Spinal cord injuries in South African Rugby Union (1980 - 2007)

Objectives and design. To address an apparent increase in the number of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby. Methods. We identified 264 rugby-related SCIs. A structured questionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died. Results. SCIs increased in number in the 1980s and in 2006. Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance. Conclusion. A register of all rugby-related SCIs in South Africa is essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation

Far-UVC (222 nm) efficiently inactivated an airborne pathogen in a room-sized chamber

Funding: We acknowledge the financial assistance of the United Kingdom’s Department for Health and Social Care (2020/092).Many infectious diseases, including COVID-19, are transmitted by airborne pathogens. There is a need for effective environmental control measures which, ideally, are not reliant on human behaviour. One potential solution is Krypton Chloride (KrCl) excimer lamps (often referred to as Far-UVC), which can efficiently inactivate pathogens, such as coronaviruses and influenza, in air. Research demonstrates that when KrCl lamps are filtered to remove longer-wavelength ultraviolet emissions they do not induce acute reactions in the skin or eyes, nor delayed effects such as skin cancer. While there is laboratory evidence for Far-UVC efficacy, there is limited evidence in full-sized rooms. For the first time, we show that Far-UVC deployed in a room-sized chamber effectively inactivates aerosolised Staphylococcus aureus. At a room ventilation rate of 3 air-changes-per-hour (ACH), with 5 filtered-sources the steady-state pathogen load was reduced by 98.4% providing an additional 184 equivalent air changes (eACH). This reduction was achieved using Far-UVC irradiances consistent with current American Conference of Governmental Industrial Hygienists threshold limit values for skin for a continuous 8-h exposure. Our data indicate that Far-UVC is likely to be more effective against common airborne viruses, including SARS-CoV-2, than bacteria and should thus be an effective and “hands-off” technology to reduce airborne disease transmission. The findings provide room-scale data to support the design and development of effective Far-UVC systems.Publisher PDFPeer reviewe

What is the relationship between indoor air quality parameters and airborne microorganisms in hospital environments? A systematic review and meta?analysis

Airborne microorganisms in hospitals have been associated with several hospital‐acquired infections (HAIs), and various measures of indoor air quality (IAQ) parameters such as temperature, relative humidity, carbon dioxide (CO2), particle mass concentration, and particle size have been linked to pathogen survival or mitigation of pathogen spread. To investigate whether there are quantitative relationships between the concentration of airborne microorganisms and the IAQ in the hospital environment. Web of Science, Scopus and PubMed databases were searched for studies reporting airborne microbial levels and any IAQ parameter(s) in hospital environments, from database inception to October 2020. Pooled effect estimates were determined via random‐effects models. Seventeen of 654 studies were eligible for the meta‐analysis. The concentration of airborne microbial measured as aerobic colony count (ACC) was significantly correlated with temperature (r = 0.25 [95% CI = 0.06–0.42], p = 0.01), CO2 concentration (r = 0.53 [95% CI = 0.40–0.64], p ˂ 0.001), particle mass concentration (≤5 µg/m3; r = 0.40 [95% CI = 0.04–0.66], p = 0.03), and particle size (≤5 and ˃5 µm), (r = 0.51 [95% CI = 0.12–0.77], p = 0.01 and r = 0.55 [95% CI = 0.20–0.78], p = 0.003), respectively, while not being significantly correlated with relative humidity or particulate matter of size >5 µm. Conversely, airborne total fungi (TF) were not significantly correlated with temperature, relative humidity, or CO2 level. However, there was a significant weak correlation between ACC and TF (r = 0.31 [95% CI = 0.07–0.52], p = 0.013). Although significant correlations exist between ACC and IAQ parameters, the relationship is not definitive; the IAQ parameters may affect the microorganisms but are not responsible for the presence of airborne microorganisms. Environmental parameters could be related to the generating source, survival, dispersion, and deposition rate of microorganisms. Future studies should record IAQ parameters and factors such as healthcare worker presence and the activities carried out such as cleaning, sanitizing, and disinfection protocols. Foot traffic would influence both the generation of microorganisms and their deposition rate onto surfaces in the hospital environment. These data would inform models to improve the understanding of the likely concentration of airborne microorganisms and provide an alternative approach for real‐time monitoring of the healthcare environment

Field measurement of natural ventilation rate in an idealised full-scale building located in a staggered urban array: comparison between tracer gas and pressure-based methods

Currently, no clear standards exist for determining urban building natural ventilation rates, especially under varying realistic meteorological conditions. In this study, ventilation rates are determined using tracer gas decay and pressure-based measurements for a full-scale (6 m tall) cube. The cube was either isolated (2 months of observations) or sheltered within a staggered array (7 months), for both single-sided and cross ventilation (openings 0.4 x 1 m). Wind speeds at cube height ranged between 0.04 m s-1 and 13.1 m s-1. Errors for both ventilation methods are carefully assessed. There is no discernible linear relation between normalised ventilation rates from the two methods, except for cross ventilation in the array case. The ratio of tracer gas and pressure derived ventilation rates is assessed with wind direction. For single-sided (leeward opening) cases it approached 1. For cross ventilation the ratio was closer to 1 but with more scatter. One explanation is that agreement is better when internal mixing is less jet-dominated, i.e. for oblique directions in the isolated case and for all directions for unsteady array flows. Sheltering may reduce the flushing rate of the tracer gas from the cube relative to internal mixing rate. This new dataset provides an extensive range of conditions for numerical model evaluation and for understanding uncertainty of ventilation rates. Knowledge of the latter is critical in buildin

Evaluating a transfer gradient assumption in a fomite-mediated microbial transmission model using an experimental and Bayesian approach

Current microbial exposure models assume that microbial exchange follows a concentration gradient during hand-to-surface contacts. Our objectives were to evaluate this assumption using transfer efficiency experiments and to evaluate a model's ability to explain concentration changes using approximate Bayesian computation (ABC) on these experimental data. Experiments were conducted with two phages (MS2,; Φ; X174) simultaneously to study bidirectional transfer. Concentrations on the fingertip and surface were quantified before and after fingertip-to-surface contacts. Prior distributions for surface and fingertip swabbing efficiencies and transfer efficiency were used to estimate concentrations on the fingertip and surface post contact. To inform posterior distributions, Euclidean distances were calculated for predicted detectable concentrations (log; 10; PFU cm; -2; ) on the fingertip and surface post contact in comparison with experimental values. To demonstrate the usefulness of posterior distributions in calibrated model applications, posterior transfer efficiencies were used to estimate rotavirus infection risks for a fingertip-to-surface and subsequent fingertip-to-mouth contact. Experimental findings supported the transfer gradient assumption. Through ABC, the model explained concentration changes more consistently when concentrations on the fingertip and surface were similar. Future studies evaluating microbial transfer should consider accounting for differing fingertip-to-surface and surface-to-fingertip transfer efficiencies and extend this work for other microbial types

Upper-Room Ultraviolet Light and Negative Air Ionization to Prevent Tuberculosis Transmission

Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper-room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Perú, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p < 0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p < 0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p < 0.0001) and by UV lights (log-rank 46; p < 0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings

Environmental data monitoring and infection risks in UK care-homes in the context of COVID-19

The COVID-19 pandemic drew attention to the critical role of building ventilation as a measure for controlling infection transmission. With the substantial number of COVID-19 outbreaks in care homes worldwide, the effectiveness of ventilation is an important consideration for infection control and wider exposure to indoor air pollutants. In this study, we used IoT-based sensors in two residential care homes to evaluate ventilation in various areas, including bedrooms, corridors, and communal spaces. Our monitoring focused on carbon dioxide (CO2) levels as a proxy for ventilation, as well as temperature and humidity, during the spring of 2022. We also developed a ventilation model using the software CONTAM and coupled it with an infection risk model to assess airborne transmission risks under different weather and occupancy conditions. Our results suggest that ventilation is generally adequate based on UK COVID-19 guidelines at the time, with CO2 below 800 ppm for the majority of the time, and opening windows in communal spaces in elderly care environments can help preserve indoor ventilation during periods of high occupancy. However, modelling data suggests that low CO2 values may be indicative of low occupancy in many spaces and therefore ventilation rates may not be sufficient to mitigate infection transmission. Encouraging positive ventilation behaviours in staff and residents, potentially supported by visible CO2 monitors, and taking additional precautions such as using air cleaners, enabling additional window openings or staff wearing masks during outbreaks and periods of high disease prevalence is likely to be beneficial for resident and staff health

The infectiousness of tuberculosis patients coinfected with HIV

The current understanding of airborne tuberculosis (TB) transmission is based on classic 1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we recreated this model in Lima, Peru, and in this paper we report the use of molecular fingerprinting to investigate patient infectiousness in the current era of HIV infection and multidrug-resistant (MDR) TB

Bacterial Transfer To Fingertips During Sequential Surface Contacts With And Without Gloves

Bacterial transmission from contaminated surfaces via hand contact plays a critical role in disease spread. However, the fomite‐to‐finger transfer efficiency of microorganisms during multiple sequential surface contacts with and without gloves has not been formerly investigated.We measured the quantity of Escherichia coli on fingertips of participants after one‐to‐eight sequential contacts with inoculated plastic coupons with and without nitrile gloves. A Bayesian approach was used to develop a mechanistic model of pathogen accretion to examine finger loading as a function of the difference between E. coli on surfaces and fingers. We used the model to determine the coefficient of transfer efficiency (λ), and influence of swabbing efficiency and finger area.Results showed λ for bare skin was higher (49%, 95%CI=32‐72%) than for gloved hands (30%, CI=17‐49%). Microbial load tended towards a dynamic equilibrium after four and six contacts for gloved hands and bare skin, respectively. Individual differences between volunteers’ hands had a negligible effect compared with use of gloves (p < 0.01). Gloves reduced loading by 4.7% (CI=‐12%‐21%) over bare skin contacts whilst 20% of participants accrued more microorganisms on gloved hands. This was due to poor fitting, which created a larger finger surface area than bare hands