Microbiological Contamination of Hospital Air: I. Quantitative Studies

The levels of airborne contamination in various areas of two hospitals were determined during a 15-month sampling period, using Casella and Andersen volumetric samplers. Based on nearly 5,000 samples, the mean count per ft³ ranged from 4.5 in obstetric-gynecology delivery rooms to 72.4 in waste-handling areas. The mean count for the entire hospital environment was on the order of 20 contaminants per ft³; 48% were associated with particles >5 μ diam, 30% with particles between 2 and 6 μ diam, and 22% with particles <2 μ diam. The airborne contamination was influenced by traffic, activity, ventilation considerations, and gross surface contamination, but not markedly by seasonal changes. When suitable control measures were implemented, the level of contamination could be diminished and kept low.     

Airborne bacteria, fungi, and endotoxin levels in residential microenvironments: a case study

Limited data are currently available on the concentrations of airborne bacteria, fungi, and endotoxins in indoor environments. The levels of aerial bacteria and fungi were measured at several microenvironments within a well-ventilated residential apartment in Singapore including the living room, kitchen, bedroom, toilet, and at a workplace environment by sampling indoor air onto culture medium plates using the 6-stage Andersen sampler. Total microbial counts were determined by collecting the air samples in water with the Andersen sampler, staining the resultant extracts with a fluorescent dye, acridine orange, and counting the microbes using a fluorescent microscope. The levels of airborne endotoxins were also determined by sampling the airborne microorganisms onto 0.4?μm polycarbonate membrane filter using the MiniVol sampler at 5?l/min for 20?h with a PM_2.5 cut-off device. The aerial bacterial and fungal concentrations were found to be in the ranges of 117–2,873?CFU/m³ and 160–1,897?CFU/m³, respectively. The total microbial levels ranged from 49,000 to 218,000?microbes/m³. The predominant fungi occurring in the apartment were Aspergillus and Penicillium while the predominant bacterial strains appeared to be Staphylococcus and Micrococcus. The average indoor endotoxin level was detectable in the range of 6–39?EU/m³. The amount of ventilation and the types of human activities carried out in the indoor environment appeared to be important factors affecting the level of these airborne biological contaminants.     

Bacteriophage aerosol challenge of installed air contamination control systems

The effectiveness of installed air contamination control systems for removal of airborne microorganisms was determined. Seven separate systems were challenged with aerosolized T1 bacteriophage. Air samples were collected with Andersen samplers containing agar plates that had been swabbed with susceptible Escherichia coli. The advantages of using bacteriophage for testing air-handling systems are discussed. The air systems employed both filtration and ultraviolet irradiation and air-flow rates varied from 600 to 18,000 ft³/min. Reduction rates of airborne bacteriophage passing through the various air systems ranged from 99.8 to 99.99%.     

Site-related and seasonal variation of bioaerosol emission in an indoor wastewater treatment station: level,characteristics of particle size,and microbial structure

The emission of the airborne bacteria and fungi from an indoor wastewater treatment station adopting an integrated oxidation ditch with a vertical circle was investigated. Microbial samples were collected by the six-stage viable Andersen cascade impactor, and the samples were collected in triplicate in each sampling site per season. Culture-based method was applied to determine the concentrations of the airborne bacteria and fungi, while the cloning/sequencing method was used to characterize the genetic structure and community diversity of airborne bacteria. The highest concentrations of airborne bacteria (4155 ± 550 CFU/m³) and fungi (883 ± 150 CFU/m³) were obtained in June (summer). The lowest concentration of bacteria (1458 ± 434 CFU/m³) was determined in January (winter), and the lowest concentration of fungi (169 ± 40 CFU/m³) was found in March (spring), respectively. The particle size distribution analysis showed that most culturable bacteria obtained in all the sampling sites were in the particle size range of 1.1–4.7 µm. Most culturable fungi had particle sizes in the range 1.1–3.3 µm. Microbial population analysis showed that Bacillus sp., Acinetobacter sp., and Lysinibacillus were the main groups obtained in S1. Enterobacter was the dominant group in sampling site S2. Both the concentrations and particle size distribution of the bioaerosols in the enclosed space presented a seasonal and site-related variation. Concentration and richness of microorganisms in bioaerosols in June were higher than in September and January. The particle size distribution varied between the sampling sites, and proportion of large particles was higher in S2 than in S1 because of the settlement of large particles. Pathogenic species, such as Acinetobacter lwoffii, Staphylococcus saprophyticus, and Enterobacter sp., were isolated from the bioaerosols, which could pose serious latent danger to sewage workers’ health.     

Evaluation of Four Aerobiological Sampling Methods for the Retrieval of Aerosolized Pseudomonas syringae

The Andersen six-stage impactor, the SAS (Surface Air System) impactor, the AGI-30 impinger, and gravity plates were evaluated for the retrieval of aerosol-released Pseudomonas syringae. The upper limits of the impactor samplers were exceeded at a spray concentration of 10⁷ CFU/ml, indicating that these samplers are not appropriate for monitoring high airborne concentrations. Decreased cell concentrations were retrieved with increased sampling time for the Andersen and AGI samplers, indicating that a minimum sampling time is preferable for monitoring aerosolized vegetative cells.     

Bioaerosol Mass Spectrometry for Rapid Detection of Individual Airborne Mycobacterium tuberculosis H37Ra Particles

Single-particle laser desorption/ionization time-of-flight mass spectrometry, in the form of bioaerosol mass spectrometry (BAMS), was evaluated as a rapid detector for individual airborne, micron-sized, Mycobacterium tuberculosis H37Ra particles, comprised of a single cell or a small number of clumped cells. The BAMS mass spectral signatures for aerosolized M. tuberculosis H37Ra particles were found to be distinct from M. smegmatis, Bacillus atrophaeus, and B. cereus particles, using a distinct biomarker. This is the first time a potentially unique biomarker was measured in M. tuberculosis H37Ra on a single-cell level. In addition, M. tuberculosis H37Ra and M. smegmatis were aerosolized into a bioaerosol chamber and were sampled and analyzed using BAMS, an aerodynamic particle sizer, a viable Anderson six-stage sampler, and filter cassette samplers that permitted direct counts of cells. In a background-free environment, BAMS was able to sample and detect M. tuberculosis H37Ra at airborne concentrations of >1 M. tuberculosis H37Ra-containing particles/liter of air in 20 min as determined by direct counts of filter cassette-sampled particles, and concentrations of >40 M. tuberculosis H37Ra CFU/liter of air in 1 min as determined by using viable Andersen six-stage samplers. This is a first step toward the development of a rapid, stand-alone airborne M. tuberculosis particle detector for the direct detection of M. tuberculosis bioaerosols generated by an infectious patient. Additional instrumental development is currently under way to make BAMS useful in realistic environmental and respiratory particle backgrounds expected in tuberculosis diagnostic scenarios.     

Concentration and distribution characteristics of airborne fungi in indoor and outdoor air of Tehran subway stations

The concentration and distribution characteristics of airborne fungi were investigated in indoor and outdoor air of two metro stations (Imam Khomeini and Sadeghiyeh stations) in Tehran subway. Samples were taken from indoor air at each station from platform and ticket office area also from adjacent outdoor air of each station. Indoor sampling was conducted for two types of trains, old and new. The concentration of airborne fungi ranged from 21 CFU/m³ at the outdoor air of Imam Khomeini station to 1,402 CFU/m³ in the air samples collected from the platform of this station. Results showed that airborne fungi concentrations at indoor air were higher than the outdoor air (p < 0.05), and fungal levels significantly correlated with the number of passengers (p < 0.05; r = 0.68) and RH % (p < 0.05; r = 0.43). Sixteen genera of fungi were isolated in all sampled environments. The predominant genera identified in indoor and outdoor air were Penicillium spp. (34.88 % of total airborne fungi) and Alternaria spp. (29.33 % of total airborne fungi), respectively. The results of this study showed that the indoor air quality in subway is worse than the outdoor air.     

Inactivation of Airborne Viruses by Ultraviolet Irradiation

Aerosolized viruses were passed through a high-intensity ultraviolet (UV) cell. This cell consisted of a long cylindrical aluminum tube [diameter, 7 in. (17.7 cm); length, 36 in. (91.4 cm)] with a highly reflective inner surface and a longitudinally extending helical baffle system which directed airborne particles in close proximity to a centrally located UV lamp. After having been passed through the UV cell, viral aerosols were collected with an Andersen sampler, and viral concentrations were determined by plaque assay methods on tissue cultures. Inactivation rates of greater than 99.9% were obtained for Coxsackie, influenza, Sindbis, and vaccinia viruses, and slightly less for adenovirus (96.8%), when the aerosols passed through the UV cell at 100 ft³/min. At aerosol flow rates of 200 ft³/min, inactivation rates were slightly lower; 91.3 for adenovirus, 97.5 and 96.7 for Coxsackie and Sindbis, respectively, and greater than 99.9% for influenza and vaccinia viruses.     

A comparison of two air samplers for recovery of indoor bioaerosols

Summary A preliminary study was performed using two sampling instruments for airborne bacteria and fungi collection. A Reuter Centrifugal Sampler (RCS) and the open-faced type membrane filter sampler (Sartorius MD8) were compared for evaluating their capability of viable particles recovery. 61 series of parallel samples were collected in the air of a microbiological laboratory. Bacteria and fungi per cubic metre of air were enumerated using appropriate culture media and reported in terms of colony forming units (CFU). Performances of the two instruments for fungi were comparable and significantly correlated, particularly when the Rose Bengal Agar (RBA) medium was used (geometric mean: 237 CFU/m³ for RCS and 247 CFU/m³ for MD8; correlation coefficient: 0.78). Bacterial counts from MD8 resulted consistently lower than those obtained from RCS. The observed high variability suggests the existence of selective collection efficiencies which tend to underestimate the actual occurrence of airborne microrganisms.     

Exposure of Workers to Airborne Microorganisms in Open-Air Swine Houses

This study quantified the levels of airborne microorganisms in six swine farms with more than 10,000 pigs in subtropical Taiwan. We evaluated breeding, growing, and finishing stalls, which were primarily open-air buildings, as well as partially enclosed farrowing and nursery piggeries. Airborne culturable bacteria, gram-negative bacteria, and fungi were placed on appropriate media by using an all-glass impinger or single-stage Andersen microbial sampler. Results showed that mean concentrations of culturable bacteria and gram-negative bacteria were 3.3 × 10⁵ and 143.7 CFU/m³, respectively. The concentration of airborne culturable fungi was about 10³ CFU/m³, with Cladosporium the predominant genus. The highest airborne levels of culturable bacteria and gram-negative bacteria were identified in the finishing units. The air of the nursery stalls was the least contaminated with culturable and gram-negative bacteria. Irregular and infrequent cleaning, high pig density, no separation of wastes from pen floors, and accumulation of water as a result of the processes for cleaning and reducing pig temperature possibly compromise the benefits of the open characteristic of the finishing units with respect to airborne bacterial concentration.     

Indoor air quality in schools: exposure to fungal allergens

This study examined indoor air quality within schools in Kansas City, Spokane, Santa Fe, and Orlando. Air sampling was undertaken with both Andersen Single Stage Samplers and Burkard Personal Air Samplers. The data show a wide range of indoor exposures ranging from less than 100 colony forming units (CFU/m³) for viable fungi and 100 spores/m³ for total spores in Spokane and Santa Fe to concentrations over 6000 CFU/m³ for viable fungi and 15 000 spores/m³ for total fungi in Orlando and Kansas City, respectively. In the majority of sites the indoor airspora reflected the outdoor taxa withCladosporium the most abundant genus identified; however, several indoor locations had elevated levels ofPenicillium andAspergillus indicating possible sources of indoor contamination. Airborne basidiospores and smut spores were also fairly abundant in the schools and were among the top five taxa identified. The data also indicated that the airborne concentrations vary significantly during the day and between classrooms within each school. Continued studies in schools are needed to fully assess both the exposure levels and the clinical significance to atopic children allergic to these spores.     

Outdoor airborne fungi: sampling strategies

Summary A six-stage Andersens's sampler was compared with a single stage type (SAS) for the collection of airborne fungi particles. The efficiency of two non selective culture media, and namely malt agar (MA) and potato dextrose agar (PDA), which were both modified in order to inhibit bacterial growth, was compared as well. An overall assessment of quantitative results suggests that the two samplers have a comparable degree of efficiency. However, the SAS appears to collect a greater number of CFU/m³ in absence of wind and viceversa the Andersen one appears to be more efficient in the presence of wind. The number of species detected with the SAS device is smaller, thus requiring an increased number of suctions. Andersen sampler sieving, according to the aerodynamic characteristics of the particles, appears to be not too accurate: there is an overlap from stage to stage of the sampler and some larger particles settle on smaller particle-collecting stages and viceversa. The PDA, with streptomycin and chloramphenicol, is better and closer to the natural distribution pattern: the number of CFU/m³ is higher although the number of the collected species is about the same.     

The assessment of airborne microorganisms in large-scale composting facilities and their immediate surroundings

The number of airborne microorganisms in the area of large-scale composting facilities with different composting techniques (A: open facility using the intensive decomposition process [4000 t/year]. B: closed facility with compost containers [7000 t/year], C: closed facility with table-pile compositing and automatic turning equipment [22 000 t/year]) was investigated using impactor sampling systems (Andersen samplers). All counts carried out inside the closed facilities, especially during the turning process, showed values of >5.0 × 10⁵ CFU/m³ for viable bacteria and moulds with a proportion ofAspergillus fumigatus of up to 64%. Depending on the type of facility, different median values were determined inside the plant area. Counts were highest in the immediate area around the biofilter outside of Facility C (1.7 × 10⁴ CFU/m³ for bacteria and 9.5 × 10³ CFU/m³ for moulds). In view of the high load of ambient airborne microorganisms inside the composting facilities, adequate occupational health measures are urgently required. Counts determining the hazard to neighbourhood residents at distances of between 150 and 2000 m showed, depending on the facility, annual median values of 170–330 CFU/m³ for bacteria, 75–340 CFU/m³ for moulds, and 15–52 CFU/m³ forA. fumigatus. Higher individual counts — up to 3 × 10³ CFU/m³ for moulds and up to 350 CFU/m³ forA. fumigatus — were found as a result of specific climatic influences, (e.g. winds) and activities as well poor operation. Given the high proportion ofA. fumigatus in the exhaust air, this mould can serve as an indicator for the evaluation of the health risk. However, the maximum values found in the present study, may also be caused by other events in rural areas, (e.g. agricultural activities). With regard to neighbourhood residents, odour complaints are more important than pollution by microorganisms.     

Influence of meteorological parameters and PM2.5 on the level of culturable airborne bacteria and fungi in Abadan,Iran

In recent years, monitoring of airborne bacteria and fungi concentrations has obtained increasing universal attraction not only for influences on ecological balance but also for evaluating their public health consequences. In this study, we aimed to investigate culturable airborne bacteria and fungi levels in different sites of Abadan, and their association with meteorological parameters and PM_2.5 levels. Abadan is one of the most industrialized cities in the southwest of Iran where over the current decade has experienced lots of dust storm episodes. In total, 400 air samples were collected in 6 months (autumn and winter) using a single-stage viable Andersen cascade impactor for sampling airborne bacteria and fungi and portable DustTrak Aerosol Monitor 8520 for measuring PM_2.5 concentrations and meteorological parameters. Microbial concentrations showed a significant difference between various sites over the study period with averages of 569.57?±?312.64 and 482.73?±?242.86 CFU/M³ for bacteria and fungi, respectively. The air temperature had a significant effect on the concentration of both airborne bacteria and fungi. A significant positive correlation between relative humidity and fungi but no correlation between relative humidity and bacteria concentrations were observed. The average airborne PM_2.5 concentrations of all sites among the study period was 93.24?±?116.72 μg/m³. The atmospheric bacterial and fungal communities were strongly positively correlated with the ambient PM_2.5 level. The levels of airborne bacteria and fungi along with PM_2.5 in the air of the city were relatively higher than the recommended levels. Therefore, the best course of action is needed to control emission sources. Further studies are also needed to evaluate the clinical analysis of the health effects of exposure to these pollutants.

     

Triazole Susceptibilities in Thermotolerant Fungal Isolates from Outdoor Air in the Seoul Capital Area in South Korea

Emerging fungi resistant to triazoles are a concern because of the increased use of medical triazoles and exposure to agricultural triazoles. However, little is known about the levels of triazole susceptibility in outdoor airborne fungi making it difficult to assess the risks of inhalation exposure to airborne, antifungal-resistant fungi. This study examined triazole susceptibilities of the airborne thermotolerant fungi isolated from the ambient air of the Seoul Capital Area of South Korea. We used impactor air sampling with triazole-containing nutrient agar plates as the collection substrates to screen for airborne fungal isolates based on their triazole susceptibilities. This study estimated that 0.17% of all the culturable fungi belong to the pathogenic thermotolerant taxa, among which each isolate of Aspergillus niger and Aspergillus tubingensis showed a minimum inhibitory concentration (MIC) of 2 μg/mL or greater for itraconazole. Their concentration in air was 0.4 CFU/m³. Seven human pathogenic Paecilomyces variotii isolates had MICs of 32 μg/mL or greater and lower than 2 μg/mL for the agricultural fungicide tebuconazole and the medical triazole itraconazole, respectively. Though the concentration was low, our results confirm the presence of airborne fungi with high MICs for itraconazole in ambient air. Inhalation is an important exposure route because people inhale more than 10 m³ of air each day. Vigilance is preferred over monitoring for the emergence of triazole-resistant fungal pathogens in ambient outdoor air.     

Testing Air-Filtering Systems: I. Procedure for Testing High-Efficiency Air Filters on Exhaust Systems

A procedure was developed for evaluating high-efficiency filters mounted in exhaust ducts at the National Animal Disease Laboratory. An aerosol of the test organism, Escherichia coli B T₃ bacteriophage, was generated in a chamber attached to a ceiling exhaust register in concentrations of at least 1000 viable organisms per ft³ of air. Samples were collected from both the pre- and postfilter areas, and the number of organisms per ft³ of air was determined. The efficiency of the filter was calculated from these figures. A total of 269 high-efficiency filters were tested. Of these, 249 had efficiencies of 98% or greater. The remaining 20, with efficiencies of less than 98%, were repaired and retested. No filter was accepted with an efficiency of less than 98%.     

Assessment of Bioaerosols in Swine Barns by Filtration and Impaction

Bioaerosol concentrations inside one naturally ventilated and one mechanically ventilated swine finishing barn were assessed by sampling air using membrane filtration and impaction (six-stage Andersen sampler), and assayed by culture method. The barns, located on the same commercial farm in northeast Kansas, did not show any significant difference (p > 0.05) in concentrations of total and respirable airborne microorganisms. The overall mean total concentrations inside the two barns were 6.6 × 10⁴ colony forming units (CFU)/m³ (SD = 3.8 × 10⁴ CFU/m³) as measured by filtration and 8.6 × 10⁴ CFU/m³ (SD = 5.1 × 10⁴ CFU/m³) by impaction. The overall mean respirable concentrations were 9.0 × 10³ CFU/m³ (SD = 4.1 × 10³ CFU/m³) measured by filtration and 2.8 × 10⁴ CFU/m³ (SD = 2.2 × 10⁴ CFU/m³) by impaction. Total and respirable CFU concentrations measured by impaction were significantly (p < 0.05) higher than that by filtration. The persistent strains of microorganisms were various species of the following genera: Staphylococcus, Pseudomonas, Bacillus, Listeria, Enterococcus, Nocardia, Lactobacillus, and Penicillium. It appears that filtration sampling can be used for a qualitative survey of bioaerosols in swine barns while the Andersen sampler is suitable for both quantitative and qualitative assessments. Received: 2 April 2001 / Accepted: 13 June 2001     

A case study of airborne culturable microorganisms in a poultry slaughterhouse in Styria, Austria

According to Council Directive 90/679/EEC on the protection of workers from risks related to exposure to biological agents at work, nature, degree and duration of workers’ exposure to microorganisms must be determined. This directive has already been implemented in waste and wastewater management. The present case study investigates concentration and composition of microorganisms in a poultry slaughterhouse in the State of Styria, Austria. From June to November 2002, measurements were conducted at the sampling sites ‘moving rail’ and ‘gall bladder separation’ using the Andersen six stage viable cascade impactor and the SKC BioSampler. The results of this study were compared with other previous studies which were carried out using the same device (ACFM) and the same measurement methods. At the processing area of the ‘moving rail’, the median concentration of airborne mesophilic bacteria was 1.7×10⁶ CFU/m³ which is 8000 times higher than the background concentration of residential areas (approx. 210 CFU/m³). The airborne microorganisms concentration was 1.7×10⁴ CFU/m³ at composting plants which is 100 times lower than at a workplace of a poultry slaughterhouse. The study shows that poultry slaughterhouse employees are exposed to high concentrations of airborne microorganisms throughout the entire work time without using a respiratory protective device. For the protection of employees against airborne biological agents, relevant measures should be introduced to this field of work.     

Real-time monitoring of non-viable airborne particles correlates with airborne colonies and represents an acceptable surrogate for daily assessment of cell-processing cleanroom performance

Background aimsAirborne particulate monitoring is mandated as a component of good manufacturing practice. We present a procedure developed to monitor and interpret airborne particulates in an International Organization for Standardization (ISO) class 7 cleanroom used for the cell processing of Section 351 and Section 361 products.MethodsWe collected paired viable and non-viable airborne particle data over a period of 1 year in locations chosen to provide a range of air quality. We used receiver operator characteristic (ROC) analysis to determine empirically the relationship between non-viable and viable airborne particle counts.ResultsViable and non-viable particles were well-correlated (r² = 0.78), with outlier observations at the low end of the scale (non-viable particles without detectable airborne colonies). ROC analysis predicted viable counts ≥ 0.5/feet³ (a limit set by the United States Pharmacopeia) at an action limit of ≥ 32 000 particles (≥ 0.5 µ)/feet³, with 95.6% sensitivity and 50% specificity. This limit was exceeded 2.6 times during 18 months of retrospective daily cleanroom data (an expected false alarm rate of 1.3 times/year). After implementing this action limit, we were alerted in real time to an air-handling failure undetected by our hospital facilities management.ConclusionsA rational action limit for non-viable particles was determined based on the correlation with airborne colonies. Reaching or exceeding the action limit of 32 000 non-viable particles/feet³ triggers suspension of cleanroom cell-processing activities, deep cleaning, investigation of air handling, and a deviation management process. Our full procedure for particle monitoring is available as an online supplement.     

Bioaerosol mass spectrometry for rapid detection of individual airborne Mycobacterium tuberculosis H37Ra particles

Single-particle laser desorption/ionization time-of-flight mass spectrometry, in the form of bioaerosol mass spectrometry (BAMS), was evaluated as a rapid detector for individual airborne, micron-sized, Mycobacterium tuberculosis H37Ra particles, comprised of a single cell or a small number of clumped cells. The BAMS mass spectral signatures for aerosolized M. tuberculosis H37Ra particles were found to be distinct from M. smegmatis, Bacillus atrophaeus, and B. cereus particles, using a distinct biomarker. This is the first time a potentially unique biomarker was measured in M. tuberculosis H37Ra on a single-cell level. In addition, M. tuberculosis H37Ra and M. smegmatis were aerosolized into a bioaerosol chamber and were sampled and analyzed using BAMS, an aerodynamic particle sizer, a viable Anderson six-stage sampler, and filter cassette samplers that permitted direct counts of cells. In a background-free environment, BAMS was able to sample and detect M. tuberculosis H37Ra at airborne concentrations of >1 M. tuberculosis H37Ra-containing particles/liter of air in 20 min as determined by direct counts of filter cassette-sampled particles, and concentrations of >40 M. tuberculosis H37Ra CFU/liter of air in 1 min as determined by using viable Andersen six-stage samplers. This is a first step toward the development of a rapid, stand-alone airborne M. tuberculosis particle detector for the direct detection of M. tuberculosis bioaerosols generated by an infectious patient. Additional instrumental development is currently under way to make BAMS useful in realistic environmental and respiratory particle backgrounds expected in tuberculosis diagnostic scenarios.