Melvin W. First

The application of ultraviolet germicidal irradiation to control transmission of airborne disease: bioterrorism countermeasure

Bioterrorism is an area of increasing public health concern. The intent of this article is to review the air cleansing technologies available to protect building occupants from the intentional release of bioterror agents into congregate spaces (such as offices, schools, auditoriums, and transportation centers), as well as through outside air intakes and by way of recirculation air ducts. Current available technologies include increased ventilation, filtration, and ultraviolet germicidal irradiation (UVGI) UVGI is a common tool in laboratories and health care facilities, but is not familiar to the public, or to some heating, ventilation, and air conditioning engineers. Interest in UVGI is increasing as concern about a possible malicious release of bioterror agents mounts. Recent applications of UVGI have focused on control of tuberculosis transmission, but a wide range of airborne respiratory pathogens are susceptible to deactivation by UVGI. In this article, the authors provide an overview of air disinfection technologies, and an in-depth analysis of UVGI-its history, applications, and effectiveness.

A Method for Measuring Respiratory Deposition of Cigarette Smoke During Smoking

An understanding of the factors influencing respiratory deposition of cigarette smoke in smokers is needed to accurately control this important source of respiratory exposure in epidemiological studies of workers. Only a few studies have characterized the deposition of cigarette smoke in smokers and these involve methods that interfere with normal smoking. A technique for measuring puff volume, inhaled amount, and respiratory deposition of cigarette smoke particulate phase has been developed. It provides satisfactory accuracy (+/- 10%) and causes minimal disruption of normal smoking pattern. The technique captures exhaled smoke with an exhaust hood and establishes the amount of inhaled smoke by monitoring puff volume, puff duration, and puff timing and replaying the exact smoking sequence with matched cigarettes. Mass of captured cigarette smoke is evaluated by fluorophotometry. Preliminary trials with 11 paid volunteers gave an average puff volume of 53 mL and smoke deposition ranged from 22% to 75% with an average of 47%. Measured depositions are lower than previously published values and higher than would be predicted for submicrometer sized particles during normal breathing.

Surgical face masks worn by patients with multidrug-resistant tuberculosis: impact on infectivity of air on a hospital ward.

RATIONALE Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. OBJECTIVES We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). METHODS Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. MEASUREMENTS AND MAIN RESULTS Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68-85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31-51%), representing a 56% (95% CI, 33-70.5%) decreased risk of TB transmission when patients used masks. CONCLUSIONS Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.

Role of absolute humidity in the inactivation of influenza viruses on stainless steel surfaces at elevated temperatures.

ABSTRACT Influenza virus has been found to persist in the environment for hours to days, allowing for secondary transmission of influenza via inanimate objects known as fomites. We evaluated the efficacy of heat and moisture for the decontamination of surfaces for the purpose of preventing of the spread of influenza. Aqueous suspensions of influenza A virus were deposited onto stainless steel coupons, allowed to dry under ambient conditions, and exposed to temperatures of 55°C, 60°C, or 65°C and relative humidity (RH) of 25%, 50%, or 75% for up to 1 h. Quantitative virus assays were performed on the solution used to wash the viruses from these coupons, and results were compared with the solution used to wash coupons treated similarly but left under ambient conditions. Inactivation of influenza virus on surfaces increased with increasing temperature, RH, and exposure time. Reductions of greater than 5 logs of influenza virus on surfaces were achieved at temperatures of 60 and 65°C, exposure times of 30 and 60 min, and RH of 50 and 75%. Our data also suggest that absolute humidity is a better predictor of surface inactivation than RH and allows the prediction of survival using two parameters rather than three. Modest amounts of heat and adequate moisture can provide effective disinfection of surfaces while not harming surfaces, electrical systems, or mechanical components, leaving no harmful residues behind after treatment and requiring a relatively short amount of time.

Concentrations of Nicotine and Tobacco Smoke in Public Places

PUBLIC interest has focused on health effects to the large numbers of nonsmokers exposed to tobacco smoke in public places. Recent regulations in a few cities have banned smoking in public places, ...

Marijuana and tobacco smoke gas-phase cytotoxins

To evaluate the in vivo versus in vitro paradoxical effects of marijuana and tobacco smoke on pulmonary defenses, the responses to smoke constituents were assessed with an alveolar macrophage tissue culture bioassay. A dose-response impairment of macrophage bactericidal activity was associated with water-soluble, gas-phase constituents. A model airway surface was constructed to examine the behavior of specific gas-phase constituents removed as they passed over wetted surfaces simulating the characteristics of the human respiratory system. Chemical analyses in the bioassay flask and in the model airway were compared. Gas-phase cytotoxins were measured after passage over wetted surface areas analogous to the trachea between the larynx and second-order bronchus. A wetted surface comparable to only 5% of the human airway, or less than 0.05% of the gas-exchanging surface of the entire lung, was capable of complete detoxification of the highly water-soluble gas-phase cytotoxins. In conclusion, gas-phase cytotoxins demonstrable by in vitro bioassays may have no cytotoxic potential when inhaled by humans.

Characterization of UVC Light Sensitivity of Vaccinia Virus

ABSTRACT Interest in airborne smallpox transmission has been renewed because of concerns regarding the potential use of smallpox virus as a biothreat agent. Air disinfection via upper-room 254-nm germicidal UV (UVC) light in public buildings may reduce the impact of primary agent releases, prevent secondary airborne transmission, and be effective prior to the time when public health authorities are aware of a smallpox outbreak. We characterized the susceptibility of vaccinia virus aerosols, as a surrogate for smallpox, to UVC light by using a benchtop, one-pass aerosol chamber. We evaluated virus susceptibility to UVC doses ranging from 0.1 to 3.2 J/m2, three relative humidity (RH) levels (20%, 60%, and 80%), and suspensions of virus in either water or synthetic respiratory fluid. Dose-response plots show that vaccinia virus susceptibility increased with decreasing RH. These plots also show a significant nonlinear component and a poor fit when using a first-order decay model but show a reasonable fit when we assume that virus susceptibility follows a log-normal distribution. The overall effects of RH (P < 0.0001) and the suspending medium (P = 0.014) were statistically significant. When controlling for the suspending medium, the RH remained a significant factor (P < 0.0001) and the effect of the suspending medium was significant overall (P < 0.0001) after controlling for RH. Virus susceptibility did not appear to be a function of virus particle size. This work provides an essential scientific basis for the design of effective upper-room UVC installations for the prevention of airborne infection transmission of smallpox virus by characterizing the susceptibility of an important orthopoxvirus to UVC exposure.

Fundamental Factors Affecting Upper-Room Ultraviolet Germicidal Irradiation—Part I. Experimental

The objective of this research was to study the factors that relate to the effectiveness of upper-room ultraviolet germicidal irradiation for inactivating airborne microorganisms. The work was conducted in a room-sized chamber designed and furnished for investigations of this nature. Nebulized Serratia marcescens, Bacillus subtilis spores, and vaccinia virus were used as test aerosols. Most data were collected from steady-state experiments comparing the number of viable organisms in the chamber air remaining with UV lamps turned on to the number with UV lamps turned off, but some decay experiments were conducted to compare the two methods. UV power level had a strong influence but was fully effective only in the presence of air mixing that produced vigorous vertical air currents. A conclusion of the study is that an upper-room ultraviolet installation is a complex system that requires careful integration of UV luminaires, UV power, and room ventilation arrangements.

Characterization of Ultraviolet Upper Room Air Disinfection Devices

Ultraviolet germicidal irradiation (UVGI) is one method currently used to reduce transmission of airborne infectious diseases such as tuberculosis. UVGI is defined as optical radiation in the shortwave UV-C spectrum capable of killing microorganisms and has been demonstrated to be effective against certain airborne bacteria. Because prolonged direct exposure to low intensity UVGI can cause skin and eye irritation, fixtures appropriate for upper room air disinfection are installed above eye level and designed to limit the vertical emission spread to prevent excessive exposure to occupants. Accurate UVGI fixture emission profiles, in combination with appropriate room ventilation measurements, are needed to calculate the dose to airborne microorganisms and estimate the effectiveness of these air disinfection devices in preventing disease transmission in susceptible populations. Manufacturers of fixtures usually provide nominal wattage and horizontal centerplane intensity levels, but to quantify the dose to e...

Fundamental factors affecting upper-room ultraviolet germicidal irradiation - part II. Predicting effectiveness.

Compared with increasing outdoor air ventilation rate, upper-room ultraviolet germicidal irradiation (UVGI) is an attractive technology for lowering the indoor concentration of airborne microorganisms and thereby reducing the risk of airborne transmission of disease. With relatively modest vertical air circulation, most of the air in a room can be irradiated in a relatively brief time period without noise or significant power consumption. The hypothesis tested in this study is that the efficacy of upper-room UVGI to inactivate or kill airborne infectious microorganisms can be determined from an index of UVGI effectiveness, a dimensionless parameter designed to characterize adequacy of vertical air circulation, amount of UVGI provided, and their interaction. This index of effectiveness, which is determined independently of microbiological testing, was found to correlate well with experimental measurements made in a room-size chamber. A comparison of two other dimensionless parameters—the irradiation number and mixing number, from which effectiveness index is calculated—provides insight into whether the quantity of UV provided to the upper room or the intensity of the vertical air circulation is the controlling factor for effective application of upper-room UVGI. The irradiation number is calculated from the UV power output of the fixture(s), a parameter that is fixture specific and much easier to measure than mean fluence rate. An equation was also developed that relates UV fixture power output to mean fluence rate in either the irradiated zone or the entire room. In addition, reductions in viable microorganism concentration due to UVGI predicted from a two-box model are compared with experimental measurements.