He Congrong, Mackay Ian M, Ramsay Kay, Liang Zhen, Kidd Timothy, Knibbs Luke D, Johnson Graham, McNeale Donna, Stockwell Rebecca, Coulthard Mark G, Long Debbie A, Williams Tara J, Duchaine Caroline, Smith Natalie, Wainwright Claire, Morawska Lidia
International Laboratory for Air Quality and Health, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland 4001, Australia; Central Analytical Research Facility, Institute for Future Environment, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland 4001, Australia.
Public and Environmental Health - Virology, Health Support Queensland, Department of Health, Queensland Government, Coopers Plains 4108, Australia; Queensland Paediatric Infectious Diseases (QPID) Laboratory, Centre for Children's Health Research, The University of Queensland, 62 Graham St, South Brisbane, Queensland 4101, Australia; Faculty of Health, Queensland University of Technology (QUT), GPO Box 2434, Brisbane, Queensland 4001, Australia.
Environ Int. 2017 Oct;107:89-99. doi: 10.1016/j.envint.2017.06.020. Epub 2017 Jul 7.
The paediatric intensive care unit (PICU) provides care to critically ill neonates, infants and children. These patients are vulnerable and susceptible to the environment surrounding them, yet there is little information available on indoor air quality and factors affecting it within a PICU. To address this gap in knowledge we conducted continuous indoor and outdoor airborne particle concentration measurements over a two-week period at the Royal Children's Hospital PICU in Brisbane, Australia, and we also collected 82 bioaerosol samples to test for the presence of bacterial and viral pathogens. Our results showed that both 24-hour average indoor particle mass (PM) (0.6-2.2μgm, median: 0.9μgm) and submicrometer particle number (PN) (0.1-2.8×10pcm, median: 0.67×10pcm) concentrations were significantly lower (p<0.01) than the outdoor concentrations (6.7-10.2μgm, median: 8.0μgm for PM and 12.1-22.2×10pcm, median: 16.4×10pcm for PN). In general, we found that indoor particle concentrations in the PICU were mainly affected by indoor particle sources, with outdoor particles providing a negligible background. We identified strong indoor particle sources in the PICU, which occasionally increased indoor PN and PM concentrations from 0.1×10 to 100×10pcm, and from 2μgm to 70μgm, respectively. The most substantial indoor particle sources were nebulization therapy, tracheal suction and cleaning activities. The average PM and PN emission rates of nebulization therapy ranged from 1.29 to 7.41mgmin and from 1.20 to 3.96pmin×10, respectively. Based on multipoint measurement data, it was found that particles generated at each location could be quickly transported to other locations, even when originating from isolated single-bed rooms. The most commonly isolated bacterial genera from both primary and broth cultures were skin commensals while viruses were rarely identified. Based on the findings from the study, we developed a set of practical recommendations for PICU design, as well as for medical and cleaning staff to mitigate aerosol generation and transmission to minimize infection risk to PICU patients.
儿科重症监护病房（PICU）为危重新生儿、婴儿和儿童提供护理。这些患者较为脆弱，易受周围环境影响，然而关于PICU室内空气质量及其影响因素的信息却很少。为填补这一知识空白，我们在澳大利亚布里斯班皇家儿童医院的PICU进行了为期两周的室内和室外空气中颗粒物浓度的连续测量，还采集了82份生物气溶胶样本以检测细菌和病毒病原体的存在。我们的结果显示，24小时平均室内颗粒物质量（PM）（0.6 - 2.2μg/m³，中位数：0.9μg/m³）和亚微米颗粒物数量（PN）（0.1 - 2.8×10⁶个/cm³，中位数：0.67×10⁶个/cm³）浓度均显著低于室外浓度（PM为6.7 - 10.2μg/m³，中位数：8.0μg/m³；PN为12.1 - 22.2×10⁶个/cm³，中位数：16.4×10⁶个/cm³）（p < 0.01）。总体而言，我们发现PICU内的室内颗粒物浓度主要受室内颗粒物来源影响，室外颗粒物提供的背景可忽略不计。我们确定了PICU内强大的室内颗粒物来源，这些来源偶尔会使室内PN和PM浓度分别从0.1×10⁶个/cm³增加到100×10⁶个/cm³，以及从2μg/m³增加到70μg/m³。最主要的室内颗粒物来源是雾化治疗、气管抽吸和清洁活动。雾化治疗的平均PM和PN排放率分别为1.29至7.41mg/min和1.20至3.96×10⁶个/min。基于多点测量数据发现，每个位置产生的颗粒物即使来自独立的单人病房，也能迅速传输到其他位置。在原代培养和肉汤培养中最常分离出的细菌属是皮肤共生菌，而病毒很少被鉴定出来。基于该研究结果，我们为PICU的设计以及医护人员和清洁人员制定了一套实用建议，以减少气溶胶的产生和传播，将对PICU患者的感染风险降至最低。
