Aerosol and surface contamination assessment of a novel ventilated infectious aerosol containment device

Healthcare personnels (HCPs) are at risk of respiratory infectious diseases during patient care activities. HCPs rely primarily on personal protective equipment to prevent pathogen exposures, but there is a need to develop alternative, or complementary control strategies, including engineering controls. The objective of this study was to evaluate the ability of the 3 designs (denoted D1A, D1B, and D2) of the University of Utah Containment Ventilation for Exposure Reduction (U-COVER), a protective barrier enclosure device to contain respirable aerosols when placed over a simulated patient. The 2 primary performance metrics were the percent reduction in: (i) the concentration of respirable aerosols in the simulated breathing zone of an HCP, and (ii) surface contamination outside the device, which were tested using salt aerosols and fluorescein aerosols, respectively. Briefly, salt or fluorescein aerosols were generated as though expelled by a prone patient under 3 conditions: (i) no device (control), (ii) with the device but without exhaust ventilation, and (iii) with the device with exhaust ventilation. Device D2 was also tested under simulated use conditions, in which cardboard "arms" were placed inside the device ports. All 3 device designs showed the ability to reduce particle concentrations in the simulated HCP breathing zone and on surfaces by >99% with exhaust ventilation compared to the control condition. Without exhaust ventilation, device performance was lower and highly variable. Under simulated use conditions, device D2 reduced particle concentrations in the simulated HCP breathing zone by ≥91% and on surfaces by >99% relative to control for all combinations of "arms" tested. The U-COVER device demonstrates excellent aerosol containment and warrants further testing with dynamic simulated or actual use conditions.

Aerosol Measurement Degradation in Low-Cost Particle Sensors Using Laboratory Calibration and Field Validation

Increasing concern over air pollution has led to the development of low-cost sensors suitable for wide-scale deployment and use by citizen scientists. This project investigated the AirU low-cost particle sensor using two methods: (1) a comparison of pre- and post-deployment calibration equations for 24 devices following use in a field study, and (2) an in-home comparison between 3 AirUs and a reference instrument, the GRIMM 1.109. While differences (and therefore some sensor degradation) were found in the pre- and post-calibration equation comparison, absolute value changes were small and unlikely to affect the quality of results. Comparison tests found that while the AirU did tend to underestimate minimum and overestimate maximum concentrations of particulate matter, ~88% of results fell within ±1 μg/m³ of the GRIMM. While these tests confirm that low-cost sensors such as the AirU do experience some sensor degradation over multiple months of use, they remain a valuable tool for exposure assessment studies. Further work is needed to examine AirU performance in different environments for a comprehensive survey of capability, as well as to determine the source of sensor degradation.

Environmental and occupational health on the Navajo Nation: a scoping review

A scoping review was performed to answer: what environmental health concerns have been associated with adverse health outcomes in the Navajo Nation? The review focused on occupational and ambient environmental exposures associated with human industrial activities. The search strategy was implemented in PubMed, and two investigators screened the retrieved literature. Thirteen studies were included for review. Data were extracted using the matrix method. Six studies described associations between work in uranium mining and cancer. Six studies focused on environmental exposures to uranium mine waste and other metals, with outcomes that included biological markers, kidney disease, diabetes and hypertension, and adverse birth outcomes. One study explored occupational exposure to Sin Nombre Virus and infection. Most research has focused on the health effects of uranium, where occupational exposures occurred among miners and environmental exposures are a legacy of uranium mining and milling. Gaps exist with respect to health outcomes associated with current occupations and the psychosocial impact of environmental hazards. Other environmental exposures and hazards are known to exist on the Navajo Nation, which may warrant epidemiologic research.

Influence of face shields on exposures to respirable aerosol

The objective of this study was to determine the influence of face shields on the concentration of respirable aerosols in the breathing zone of the wearer. The experimental approach involved the generation of poly-dispersed respirable test dust aerosol in a low-speed wind tunnel over 15 min, with a downstream breathing mannequin. Aerosol concentrations were measured in the breathing zone of the mannequin and at an upstream location using two laser spectrophotometers that measured particle number concentration over the range 0.25-31 µm. Three face shield designs were tested (A, B, and C) and were positioned on the mannequin operated at a high and low breathing rate. Efficiency-the reduction in aerosol concentration in the breathing zone-was calculated as a function of particle size and overall, for each face shield. Face shield A, a bucket hat with flexible shield, had the highest efficiency, approximately 95%, while more traditional face shield designs had efficiency 53-78%, depending on face shield and breathing rate. Efficiency varied by particle size, but the pattern differed among face shield designs. Face shields decreased the concentration of respirable aerosols in the breathing zone when aerosols were carried perpendicular to the face. Additional research is needed to understand the impact of face shield position relative to the source.

Transmission of Respiratory Viral Diseases to Health Care Workers: COVID-19 as an Example

Health care workers (HCWs) can acquire infectious diseases, including coronavirus disease 2019 (COVID-19), from patients. Herein, COVID-19 is used with the source–pathway–receptor framework as an example to assess evidence for the role of aerosol transmission and indirect contact transmission of viral respiratory infectious diseases. Evidence for both routes is strong for COVID-19 and other respiratory viruses, but aerosol transmission is likely dominant for COVID-19. Key knowledge gaps about transmission processes and control strategies include the distribution of viable virus among respiratory aerosols of different sizes, the mechanisms and efficiency by which virus deposited on the facial mucous membrane moves to infection sites inside the body, and the performance of source controls such as face coverings and aerosol containment devices. To ensure that HCWs are adequately protected from infection, guidelines and regulations must be updated to reflect the evidence that respiratory viruses are transmitted via aerosols.

Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Indoor Air Quality Issues for Rocky Mountain West Tribes

Native American populations face considerable health disparities, especially among those who live on reservations, where access to healthcare, education, and safe housing can be limited. Previous research on tribal housing has raised concerns about housing construction, damage, and possible linkage to adverse health effects (e.g., asthma). This community-based participatory research (CBPR) project investigated indoor air quality issues on two Rocky Mountain west reservations. At the onset of the project, the research team formed a partnership with community advisory boards (CABs) consisting of representatives from tribal councils and community members. Research design, implementation, and dissemination all took place in full collaboration with the CABs following approval through official tribal resolutions. Residential homes were monitored for particulate matter with diameter <2.5 microns (PM_2.5) and radon concentrations. Low-cost air quality sensors and activated charcoal radon test kits were placed in tribal households for 6-8 days. A large amount of data were below the sensor limit of quantification (LOQ), but several homes had daily averages that exceeded suggested PM2.5 guidelines, suggestive of the potential for high exposure. Additionally, nearly half of all homes sampled had radon levels above the EPA action level, with mitigation activities initiated for the most concerning homes. Findings from this study indicate the need for future community-wide assessments to determine the magnitude and patterns of indoor air quality issues.

Development of an Empirical Formula for Describing Human Inhalability of Airborne Particles at Low Wind Speeds and Calm Air

Based on experiments conducted in low wind speed and calm air environments, the current International Organization for Standardization (ISO) and European Committee for Standardization (CEN) convention modeling human aerosol inhalability (i.e. aspiration efficiency) may not be valid when wind speeds are less than 0.5 ms-1. Additionally, the convention is based primarily on mouth breathing data and aerosols with aerodynamic diameters smaller than 100 µm. Since the convention's development, experimental inhalation data at wind speeds lower than 0.5 ms-1 for nose, mouth, and oronasal breathing have been generated for aerosols in a wider range of sizes (1.5-135 µm). These data were gathered and modeled with the intention of providing a simple convention recommendation for inhalability in low wind speed (>0 to <0.5 ms-1) and calm air (~0 ms-1) conditions to the ISO Technical Committee (TC) 146, Subcommittee 2, Working Group (WG) 1 ('Particle Size-Selective Sampling and Analysis'), as it relates to standard ISO 7708, and to CEN TC 137/WG 3, as it relates to standard EN 481. This paper presents several equations as possibilities, all relating aspiration efficiency to aerodynamic diameter. The equation AE=1+0.000019dae2-0.009788dae stands out as a possible new convention. This polynomial model balances simplicity and fit while addressing the weakness of the current convention.

Evaluation of a 25-mm disposable sampler relative to the inhalable aerosol convention

An ideal inhalable aerosol sampler for occupational exposure monitoring would have a sampling efficiency that perfectly matches the inhalable particulate matter (IPM) criterion. Two common aerosol samplers in use worldwide are the closed-face cassette (CFC) and the Institute of Occupational Medicine (IOM) sampler. However, the CFC is known to under-sample, with near zero sampling efficiency for particles >30 µm, whereas the IOM, considered by many to be the "gold standard" in inhalable samplers, has been shown to over-sample particles >60 µm. A new sampler in development incorporates characteristics of both the CFC and the IOM. Like the CFC, it would be disposable, have a simple design, and is intended to be oriented at a 45° downward angle. Like the IOM, the new sampler has a 15-mm inlet diameter and incorporates a 25-mm filter cassette with a protruding lip. The IOM is oriented at 0° to the horizontal, so it is hypothesized that orienting the new sampler at ∼45° downward angle will reduce oversampling of larger particles. In comparison, the CFC's inlet diameter is 4 mm; increasing the size of the inlet should allow the new sampler to have an increased efficiency relative to the CFC for all particles. A unique characteristic of the new sampler is the incorporation of a one-piece capsule-style filter that mimics the IOM's cassette but is made of disposable material. Seven different sizes of alumina particles (mean aerodynamic diameters from 4.9-62.4 µm) were tested (total = 124 samples collected). For each test, six samplers were placed on a manikin located inside a wind tunnel operated at 0.2 m/sec. Results indicated that the new sampler improved on the CFC for smaller particles, providing a larger range for which it matches the IPM criterion, up to 44.3 µm. However, the efficiency was significantly lower in comparison to the IPM criterion for particle sizes above 60 µm. Overall, the new sampler showed promise, but additional modifications may help improve sampling efficiency for larger particles.

Laboratory evaluation of a low-cost, real-time, aerosol multi-sensor

Exposure to occupational aerosols are a known hazard in many industry sectors and can be a risk factor for several respiratory diseases. In this study, a laboratory evaluation of low-cost aerosol sensors, the Dylos DC1700 and a modified Dylos known as the Utah Modified Dylos Sensor (UMDS), was performed to assess the sensors' efficiency in sampling respirable and inhalable dust at high concentrations, which are most common in occupational settings. Dust concentrations were measured in a low-speed wind tunnel with 3 UMDSs, collocated with an aerosol spectrometer (Grimm 1.109) and gravimetric respirable and inhalable samplers. A total of 10 tests consisting of 5 different concentrations and 2 test aerosols, Arizona road dust and aluminum oxide, were conducted. For the Arizona road dust, total particle count was strongly related between the spectrometer and the UMDS with a coefficient of determination (R²) between 0.86-0.92. Particle count concentrations measured with the UMDS were converted to mass and also were related with gravimetrically collected inhalable and respirable dust. The UMDS small bin (i.e., all particles) compared to the inhalable sampler yielded an R² of 0.86-0.92, and the large bin subtracted from the small bin (i.e., only the smallest particles) compared to the respirable sampler yielded an R² of 0.93-0.997. Tests with the aluminum oxide demonstrated a substantially lower relationship across all comparisons. Furthermore, assessment of intra-instrument variability was consistent for all instruments, but inter-instrument variability indicated that each instrument requires its own calibration equation to yield accurate exposure estimates. Overall, it appears that the UMDS can be used as a low-cost tool to estimate respirable and inhalable concentrations found in many workplaces. Future studies will focus on deployment of a UMDS network in an occupational setting.

Assessment of increased sampling pump flow rates in a disposable, inhalable aerosol sampler

A newly designed, low-cost, disposable inhalable aerosol sampler was developed to assess workers personal exposure to inhalable particles. This sampler was originally designed to operate at 10 L/min to increase sample mass and, therefore, improve analytical detection limits for filter-based methods. Computational fluid dynamics modeling revealed that sampler performance (relative to aerosol inhalability criteria) would not differ substantially at sampler flows of 2 and 10 L/min. With this in mind, the newly designed inhalable aerosol sampler was tested in a wind tunnel, simultaneously, at flows of 2 and 10 L/min flow. A mannequin was equipped with 6 sampler/pump assemblies (three pumps operated at 2 L/min and three pumps at 10 L/min) inside a wind tunnel, operated at 0.2 m/s, which has been shown to be a typical indoor workplace wind speed. In separate tests, four different particle sizes were injected to determine if the sampler's performance with the new 10 L/min flow rate significantly differed to that at 2 L/min. A comparison between inhalable mass concentrations using a Wilcoxon signed rank test found no significant difference in the concentration of particles sampled at 10 and 2 L/min for all particle sizes tested. Our results suggest that this new aerosol sampler is a versatile tool that can improve exposure assessment capabilities for the practicing industrial hygienist by improving the limit of detection and allowing for shorting sampling times.

Estimation of the Human Extrathoracic Deposition Fraction of Inhaled Particles Using a Polyurethane Foam Collection Substrate in an IOM Sampler

Extrathoracic deposition of inhaled particles (i.e., in the head and throat) is an important exposure route for many hazardous materials. Current best practices for exposure assessment of aerosols in the workplace involve particle size selective sampling methods based on particle penetration into the human respiratory tract (i.e., inhalable or respirable sampling). However, the International Organization for Standardization (ISO) has recently adopted particle deposition sampling conventions (ISO 13138), including conventions for extrathoracic (ET) deposition into the anterior nasal passage (ET₁) and the posterior nasal and oral passages (ET₂). For this study, polyurethane foam was used as a collection substrate inside an inhalable aerosol sampler to provide an estimate of extrathoracic particle deposition. Aerosols of fused aluminum oxide (five sizes, 4.9 µm-44.3 µm) were used as a test dust in a low speed (0.2 m/s) wind tunnel. Samplers were placed on a rotating mannequin inside the wind tunnel to simulate orientation-averaged personal sampling. Collection efficiency data for the foam insert matched well to the extrathoracic deposition convention for the particle sizes tested. The concept of using a foam insert to match a particle deposition sampling convention was explored in this study and shows promise for future use as a sampling device.

The effects of neutralized particles on the sampling efficiency of polyurethane foam used to estimate the extrathoracic deposition fraction

In addition to chemical composition, the site of deposition of inhaled particles is important for determining the potential health effects from an exposure. As a result, the International Organization for Standardization adopted a particle deposition sampling convention. This includes extrathoracic particle deposition sampling conventions for the anterior nasal passages (ET1) and the posterior nasal and oral passages (ET2). This study assessed how well a polyurethane foam insert placed in an Institute of Occupational Medicine (IOM) sampler can match an extrathoracic deposition sampling convention, while accounting for possible static buildup in the test particles. In this way, the study aimed to assess whether neutralized particles affected the performance of this sampler for estimating extrathoracic particle deposition. A total of three different particle sizes (4.9, 9.5, and 12.8 µm) were used. For each trial, one particle size was introduced into a low-speed wind tunnel with a wind speed set a 0.2 m/s (∼40 ft/min). This wind speed was chosen to closely match the conditions of most indoor working environments. Each particle size was tested twice either neutralized, using a high voltage neutralizer, or left in its normal (non neutralized) state as standard particles. IOM samplers were fitted with a polyurethane foam insert and placed on a rotating mannequin inside the wind tunnel. Foam sampling efficiencies were calculated for all trials to compare against the normalized ET1 sampling deposition convention. The foam sampling efficiencies matched well to the ET1 deposition convention for the larger particle sizes, but had a general trend of underestimating for all three particle sizes. The results of a Wilcoxon Rank Sum Test also showed that only at 4.9 µm was there a statistically significant difference (p-value = 0.03) between the foam sampling efficiency using the standard particles and the neutralized particles. This is interpreted to mean that static buildup may be occurring and neutralizing the particles that are 4.9 µm diameter in size did affect the performance of the foam sampler when estimating extrathoracic particle deposition.

A comparison of the closed-face cassette at different orientations while measuring total particles

The current method for sampling aerosols using the 37-mm closed-face cassette (CFC) sampler is based on the orientation of the cassette at ∼45° from horizontal. There is some concern as to whether this method is appropriate and may be underestimating exposures. An alternative orientation at ∼0° (horizontal) has been discussed. This research compared the CFC's orientation at 45° from horizontal to the proposed orientation at horizontal, 0° in a controlled laboratory setting. The particles used in this study were fused alumina oxide in four sizes, approximately 9.5 μm, 12.8 μm, 18 μm, and 44.3 μm in aerodynamic diameter. For each test, one aerosol was dispersed in a wind tunnel operating at 0.2 m/s with samplers mounted in the breathing zone of a rotating mannequin. A sampling event consisted of four pairs of samplers, placed side by side (one pair at 45° and another at 0° cassette orientation), and exposed for a period of 45 minutes. A total of 12 sampling events, 3 sample events per particle size, were conducted with a total of 94 samples collected. Mass concentration measurements were compared to assess the relationship between the sampler orientations of the cassettes. In addition, the relationship between the mass collected on the cassette filter and on the interior walls of the cassette was also assessed. The results indicated that there was no significant difference between the measured concentrations based on the orientation of the CFCs. The amount of mass collected on the interior walls of the cassettes was relatively low (<5%) compared to expected (up to 100%) wall losses for both orientations.

The impact of particle size selective sampling methods on occupational assessment of airborne beryllium particulates

In 2010, the American Conference of Governmental Industrial Hygienists (ACGIH) formally changed its Threshold Limit Value (TLV) for beryllium from a 'total' particulate sample to an inhalable particulate sample. This change may have important implications for workplace air sampling of beryllium. A history of particle size-selective sampling methods, with a special focus on beryllium, will be provided. The current state of the science on inhalable sampling will also be presented, including a look to the future at what new methods or technology may be on the horizon. This includes new sampling criteria focused on particle deposition in the lung, proposed changes to the existing inhalable convention, as well as how the issues facing beryllium sampling may help drive other changes in sampling technology.

An analysis of OSHA inspections assessing contaminant exposures in general medical and surgical hospitals

This study analyzed data from the Occupational Safety and Health Administration's (OSHA) Chemical Exposure Health Database to assess contaminant exposures in general medical and surgical hospitals. Seventy-five inspections conducted in these hospitals from 2005 through 2009 were identified. Five categories of inspections were conducted, the three most common being complaint-based, planned, and referral-based inspections. Complaint-based inspections comprised the majority of inspections-55 (73%) of the 75 conducted. The overall violation rate for all inspection types was 68%. This finding was compared to the violation rates of planned inspections (100%), referral-based inspections (83%), and complaint-based inspections (62%). Asbestos was the hazardous substance most commonly sampled and cited by OSHA in hospitals, with 127 samples collected during 24 inspections; 31% of the total 75 inspections resulting in one or more violations were due to asbestos.

Characterization of indoor air contaminants in a randomly selected set of commercial nail salons in Salt Lake County, Utah, USA

Air samples were collected in 12 randomly selected commercial nail salons in Salt Lake County, Utah. Measurements of salon physical/chemical parameters (room volume, CO2 levels) were obtained. Volatile organic compound (VOC) concentrations were collected using summa air canisters and sorbent media tubes for an 8-h period. Multivariate analyses were used to identify relationships between salon physical/chemical characteristics and the VOCs found in the air samples. The ACGIH(®) additive mixing formula was also applied to determine if there were potential overexposures to the combined airborne concentrations of chemicals monitored. Methyl methacrylate was detected in 58% of the establishments despite having been banned for use in nail products by the state of Utah. Formaldehyde was found above the NIOSH REL(®) (0.016 ppm) in 58% of the establishments. Given the assortment of VOCs to which nail salon workers are potentially exposed, a combination of engineering as well as personal protective equipment is recommended.

Performance study of personal inhalable aerosol samplers at ultra-low wind speeds

The assessment of personal inhalable aerosol samplers in a controlled laboratory setting has not previously been carried out at the ultra-low wind speed conditions that represent most modern workplaces. There is currently some concern about whether the existing inhalable aerosol convention is appropriate at these low wind speeds and an alternative has been suggested. It was therefore important to assess the performance of the most common personal samplers used to collect the inhalable aerosol fraction, especially those that were designed to match the original curve. The experimental set-up involved use of a hybrid ultra-low speed wind tunnel/calm air chamber and a rotating, heating breathing mannequin to measure the inhalable fraction of aerosol exposure. The samplers that were tested included the Institute of Occupational Medicine (IOM), Button, and GSP inhalable samplers as well as the closed-face cassette sampler that has been (and still is) widely used by occupational hygienists in many countries. The results showed that, down to ∼0.2 m s(-1), the samplers matched the current inhalability criterion relatively well but were significantly greater than this at the lowest wind speed tested. Overall, there was a significant effect of wind speed on sampling efficiency, with lower wind speeds clearly associated with an increase in sampling efficiency.

Proposed modification to the inhalable aerosol convention applicable to realistic workplace wind speeds

The current convention for sampling inhalable aerosols was based on several mannequin studies performed in wind tunnels at wind speeds between 0.5 and 4 m s(-1). In reality, as we now know, the wind speed in most modern indoor working environments is generally at or below ∼0.2 m s(-1). Inhalability studies performed in calm air aerosol chambers have shown that human aspiration efficiency at essentially zero wind speed is not consistent with the existing inhalable aerosol convention, calling into question the universal applicability of the current standard. More recently, experiments were carried out in a new hybrid wind tunnel-calm air chamber at more representative workplace wind speeds, between ∼0.1 and 0.5 m s(-1), to fill in this knowledge gap. Comparing these new data to both the existing inhalable aerosol convention and a recently proposed alternative for low wind movement suggests that, while the existing inhalable aerosol convention remains appropriate for wind speeds above ∼0.2 m s(-1), the modified version is more appropriate for the range below ∼0.2 m s(-1).