Testing Novel Interventions to Protect Workers from Airborne Infections

测试保护工人免受空气传播感染的新型干预措施

• 批准号: 8706702
• 负责人: Edward A. Nardell
• 金额: $ 48.33万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8706702
• 关键词: Testing; Novel; Interventions; Protect; Workers

DESCRIPTION (provided by applicant): Globally, tuberculosis (TB) is the most serious ongoing airborne infectious threat, but there has been recent concern about the airborne spread of influenza, SARS, and certain bioterrorism agents. While the domestic risk of TB transmission for health care workers has fallen, it remains higher than the general population. US medical, humanitarian, and research workers as well as students are increasingly exposed to drug resistant TB abroad. Prevention has depended on a hierarchy of traditional control measures, but these have been poorly implemented where they are needed most, and there have been no truly novel advances in transmission controls for over 50 years. Airborne TB is a prototype for other airborne infectious agents. Because M. tuberculosis is an environmentally hearty airborne agent, interventions that reduce airborne TB are likely to be even more effective against less environmentally well-adapted agents such as influenza. In our previous NIOSH grant we established a quantitative air sampling facility in South Africa using multidrug resistant (MDR) tuberculosis as a surrogate airborne organism. We showed that upper room ultraviolet (UV) air disinfection was 80% effective and that the use of surgical masks on TB patients was 50% effective in reducing transmission to highly susceptible sentinel guinea pigs breathing exhaust air from the ward. In this renewal grant application, we propose to use exactly the same proven quantitative air sampling methods to test three novel interventions to protect workers and other building occupants: 1) a new, more energy efficient upper room UV air disinfection system, 2) triethylene glycol (TEG) vapor as a safe chemical air disinfectant, and 3) an inhaled cationic salt solution (ICSS) to reduce production of exhaled infectious droplets. We will also test the effects of high humidity on UV air disinfection and conduct exploratory molecular-based air sampling in parallel with guinea pig air sampling. A major limitation of upper room UV air disinfection is cost contributed to by the highly inefficient tightly louvered UV fixtures currently used to prevent excessive UV in the lower room. A totally new approach to upper room UV air disinfection addresses both efficacy and safety. The inhaled salt solution is isotonic saline, a prototype for several cationic salts shown to reduce the generation of airborne particles by changing the mechanical properties of the fluid normally lining the central airways. This will be the first quantitative test of the impact of inhaled cationic salts in reducing airborne infection generated by human sources. TEG vapor was extensively studied as an air disinfectant from 1941-1952 with highly encouraging experiments published in Science and other prestigious journals. The EPA has determined that it is safe for prolonged human and animal exposure at the very low levels required (parts 1:7 million per by volume), and it continues to be found today in over-the-counter disinfectant sprays. Under experimental conditions, TEG vapor proved rapidly effective against a long list of test microorganisms. New particle generating and monitoring technologies have solved other practical problems applying TEG.

描述（由申请人提供）：在全球范围内，结核病（TB）是最严重的空中传染性威胁，但最近一直担心流感，SARS和某些生物恐怖主义者的空中传播。虽然国内TB传播医疗保健工作者的风险已经下降，但它仍然高于一般人群。美国的医学，人道主义和研究工作者以及学生越来越多地暴露于国外的耐药结核病。预防取决于传统控制措施的层次结构，但是在最需要的情况下，这些措施的实施很差，并且在50多年来没有真正的新颖进步。机载结核病是其他机载感染剂的原型。由于结核分枝杆菌是一种环保的空中剂，因此减少空气传播结核病的干预措施可能会更有效地抵抗较不环境良好的药物（如流感）。在我们以前的NIOSH赠款中，我们使用耐多药（MDR）结核病在南非建立了定量的空气采样设施，作为替代空气中的有机体。我们表明，上层房间的紫外线（UV）空气消毒有效80％，并且在结核病患者上使用手术口罩可有效地将传播降低到高度易感的前哨豚鼠，从病房呼吸排气空气。在此更新授予的申请中，我们建议使用完全相同的定量空气抽样方法来测试三种新的干预措施，以保护工人和其他建筑居民：1）一种新的，更有效的更节能的上层房间的紫外空气消毒系统，2）三乙基甘油（TEG）蒸气（TEG）蒸汽作为一种安全的化学空气倒入盐水和3）catient and cation and 3） 解决方案（ICS），以减少呼出的传染性液滴的产生。我们还将测试高湿度对紫外空气消毒的影响，并与豚鼠空气采样并行进行基于探索性分子的空气采样。上房间紫外线空气消毒的主要局限性是由目前用于防止下层房间过度紫外线的高效紫外线固定装置的高效效率低廉的紫外线固定装置所造成的。上层房间的一种全新的方法紫外线空气消毒既可以解决疗效和安全性。吸入的盐溶液是等渗盐水，这是一种用于通过更改通常在中心气道中衬里的流体的机械性能来减少空气颗粒产生的几种阳离子盐的原型。这将是对吸入阳离子盐对减少人类来源产生的空气传播感染的影响的首次定量测试。从1941 - 1952年开始，Teg Vapor作为空气消毒剂进行了广泛的研究，并在科学和其他著名的期刊上发表了极大的令人鼓舞的实验。 EPA已确定在所需的非常低的水平（每批量的1：700万部分）中可以安全地延长人和动物的暴露安全性，并且今天继续在非处方消毒剂喷雾剂中找到。在实验条件下，TEG蒸气证明了与一长串测试微生物的迅速有效。新的粒子生成和监测技术解决了应用TEG的其他实际问题。