Institutional tuberculosis transmission. Controlled trial of upper room ultraviolet air disinfection: a basis for new dosing guidelines

Details

• Personal Author:
  Dharmadhikari AS ; Jensen, Paul A. ; Leuschner W ; Milonova SP ; Mphaphlele M ; Nardell EA ; Pagano MA ; Rudnick SN ; Sears TA ; Stoltz AC ; van-der-Walt M ; van-Reenen TH ; Weyer K
• Description:
  RATIONALE: Transmission is driving the global tuberculosis epidemic, especially in congregate settings. Worldwide, natural ventilation is the most common means of air disinfection, but it is inherently unreliable and of limited use in cold climates. Upper room germicidal ultraviolet (UV) air disinfection with air mixing has been shown to be highly effective, but improved evidence-based dosing guidelines are needed. OBJECTIVES: To test the efficacy of upper room germicidal air disinfection with air mixing to reduce tuberculosis transmission under real hospital conditions, and to define the application parameters responsible as a basis for proposed new dosing guidelines. METHODS: Over an exposure period of 7 months, 90 guinea pigs breathed only untreated exhaust ward air, and another 90 guinea pigs breathed only air from the same six-bed tuberculosis ward on alternate days when upper room germicidal air disinfection was turned on throughout the ward. MEASUREMENTS AND MAIN RESULTS: The tuberculin skin test conversion rates (>6 mm) of the two chambers were compared. The hazard ratio for guinea pigs in the control chamber converting their skin test to positive was 4.9 (95% confidence interval, 2.8-8.6), with an efficacy of approximately 80%. CONCLUSIONS: Upper room germicidal UV air disinfection with air mixing was highly effective in reducing tuberculosis transmission under hospital conditions. These data support using either a total fixture output (rather than electrical or UV lamp wattage) of 15-20 mW/m(3) total room volume, or an average whole-room UV irradiance (fluence rate) of 5-7 µW/cm(2), calculated by a lighting computer-assisted design program modified for UV use. [Description provided by NIOSH]
• Subjects:
  Animals Communicable Diseases Disinfectants Health Care Facilities Workforce And Services Laboratories Occupational Health Safety Ventilation
• Keywords:
  Author Keywords: Air Disinfection Climatic-conditions Disease-transmission Diseases Infection-control Infection Control Laboratory-animals Medical-facilities Tuberculosis Prevention Tuberculosis Transmission Ultraviolet Irradiation

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• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Massachusetts ; OSHA Region 1 ; OSHA Region 4
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  477-484
• Volume:
  192
• Issue:
  4
• NIOSHTIC Number:
  nn:20046935
• Citation:
  Am J Respir Crit Care Med 2015 Aug; 192(4):477-484
• Contact Point Address:
  Edward A. Nardell, M.D., Brigham and Women's Hospital, Division of Global Health Equity, 641 Huntington Avenue, 3A-03, Boston, MA 02115
• Email:
  enardell@partners.org
• Federal Fiscal Year:
  2015
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  True
• Start Date:
  20060801
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• End Date:
  20170731
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:cfcfa1641d496ec94d94e01281d056290bc1e1c23537b086874f691c3a0c5b603369de2ad13d899c41fe780d76f281b76f6aeb2275ffd47418824af7c5522e17
• Download URL:
  https://stacks.cdc.gov/view/cdc/202193/cdc_202193_DS1.pdf
• File Type:
  [PDF - 758.43 KB ]