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PubMed2002

An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir.

We report an outbreak of Serratia marcescens infection in a special-care baby unit (SCBU) of a university-affiliated community hospital in the United Arab Emirates. The outbreak involved 36 infants and lasted for 20 weeks. Seven of the colonized infants developed invasive illnesses in the form of bacteraemia (four cases), bacteraemic meningitis (two) and clinical sepsis (one). Three other term infants had purulent conjunctivitis. There were five deaths with an overall mortality of 14%. S. marcescens was cultured from airflow samples from the air conditioning (AC) which was the reservoir of infection in this outbreak. Elimination of the nosocomial source and outbreak containment were eventually achieved by specialized robotic cleaning of the entire AC duct system of the SCBU. Strict adherence to the infection control policies was reinforced to prevent transmission of cross-infection.

Air Conditioning↗
PubMed1998

Radon properties in offices.

The radon concentration (RC), total potential alpha energy concentration of radon decay products (PAEC), equilibrium factor (F), and the fraction of unattached radon decay products (fp) were measured for 94 offices in Hong Kong. The mean values for RC, PAEC, F, and fp were 51 Bq m(-3), 1.19x10(-7) J m(-3) (5.7 mWL), 0.43, and 0.13, respectively. The first three are much higher than the corresponding values for dwellings. The radon properties vary significantly for different sites. The time for measurements, cumulative time since the air conditioning system was turned on, and whether smoking is allowed in the office have been identified from the available data as possible factors affecting the radon characteristics in offices. The mean contribution of the lung exposure to the annual effective dose equivalent due to radon in offices has been calculated to be 0.35 mSv y(-1). Considering other sources of natural radiation, a rough estimate of the total annual equivalent dose of about 2.7 mSv for a person living in Hong Kong is obtained. Two simple methods are proposed to mitigate the radon hazard in offices: (1) the provision of smoke-free environments and (2) switching on the air conditioners earlier. The first method reduces the equivalent dose by about 0.13 mSv y(-1) while the second reduces by about 0.1 mSv y(-1), which can be regarded as significant.

Air Conditioning↗
PubMed2001

Bacterial aerosols in the dental clinic: a review.

A number of sources of bacterial aerosols exist within and outside the dental clinic. The concentration of bacterial aerosols and splatters appears to be highest during dental procedures, especially those generated by some procedures such as ultrasonic scaling, or using a high speed drill. Several infectious diseases could be transmitted to staff and patients by airborne bacterial and other contaminants in the dental clinic. Air-conditioning and ventilation systems should be regularly maintained to reduce environmental contaminants and to prevent recirculation of bacterial aerosols. Pre-procedural rinsing by patients with mouthwashes as well as vacuum and electrostatic extraction of aerosols during dental procedures could also be employed. Dental staff should also consider appropriate immunizations and continue to use personal protective measures, which reduce contact with bacterial aerosols and splatters in the dental clinic.

Aerosols↗
PubMed1976

[Operating room ethrane pollution (author's transl)].

Several surveys of ethrane pollution were made by the authors in operating rooms, either equipped or not with general ventilation systems, during operations where non-rebreathing anaesthesia devices were used. In operating rooms without general ventilation systems, but with simple air conditioning systems, ethrane pollution was found to be rather high and to attain 30-40 ppm at the fourth hour of operation. No statistically significant differences were elicited among levels found at the anaesthetist, surgeon and assistance personnel sites. The authors analyze the kinetics of ethrane pollution as a function of its consumption and of time and discuss the most suitable means for decreasig and preventing such pollution.

Air Conditioning↗
PubMed1994

[Ventilation method plan in daily operations--a practical study].

On three days each we measured particles and airborne bacteria in ten ventilated operating theatres. Modern air conditioning systems achieved a significant reduction of air-pollution. Vertical systems proved to be more effective than horizontal systems. Workday conditions made several problems: During high personal activity a body exhaust system was not able to reduce the concentration of airborne bacteria; doors near the operating table and objects in the airstream had a negative effect; there was more personal than necessary in the operating theatres; some activities took place without a specific purpose and resulted in raised particle and bacteria contamination; early clearing of materials, before the operation ended, increased turbulences and door movements. A short break in personal activity before the first skin cut is recommended to reduce high air contamination due to the preparation of the operating room and the patient. One of the ventilation systems was insufficiently operated by personal. We recommend continuous measurement of particles near the operating field in order to control the input of airborne particles and bacteria into the wound.

Air Conditioning↗
PubMed2001

A follow-up study on occupational exposure to inhaled anaesthetics in Eastern European surgeons and circulating nurses.

OBJECTIVE: Although no dose-response relationship exists for the health risks associated with the occupational exposure to inhaled anaesthetics, public health authorities recommend threshold values. The aim of the present study was to assess whether and to what extent these threshold values are exceeded in surgeons and circulating nurses of an Eastern European university hospital, before and after measures had been taken to reduce occupational exposure. METHODS: At nine workplaces, occupational exposure to nitrous oxide and the volatile anaesthetic used (halothane or isoflurane) was measured within the breathing zones of surgeons and circulating nurses by means of photoacoustic infrared spectrometry. The measurements were carried out in 1996 and were repeated in 1997 after the installation of active scavenging devices at five workplaces, and an air-conditioning system at one workplace. RESULTS: Occupational exposure to nitrous oxide and halothane or isoflurane was lower in 1997 compared with that of 1996. In 1996, 89% of the nitrous oxide values were above the European threshold value of 100 ppm, whereas in 1997 approximately 50% were above this limit. In 1996 the majority of the measurements for the volatile anaesthetics were already below 5 ppm halothane and 10 ppm isoflurane and the number of measurements exceeding these limits was further reduced in 1997. CONCLUSION: The measures taken were effective in reducing waste gas exposure. Nevertheless, further efforts are necessary, especially for nitrous oxide, to reach Western European standards and to minimise possible health risks. These efforts comprise the installation of (active) scavenging devices, air-conditioning systems and new anaesthesia machines at all workplaces, the use of low-flow anaesthesia, the replacement of inhaled anaesthetics by intravenous anaesthetics and an appropriate working technique.

Anesthetics, Inhalation↗
PubMedDate not supplied

Source, significance, and control of indoor microbial aerosols: human health aspects.

The usual profile of indoor microbial aerosols probably has little meaning to healthy people. However, hazardous microbial aerosols can penetrate buildings or be generated within them; in either case, they can have significant adverse effects on human health. These aerosols can be controlled to some extent by eliminating or reducing their sources. In this regard, careful consideration should be given in building construction to the design of ventilation and air-conditioning systems and to the flooring material, so that these systems and the flooring material will not act as microbial reservoirs. It is evident that in spite of the considerable body of data available on indoor microbial aerosols, little is known of their true significance to human health except in terms of overt epidemic disease. Continued research is needed in this area, particularly in respect to situations of high risk in such locations as hospitals and schools for young children.

Adult↗
PubMed2006

Temporal and spatial dispersal of cladobotryum conidia in the controlled environment of a mushroom growing room.

Cladobotryum spp. are responsible for cobweb disease of mushrooms. In two commercial and one experimental mushroom-growing room, Cladobotryum conidia were released into the air in direct response to physical disturbance of disease colonies during either crop watering or treatment by covering with salt to 10 mm. Conidia were detected using a Burkard spore trap or agar-based trap plates. A maximum concentration of approximately 25,000 conidia m(-3) was recorded in a small (75-m(3)) experimental growing room in the hour following the salting of 16 cobweb patches (0.55 m(2)). Concentrations of 100 and 40 conidia m(-3) were recorded in the two larger commercial growing rooms in the hour following the salting of 18 and 11 patches of cobweb (diameter, approximately 50 to 200 mm), respectively. In controlled experiments, disturbed conidia were dispersed rapidly throughout a small growing room, with 91 to 97% of conidia settling out within 15 min. Eighty-five percent of conidia settled out within a 0.5-m radius when air-conditioning fans were switched off, consistent with airborne spore dispersal. Alternative methods for treating diseased areas to minimize conidial release and distribution were investigated and included covering disease colonies with damp paper tissue prior to salt application (tissue salting) and holding a dust extractor above disease colonies during salt application. Both methods resulted in no detectable airborne conidia, but the tissue paper salting technique was more convenient. Prevention of airborne conidial release and distribution is essential to avoid mushroom spotting symptoms, secondary colonies, and early crop termination.

Agaricus↗
PubMed2004

The growth of soybean under free air [CO(2)] enrichment (FACE) stimulates photosynthesis while decreasing in vivo Rubisco capacity.

Down-regulation of light-saturated photosynthesis (A(sat)) at elevated atmospheric CO(2) concentration, [CO(2)], has been demonstrated for many C(3) species and is often associated with inability to utilize additional photosynthate and/or nitrogen limitation. In soybean, a nitrogen-fixing species, both limitations are less likely than in crops lacking an N-fixing symbiont. Prior studies have used controlled environment or field enclosures where the artificial environment can modify responses to [CO(2)]. A soybean free air [CO(2)] enrichment (FACE) facility has provided the first opportunity to analyze the effects of elevated [CO(2)] on photosynthesis under fully open-air conditions. Potential ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) carboxylation (V(c,max)) and electron transport through photosystem II (J(max)) were determined from the responses of A(sat) to intercellular [CO(2)] (C(i)) throughout two growing seasons. Mesophyll conductance to CO(2) (g(m)) was determined from the responses of A(sat) and whole chain electron transport (J) to light. Elevated [CO(2)] increased A(sat) by 15-20% even though there was a small, statistically significant, decrease in V(c,max). This differs from previous studies in that V(c,max)/J(max) decreased, inferring a shift in resource investment away from Rubisco. This raised the C(i) at which the transition from Rubisco-limited to ribulose-1,5-bisphosphate regeneration-limited photosynthesis occurred. The decrease in V(c,max) was not the result of a change in g(m), which was unchanged by elevated [CO(2)]. This first analysis of limitations to soybean photosynthesis under fully open-air conditions reveals important differences to prior studies that have used enclosures to elevate [CO(2)], most significantly a smaller response of A(sat) and an apparent shift in resources away from Rubisco relative to capacity for electron transport.

Carbon Dioxide↗
PubMed2002

ASHRAE Standard 62: tobacco industry's influence over national ventilation standards.

OBJECTIVE: To describe the role of the tobacco industry in the development of ventilation standards for indoor air quality by influencing the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE). METHODS: Review of tobacco industry documents available on the internet between January 2001 and March 2002. Search terms included "ASHRAE", "ventilation", "minutes", "memo", and the names of key players and organisations as identified in the initial searches. Analysis of ASHRAE and other relevant documents publicly available and the personal files of a Standard 62 committee member; interviews of a selected number of ASHRAE players; observation of an ASHRAE meeting. RESULTS: The tobacco industry has been involved in the development of ventilation standards for over 20 years. It has successfully influenced the standard and continues to attempt to change the standard from a smoke-free framework into an "accommodation" framework. The industry acts directly and through consultants and allies. The major health groups have been largely absent and the health interests have been poorly represented in standard development. While concentrated in the USA, ASHRAE standards are adopted worldwide. CONCLUSION: The tobacco industry determined that allowing smoking in ventilation standards for indoor air quality was a high priority and dedicated significant human and financial resources to ensure that its interests were represented. The health groups, until recently, have largely ignored the policy implications for tobacco control of standard development. This situation is changing, but unless health groups maintain high visibility within ASHRAE, the tobacco industry may succeed in creating a standard that ignores the dangers of secondhand smoke.

Air Conditioning↗
PubMed1981

Pontiac fever: isolation of the etiologic agent (Legionella pneumophilia) and demonstration of its mode of transmission.

Pontiac fever, a unique epidemiologic form of legionellosis, is characterized by a short (one- to two-day) incubation period and a self-limited grippe-like illness without pneumonia. In 1968, the first documented outbreak of this syndrome affected persons who had entered a health department building in Pontiac, Michigan. Epidemiologic analyses clearly implicated as airborne agent and suggested that evaporative condenser water aerosols being disseminated by a defective air conditioning system played a key role in the outbreak. Guinea pigs that were exposed in the building and to laboratory aerosols of evaporative condenser water developed bronchopneumonia. Legionella pneumophilia (serogroup 1) was isolated from the exposed guinea pigs' lungs. Paired acute and convalescent serum specimens from 37 patients were tested by the indirect fluorescent antibody technique using L. pneumophila serogroup 1 antigen, and 31 (84%) had rises in titer from less than 32 to greater than or equal to 64.

Air Conditioning↗
PubMed2002

Indoor air quality assessment of daycare facilities with carbon dioxide, temperature, and humidity as indicators.

Poor indoor air quality (IAQ) in daycare facilities affects both attending children and care providers. Incident rates of upper-respiratory-tract infections have been reported to be higher in children who attend daycare. Excessive carbon dioxide (CO2) exposure can cause several health effects and even sudden infant death. For this study, 26 facilities were randomly selected in a Midwestern county of the United States. CO2, room temperature, and relative humidity were used as indicators for IAQ and comfort levels. These IAQ parameters were continuously monitored for eight hours at each facility by a direct-reading instrument that was calibrated before each measurement. More than 50 percent of the facilities had an average CO2 level over the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) standard of 1,000 parts per million (ppm). For temperature and relative humidity, respectively, 42.3 percent and 15.4 percent of facilities were outside of the ASHRAE-recommended comfort zones. The nap-time average CO2 level was about 117 ppm higher than the non-nap-time level. The increment of the nap-time CO2 level in the sleeping-only room over the level in multipurpose rooms was statistically significant (p < .05). According to stepwise multiple regression analysis, nap-time CO2 level was predicted by CO2 level before occupancy, nap-time average temperature, carbon monoxide, and child density (R2 = .83). It is recommended that an appropriate IAQ standard for daycare facilities be established and that children should not be placed in a completely isolated room during nap time.

Air Conditioning↗
PubMed2004

Effect of excessive environmental heat on core temperature in critically ill patients. An observational study during the 2003 European heat wave.

BACKGROUND: The primary goal of this study was to investigate the relation between the core temperature of critically ill patients and hot ambient temperatures during a heat wave. The second goal was to evaluate the impact of such a heat wave on the number of microbiological tests ordered. METHODS: During a heat wave, from August 3 to 22, 2003, we conducted an observational study in the surgical intensive care unit (ICU) of a French hospital that had no air-conditioning at the time. The core temperature of 18 critically ill patients and 36 health-care workers was measured with a non-contact, infrared tympanic membrane thermometer. The association between the core body temperature in infected and non-infected critically ill patients and the staff members, and the ambient temperature in the ICU was analysed using linear regression. The number of microbiological tests ordered was also recorded and compared with the same period in the previous year. RESULTS: The equation of the regression line for infected critically ill patients was: core temperature=33.5+0.16 x ambient temperature (R(2)=0.53; P<0.0001). The regression line was steeper than that for the non-infected patients (0.077; P<0.0001). The slopes of the regression lines for non-infected and control patients were similar (P=0.20). More blood cultures were carried out during the heat wave than at the same period during the year 2002 (4.80 blood cultures per 1000 patient-days vs 2.47 per 1000 patient-days; P=0.0006). CONCLUSION: During a sustained high ambient temperature, hyperthermia can occur in critically ill infected patients and to a lesser extent in non-infected patients and health-care workers. The number of blood cultures requested rises substantially, leading to increased costs. Installation of air-conditioning is therefore recommended.

Adult↗
PubMed1992

The feasibility of using a double blind experimental cross-over design to study interventions for sick building syndrome.

Methodological problems have limited scientific investigation of the causes of and solutions for sick building syndrome. The feasibility of using an experimental double blind cross-over study to resolve many of these methodological problems was assessed in a pilot study. The experimental intervention was to vary the amount of outdoor air from 10 cubic feet per minute per person (cfmpp) to 20 cfmpp or 50 cfmpp by central manipulation of the building heating, ventilation and air-conditioning (HVAC) system. Over 6 consecutive study weeks, 2 trials of rates were administered in random order. Study subjects and investigators of the study were blinded to intervention sequence. Unblinding, office environment rating and symptom occurrence were measured weekly. Of 305 eligible workers, 254 participated. Problems were encountered in delivering the lowest dose of ventilation due to building leakage. The prevalence of symptoms diminished steadily over the 6 study weeks, time trends which could be controlled by recommended design modifications. Blinding to the intervention was successfully maintained. Weekly non-response did not introduce a response bias but reduced the number of subjects available for analysis by one-third for each trial. We conclude that this design, with certain modifications, is feasible to evaluate many proposed interventions for sick building syndrome.

Adult↗
PubMed1996

Prevalence of the sick building syndrome symptoms in office workers before and after being exposed to a building with an improved ventilation system.

OBJECTIVE: To find if the prevalence of symptoms associated with sick building syndrome decreased among office workers after moving to a building with improved ventilation (after controlling for potential confounders). METHODS: Workers in five buildings in 1991 all moved in 1992 into a single building with improved design, operation, and maintenance of the ventilation system. All buildings had sealed windows with mechanical ventilation, air conditioning, and humidification. Workers completed a self administered questionnaire during normal working hours in February 1991 and February 1992. The questionnaire encompassed symptoms of the eyes, nose and throat, respiratory system, skin, fatigue, headache, and difficulty concentrating, personal, psychosocial, and work related factors. During normal office hours of the same week environmental variables were measured. RESULTS: The study population comprised 1390 workers in 1991 and 1371 workers in 1992 who represented more than 80% of the eligible population. The prevalence of most symptoms decreased when workers moved to the new building: skin (54%), respiratory system (53%), nose and throat (46%), fatigue (44%), headache (37%), eyes (23%). These findings were all significant and remained generally similar after controlling for personal, psychosocial, and work related factors. Furthermore, more than 60% of workers symptomatic in 1991 were asymptomatic in 1992 for all types of symptoms. In contrast, less than 15% of workers were asymptomatic in 1991 but symptomatic in 1992 for all types of symptoms. CONCLUSION: In this study, the prevalence of most symptoms usually associated with the sick building syndrome decreased by 40% to 50% after workers were transferred to a building with an improved ventilation system. The results show that it is possible to diminish the prevalence of symptoms associated with the sick building syndrome among office workers occupying a building with mechanical ventilation, air conditioning, and sealed windows.

Female↗
PubMed1998

Waste gas exposure during desflurane and isoflurane anaesthesia.

BACKGROUND: Currently, there are no data available concerning the occupational exposure to desflurane during general anaesthesia. This prospective, randomized study reports on occupational exposure to desflurane, compared to isoflurane, in a modern operation theatre (OT). METHODS: The study was performed in an OT equipped with a modern air-conditioning system and with a low-leakage anaesthesia machine connected to a central scavenging system. Trace concentrations of the anaesthetics were measured continuously by means of a photoacoustic infrared spectrometer during general anaesthesia in 30 patients undergoing eye surgery. Values were obtained within the breathing zone of the anaesthetist, the surgeon, the auxiliary nurse and at the mouth of the patient. RESULTS: Desflurane and isoflurane were administered with median (range) endtidal concentrations of 4.7 (3.8-10.3) vol% and 0.9 (0.6-1.4) vol%, respectively. The personnel-related median values of the average trace concentrations of desflurane and isoflurane were 0.5 (0.01-7.5) ppm and 0.2 (0.01-1.6) ppm, respectively. CONCLUSIONS: Occupational exposure to desflurane is low in the environment of a modern OT, even though it has to be administered in approximately 5-fold higher concentrations compared to isoflurane.

Air Conditioning↗
PubMed1989

Hypersensitivity pneumonitis treated with an electrostatic dust filter.

A 60-year-old woman had had recurrent acute migratory pneumonias for 9 months. The results of an evaluation, which included tests for serum precipitins, a transbronchial biopsy, and a bronchial provocation, confirmed a diagnosis of hypersensitivity pneumonitis caused by an Aspergillus species. The findings from gravity air cultures in the home showed a heavy infestation of mold. The installation of electrostatic dust filters in the return ducts of the central air conditioning system resulted in the lowering of mold colony counts to normal levels. This change in the environment enabled the patient to live at home without having the signs and symptoms of hypersensitivity pneumonitis, or a need for medication. Thirty months after the electrostatic dust filters were installed, total mold colony counts were still normal, the patient remained free of the signs and symptoms of hypersensitivity pneumonitis, and serum precipitins could no longer be demonstrated. The results of a bronchial challenge to Aspergillus species, however, remained positive; these positive results suggest that long-term memory immune mechanisms may play an important role in the pathogenesis of hypersensitivity pneumonitis and lessen the importance of precipitins in establishing a diagnosis. We report that electrostatic dust filters may be an effective treatment for patients with hypersensitivity pneumonitis when avoidance of the causative antigen cannot be easily and rapidly achieved.

Air Conditioning↗
PubMed2002

Work environment effects on labor productivity: an intervention study in a storage building.

BACKGROUND: Although increased attention has been focused on the relationship between occupational health and productivity, solid scientific data on this topic are sparse. The purpose of the present case study was to assess the relationship between productivity and work environment in a storage building. MATERIALS AND METHODS: The study was implemented as an intervention consisting of the renovation of a harbor storage facility. The study design consisted of a single group of employees working in the storage hall. The physical and chemical factors, perceived environment, and labor productivity were measured before and after the renovation. RESULTS: As a result of the renovation, thermal conditions, air quality, and lighting conditions improved notably. In addition, the employees' subjective evaluations showed the significant decrease in dissatisfaction ratings. The direct measure for the labor productivity, expressed as zinc tons/work-hour (tn) increased about 9% after the renovation. DISCUSSION: We conclude that increased productivity is most likely related to the combined effect of the improved work environment, i.e., better thermal climate, reduced contaminant concentrations, and better lighting conditions.

Adult↗