Centre for Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom.
PLoS One. 2021 Apr 29;16(4):e0251049. doi: 10.1371/journal.pone.0251049. eCollection 2021.
Respiratory infections, including SARS-CoV-2, are spread via inhalation or ingestion of airborne pathogens. Airborne transmission is difficult to control, particularly indoors. Manufacturers of high efficiency particulate air (HEPA) filters claim they remove almost all small particles including airborne bacteria and viruses. This study investigates whether modern portable, commercially available air filters reduce the incidence of respiratory infections and/or remove bacteria and viruses from indoor air. We systematically searched Medline, Embase and Cochrane for studies published between January 2000 and September 2020. Studies were eligible for inclusion if they included a portable, commercially available air filter in any indoor setting including care homes, schools or healthcare settings, investigating either associations with incidence of respiratory infections or removal and/or capture of aerosolised bacteria and viruses from the air within the filters. Dual data screening and extraction with narrative synthesis. No studies were found investigating the effects of air filters on the incidence of respiratory infections. Two studies investigated bacterial capture within filters and bacterial load in indoor air. One reported higher numbers of viable bacteria in the HEPA filter than in floor dust samples. The other reported HEPA filtration combined with ultraviolet light reduced bacterial load in the air by 41% (sampling time not reported). Neither paper investigated effects on viruses. There is an important absence of evidence regarding the effectiveness of a potentially cost-efficient intervention for indoor transmission of respiratory infections, including SARS-CoV-2. Two studies provide 'proof of principle' that air filters can capture airborne bacteria in an indoor setting. Randomised controlled trials are urgently needed to investigate effects of portable HEPA filters on incidence of respiratory infections.
呼吸道感染,包括 SARS-CoV-2,通过吸入或摄入空气中的病原体传播。空气传播难以控制,尤其是在室内。高效空气(HEPA)过滤器的制造商声称,它们可以去除几乎所有的小颗粒,包括空气中的细菌和病毒。本研究调查了现代便携式、商业可用的空气过滤器是否能降低呼吸道感染的发生率,以及/或从室内空气中去除细菌和病毒。我们系统地检索了 Medline、Embase 和 Cochrane 数据库,以获取 2000 年 1 月至 2020 年 9 月期间发表的研究。如果研究在任何室内环境(包括养老院、学校或医疗机构)中使用便携式、商业可用的空气过滤器,调查与呼吸道感染发生率的关联,或从过滤器内空气中去除和/或捕获气溶胶化的细菌和病毒,则符合纳入标准。采用双数据筛选和叙述性综合分析。没有发现研究调查空气过滤器对呼吸道感染发生率的影响。两项研究调查了过滤器内细菌的捕获和室内空气中的细菌负荷。一项研究报告称,HEPA 过滤器中的活细菌数量高于地板灰尘样本中的数量。另一项研究报告称,HEPA 过滤与紫外线相结合可使空气中的细菌负荷减少 41%(未报告采样时间)。两篇论文都没有研究对病毒的影响。对于包括 SARS-CoV-2 在内的呼吸道感染室内传播的一种潜在成本效益干预措施的有效性,存在重要的证据缺失。两项研究提供了“原理证明”,即空气过滤器可以在室内环境中捕获空气中的细菌。迫切需要进行随机对照试验,以调查便携式 HEPA 过滤器对呼吸道感染发生率的影响。