Testing Novel Interventions to Protect Workers from Airborne Infections

Details

• Personal Author:
  Demokritou P ; Nardell E ; Stoltz A
• Description:
  Background: A decade ago, our original proposal was stimulated by NIOSH concerns about the spread of SARS in the workplace, pandemic influenza, bioterrorism agents, and other airborne infections. Globally, however, tuberculosis (TB), an exclusively airborne infection, remains the greatest infectious killer of adults. Traveling to high-risk settings abroad, US military, medical, humanitarian, and research workers as well as students are increasingly exposed to drug resistant TB. US health care workers continue to be at increased risk of TB compared to the general population. Interventions that are effective in preventing TB are likely to be even more effective against less well environmentally adapted agents such as influenza. Although we tested one novel approach, our greatest impact has been the testing and optimization of established control strategies: prompt and effective treatment of source cases, surgical masks, and upper room germicidal ultraviolet (GUV) air disinfection in congregate settings. GUV has become an increasingly important intervention as climate change results in greater use of ductless cooling systems requiring the closing of windows with reduced natural ventilation. Although GUV technology is over 70 years old, it has been poorly implemented for reasons that this research project has successfully addressed. Specific Aims (renewal): 1) to test the impact of new, more energy efficient upper room GUV systems; 2) to test propylene glycol (PG) vapor for airborne infection control; and 3) to test nebulized cationic solution (normal saline solution) as a method of reducing infectiousness of patients with MDR TB. Description/Methods: Both bench scale and room scale test chambers at the Harvard School of Public Health (HSPH), and the unique human-to-guinea pig Airborne Infections Research (AIR) facility in South Africa were used to test the efficacy of the novel (and conventional) interventions listed below to prevent airborne transmission of TB. Building on prior NIOSH-funded research, we tested propylene glycol (PG) vapor, a lower dose of upper room GUV, eggcrate and LED GUV. Additionally, our efforts to characterize LED UV output using the bench-scale HSPH test chamber continue as does our testing of real-time florescent viable particle counting to measure the impact of GUV on air disinfection. Results: 1) Although PG was effective in our room scale test chamber, the logistics of maintaining the PG fog at sufficiently high concentrations rendered it an impractical intervention; 2) a lower GUV dose study showed equally high efficacy in the AIR facility, suggesting a potentially more sustainable but equally effective lower dose strategy; 3) based on high efficacy in room-scale studies, an eggcrate GUV pilot test is planned in a hospital ward in Pretoria, South Africa, but hampered by delays in calibrating our viable particle counter in Boston; 4) a new South African treatment regimen did not stop XDR-TB transmission over the first 11 days in related (NIH-funded) research, emphasizing the need for environmental controls. We have not tested inhaled normal saline in patients to reduce transmission. Although promising when proposed, commercial development of more effective airway lining fluid modifying agents has ceased, and this approach has become a lower priority. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Communicable Diseases Disinfectants Environmental Monitoring Microbiology Occupational Health Safety Tuberculosis
• Keywords:
  Airborne Particles Air Monitoring Air Purifiers Air Treatment Equipment Bacteria Bacterial Disease Contagious Diseases Control Equipment Disease Control Disease Transmission Infection Control Infection Prevention Infectious Agents Infectious Diseases Propylene Glycol TB Ultraviolet Radiation

  More +
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-13
• NIOSHTIC Number:
  nn:20051953
• NTIS Accession Number:
  PB2018-101411
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-009050, 2018 Jan; :1-13
• Contact Point Address:
  Edward Nardell, MD, BWH/DGHE, 75 Francis Street, Boston, MA 02115
• Email:
  enardell@gmail.com
• CAS Registry Number:
  (±)-Propylene glycol (CAS RN 57-55-6)
• Federal Fiscal Year:
  2018
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20060801
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20170731
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:993428a3fe7222012ff3e1362d8e6eea87c36ad9833d02c7d39815b68e9698a287bbf4bf5991ccda59639e84e69307b7cd6f5cdee0180072827c7971088e9959
• Download URL:
  https://stacks.cdc.gov/view/cdc/218684/cdc_218684_DS1.pdf
• File Type:
  [PDF - 794.78 KB ]