanced human organoids will provide promising models for MP/NP risk assessment. Moreover, in-depth investigations are required to identify the release of MPs/NPs from discarded face masks and characterize their transportation through the food chains. More importantly, innovative approaches and eco-friendly strategies are urgently demanded to reduce DFM-derived MP/NP pollution.

Single-Side Superhydrophobicity in Si3N4-Doped and SiO2-Treated Polypropylene Nonwoven Webs with Antibacterial Activity

Meltblown (MB) nonwovens as air filter materials have played an important role in protecting people from microbe infection in the COVID-19 pandemic. As the pandemic enters the third year in this current global event, it becomes more and more beneficial to develop more functional MB nonwovens with special surface selectivity as well as antibacterial activities. In this article, an antibacterial polypropylene MB nonwoven doped with nano silicon nitride (Si₃N₄), one of ceramic materials, was developed. With the introduction of Si₃N₄, both the average diameter of the fibers and the pore diameter and porosity of the nonwovens can be tailored. Moreover, the nonwovens having a single-side moisture transportation, which would be more comfortable in use for respirators or masks, was designed by imparting a hydrophobicity gradient through the single-side superhydrophobic finishing of reactive organic/inorganic silicon coprecipitation in situ. After a nano/micro structural SiO₂ precipitation on one side of the fabric surfaces, the contact angles were up to 161.7° from 141.0° originally. The nonwovens were evaluated on antibacterial activity, the result of which indicated that they had a high antibacterial activity when the dosage of Si₃N₄ was 0.6 wt%. The bacteriostatic rate against E. coli and S. aureus was up to over 96%. Due to the nontoxicity and excellent antibacterial activity of Si₃N₄, this MB nonwovens are promising as a high-efficiency air filter material, particularly during the pandemic.

CHX and a Face Shield Cannot Prevent Contamination of Surgical Masks

Background

Bacterial contamination on surgical masks puts a threat to medical staff and patients. The aim of the study was to investigate its contamination during dental treatments, wearing a face shield and performing a pre-procedural mouth rinsing with chlorhexidine (CHX).

Methods

In this prospective, randomized study, 306 treatments were included, 141 single-tooth (restorations) and 165 total dentition treatments (preventive or periodontal supportive ultrasonic application). A total of three groups (each: n = 102) were formed: participants rinsed for 60 s with 0.1 % CHX or with water before treatment, and, for control, a non-rinsing group was included. In view of the COVID-19 pandemic, a face shield covering the surgical mask enhanced personal protective equipment. After treatment, masks were imprinted on agar plates and incubated at 35°C for 48 h. Bacteria were classified by phenotypic characteristics, biochemical assay methods, and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). Colonies (CFU) were counted and mean values were compared (Kruskal–Wallis-, U test, p < 0.05).

Results

Chlorhexidine led to a statistically significant reduction of bacterial contamination of the surgical mask (mean: 24 CFU) in comparison with water (mean: 47 CFU) and non-rinsing (mean: 80 CFU). Furthermore, rinsing with water reduced CFU significantly in comparison with the non-rinsing group. There were no significant differences between single or total dentition treatments. Streptococcus spp., Staphylococcus spp., Micrococcus spp., and Bacillus spp. dominated, representing the oral and cutaneous flora.

Conclusion

A pre-procedural mouth rinse is useful to reduce the bacterial load of the surgical mask. However, contamination cannot be prevented completely, even by applying a face shield. In particular, during pandemic, it is important to consider that these additional protective measures are not able to completely avoid the transmission of pathogens bearing aerosols to the facial region. If antiseptic rinsing solutions are not available, rinsing with water is also useful.

Data on antibiotic resistance among indoor microbiome at Meerut, India

Microbial dynamics of the domestic environment and their antibiotic-resistant properties have been poorly characterized. We surveyed the microbial community and their antibiotic profiling located in the rural and urban areas of Meerut city, Uttar Pradesh, India. Results show that bacterial community load across all samples had more than 100-fold higher than fungal community (all p<0.05.). Based on population load, the kitchen of both rural (Fungal: 4.16±1.81 vs Bacteria: 160.5±27.13) and urban areas (Fungal: 6.2±1.02 vs Bacteria: 205.46±30.9) were more contaminated than living rooms (rural area-Fungal: 2.13±0.74 vs Bacteria: 62.17±20.68 and urban area- Fungal: 4.75±1.68 vs Bacteria: 74.88±7.53). Six bacteria, namely Pseudomonas sps; Citrobacter sps; Bacillus Subtilis; Brevundimonas diminuta; Bacillus megaterium; and Klebsiella pneumonia, showed dominance on all other bacterial and fungal sp hence, only these six bacteria were subjected to antibiotic sensitivity test (AST). In AST, Klebsiella pneumoniae, Bacillus Subtilis, Bacillus megaterium, were resistant to more than three antibiotics. The most sensitive strain for Ciprofloxacin, Streptomycin was Citrobacter sp. However, Pseudomonas sp was found sensitive only to Amoxillin. Brevundimonas diminuta is found most sensitive to all antibiotics. Plasmid profiling of selected bacteria suggests that antibiotic resistance properties arose from plasmids, not genomic ones. These findings give new insights into the local-scale distribution of MDR bacteria in a household environment.

Effect of five decontamination methods on face masks and filtering facepiece respirators contaminated with Staphylococcus aureus and Pseudomonas aeruginosa

Introduction. In the context of the global pandemic due to SARS-CoV-2, procurement of personal protective equipment during the crisis was problematic. The idea of reusing and decontaminating personal surgical masks in facilities was explored in order to avoid the accumulation of waste and overcome the lack of equipment.

Hypothesis. Our hypothesis is that this work will show the decontamination methods assessed are effective for bacteria, such as Staphylococcus aureus and Pseudomonas aeruginosa .

Aim. We aim to provide information about the effects of five decontamination procedures (UV treatment, dry heat, vaporized H2O2, ethanol treatment and blue methylene treatment) on S. aureus and P. aeruginosa . These bacteria are the main secondary bacterial pathogens responsible for lung infections in the hospital environment.

Methodology. The surgical masks and the filtering facepiece respirators were inoculated with two bacterial strains ( S. aureus ATCC 29213 and P. aeruginosa S0599) and submitted to five decontamination treatments: vaporized H2O2 (VHP), UV irradiation, dry heat treatment, ethanol bath treatment and blue methylene treatment. Direct and indirect microbiology assessments were performed on three positive controls, five treated masks and one negative control.

Results. The five decontaminations showed significant (P<0.05) but different degrees of reductions of S. aureus and P. aeruginosa . VHP, dry heat treatment and ethanol treatment adequately reduced the initial contamination. The 4 min UV treatment allowed only a reduction to five orders of magnitude for face mask respirators. The methylene blue treatment induced a reduction to two orders of magnitude.

Conclusions. The three methods that showed a log10 reduction factor of 6 were the dry heat method, VHP and ethanol bath treatment. These methods are effective and their establishment in the medical field are easy but require economic investment.

Liquid-Immersion Reprocessing Effects on Filtration Efficiency of 'Single-Use' Commercial Medical Face Masks

PURPOSE

Medical masks have inferior filtration efficiency and fit to filtering facepiece respirators (FFRs) but are widely used in healthcare and the community. These masks are intended for disposal after use but in the event of mask shortage re-use after reprocessing may be an option. We investigated eight reprocessing methods that each involved washing or soaking in liquid, are likely to eliminate respiratory viruses, and are safe and available in most community and healthcare settings.

METHODS

Three brands of EN 14683 standards-compliant commercial medical mask were each reprocessed 10 times by one of eight methods. We measured filtration efficiency for poly-dispersed sodium chloride particles and pressure differential.

RESULTS

Compared with new medical masks, reprocessed masks had significantly reduced filtration efficiency. The reduction was mild-moderate (6.5-25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1-51.5%) after detergent, soap or laundry machine wash, or bleach soak. There were mixed and minor changes in pressure differential. Most reprocessed standards-compliant masks had better filtration efficiency than new non-standard commercial masks and then cotton and cotton-polyester mix fabric samples, even triple-layered fabrics.

CONCLUSIONS

High-quality commercial medical masks reprocessed 10 times by water immersion methods had better filtration efficiency than new non-standard masks and washable fabrics. These findings have particular relevance for community and low-resource healthcare settings.

Exposure and Health Effects of Bacteria in Healthcare Units: An Overview

Healthcare units consist of numerous people circulating daily, such as workers, patients, and companions, and these people are vehicles for the transmission of microorganisms, such as bacteria. Bacteria species may have different allergenic, pathogenic, infectious, or toxic properties that can affect humans. Hospital settings foment the proliferation of bacteria due to characteristics present in the indoor hospital environment. This review article aims to identify the potential health effects caused by bacterial contamination in the context of healthcare units, both in patients and in workers. A search was carried out for articles published in PubMed, Web of Science and Scopus, between 1 January 2000 and 31 October 2021, using the descriptor hospital exposure assessment bacteria. This bibliographic research found a total of 13 articles. Bacteria transmission occurs mainly due to the contact between healthcare workers and patients or through the handling of/contact with contaminated instruments or surfaces. The most common bacterial contaminants are Escherichia coli, Pseudomonas aeruginosa, Staphylococcus spp., Staphylococcus aureus and Micrococcus luteus, and the principal health effects of these contaminants are hospital-acquired infections and infections in immunocompromised people. A tight control of the disinfection methods is thus required, and its frequency must be increased to remove the microbial contamination of wards, surfaces and equipment. A better understanding of seasonal variations is important to prevent peaks of contamination.

Implications of COVID-19 pandemic on environmental compartments: Is plastic pollution a major issue?

The COVID-19 anthropause has impacted human activities and behaviour, resulting in substantial environmental and ecological changes. It has assisted in restoring the ecological systems by improving, for instance, air and water quality and decreasing the anthropogenic pressure on wildlife and natural environments. Notwithstanding, such improvements recessed back, even to a greater extent, when considering increased medical waste, hazardous disinfectants and other chemical compounds, and plastic waste disposal or mismanagement. This work critically reviews the short- and long-term implications of measures against COVID-19 spreading, namely on human activities and different environmental compartments. Furthermore, this paper highlights strategies towards environmental restoration, as the recovery of the lost environment during COVID-19 lockdown suggests that the environmental degradation caused by humans can be reversible. Thus, we can no longer delay concerted international actions to address biodiversity, sustainable development, and health emergencies to ensure environmental resilience and equitable recovery.

Reuse of medical face masks in domestic and community settings without sacrificing safety: Ecological and economical lessons from the Covid-19 pandemic

The need for personal protective equipment increased exponentially in response to the Covid-19 pandemic. To cope with the mask shortage during springtime 2020, a French consortium was created to find ways to reuse medical and respiratory masks in healthcare departments. The consortium addressed the complex context of the balance between cleaning medical masks in a way that maintains their safety and functionality for reuse, with the environmental advantage to manage medical disposable waste despite the current mask designation as single-use by the regulatory frameworks. We report a Workflow that provides a quantitative basis to determine the safety and efficacy of a medical mask that is decontaminated for reuse. The type IIR polypropylene medical masks can be washed up to 10 times, washed 5 times and autoclaved 5 times, or washed then sterilized with radiations or ethylene oxide, without any degradation of their filtration or breathability properties. There is loss of the anti-projection properties. The Workflow rendered the medical masks to comply to the AFNOR S76-001 standard as "type 1 non-sanitory usage masks". This qualification gives a legal status to the Workflow-treated masks and allows recommendation for the reuse of washed medical masks by the general population, with the significant public health advantage of providing better protection than cloth-tissue masks. Additionally, such a legal status provides a basis to perform a clinical trial to test the masks in real conditions, with full compliance with EN 14683 norm, for collective reuse. The rational reuse of medical mask and their end-of-life management is critical, particularly in pandemic periods when decisive turns can be taken. The reuse of masks in the general population, in industries, or in hospitals (but not for surgery) has significant advantages for the management of waste without degrading the safety of individuals wearing reused masks.

Multifunctional filter membrane for face mask using bacterial cellulose for highly efficient particulate matter removal

ABSTRACT

Particulate matter (PM) pollution and SARS-CoV-2 (COVID-19) have brought severe threats to public health. High level of PM serves as a carrier of COVID-19 which is a global pandemic. This study fabricated filter membrane for face mask using bacterial cellulose and fingerroot extract (BC-FT) via immersion technique. The surface area, pore volume and pore size of BC were analyzed by Brunauer-Emmett-Teller. The physiochemical properties of the membrane were analyzed by scanning electron microscopy, Fourier transform infrared spectroscopy and X-ray diffractometer. The crystallinity decreased from 63.7% in pure BC to 52.4% in BC-FT filter membrane. Young's modulus increased from 1277.02 MPa in pure BC to 2251.17 MPa in BC-FT filter membrane. The filter membrane showed excellent PM 0.1 removal efficiency of 99.83% and antimicrobial activity against Staphylococcus aureus and Escherichia coli. The fabricated membrane is excellent to prevent inhalation of PM2.5 and COVID-19 respiratory droplet.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10570-022-04641-3.

An urgent call to think globally and act locally on landfill disposable plastics under and after covid-19 pandemic: Pollution prevention and technological (Bio) remediation solutions

Landfilling and illegal waste disposal have risen to deal with the COVID-19 potentially infectious waste, particularly in developing countries, which aggravates plastic pollution and inherent environmental threats to human and animal health. It is estimated that 3.5 million metric tonnes of masks (equivalent to 601 TIR containers) have been landfilled worldwide in the first year, with the potential to increase global plastic municipal solid waste by 3.5%, alter biogas composition, and release 2.3 × 10²¹ microplastics to leachates or adjacent environments, in the coming years. This paper reviews the challenges raised in the pandemic scenario on landfills and discusses the potential environmental and health implications that might drive us apart from the 2030 U.N. sustainable goals. Also, it highlights some innovative technologies to improve waste management (from collection to disposal, waste reduction, sterilization) and mitigates plastic leakage (emission control approaches, application of biotechnological and monitoring/computational tools) that can pave the way to environmental recovery. COVID-19 will eventually subside, but if no action is taken in the short-term towards effective plastic policies, replacement of plastics for sustainable alternatives (e.g., biobased plastics), improvement of waste management streams (prioritising flexible and decentralized approaches), and a greater awareness and responsibility of the general public, stakeholders, industries; we will soon reach a tipping-point in natural environments worldwide.

FACE MASK CONTAMINATION DURING COVID-19 PANDEMIA. A STUDY ON PATIENTS RECEIVING INTRAVITREAL INJECTIONS

PURPOSE

To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks.

METHODS

Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples.

RESULTS

The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/μL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44).

CONCLUSION

Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.

Risks of Covid-19 face masks to wildlife: Present and future research needs

The use of disposable face masks became essential to fight against the COVID-19 pandemic, resulting in an unprecedented rise in their production and, unfortunately, to a new form of environmental contamination due to improper disposal. Recent publications reported the abundance of COVID-19-related litter in several environments, wildlife interaction with such items, and the contaminants that can be released from such protective equipment that has the potential to induce ecotoxicological effects. This paper provides a critical review of COVID-19 face mask occurrence in diverse environments and their adverse physiological and ecotoxicological effects on wildlife. It also outlines potential remediation strategies to mitigate the environmental challenge impose by COVID-19-related litter.

Role of Candida glabrata as nosocomial pathogen and its susceptibility to Fluconazole, Voriconazole, Caspofungin, Micafungin and Amphotericin B

Candida has different types that could cause bloodstream infections. A total number of 150 samples were collected from candidemia patients and examined. The Candida spp. Species isolated from blood samples were analysed. These were identified by culturing the species using different media, namely the chromogenic agar test. Then, the virulence factors of all samples were tested. The Candida glabrata isolates were tested with six commercial antifungal drugs. C. glabrata 67 (44.6%), C. albicans 34 (22.6%), C. krusei 18 (12%), C. tropicalis 17 (11.3%), and C. parasilosis 14 (9.3%). the production of phospholipase ranged between 0.63-0.99 mm. It was found that 96% of the species showed phospholipase activity in aerobic conditions. The protease activities of Candida spp. Isolates were experimentally tested by area of inhibition around the colonies, where 59.3% had the double (++) protease activity, 31.4% with (+) grade, and 9.3% had (–) grade or clear zone around the colony. The hemolytic capacity ranged from 0.69-0.89 in the optimum aerobic environments. Finally, 38.33% of the isolated Candida spp. were positive and 61.67% negative for biofilm formation. Out of the total positive Candida spp. for biofilm formation, 21.73% were strong biofilm producers, and 78.27% were weak. Minimum fungicidal concentration (MFC) of Fluconazole for C. glabrata isolates was not appropriate (NA) due to the occurrence of low inhibition tested for species. Micafungin exhibited the lowest fungicidal activity against C. glabrata ranging from 0.03 - 0.125, while Fluconazole showed the highest.

How safe are gloves and masks used for protection against Legionella longbeachae infection when gardening?

Legionella longbeachae has been frequently identified in composted plant material and can cause Legionnaires' disease (LD). We wanted to determine how frequently L. longbeachae DNA was present on gardeners' gloves, and how long L. longbeachae could persist on inoculated gloves and masks. Volunteers completed a survey of gardening practices and their gardening gloves were tested for L. longbeachae DNA by qPCR. The persistence of viable L. longbeachae was assessed by timed subcultures after inoculation of gardening gloves and masks. Gloves but not masks were used regularly. L. longbeachae was detected on 11 (14%; 95% CI 8-24%) gloves. Viable organisms were recovered from 25-50% of inoculated cotton, leather and PU coated gloves but not rubber gloves after 8 h incubation. There was a difference in dose-response curve slopes by glove material (P = 0·001) and time to 50% sterility (P = 0·036). There were differences in persistence of L. longbeachae between mask types from analysis of the slopes and 50% sterility on the decay curves (P = 0·042, P < 0·001 respectively). Gardening gloves and masks may act as a vector for transmission of L. longbeachae during gardening. Washing gardening gloves and prompt disposal of masks could reduce risk of LD.

Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?

Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.

Salt coatings functionalize inert membranes into high-performing filters against infectious respiratory diseases

Respiratory protection is key in infection prevention of airborne diseases, as highlighted by the COVID-19 pandemic for instance. Conventional technologies have several drawbacks (i.e., cross-infection risk, filtration efficiency improvements limited by difficulty in breathing, and no safe reusability), which have yet to be addressed in a single device. Here, we report the development of a filter overcoming the major technical challenges of respiratory protective devices. Large-pore membranes, offering high breathability but low bacteria capture, were functionalized to have a uniform salt layer on the fibers. The salt-functionalized membranes achieved high filtration efficiency as opposed to the bare membrane, with differences of up to 48%, while maintaining high breathability (> 60% increase compared to commercial surgical masks even for the thickest salt filters tested). The salt-functionalized filters quickly killed Gram-positive and Gram-negative bacteria aerosols in vitro, with CFU reductions observed as early as within 5 min, and in vivo by causing structural damage due to salt recrystallization. The salt coatings retained the pathogen inactivation capability at harsh environmental conditions (37 °C and a relative humidity of 70%, 80% and 90%). Combination of these properties in one filter will lead to the production of an effective device, comprehensibly mitigating infection transmission globally.

Is safeguard compromised? Surgical mouth mask harboring hazardous microorganisms in dental practice

Context:

Dental personals are more prone to acquire infections through saliva and aerosols. Surgical masks (SMs) are used by dental professionals to reduce microorganism shedding from the mouth, nose, and face of the patient.

Aims:

This aim of the study is to assess the bacterial and fungal presence and their prevalence over the contaminated surgical mask in dental practice.

Settings and Design:

This study was conducted with sample size 240 used surgical masks collected from 130 dental personnel.

Subjects and Methods:

A cross-sectional questionnaire survey was conducted with analysis involved inoculation of external and internal surfaces in an enrichment media for isolation of bacteria and fungi. Group of isolated bacteria and fungi were preliminarily identified by morphology and using Gram's stain and lacto-phenol cotton blue mediums. Data were analyzed using paired t-test; the significant level of P < 0.050.

Results:

Microbiological analysis of samples revealed bacteria Staphylococci 26.35% as a predominant species followed by Pseudomonas 17.82% and Streptococci 15.50%. Aspergillus fungal species was also present in 6.97%. Mean ± SD of bacterial and fungal contamination on inside/outside area of the used masks was 48 ± 26 and 180 ± 110 cfu/ml/piece and 14 ± 6 and 32 ± 13 cfu/ml/piece, respectively, P < 0.001. The used surgical masks from dental department personnel working outpatient dental department had relatively higher bacterial and fungal contamination than the other dental departments.

Conclusions:

To reduce a load of microorganism contamination in the clinical environment, more awareness campaigns should be implemented in daily routine and air quality of dental departments should be improved with necessary protective measures.

Assessment of Airborne Bacterial and Fungal Communities in Selected Areas of Teaching Hospital, Kandy, Sri Lanka

Nosocomial infections, in lay term known as hospital acquired infections, are caused mainly by airborne pathogens found in healthcare facilities and their surroundings. The aim of this study was to quantify and identify bacteria and fungi in a hospital, which is an understudied area of air quality in Sri Lanka. Air samples were collected in agar medium and petri plates containing sterile filter papers. The number of culturable and total airborne microorganisms was estimated by manual counting and fluorescent microscopy, respectively. The morphologically distant bacteria and fungi were identified by DNA sequencing. The statistical analysis revealed significant variances between studied sites (p < 0.05) where Outpatients Department and Respiratory Unit showed higher levels of airborne microbial load. Culturable microbial count was higher at noon (hospital visiting hours) compared to other sampling periods (after hospital visiting hours) within the hospital. Total count of airborne microbes was found to be the highest during the afternoon. The most sensitive zones such as Operating Theatre and Intensive Care Unit showed considerably higher counts of airborne microbes. Identification by molecular means revealed the presence of human pathogens in the hospital air including Bacillus sp, Micrococcus sp, Pseudomonas sp, Staphylococcu ssp, Exiguobacterium sp, Enterobacter sp, Escherichia sp, Sphingomonas sp, Massilia sp, Kocuria sp, Fusarium sp, and Aspergillus sp. In conclusion, the results from this study indicate that the hospital air was generally contaminated. Therefore, the implementation of proactive policies and strategies are needed to monitor hospital air quality in sensitive zones as well as other areas of the hospitals.

Assessment of bioaerosols in tuberculosis high-risk areas of health care facilities in central Thailand

Background

Long-term surveillance of airborne bioaerosols in health care facilities is required to protect the health of patients and health care workers. Feasible methods to measure airborne bioaerosol concentrations and determine associated environmental factors may help to avoid nosocomial tuberculosis (TB).

Objectives

To describe the concentrations and size of airborne bioaerosols and to identify the potential contributors to indoor airborne bioaerosols in TB high-risk areas in health care facilities.

Methods

We conducted a cross-sectional study in 7 large health care facilities located in Bangkok and nearby in central Thailand using a 6-stage Andersen cascade impactor to collect viable airborne bioaerosols that were quantified using culture techniques. Environmental parameters were determined using a tracer gas technique with an indoor air quality meter. Other potential factors were assessed using a questionnaire.

Results

The mean indoor airborne bacterial and fungal concentrations were 596.1 and 521.2 colony-forming units (cfu)/m3, respectively, and the mean outdoor airborne bacterial and fungal concentrations were 496.5 and 650.1 cfu/m3, respectively. The majority of airborne bioaerosols were in respirable sizes. The indoor-to-outdoor ratios were 1.2 for bacteria and 0.8 for fungi. Air change rate was inversely correlated with indoor airborne bioaerosol concentrations, whereas emergency department central-type air conditioners and relative humidity were positively correlated with the indoor airborne bioaerosol concentrations (P < 0.05).

Conclusions

High indoor bioaerosol concentrations found in the health care facilities suggest that it is imperative to improve the indoor air quality. Improved air change rate and avoiding use of central-type air-conditioning systems may reduce bioaerosol concentrations.

Assessment of environmental and surgical mask contamination at a student health center - 2012-2013 influenza season

Increased understanding of influenza transmission is critical for pandemic planning and selecting appropriate controls for healthcare personnel safety and health. The goals of this pilot study were to assess environmental contamination in different areas and at two time periods in the influenza season and to determine the feasibility of using surgical mask contamination to evaluate potential exposure to influenza virus. Bioaerosol samples were collected over 12 days (two 6-day sessions) at 12 locations within a student health center using portable two-stage bioaerosol samplers operating 8 hr each day. Surface samples were collected each morning and afternoon from common high-contact non-porous hard surfaces from rooms and locations where bioaerosol samplers were located. Surgical masks worn by participants while in contact with patients with influenza-like illness were collected. A questionnaire administered to each of the 12 participants at the end of each workday and another at the end of each workweek assessed influenza-like illness symptoms, estimated the number of influenza-like illness patient contacts, hand hygiene, and surgical mask usage. All samples were analyzed using qPCR. Over the 12 days of the study, three of the 127 (2.4%) bioaerosol samples, 2 of 483 (0.41%) surface samples, and 0 of 54 surgical masks were positive for influenza virus. For the duration of contact that occurred with an influenza patient on any of the 12 days, nurse practitioners and physicians reported contacts with influenza-like illness patients >60 min, medical assistants reported 15-44 min, and administrative staff reported <30 min. Given the limited number of bioaerosol and surface samples positive for influenza virus in the bioaerosol and surface samples, the absence of influenza virus on the surgical masks provides inconclusive evidence for the potential to use surgical masks to assess exposure to influenza viruses. Further studies are needed to determine feasibility of this approach in assessing healthcare personnel exposures. Information learned in this study can inform future field studies on influenza transmission.

Healthcare personnel exposure in an emergency department during influenza season

Introduction

Healthcare personnel are at high risk for exposure to influenza by direct and indirect contact, droplets and aerosols, and by aerosol generating procedures. Information on air and surface influenza contamination is needed to assist in developing guidance for proper prevention and control strategies. To understand the vulnerabilities of healthcare personnel, we measured influenza in the breathing zone of healthcare personnel, in air and on surfaces within a healthcare setting, and on filtering facepiece respirators worn by healthcare personnel when conducting patient care.

Methods

Thirty participants were recruited from an adult emergency department during the 2015 influenza season. Participants wore personal bioaerosol samplers for six hours of their work shift, submitted used filtering facepiece respirators and medical masks and completed questionnaires to assess frequency and types of interactions with potentially infected patients. Room air samples were collected using bioaerosol samplers, and surface swabs were collected from high-contact surfaces within the adult emergency department. Personal and room bioaerosol samples, surface swabs, and filtering facepiece respirators were analyzed for influenza A by polymerase chain reaction.

Results

Influenza was identified in 42% (53/125) of personal bioaerosol samples, 43% (28/ 96) of room bioaerosol samples, 76% (23/30) of pooled surface samples, and 25% (3/12) of the filtering facepiece respirators analyzed. Influenza copy numbers were greater in personal bioaerosol samples (17 to 631 copies) compared to room bioaerosol samples (16 to 323 copies). Regression analysis suggested that the amount of influenza in personal samples was approximately 2.3 times the amount in room samples (Wald χ2 = 16.21, p<0.001).

Conclusions

Healthcare personnel may encounter increased concentrations of influenza virus when in close proximity to patients. Occupations that require contact with patients are at an increased risk for influenza exposure, which may occur throughout the influenza season. Filtering facepiece respirators may become contaminated with influenza when used during patient care.

The tuberculocidal activity of polyaniline and functionalised polyanilines

Tuberculosis is considered a leading cause of death worldwide. More than 95% of cases and deaths occur in low- and middle-income countries. In resource-limited countries, hospitals often lack adequate facilities to manage and isolate patients with infectious tuberculosis (TB), relying instead on personal protective equipment, such as facemasks, to reduce nosocomial transmission of the disease. Facemasks impregnated with an antimicrobial agent may be a cost-effective way of adding an extra level of protection against the spread of TB by reducing the risk of disease transmission. Conducting polymers, such as polyaniline (PANI), and their functionalised derivatives are a novel class of antimicrobial agents with potential as non-leaching additives to provide contamination resistant surfaces. We have investigated the antimicrobial action of PANI and a functionalised derivative, poly-3-aminobenzoic acid (P3ABA), against mycobacteria and have determined the optimal treatment time and concentration to achieve significant knockdown of Mycobacterium smegmatis and Mycobacterium tuberculosis on an agar surface. Results indicated that P3ABA is a potential candidate for use as an anti-tuberculoid agent in facemasks to reduce TB transmission.

Microbial air quality and bacterial surface contamination in ambulances during patient services

OBJECTIVES

We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service.

METHODS

We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson's correlation coefficient with a p-value of less than 0.050 considered significant.

RESULTS

The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m(3) and 522±581cfu/m(3), respectively. Bacterial counts during patient services were 468±607cfu/m(3) and fungal counts were 656±612cfu/m(3). Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm(2) and 1.3±1.1cfu/cm(2), respectively (p<0.001). The predominant isolated bacteria and fungi were Staphylococcus spp. and Aspergillus spp., respectively. Additionally, there was a significantly positive correlation between bacterial (r=0.3, p<0.010) and fungal counts (r=0.2, p=0.020) in air samples and bacterial counts on medical instruments and allocated areas.

CONCLUSIONS

This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs. Additionally, bacterial and fungal counts in ambulance air showed a significantly positive correlation with the bacterial surface contamination on medical instruments and allocated areas. Further studies should be conducted to determine the optimal intervention to reduce microbial contamination in the ambulance environment.