Indian Journal of Medical Microbiology IAMM  | About us |  Subscription |  e-Alerts  | Feedback |  Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Ahead of Print | Current Issue | Archives | Search | Instructions  
Users Online: 1707 Official Publication of Indian Association of Medical Microbiologists 
  Search
 
 ~ Next article
 ~ Previous article 
 ~ Table of Contents
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~Related articles
 ~  Article in PDF (227 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
 ~  Abstract
 ~  Factors influenc...
 ~  Sources of Bio-a...
 ~  Modes of Transmi...
 ~  Immunopathogenesis
 ~  Health Effects
 ~  Infectious Diseases
 ~  Respiratory Diseases
 ~  Cancer
 ~  Role of Bio-aero...
 ~  Role of Airborne...
 ~  Bio-aerosol Eval...
 ~  Analysis for Det...
 ~  Data Interpretat...
 ~  Control Measures...
 ~  Conclusions
 ~  References
 ~  Article Figures
 ~  Article Tables

 Article Access Statistics
    Viewed25453    
    Printed926    
    Emailed35    
    PDF Downloaded1809    
    Comments [Add]    
    Cited by others 58    

Recommend this journal

 


 
REVIEW ARTICLE
Year : 2008  |  Volume : 26  |  Issue : 4  |  Page : 302-312
 

Bio-aerosols in indoor environment: Composition, health effects and analysis


1 Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu-600 116, India
2 Department of Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu-600 116, India

Date of Submission11-Sep-2007
Date of Acceptance20-Oct-2007

Correspondence Address:
Padma Srikanth
Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, Tamil Nadu-600 116
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.43555

Rights and Permissions

 ~ Abstract 

Bio-aerosols are airborne particles that are living (bacteria, viruses and fungi) or originate from living organisms. Their presence in air is the result of dispersal from a site of colonization or growth. The health effects of bio-aerosols including infectious diseases, acute toxic effects, allergies and cancer coupled with the threat of bioterrorism and SARS have led to increased awareness on the importance of bio-aerosols. The evaluation of bio-aerosols includes use of variety of methods for sampling depending on the concentration of microorganisms expected. There have been problems in developing standard sampling methods, in proving a causal relationship and in establishing threshold limit values for exposures due to the complexity of composition of bio-aerosols, variations in human response to their exposure and difficulties in recovering microorganisms. Currently bio-aerosol monitoring in hospitals is carried out for epidemiological investigation of nosocomial infectious diseases, research into airborne microorganism spread and control, monitoring biohazardous procedures and use as a quality control measure. In India there is little awareness regarding the quality of indoor air, mould contamination in indoor environments, potential source for transmission of nosocomial infections in health care facilities. There is an urgent need to undertake study of indoor air, to generate baseline data and explore the link to nosocomial infections. This article is a review on composition, sources, modes of transmission, health effects and sampling methods used for evaluation of bio-aerosols, and also suggests control measures to reduce the loads of bio-aerosols.


Keywords: Bio-aerosols, indoor air, health effects, monitoring nosocomial infections


How to cite this article:
Srikanth P, Sudharsanam S, Steinberg R. Bio-aerosols in indoor environment: Composition, health effects and analysis. Indian J Med Microbiol 2008;26:302-12

How to cite this URL:
Srikanth P, Sudharsanam S, Steinberg R. Bio-aerosols in indoor environment: Composition, health effects and analysis. Indian J Med Microbiol [serial online] 2008 [cited 2019 Jun 27];26:302-12. Available from: http://www.ijmm.org/text.asp?2008/26/4/302/43555


Bio-aerosols are airborne particles that are living (bacteria, viruses and fungi) or originate from living organisms. Bio-aerosols are ubiquitous, highly variable, complex, natural or man-made in origin. The sampling and analysis of airborne microorganisms has received attention in recent years due to concerns with mould contamination in indoor environments, the threat of bioterrorism and the occurrence of associated health effects, including infectious diseases, acute toxic effects, allergies and cancer. [1],[2],[3] Bio-aerosols contribute to about 5-34% of indoor air pollution. [4],[5]

Bacterial cells and cellular fragments, fungal spores and by-products of microbial metabolism, present as particulate, liquid or volatile organic compounds may be components of bio-aerosols. [6] Air, contains significant number of microorganisms, acting as a medium for their transmission or dispersal. Inhalation, ingestion and dermal contact are the routes of human exposure to airborne microorganisms, inhalation being the predominant. The particles in a bio-aerosol are generally 0.3 to 100 µm in diameter; however, the respirable size fraction of 1 to 10 µm is of primary concern. [7] Bio-aerosols ranging in size from 1.0 to 5.0 µm generally remain in the air, whereas larger particles are deposited on surfaces. [8]

Exposure to bio-aerosols unlike exposure to chemicals do not have threshold limits to assess health impact/toxic effects, due to the complexity in their entity, variations in human response to their exposure and difficulties in recovering microorganisms that can pose hazard during routine sampling. [9] While their role in various industrial settings has been well studied, [1] the role of these airborne microorganisms in healthcare settings is poorly understood. Increasing incidences of nosocomial and occupational diseases due to bio-aerosol exposure [10],[11],[12],[13] indicate the need for a thorough knowledge in this respect. Bio-aerosol monitoring in hospitals provides information for epidemiological investigation of nosocomial infectious diseases, research into airborne microorganism spread and control, monitoring biohazardous procedures and use as a quality control measure to determine the quality of indoor air. [6] In this article, an overview of bio-aerosols, their sources and possible health effects, various sampling methods and a characterisation of common airborne agents is presented.


 ~ Factors influencing Bio-aerosols Top


The transport and the ultimate settling of a bio-aerosol are affected by its physical properties and the environmental parameters that it encounters. [14] The physical characteristics are size, density, and shape of droplets or particles, the environmental factors include magnitude of air currents, relative humidity and temperature, which determine the capacity to be airborne. [14] Bio-aerosols generated from liquid suspensions undergo desiccation, whereas those generated as dusts or powders partially rehydrate. [15] The presence of moulds indicates a problem with water penetration or high humidity. [16]


 ~ Sources of Bio-aerosols in Indoor and Outdoor Environments Top


Bio-aerosols originate from any natural or man-made surface and each source gives rise to an entirely unique assemblage of bio-aerosols. Bioaerosols concentrations in air systems, indoor surfaces and water treatment plants are highlighted in [Table 1]. [17] Deterioration of building materials, offensive odour and adverse human health effects are associated with microbial contamination of indoor environments.

Buildings

The presence of undesirable bio-aerosols is often associated with sick building syndrome (SBS) and building related illnesses (BRI). Sources include furnishings and building materials; fungal contamination within wall, ceiling, and floor cavities by movement of cells, spores, and cell fragments via wall openings and gaps at structural joints. [17] Lack of fresh air due to increased insulation of buildings, poorly maintained or operated ventilation systems, poorly regulated temperature and relative humidity levels contribute to the presence and multiplication of bio-aerosols. [18] In developing countries, inadequacies in the building design and improper ventilation may contribute to poor indoor air quality.

Healthcare Facilities

The microbial load in hospital indoor air is highly influenced by the number of occupants, their activity and the ventilation. [19] Occupants are a potential source of microorganisms as they shed the microorganisms from the skin squames and the respiratory tract. Ventilation causes dilution thus reducing the microbial load. Sinks, wash-basins and drains, nebulisers, humidifiers, and cooling towers are the potential sources of gram negative bacilli, which colonise on the moist surfaces. Dressings and bedding also can be the sources of airborne microorganisms. [19] Sweeping of floors and changing of bed linens also can cause suspension of bio-aerosols in air. [19] Fungal spores gain entry into the hospital buildings through ventilation ducts with inadequate filtration. Since exposure levels are high, this may be an issue in the immunocompromised patients.


 ~ Modes of Transmission Top


Bio-aerosols can be transmitted either at long distances beyond the patient room environment, or within short distances. Small particle aerosols (e.g., generated during endotracheal intubation) are transmitted to persons in the immediate area near the patient. Viruses like Severe Acute Respiratory Syndrome (SARS), influenza and norovirus are transmitted from patients primarily by contact and/or droplet routes, while airborne transmission occurs over a limited distance. [20] Legionella may be derived from the environment, [21] others include contaminated food, water, medications (e.g., intravenous fluids) or through vectors. [22] Aspergillus spp. can be transmitted from patients or the environment. [22],[23]

Roy and Milton proposed a new classification for airborne pathogens when evaluating routes of SARS transmission, [24] based on the agent's capacity to be transmitted and to induce disease. Obligate airborne pathogens produce an infection that, under natural conditions, is initiated only through aerosols deposited in the distal lung tissue such as Mycobacterium tuberculosis . Preferential airborne pathogen can naturally initiate infection through multiple routes but are predominantly transmitted by aerosols deposited in distal airways, e.g., measles virus and variola (smallpox) virus. Opportunistic airborne pathogens naturally cause disease through other routes (e.g., the gastrointestinal tract) but can also initiate infection through the distal lung and may use fine-particle aerosols as an efficient means of propagating in favourable environments.


 ~ Immunopathogenesis Top


Individuals are exposed to an array of bio-aerosols in a single day that may interact in complex ways to cause airway inflammation and infection. Smaller cells and spores become trapped within lung tissue and are not easily expelled posing greater health risks. [17]

The clinical expression of airway disease is influenced by a combination of components of bio-aerosols and the dose and duration of exposure (environment), as well as intrinsic differences in the host response to bio-aerosols (genetic polymorphisms). [25] Many of the components of bio-aerosols are pathogen-associated molecular patterns (PAMPs) that bind specific recognition molecules and activate innate immune pathways. The most frequently detected PAMPs in bio-aerosols are endotoxin, peptidoglycan and β-(1→3)-glucans.[26]

Endotoxin signalling is being achieved through TLR4 (Toll-like receptors) pathway, a PAMP recognition molecule. Immune cells first develop tolerance to repeated exposures to endotoxin. Then, there is increased expression of TLR4 on the cell surface that leads to increase in the inflammatory response to lipopolysaccharide (LPS). Respiratory Syncytial Virus (RSV), present in bio-aerosols in domestic and day-care settings, increases TLR4 expression and sensitizes respiratory epithelial cells to endotoxin. [27] Although endotoxin causes inflammation in everyone, people with asthma tend to be more sensitive. Certain proteins found attached to white blood cells and floating free in blood and fluid surrounding lung cells are involved in a person's reaction to endotoxin. A protein called CD14, a mannose receptor specific to LPS and found on the surfaces of mature macrophages, [28] is present in higher levels in people with asthma. EPA (US Environmental Protection Agency) researchers examined healthy controls and asthmatics to investigate the relationship between CD14 and severity of response to endotoxin. They measured CD14 levels in samples of the participants' sputum collected both before and after the exposure and showed a correlation between levels of CD14 and the severity of the inflammatory response; when levels of CD14 were high before exposure to endotoxin, the inflammation was more severe. [29] Estimation of CD14 in serum by enzyme immunoassay (EIA) [30] can be used to predict the severity of a person's response to endotoxin. Exposure to endotoxins is associated with increased severity of asthma and BRI. [31],[32]

Peptidoglycan recognition by the innate immune system involves three molecules - TLR2, peptidoglycan recognition proteins (PGRPs), and nucleotide-binding oligomerization domain molecules (NODs). [33] NOD1 and NOD2 are intracellular molecules that recognize peptidoglycans from gram positive and gram negative bacteria. PGRPs are cell surface recognition molecules for peptidoglycan that signal in association with toll receptors. One PGRP, PGRP-S expressed in neutrophils and eosinophils, is bacteriostatic for gram positive bacteria. [34]

β-(1→3)-glucans, polymers of glucose produced in fungi, plants, and some bacteria, are associated with increased respiratory symptoms in a number of occupational settings,[35] and are also potent activators of the innate immune system. A trans-membrane lectin molecule, dectin-1, expressed on macrophages and neutrophils is the β-glucan receptor.[36] Dectin-1 may function as a T-cell co-stimulatory molecule, suggesting that β-glucan stimulation may be a link between innate and adaptive immune responses.[37]


 ~ Health Effects Top


Biological hazards to man arise from exposure to high concentrations or unfamiliar forms of bio-aerosols and three major groups of diseases associated with bio-aerosol exposure are infectious diseases, respiratory diseases and cancer. [1] Current knowledge is unclear regarding risk to cancer whether these excess risks occur from exposures to biological agents or are due to various chemicals used in these industries. [1] [Table 2] highlights the microorganisms associated with an airborne route of exposure that result in adverse human health effects. [3]


 ~ Infectious Diseases Top


Infectious diseases arise from viruses, bacteria, fungi, protozoa and helminths and involve the transmission of an infectious agent from a reservoir to a susceptible host through airborne transmission.

Bacterial diseases

Various bacterial diseases such as legionellosis and tuberculosis are linked to cause significant public health concern due to their low infectious dose. [14]

Legionellosis: Legionella pneumophila causes human legionellosis and community-acquired and nosocomial pneumonia in adults following either occupational or non-occupational exposures. Legionellae become airborne often as a result of active aerosolising processes (aeration of contaminated water) and may inhabit various water environments including man-made water systems, often in biofilms in cooling towers, air conditioning systems, etc. Nosocomial infections and hospital outbreaks have been linked to contaminated hot water supply of temperature 45°C. [38] The use of monochloramine for residual drinking water disinfection may help prevent Legionnaires' disease. [39] In comparison to free chlorine, monochloramine is better at reaching distant points in a water system and penetrates better into biofilm, but requires a higher pH than free chlorine for optimal disinfection. [40]

Tuberculosis: The transmission of tubercle bacilli occurs through the inhalation of aerosolised bacilli in droplet nuclei of expectorated sputum-positive tuberculosis patients during coughing, sneezing and talking. Several outbreaks of multi-drug resistant tuberculosis in UK have highlighted the potential for transmission within the hospital environment. [41]

Anthrax: The transmission occurs due to inhalation of the spores of Bacillus anthracis and outbreaks are often linked to bioterrorism that are spread through intentionally contaminated mail, apart from occupational exposures. [42]

Illness due to endotoxins: Endotoxins are the lipopolysaccharides (toxins) of gram negative bacterial cell wall. These are potent pyrogens, capable of causing fever in very low concentrations. [43] High exposure to endotoxins is often associated with nausea and diarrhoea. [44]

Fungal diseases

Airborne fungi causing respiratory infections and allergic reactions include Penicillium, Aspergillus, Acremonium, Paecilomyces, Mucor and Cladosporium . [45]

Most infections, commonest being Aspergillosis , can occur in immunocompromised hosts or as a secondary infection, following inhalation of fungal spores or the toxins produced by them. Symptoms include persistent cold, watering eyes, prolonged muscle cramps and joint pain, etc. [46] Coccidioides, Histoplasma and Blastomyces grow in soil or may be carried by bats and birds and is linked to exposure to wind-borne or animal-borne contamination. Volatile products of fungal metabolism are capable of inducing sensory irritation to eyes and upper respiratory tract. [47] Aspergillus species that can grow indoors include Aspergillus fumigatus and Aspergillus flavus and can cause nosocomial infections [48] , allergic broncho-pulmonary aspergillosis (ABPA) and sinusitis. Chronic asthmatics may progress to have their bronchial passages colonized by either Aspergillus fumigatus , Bipolaris hawaiiensis , or Wangiella dermatitidis . [46] Constant allergic response maintains the fungal colonisation, and first-line therapy with steroids, brings down the level of inflammation and may result in elimination of the colonising organism. [46]

Illness due to mycotoxins: Mycotoxins are absorbed by the intestinal lining, airways and skin; toxic effects follow exposure to toxins on the surface of the mould spores. Aspergillus , Fusarium and Stachybotrys act as aeroallergens and also produce mycotoxins. [49] A case report from the US described upper respiratory tract irritation and rash in a family living in a Chicago home with a heavy growth of Stachybotrys atra producing trichothecene mycotoxins. The symptoms disappeared when the amount of mould was substantially reduced. [50] Other adverse health effects include pre-term births or late abortions in farm women exposed to mycotoxins with immunotoxic and hormone-like effects. [51]

Viral diseases

Viruses are readily transmitted by airborne route, and include SARS virus [52] , enteric viruses of intestinal origin produced at sewage treatment facilities, RSV, Hantavirus from rodent faeces, [53] varicella - zoster virus, measles, mumps and rubella viruses. Airborne transmission of rabies virus is uncommon; spread of the infection due to aerosolisation of laboratory strains has been reported, resulting in revised safety recommendations for laboratory personnel working with rabies virus. [54] SARS, caused by novel corona virus, is a highly contagious respiratory illness of significant morbidity and mortality, and causes very severe atypical pneumonia. [55],[56] The use of aerosol-generating procedures (such as endotracheal intubation, bronchoscopy, and treatment with aerosolised medication) in hospitals may amplify the transmission of SARS. [52]

Diseases caused by parasites and Actinomycetes

Free-living amoebae like Acanthamoeba and Naegleria fowleri get aerosolised from natural and artificially heated waters, [57] and cause respiratory illness and meningoencephalitis. Actinomycetes such as Streptomyces and algae cause allergy, inflammatory reactions and hypersensitivity pneumonitis.


 ~ Respiratory Diseases Top


Many of the BRI are respiratory diseases and include asthma, hypersensitivity pneumonitis and multiple chemical sensitivity. [18] Asthma and allergic rhinitis are the most extensively studied respiratory diseases associated with bio-aerosol exposure. Both innate and adaptive immune mechanisms are implicated in the pathogenesis of disease.

Hypersensitivity pneumonitis or extrinsic allergic alveolitis (EAA) is an inflammatory airway disease caused by an unusual immune response to antigens like fungi (Farmer's lung), bird excreta (pigeon breeder's disease), and microbial contaminants in grain dust. [58]

Organic Dust Toxic Syndrome (ODTS) occurs within hours of a high dose inhalation of endotoxin, fungal spores and mycotoxins, [59] which may lead to chronic obstructive pulmonary disease (COPD). [60]

Bioallergens are potent allergens and include enzymes derived from fungi and bacteria produced by biotechnological companies, [61],[62],[63] and plant pollens. [64]


 ~ Cancer Top


Established biological occupational carcinogens are the mycotoxins. Aflatoxin from Aspergillus flavus is capable of causing liver cancer. [65],[66] while Ochratoxin A is a possible human carcinogen. Exposure to aflatoxin and ochratoxin occurs by ingestion, but can also occur by inhalation in industries such as peanut processing, livestock feed processing, or when grain dust exposure occurs. [66,67] Studies have found associations between exposure to wood dust and various specific cancers, in particular, sinonasal cancer in furniture making, and in other wood-related jobs including sawmills. [68]


 ~ Role of Bio-aerosols in Healthcare Settings Top


Operating rooms are a high risk area for both patients and staffs; air-quality management is important so that such environments are ensured to be free of airborne infectious agents. Adequate air changes and installation of filtration equipment are a necessity; proper air-conditioning systems can significantly reduce airborne concentrations of fungi. [69] Airborne bacteria have a considerable impact on infection during surgery. When the levels of airborne bacteria are reduced in operating rooms (OR), contamination of wounds is substantially reduced. [70]


 ~ Role of Airborne Infectious Agents in Nosocomial Infections Top


Airborne nosocomial infections are transmitted directly or indirectly through air and may cause respiratory (primarily pneumonia) and surgical-site infections. [71] Earlier studies have shown increasing evidences of airborne transmission in nosocomial outbreaks of methicillin resistant Staphylococcus aureus (MRSA) [72],[73] Acinetobacter spp. [73],[74] and Pseudomonas spp. [75]

A variety of bacteria such as Acinetobacter, Bacillus, Corynebacterium,  Escherichia More Details, Listeria, Micrococcus, Staphylococcus and Streptococcus , and fungi such as Alternaria, Aspergillus, Cladosporium, Penicillium and Scopulariopsis were isolated from operating theatre, birthing-room, emergency department, service area for infectious diseases, intensive care unit (ICUs) and canteen in Trakya University Hospital (Edirne, Turkey). [76]

A recent report evaluated the characteristics of total particles and viable bacterial and fungal species in clean rooms of different classes in hospital and found that the significant particle concentration fluctuations might be related to variations in operating personnel numbers and activities for operating rooms, and suggested that further evaluation of bio-aerosols characteristics in relation to nosocomial infection and the efficiency of particulate control in clean rooms are needed. [77]

In another study, the frequency of nosocomial infection related to air-colonisation was higher in patients of anaesthesia intensive care unit (16.4%) than in general surgery intensive care unit (4.9%), the most frequent being bacteraemia and surgical wound infections respectively. The most frequently isolated microorganisms were MRSA and Acinetobacter baumannii, suggesting that airborne viable particles in operating theatres and intensive care units can be a significant risk factor for the development of nosocomial infections. [78] A study from Pune, India assessed environmental bacteria carrying particle (BCP) load and found potentially pathogenic fungi in the filters of the air-conditioning units, highlighting the need for standardising the microbiological evaluation protocols for operating rooms. [79]

The Central Pollution Control Board (CPCB), New Delhi, India [80] studied the bacterial, fungal and total pathogenic populations in different months in various settings and found seasonal variation in fungal and bacterial concentrations. The CPCB report raised concerns regarding quality of indoor air in various sectors, including medical devices manufacture, operation theatres and hospitals, but did not include the details of identification of individual bacterial and fungal species. [80]

A pilot study conducted in a healthcare facility in Chennai, India characterised Bio-aerosols and found Staphylococcus aureus in microbiology laboratory, female ward and animal house, Shigella in BWD (biomedical waste disposal), Pseudomonas and Acinetobacter species in wards, animal house and BWD, and Aspergillus fumigatus in laboratory and animal house; indicating that bio-aerosols in healthcare facilities may be a significant occupational safety and health concern. [81]


 ~ Bio-aerosol Evaluation Top


In general, indoor microflora concentrations of a healthy work environment are lower than outdoor concentrations at the same location. [82] The purpose of bio-aerosol sampling is to verify and quantify their presence in air and in most cases no single sampling method can collect, identify and quantify all of the bio-aerosol components existing in a particular environment. When sampling is indicated, it is advisable to sample before, during, and after the sampling area is occupied, including times when the heating, ventilating, and air conditioning system is activated and inactivated. [82]

In comparison to settings like agricultural and poultry farming, where bio-aerosol concentrations are high, microbial loads are less in laboratories and wards. Healthcare settings represent a unique assemblage of indoor microflora as bio-aerosols in indoor air, which may be a source of nosocomial infection. In order to evaluate the quality of indoor air in hospitals, passive and active sampling methods can be used. Wherever higher concentrations of bacteria and fungi are found, active sampling techniques like filter and impinger methods can be used in addition to passive sampling to determine the concentrations and composition of bio-aerosols. Areas such as ICUs, ORs, labour rooms and orthopaedic wards, where indoor air quality are of concern can be targeted.

The choice of the sampling method, in terms of air flow rate and the duration of sampling, is made based on the extent of the loads of bio-aerosols; there is however no internationally accepted recommendations on sampling flow-rate and the media used for sampling. Reports suggest that high-containment laboratory and hospitals require air samplers with flow-rates ≥ 25 L/minute for monitoring, and those with flow-rates < 5 L/minute are not suitable and practical when the bio-aerosol concentration is <10 2 CFU/m 3 , [83] and recommends less sampling time for bioimpactor samplers with an airflow rate of 100 L/minute, and an air impact speed of less than 20 m/second (to avoid the risk of impact stress and dehydration of the agar surface). [84] As the environment is polluted in India, it is necessary to carry out repeated sampling to develop a standard protocol in the context of Indian settings.

Environmental Sampling for Bio-aerosols

Most bio-aerosol sampling devices involve techniques that separate particles from the air stream and collect them in or on a pre-selected medium. In addition, surface sampling is used to locate areas of contamination due to re-aerosolisation from surfaces and in identifying the source(s) of bio-contamination. The following methods may be used to monitor ambient indoor air quality in hospitals.

Inertial sampling methods used for bio-aerosol collection include impingement whereas filtration is a commonly used non-inertial sampling method. Gravity settling is the widely used gravitational sampling method.

Gravitation or settling

An adhesive substrate such as a coated microscope slide or a petri-plate containing agar medium is exposed face upwards to the atmosphere to collect particles settling by gravity. This method is simple, frequently used, sometimes in preference to other aerobiological samplers. [85] It is, however, a passive (non-volumetric) method that does not give information on the volume of air from which the particles have been collected. It also over-represents larger particles sampled during the exposure period because of their faster sedimentation rate. [85] Use of settle plates can provide a hint whether an environment is more or less contaminated with airborne microorganisms.

Impingement

Liquid impingers are a special type of impactor. Impingers are useful for the collection of culturable aerosols. [82] Impingers use a liquid (e.g., a simple salt solution such as 0.3 mM phosphate-buffered dilution water) as collection medium. Additives to the collection medium such as proteins, antifoam, or antifreeze aid in resuscitation of bacterial cells, prevent foaming and loss of the collection fluid, and minimize injury to the cells. [82] In this method, air samples are impinged into 20 mL of inert liquid medium at the rate of 12.5 Litres/minute for 20 minutes [Figure 1]. The samplers operate by drawing aerosols through an inlet tube. Curved inlet tube helps to simulate particle collection in the nasal passage for separating respirable (collection fluid) and non-respirable (inlet tube) microorganisms. After sampling for the appropriate amount of time, the liquid sample can be analysed by dilution (through liquid addition) or concentration (by filtration) to maximize accuracy in quantitation. [84] A liquid sample can also be used with a variety of analytical methods, including culture, microscopy, immunoassay, flow cytometry and molecular methods. [86]

Filtration

Collection of particles from a non-biological aerosol sample is most commonly achieved by filtration. [82] Filter media are available in both fibrous (typically glass) and membranous forms. Particles smaller than the pore size may be efficiently collected. Sampling filter media may have pore sizes of 0.01 - 10 µm. Membrane filters are manufactured in a variety of pore sizes from polymers such as cellulose ester, polyvinyl chloride, and polycarbonate. Filters are often held in disposable plastic filter cassettes during bio-aerosol sampling. [82]

Sampling is done by allowing the air to pass through the filter (preferably gelatine or polycarbonate) at the rate of 3.5 Litres/minute for 15 minutes [Figure 1]. The sampled organisms are washed from the surface of the filters and the wash solution cultured or refiltered to distribute the organisms uniformly on the membrane filter. In areas of high concentration, the organisms have to be eluted, diluted and refiltered for microscopic analysis. [82] Filtration techniques are used for the collection of certain fungi and endospores-forming bacteria that are desiccation-resistant. Though filter methods are known for their simplicity, low cost and versatility, loss of viability of vegetative cells may occur due to desiccation stress during sampling. [86],[87]

Surface Sampling

Since air sampling alone does not provide assurance that an area is free of biological contamination [88] , due to re-aerosolisation of the organisms from surfaces during routine activity, surface sampling is essential to identify the areas and sources of contamination in determining the effectiveness of remediation and clean-up of contaminated indoor environments. [88],[89],[90]


 ~ Analysis for Detection of Microorganisms and Microbial Constituents Top


Detection of Microorganisms

Viable microorganisms include culturable and non-culturable. During sampling, only culturable microorganisms are enumerated and identified, leading to an underestimation of bio-aerosol concentration. Therefore estimation of both culturable and non-culturable organisms using appropriate microscopy to identify bacteria and fungi (using gram staining for bacteria, and lactophenol cotton blue and calcofluor white for fungi) and classical microbiology techniques such as observation of growth characteristics, cellular or spore morphology, and biochemical tests for identification is essential. [91] After sample collection, colonies of bacteria and fungi are grown on culture media at a defined temperature over a 3 - 7 day period and then identified. Molecular biology techniques such as restriction fragment length polymorphic (RFLP) analysis are further used for better identification. [92],[93]

Analytical techniques applied for nonviable and viable microorganisms include polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA); these are usually qualitative, while semi-quantitative and quantitative methods are evolving.

PCR was first demonstrated as a means to detect bacteria [94] and viruses [95] in air samples in 1994, and was later used to detect airborne Pneumocystis jiroveci [96] and Aspergillus spp. [97] It has also been used for the enhanced detection of bacterial WMD surrogates and actual bioterrorism agents. Quantitative PCR is being evaluated in bio-aerosol monitoring.

Detection of microbial constituents

Endotoxin assay: Samples are collected from air by filter method, using polycarbonate capillary pore membrane filters. After sampling, it is extracted by sonication and then analysed for the presence of endotoxins by limulus amebocyte lysate (LAL) test, or chromogenic kinetical limulus test. LAL test is a comparative and not an analytical bioassay method as measured endotoxin activity levels change with changes in factors other than lipopolysaccharide concentrations. [98] The measurement of optical density is by means of a modified spectrophotometer. [99]

Fungal biomass assay: Some markers for the assessment of fungal biomass include ergosterol measured by gas chromatography-mass spectrometry [100] or fungal extracellular polysaccharides measured with specific enzyme immunoassays. [101]


 ~ Data Interpretation for Bio-aerosols Top


Threshold limit values (TLV) for bio-aerosols are referred to air concentrations of substances under conditions to which people are repeatedly exposed day after day without adverse health effects. [9] There are no established guidelines specifying the threshold limit values for interpreting environmental measurements of bio-aerosols because bio-aerosols do not comprise of a single entity. Human responses to bio-aerosols range from innocuous effects to serious diseases depending on the exposure and the susceptibility of human beings to it (e.g., genetic factors, age, personal habits, medication). Also, little is known about the minimum dose needed to pose a hazard.

While there are no internationally accepted guidelines, recommendations have been made by World Health Organization (Indoor air quality: Biological contaminants), [102] Federal-Provincial Advisory Committee on Environmental and Occupational Health, Canada (Indoor Air Quality in Office Buildings: A Technical Guide) [103] and NASA standard NhB5340.2. [104]

Though ACGIH (American Conference of Governmental Industrial Hygienists) had published numerical guidelines earlier, it currently does not support any existing numerical criteria for interpreting data on biological agents from source or air samples in non-manufacturing environments.


 ~ Control Measures for Reducing Bio-aerosols Top


In order to reduce bio-aerosol loads in indoor environments, certain control measures can be followed. [4] These include, proper identification and elimination of the microbial source in occupational and house-hold settings, maintenance of equipment, humidity control, natural ventilation, use of filters in ventilation, and air cleaning by the use of disinfectants and biocides. Periodical use of disinfectants and biocides is one of the methods to ensure controlled bio-aerosol concentrations. Air in the operating rooms and other critical areas like isolation rooms can be disinfected by fumigation using various microbicidal agents. Bacillocid [105] is the most commonly used commercially available surface and environmental disinfectant that has very good cleansing property along with bactericidal, viricidal, sporicidal and fungicidal activity. It is either sprayed or mopped liberally allowing a contact time of 30 minutes and provides complete asepsis within 30 - 60 minutes. It does not require cleaning with detergent or carbolic acid or formalin fumigation. It does not require shutdown of the disinfected areas such as operating rooms for 24 hours.


 ~ Conclusions Top


In the context of healthcare settings, bio-aerosols can cause occupational hazards and nosocomial infections. Modern built environment can be a potential source of bio-aerosols. Bio-aerosol monitoring in hospitals can be used for tracking of nosocomial infections, identify the source and spread of airborne microorganisms to control hospital associated infections (HAI). This will also serve as a tool to measure biosafety while handling biohazardous materials. The complexity of these bio-aerosols requires a multidisciplinary approach. There is heightened awareness regarding the study of bio-aerosols and its impact on human health and quality of indoor air and environment in the West. In the context of a developing country, there is a need for increased awareness for targeted surveillance for infection control.

 
 ~ References Top

1.Douwes J, Thorne P, Pearce N, Heederik D. Bio-aerosol Health Effects and Exposure Assessment: Progress and Prospects. Ann occup Hyg 2003;47:187-200.   Back to cited text no. 1    
2.O′Riordan TG, Smaldone GC. Respiratory medical societies and the threat of bioterrorism. Thorax 2004;59:265-67.  Back to cited text no. 2    
3.Stetzenbach LD, Buttner MP, Cruz P. Detection and enumeration of airborne biocontaminants. Curr Opin Biotechnol 2004;15:170-4.  Back to cited text no. 3    
4.Available at: http://www.pollutionissues.com/Ho-Li/Indoor-Air-Pollution.html. Accessed November 10, 2006.  Back to cited text no. 4    
5.Available at: http://www.airqualitydirect.com/bio-aerosols.htm. Accessed September 02, 2007.  Back to cited text no. 5    
6.Stetzenbach LD. Airborne Bacteria, Chapter 7. In: Topley and Wilson′s Microbiology and Microbial Infections: Bacteriology-I, 10 th ed. Borriello PS, Murray PR, Funke G, Eds. (ASM Press, Washington DC) 2005:185-194.  Back to cited text no. 6    
7.Cox CS, Wathes CM. Bio-aerosols in the environment. In: Bio-aerosols Handbook. Cox CS, Wathes CM, Eds. (Lewis Publishers, Boca Raton, FL) 1995:11-14.  Back to cited text no. 7    
8.Mohr AJ. Fate and Transport of Microorganisms in Air, Chapter 74. In: Manual of Environmental Microbiology, 2 nd ed. Hurst CJ, Crawford RL, Knudsen G, McInerney M, Stetzenbach LD, Eds. (ASM Press, Washington DC) 2002:827-38.  Back to cited text no. 8    
9.Macher J, Ammann HA, Burge HA, Milton DK, Morey PR. (Eds) Chapter 1. In: Bio-aerosols: Assessment and Control (American Conference of Governmental Industrial Hygienists, Cincinnati) 1999:1-5.   Back to cited text no. 9    
10.Schaal KP. Medical and microbiological problems arising from airborne infection in hospitals. J Hosp Infect 1991;18(Suppl A):451-9.  Back to cited text no. 10    
11.Ayliffe GA. Role of the environment of the operating suite in surgical wound infection Rev Infect Dis 1991;13(Suppl.10):S800-S804.  Back to cited text no. 11    
12.Eickhoff TC. Airborne nosocomial infection: A contemporary perspective. Infect Control Hosp Epidemiol 1994;15:663-72.  Back to cited text no. 12    
13.Beggs CB. The Airborne Transmission of Infection in Hospital Buildings: Fact or Fiction? Indoor Built Environ 2003;12:9-18.  Back to cited text no. 13    
14.Stetzenbach LD. Introduction to Aerobiology, Chapter 72. In: Manual of Environmental Microbiology, 2 nd ed. Hurst CJ, Crawford RL, Knudsen G, McInerney M, Stetzenbach LD, Eds. (ASM Press, Washington DC) 2002:801-813.  Back to cited text no. 14    
15.Cox CS. Stability of Airborne Microbes and Allergens, Chapter 6. In: Bio-aerosols Handbook. Cox CS, Wathes CM, Eds. (Lewis Publishers, Boca Raton, FL) 1995:77-86.  Back to cited text no. 15    
16.Pasanen P, Pasanen AL, Janunen M. Water condensation promotes fungal growth in ventilation ducts. Indoor Air 1993;3:106-112.  Back to cited text no. 16    
17.Available at: Indoor air quality corporation. http://www.germology.com/bio-aerosols.htm. Accessed January 25, 2007.  Back to cited text no. 17    
18.Available at: PEOSH Indoor Air Quality. http://www.state.nj.us/health/eoh/peoshweb/iaqdoc.htm. Accessed January 25, 2007.  Back to cited text no. 18    
19.Ayliffe GAJ, Babb JR, Taylor LJ. (Eds) Infection and the spread of microorganisms, Chapter 3. In: Hospital Acquired Infections: Principles and prevention, 3 rd ed. (Butterworth Heinemann publications, Oxford) 1999:38-40.  Back to cited text no. 19    
20.Sawyer LA, Murphy JJ, Kaplan JE, Pinsky PF, Chacon D, Walmsley S et al . 25- to 30-nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission. Am J Epidemiol 1988;127:1261-71.  Back to cited text no. 20    
21.Bollin GE, Plouffe JF, Para MF, Hackman B. Aerosols containing Legionella pneumophila generated by Shower Heads and Hot-Water Faucets. Appl Environ Microbiol 1985;50:1128-1131.  Back to cited text no. 21    
22.Anaissie EJ, Stratton SL, Dignani MC, Lee Ck, Summerbell RC, Rex JH et al . Pathogenic molds (including Aspergillus species) in hospital water distribution systems: A 3-year prospective study and clinical implications for patients with hematologic malignancies. Blood 2003;101:2542-2546.  Back to cited text no. 22    
23.Pegues DA, Lasker BA, McNeil MM, Hamm PM, Lundal JL, Kubak BM. Cluster of cases of invasive aspergillosis in a transplant intensive care unit: evidence of person-to-person airborne transmission. Clin Infect Dis 2002;34(3):412-6.  Back to cited text no. 23    
24.Roy CJ, Milton DK. Airborne Transmission of Communicable Infection - The Elusive Pathway. N Engl J Med 2004;350:1710-12.   Back to cited text no. 24    
25.Hattis D, Russ A, Goble R, Banati P, Chu M. Human inter-individual variability in susceptibility to airborne particles. Risk Analysis 2001;21:585-600.  Back to cited text no. 25    
26.Hauswirth DW, Sundy JS. Bio-aerosols and Innate Immune Responses in Airway Diseases. Curr Opin Allergy Clin Immunol 2004;4:361-366.  Back to cited text no. 26    
27.Monick MM, Yarovinsky TO, Powers LS, Butler NS, Carter AB, Gudmundsson G, et al . Respiratory syncytial virus up-regulates TLR4 and sensitizes airway epithelial cells to endotoxin. J Biol Chem 2003;278:53035-53044.  Back to cited text no. 27    
28.Parslow TG, Bainton DF. Innate Immunity, Chapter 2. In: Medical Immunology, 9 th ed. Stites DP, Terr AI, Parslow TG, Eds. (Appleton and Lange, Stamford) 1997:40.  Back to cited text no. 28    
29.Alexis N, Eldridge M, Reed W, Bromberg P, Peden DB. CD14-dependent airway neutrophil response to inhaled LPS: Role of atopy. J Allergy Clin Immunol 2001;107:31-35.  Back to cited text no. 29    
30.Blanco A, Solis G, Arranz E, Coto GD, Ramos A, Telleria J. Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria. Acta Paediatr 1996;85:728-32.  Back to cited text no. 30    
31.Rylander R. Airborne (1→3)-beta-D-glucan and airway disease in a day-care center before and after renovation. Arch Environ Health 1997;52:281-285.   Back to cited text no. 31    
32.Michel O, LeVan TD, Stern D, Dentener M, Thorn J, Gnat D et al . Systemic responsiveness to lipopolysaccharide and polymorphisms in the toll-like receptor 4 gene in human beings. J Allergy Clin Immunol 2003;112:923-929.  Back to cited text no. 32    
33.Girardin SE, Philpott DJ. Mini-review: The role of peptidoglycan recognition in innate immunity. Eur J Immunol 2004;34:1777-1782.   Back to cited text no. 33    
34.Dziarski R, Platt KA, Gelius E, Steiner H, Gupta D. Defect in neutrophil killing and increased susceptibility to infection with non-pathogenic gram-positive bacteria in peptidoglycan recognition protein-S (PGRP-S)-deficient mice. Blood 2003;102:689-697.  Back to cited text no. 34    
35.Rylander R. Airway Responsiveness and Chest Symptoms after Inhalation of Endotoxin or (1 →3)-β-D-Glucan. Indoor Built Environ 1996;5:106-11.  Back to cited text no. 35    
36.Brown GD, Gordon S. Immune recognition. A new receptor for beta-glucans. Nature 2001;413:36-37.  Back to cited text no. 36    
37.Ariizumi K, Shen G-L, Shikano S, Xu S, Ritter R-III, Kumamoto T et al . Identification of a novel, dendritic cell-associated molecule, dectin-1, by subtractive cDNA cloning. J Biol Chem 2000;275:20157-20167.  Back to cited text no. 37    
38.Darelid J, Bengtsson L, Gδstrin B, Hallander H, Lofgren S, Malmvall BE et al . An outbreak of Legionnaires′ disease in a Swedish hospital. Scand J Infect Dis 1994;26:417-25.  Back to cited text no. 38    
39.Kool JL, Bergmire-Sweat D, Butler JC, Brown EW, Peabody DJ, Massi DS et al . Hospital characteristics associated with colonization of water systems by Legionella and risk of nosocomial legionnaires′ disease: a cohort study of 15 hospitals. Infect Control Hosp Epidemiol 1999;20:798-805.  Back to cited text no. 39    
40.Kirmeyer GJ, Foust GW, Pierson GL, Simmler JJ, LeChevalier MW. Optimizing Chloramine Treatment. Denver, CO: American Water Works Research Foundation; 1993.  Back to cited text no. 40    
41.Breathnach AS, de Ruiter A, Holdworth GM, Bateman NT, O-Sullivan DG, Rees PJ et al . An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital. J Hosp Infect 1998;39:11-17.  Back to cited text no. 41    
42.Traeger MS, Wiersma ST, Rosenstein NE, Malecki JM, Shepard CW, Raghunathan PL et al . First Case of Bioterrorism- Related Inhalational Anthrax in the United States, Palm Beach County, Florida, 2001. Emerg Infect Dis 2002;8:1029-1034.  Back to cited text no. 42    
43.Parillo JE. Pathogenic mechanisms of septic shock. N Engl J Med 1993;328:1471-1477.  Back to cited text no. 43    
44.Ivens UI, Breum NO, Ebbehoj N, Nielsen BH, Poulsen OM, Wurtz H. Exposure-response relationship between gastrointestinal problems among waste collectors and bio-aerosol exposure. Scand J Work Environ Health 1999;25:238-245.  Back to cited text no. 44    
45.Lugauskas A. Filamentous Fungi Isolated in Hospitals and Some Medical Institutions in Lithuania. Indoor Built Environ 2004;13:101-108.  Back to cited text no. 45    
46.Available at: http://www.advancedmoldinspection.com/health_effects.html. Accessed November 16, 2006.  Back to cited text no. 46    
47.Korpi A, Kasanen JP, Alarie Y, Kosma VM, Pasanen AL. Sensory irritating potency of some microbial volatile organic compounds (MVOCs) and a mixture of five MVOCs. Arch Environ Health 1999;54:347-352.  Back to cited text no. 47    
48.Verma KS, Jain V, Rathore AS. Role of Aspergillus spp. in causing possible Nosocomial Aspergillosis among Immunocompromised Cancer Patients. Indian J Allergy Asthma Immunol 2003;17:77-83.  Back to cited text no. 48    
49.Etzel RA, Balk SJ, Bearer CF, Miller MD, Shannon MW, Shea KM. American Academy of Pediatrics: Toxic Effects of Indoor Moulds. Pediatrics 1998;101:712-714. Available at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b101/4/712. Accessed November 16, 2006.   Back to cited text no. 49    
50.Croft WA, Tarvis BB, Yatawara CS. Airborne outbreak of trichothecene toxicosis. Atmos Environ 1986;20:549-552.  Back to cited text no. 50    
51.Kristensen P, Andersen A, Irgens LM. Hormone-dependent cancer and adverse reproductive outcomes in farmers′ families--effects of climatic conditions favouring fungal growth in grain. Scand J Work Environ Health 2000;26:331-337.  Back to cited text no. 51    
52.Yu ITS, Li Y, Wong TW, Tam W, Chan AT, Lee JHW, et al . Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus. N Engl J Med 2004;350:1731-1739.   Back to cited text no. 52    
53.Diglisic G, Rossi CA, Doti A, Walshe DK. Seroprevalence study of Hantavirus infection in the community based population. Md Med J 1999;48:303-306.  Back to cited text no. 53    
54.Aitken C and Jeffries DJ. Nosocomial Spread of Viral Disease. Clin. Microbiol. Rev. 2001;14:528-546.  Back to cited text no. 54    
55.Peiris JSM, Yuen KY, Osterhaus ADME, Stohr K. The Severe Acute Respiratory Syndrome. N Engl J Med 2003;349:2431-2441.  Back to cited text no. 55    
56.Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM et al . A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong. N Engl J Med 2003;348:1986-94.  Back to cited text no. 56    
57.Lawande RV, Abraham SN, John I and Egler LJ. Recovery of soil Amoebas from the nasal passages of children during the dusty harmattan period in Zaria. Am J Clin Pathol 1979;71:201-203.  Back to cited text no. 57    
58.Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE. Hypersensitivity pneumonitis: current concepts. Eur Respir J 2001;32(suppl.):81S-92S.  Back to cited text no. 58    
59.Von Essen S, Robbins RA, Thompson AB, Rennard SI. Organic dust toxic syndrome: an acute febrile reaction to organic dust exposure distinct from hypersensitivity pneumonitis. Clin Toxicol 1990;28:389-420.  Back to cited text no. 59    
60.Vogelzang PF, van der Gulden JW, Folgering H, Kolk JJ, Heederik D, Preller L et al . Endotoxin exposure as a major determinant of lung function decline in pig farmers. Am J Respir Crit Care Med 1998;157:15-18.  Back to cited text no. 60    
61.Sandiford CP, Tee RD, Taylor AJ. The role of cereal and fungal amylases in cereal flour hypersensitivity. Clin Exp Allergy 1994;24:549-57.  Back to cited text no. 61    
62.Cullinan P, Harris JM, Newman Taylor AJ, Hole AM, Jones M, Barnes F, Jolliffe G. An outbreak of asthma in a modern detergent factory. Lancet 2000;356:1899-900.  Back to cited text no. 62    
63.Cullinan P, Cook A, Nieuwenhuijsen MJ, Sandiford C, Tee RD, Venables KM, McDonald JC, Taylor AJN. Allergen and dust exposure as determinants of work-related symptoms and sensitization in a cohort of flour-exposed workers; a case-control analysis. Ann occup Hyg 2001;45:97-103.  Back to cited text no. 63    
64.Miesen WMAJ, van der Heide S, Kerstjens HAM, Dubois AEJ, de Monchy JGR. Occupational asthma due to IgE mediated allergy to the flower Molucella laevis (Bells of Ireland). Occup Environ Med 2003;60:701-703.  Back to cited text no. 64    
65.Hayes RB, Van Nieuwenhuize JP, Raatgever JW, Kate FJW. Aflatoxin exposures in the industrial setting: An epidemiological study of mortality. Food Chem Toxicol 1984;22:39-43.  Back to cited text no. 65    
66.Sorenson WG, Jones W, Simpson J, Davidson JI. Aflatoxin in respirable airborne peanut dust. J Toxicol Environ Health 1984;14:525-33.  Back to cited text no. 66    
67.Autrup JL, Schmidt J, Autrup H. Exposure to aflatoxin B1 in animal-feed production plant workers. Environ Health Perspect 1993;99:195-7.  Back to cited text no. 67    
68.Demers PA, Boffetta P. (1998) Cancer risk from occupational exposure to wood dust. IARC Technical Report no. 30. Lyon: IARC.  Back to cited text no. 68    
69.Curtis L, Ross M, Persky V, Scheff P, Wadden R, Ramakrisnan V et al . Bio-aerosol concentrations in the quad cities 1 year after the 1993 Mississippi river floods. Indoor Built Environ 2000;9:35-43.  Back to cited text no. 69    
70.Lidwell OM. Airborne bacteria and surgical infection. Am J Med 1981;70:693-697.  Back to cited text no. 70    
71.Kowalski WJ. The epidemiology and aerobiological pathways of airborne nosocomial infections and methods of air and surface disinfection. HPAC Engineering: Air-Treatment Systems for Controlling Hospital-Acquired Infections 2007. Available at: http://www.hpac.com/Issue/Article/44503/AirTreatment_Systems_for_Controlling_HospitalAcquired_Infections Accessed August 03, 2007.  Back to cited text no. 71    
72.Farrington M, Ling J, Ling T, French GL. Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burns units of a new hospital. Epidemiol Infect 1990;105:215-28.  Back to cited text no. 72    
73.Bernards AT, Frenay HM, Lim BT, Hendriks WD, Dijkshoorn L, van Boven CP. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii : An unexpected difference in epidemiologic behaviour. Am J Infect Control 1998;26:544-551.  Back to cited text no. 73    
74.Allen KD, Green HT. Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread? J Hosp Infect 1987;9:110-119.  Back to cited text no. 74    
75.Jones AM, Govan JR, Doherty CJ, Dodd ME, Isalska BJ, Stanbridge TN et al . Identification of airborne dissemination of epidemic multiresistant strains of Pseudomonas aeruginosa at a CF centre during a cross infection outbreak. Thorax 2003;58:525-527.  Back to cited text no. 75    
76.Sarca S, Asan A, Otkun MT, Ture M. Monitoring Indoor Airborne Fungi and Bacteria in the Different Areas of Trakya University Hospital, Edirne, Turkey. Indoor Built Environ 2002;11:285-292.  Back to cited text no. 76    
77.Li CS, Hou PA. Bio-aerosol characteristics in hospital clean rooms. Sci Total Environ 2003;305:169-176.  Back to cited text no. 77    
78.Durmaz G, Kiremitci A, Akgun Y, Oz Y, Kasifoglu N, Aybey A, et al . The relationship between airborne colonization and nosocomial infections in intensive care units. Mikrobiyol Bul 2005;39:465-71.  Back to cited text no. 78    
79.Kelkar U, Kelkar S, Bal AM, Kulkarni S, Kulkarni S. Microbiological Evaluation of Various Parameters in Ophthalmic Operating Rooms. The Need to Establish Guidelines. Indian J Ophthalmol 2002;51:171-76.  Back to cited text no. 79    
80.Studies on Indoor and Outdoor Air micro flora. Available at: http://cpcbenvis.nic.in/newsletter/r&d-cpcb/ch7-10603.htm Accessed October 18, 2008.  Back to cited text no. 80    
81.Ravisankar S., Srikanth P., Steinberg R. and Balakrishnan K. (2005) ‚ ′Characterization of Bio-aerosols in a Health Care Facility in India′ In: ACGIH-AIHce 2005: International Occupational Safety and Health Issues held at Anaheim, California, poster session 402, abstract no. 277.   Back to cited text no. 81    
82.Jensen PA, Schafer MP eds. Sampling and characterization of bio-aerosols, Chapter J. In: NIOSH Manual of Analytical Methods. 1998:82-112.  Back to cited text no. 82    
83.Macher JM, Streifel AJ, Vesley D. Problem buildings, Laboratories and Hospitals, Chapter 18. In: Bio-aerosols handbook. Cox CS, Wathes CM, Eds. (Lewis publishers, Boca Raton, FL) 1995:505-530.  Back to cited text no. 83    
84.International Organization for Standardization (ISO). Cleanrooms and associated controlled environments: biocontamination control. Part 1: general principles and methods. Document ISO 14698-1:2003. ISO: September 2003. Available at: http://www.iso.org. Accessed October 18, 2006.  Back to cited text no. 84    
85.Crook B (a): Inertial samplers: biological perspectives, Chapter 9. In: Bio-aerosols Handbook. Cox CS, Wathes CM, Eds. (Lewis Publishers, Boca Raton, FL) 1995;247-267.   Back to cited text no. 85    
86.Buttner MP, Willeke K, Grinshpun SA: Sampling and Analysis of Airborne Microorganisms, Chapter 73. In Manual of Environmental Microbiology, 2 nd ed. Hurst CJ, Crawford RL, Knudsen G, McInerney M, Stetzenbach LD, Eds. (ASM Press, Washington DC) 2002:814-826.  Back to cited text no. 86    
87.Crook B (b): Non-inertial samplers: biological perspectives, Chapter 10. In: Bio-aerosols Handbook. Cox CS, Wathes CM, Eds. (Lewis Publishers, Boca Raton, FL) 1995;269-283.  Back to cited text no. 87    
88.Higgins JA, Cooper M, Schroeder-Tucker L, Black S, Miller JD, Karns JS et al . A field investigation of Bacillus anthracis contamination of US Department of Agriculture and other Washington DC buildings during the anthrax attack of October 2001. Appl Environ Microbiol 2003;69:593-599.  Back to cited text no. 88    
89.Andersson MA, Nikulin M, Koljalg U, Andersson MC, Rainey F, Reijula K et al . Bacteria, molds, and toxins in water-damaged building materials. Appl Environ Microbiol 1997;63:387-393.  Back to cited text no. 89    
90.Buttner MP, Cruz-Perez P, Stetzenbach LD. Enhanced detection of surface-associated bacteria in indoor environments by quantitative PCR. Appl Environ Microbiol 2001;67:2564-2570.  Back to cited text no. 90    
91.Eduard W, Heederik D. Methods for quantitative assessment of airborne levels of non-infectious microorganisms in highly contaminated work environments. Am Ind Hyg Assoc J 1998;59:113-27.  Back to cited text no. 91    
92.Hensel A, Petzoldt K. Biological and Biochemical Analysis of Bacteria and Viruses, Chapter 13. In: Bio-aerosols handbook. Cox CS, Wathes CM, Eds. (Lewis publishers, New York) 1995:335-360.  Back to cited text no. 92    
93.Madelin TM, Madelin MF. Biological Analysis of Fungi and Associated Molds, Chapter 14. In: Bio-aerosols handbook. Cox CS, Wathes CM Eds. (Lewis publishers, New York) 1995:361-386.  Back to cited text no. 93    
94.Alvarez AJ, Buttner MP, Toranzos GA, Dvorsky EA, Toro A, Heikes TB, et al . The use of solid-phase PCR for enhanced detection of airborne microorganisms. Appl Environ Microbiol 1994;60:374-376.  Back to cited text no. 94    
95.Sawyer MH, Chamberlain CJ, Wu YN, Aintablian N, Wallace MR: Detection of Varicella-Zoster virus DNA in air samples from hospital rooms. J Infect Dis 1994; 169:91-94.  Back to cited text no. 95    
96.Olsson M, Lidman C, Latouche S, Bjorkman A, Roux P, Linder E, Wahlgren M: Identification of Pneumocystis carinii f. sp. hominis gene sequences in filtered air in hospital environments. J Clin Microbiol 1998;36:1737-1740.   Back to cited text no. 96    
97.Leenders ACAP, van Belkum A, Behrendt M, Luijendijk A, Verbrugh HA. Density and molecular epidemiology of Aspergillus in air and relationship to outbreaks of Aspergillus infection. J Clin Microbiol 1999;37:1752-1757.  Back to cited text no. 97    
98.Finney DJ: Statistical Method in Biological Assay, 3rd ed. London, Charles Griffin and Company Ltd, 1978.  Back to cited text no. 98    
99.Milton DK, Feldman HA, Neuberg DS, Bruckner RJ, Greaves IA. Environmental endotoxin measurement: the Kinetic Limulus Assay with Resistant-parallel-line Estimation. Environ Res 1992;57:212-30.  Back to cited text no. 99    
100.Pasanen AL, Yli-Pietila K, Pasanen P, Kalliokoski P, Tarhanen J. Ergosterol Content in Various Fungal Species and Biocontaminated Building Materials. Appl Environ Microbiol 1999;65:138-142.  Back to cited text no. 100    
101.Douwes J, van der Sluis B, Doekes G, van Leusden F, Wijnands L, van Strien R et al . Fungal extracellular polysaccharides in house dust as a marker for exposure to fungi: Relations with culturable fungi, reported home dampness, and respiratory symptoms. J Allergy Clin Immunol 1999;103:494-500.  Back to cited text no. 101    
102.WHO (1988). Indoor air quality: Biological contaminants. Copenhagen, Denmark: World Health Organization.   Back to cited text no. 102    
103.Nathanson T. 1995. Indoor Air Quality in Office Buildings: A Technical Guide. Communications Branch, Health Canada, Ottawa, On. Available at: http://www.cdc.gov/ncidod/EID/vol8no10/pdf/02-0354.pdf Accessed October 06, 2007.  Back to cited text no. 103    
104.NASA standard NhB5340.2. Available at: http://translate.google.com/translate?hl=enandsl=koandu=http://www.jieng.co.kr/sub_b003.htmandsa=Xandoi=translateandresnum=2andct=resultandprev=/search%3Fq%3DNASA%2Bstandard%2BNhB5340.2%26start%3D10%26hl%3Den%26sa%3DN Accessed June 08, 2007.  Back to cited text no. 104    
105.Ghosh A, Hazra A, Mandal SC. New drugs in India over the past 15 years: Analysis of trends. Natl Med J India 2004;17:8-14.  Back to cited text no. 105    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]

This article has been cited by
1 Infrequent Air Contamination With Acinetobacter baumannii of Air Surrounding Known Colonized or Infected Patients
Clare Rock,Anthony D. Harris,J. Kristie Johnson,Werner E. Bischoff,Kerri A. Thom
Infection Control & Hospital Epidemiology. 2015; : 1
[Pubmed] | [DOI]
2 Indoor fungi: companions and contaminants
A. Nevalainen,M. Täubel,A. Hyvärinen
Indoor Air. 2015; : n/a
[Pubmed] | [DOI]
3 A review of indoor air treatment technologies
Angela Luengas,Astrid Barona,Cecile Hort,Gorka Gallastegui,Vincent Platel,Ana Elias
Reviews in Environmental Science and Bio/Technology. 2015;
[Pubmed] | [DOI]
4 Indoor/outdoor relationships of bioaerosol concentrations in a retirement home and a school dormitory
Sasan Faridi,Mohammad Sadegh Hassanvand,Kazem Naddafi,Masud Yunesian,Ramin Nabizadeh,Mohammad Hossein Sowlat,Homa Kashani,Akbar Gholampour,Sadegh Niazi,Ahad Zare,Shahrokh Nazmara,Mahmood Alimohammadi
Environmental Science and Pollution Research. 2014;
[Pubmed] | [DOI]
5 Survival of bioaerosols in HVAC system photocatalytic filters
S. Pigeot-Remy,J.C. Lazzaroni,F. Simonet,P. Petinga,C. Vallet,P. Petit,P.J. Vialle,C. Guillard
Applied Catalysis B: Environmental. 2014; 144: 654
[Pubmed] | [DOI]
6 Quantitative and Qualitative Evaluation of Bio-Aerosols in Surgery Rooms and Emergency Department of an Educational Hospital
Ramazan Mirzaei,Esmat Shahriary,Mazhar Iqbal Qureshi,Ataollah Rakhshkhorshid,Abdolali Khammary,Mahdi Mohammadi
Jundishapur Journal of Microbiology. 2014; 7(8)
[Pubmed] | [DOI]
7 Fungal Contamination Assessment in Portuguese Elderly Care Centers
C. Viegas,M. Almeida-Silva,A. Quintal Gomes,H. T. Wolterbeek,S. M. Almeida
Journal of Toxicology and Environmental Health, Part A. 2014; 77(1-3): 14
[Pubmed] | [DOI]
8 Aerobiological study in the Mexico City subway system
O. Hernández-Castillo,V. Mugica-Álvarez,M. T. Castañeda-Briones,J. M. Murcia,F. García-Franco,Y. Falcón Briseño
Aerobiologia. 2014;
[Pubmed] | [DOI]
9 Seasonal evaluation of bioaerosols from indoor air of residential apartments within the metropolitan area in South Korea
Kyong Whan Moon,Eun Hae Huh,Ho Chul Jeong
Environmental Monitoring and Assessment. 2013;
[Pubmed] | [DOI]
10 The TG and zeta-potential characterization of silver-zeolite composites for anti-bacterial capability
Yeoung-Sheng Wang,Jyun-Hong Shen,Jhan-Ping Lin,Jao-Jia Horng
Journal of Thermal Analysis and Calorimetry. 2013; 111(2): 1443
[Pubmed] | [DOI]
11 Size Distribution of Airborne Fungi in Vehicles Under Various Driving Conditions
Ya-Fen Wang,Cheng-Hsien Tsai,Yu-Tzu Huang,How-Ran Chao,Tsui-Chun Tsou,Yi-Ming Kuo,Lin-Chi Ang,Shih-Hsuan Chen
Archives of Environmental & Occupational Health. 2013; 68(2): 95
[Pubmed] | [DOI]
12 A Qualitative and Quantitative Study Monitoring Airborne Fungal Flora in the Kidney Transplant Unit
Mohammad Ali Afshari,Majid Riazipour,Reza Kachuei,Mojtaba Teimoori,Behzad Einollahi
Nephro-Urology Monthly. 2013; 5(2): 736
[Pubmed] | [DOI]
13 Fungal contribution to size-segregated aerosol measured through biomarkers
Patrizia Di Filippo,Donatella Pomata,Carmela Riccardi,Francesca Buiarelli,Cinzia Perrino
Atmospheric Environment. 2013; 64: 132
[Pubmed] | [DOI]
14 Application of Real-Time Polymerase Chain Reaction (PCR) in Detection of Microbial Aerosols
Song Li,Yanling Li,Ling Zhang,Zengmin Miao
Environmental Forensics. 2013; 14(1): 16
[Pubmed] | [DOI]
15 A flash-lamp based device for fluorescence detection and identification of individual pollen grains
Denis Kiselev,Luigi Bonacina,Jean-Pierre Wolf
Review of Scientific Instruments. 2013; 84(3): 033302
[Pubmed] | [DOI]
16 Bioaerosols from a Food Waste Composting Plant Affect Human Airway Epithelial Cell Remodeling Genes
Min-Wei Chang,Chung-Ru Lee,Hsueh-Fen Hung,Kuo-Sheng Teng,Hsin Huang,Chun-Yu Chuang
International Journal of Environmental Research and Public Health. 2013; 11(1): 337
[Pubmed] | [DOI]
17 Study of bio-aerosols in a prominent temple in Mumbai City, India
Shraddha Mehta,Priyanka Kambli,Kirti Wani,Shraddha Tanavde,Swapnil Mirgal,Varsha Kelkar-Mane,Rakesh Kumar
International Journal of Environmental Studies. 2013; 70(4): 583
[Pubmed] | [DOI]
18 Determination of non-certified levoglucosan, sugar polyols and ergosterol in NIST Standard Reference Material 1649a
Donatella Pomata,Patrizia Di Filippo,Carmela Riccardi,Francesca Buiarelli,Valentina Gallo
Atmospheric Environment. 2013;
[Pubmed] | [DOI]
19 Fungal Contamination in Swine: A Potential Occupational Health Threat
C. Viegas,E. Carolino,R. Sabino,S. Viegas,C. Veríssimo
Journal of Toxicology and Environmental Health, Part A. 2013; 76(4-5): 272
[Pubmed] | [DOI]
20 NanoPCR detection of bacterial aerosols
Siyu Xu,Maosheng Yao
Journal of Aerosol Science. 2013; 65: 1
[Pubmed] | [DOI]
21 Inactivation of Aspergillus niger spores from indoor air by photocatalytic filters
S. Pigeot-Remy,P. Real,F. Simonet,C. Hernandez,C. Vallet,J.C. Lazzaroni,S. Vacher,C. Guillard
Applied Catalysis B: Environmental. 2013; 134-135: 167
[Pubmed] | [DOI]
22 Inactivation of Aspergillus niger spores from indoor air by photocatalytic filters
Pigeot-Remy, S. and Real, P. and Simonet, F. and Hernandez, C. and Vallet, C. and Lazzaroni, J.C. and Vacher, S. and Guillard, C.
Applied Catalysis B: Environmental. 2013; 134-135: 167-173
[Pubmed]
23 A qualitative and quantitative study monitoring airborne fungal flora in the kidney transplant unit
Afshari, M.A. and Riazipour, M. and Kachuei, R. and Teimoori, M. and Einollahi, B.
Nephro-Urology Monthly. 2013; 5(2): 736-740
[Pubmed]
24 Size distribution of airborne fungi in vehicles under various driving conditions
Wang, Y.-F. and Tsai, C.-H. and Huang, Y.-T. and Chao, H.-R. and Tsou, T.-C. and Kuo, Y.-M. and Ang, L.-C. and Chen, S.-H.
Archives of Environmental and Occupational Health. 2013; 68(2): 95-100
[Pubmed]
25 A flash-lamp based device for fluorescence detection and identification of individual pollen grains
Kiselev, D. and Bonacina, L. and Wolf, J.-P.
Review of Scientific Instruments. 2013; 84(3)
[Pubmed]
26 Fungal contamination in swine: A potential occupational health threat
Viegas, C. and Carolino, E. and Sabino, R. and Viegas, S. and Veríssimo, C.
Journal of Toxicology and Environmental Health - Part A: Current Issues. 2013; 76(4-5): 272-280
[Pubmed]
27 The TG and zeta-potential characterization of silver-zeolite composites for anti-bacterial capability
Wang, Y.-S. and Shen, J.-H. and Lin, J.-P. and Horng, J.-J.
Journal of Thermal Analysis and Calorimetry. 2013; 111(2): 1443-1448
[Pubmed]
28 Application of Real-Time Polymerase Chain Reaction (PCR) in Detection of Microbial Aerosols
Li, S. and Li, Y. and Zhang, L. and Miao, Z.
Environmental Forensics. 2013; 14(1): 16-19
[Pubmed]
29 Fungal contribution to size-segregated aerosol measured through biomarkers
Di Filippo, P. and Pomata, D. and Riccardi, C. and Buiarelli, F. and Perrino, C.
Atmospheric Environment. 2013; 64: 132-140
[Pubmed]
30 Adsorption of pseudomonas aeruginosa from air by clinoptilolite: Modeling, isotherm and kinetic
Rezaee, A. and Valipor, F. and Jonidi-Jafari, A. and Khavanin, A. and Rastegar, S. and Soltani, R.D.C.
Fresenius Environmental Bulletin. 2012; 21(9 A): 2826-2832
[Pubmed]
31 A study of indoor air quality issues for non-industrial work place
Deros, B.M. and Ismail, S.H. and Khamis, N.K. and Yusof, M.Y. and Ismail, A.R.
Advances in Natural and Applied Sciences. 2012; 6(8): 1207-1213
[Pubmed]
32 Fungal pollution of indoor environments and its management
Haleem Khan, A.A. and Mohan Karuppayil, S.
Saudi Journal of Biological Sciences. 2012; 19(4): 405-426
[Pubmed]
33 Radon-The Silent Killer
Pathania, R. and Suresh, R.
Indian Journal of Environmental Protection. 2012; 32(10): 808-814
[Pubmed]
34 Aeromycological study at the intensive care unit of the "Dr. Manuel Gea Gonzalez" General Hospital
Ríos-Yuil, J.M. and Arenas, R. and Fernández, R. and Calderón-Ezquerro, M. and Rodriguez-Badillo, R.
Brazilian Journal of Infectious Diseases. 2012; 16(5): 432-435
[Pubmed]
35 Characterization of indoor bioaerosols from a hospital ward in a tropical setting
Sudharsanam, S. and Swaminathan, S. and Ramalingam, A. and Thangavel, G. and Annamalai, R. and Steinberg, R. and Balakrishnan, K. and Srikanth, P.
African Health Sciences. 2012; 12(2): 217-225
[Pubmed]
36 An extramural aero mycological investigation of dental college hospital associated environment
Pathak, A.K.
Agris On-line Papers in Economics and Informatics. 2012; 2(4): 2145-2155
[Pubmed]
37 Antibacterial and regenerated characteristics of Ag-zeolite for removing bioaerosols in Indoor environment
Cheng, H.-H. and Hsieh, C.-C. and Tsai, C.-H.
Aerosol and Air Quality Research. 2012; 12(3): 405-415
[Pubmed]
38 Analysis of Indoor Fungal Contaminants Using Internal Transcribed Spacer Sequence Variability
M. Leo Antony,D. Mubarak Ali,E. Baldev,D. Pandiaraj,R. Praveen Kumar,N. Thajuddin
Asian Journal of Biological Sciences. 2012; 5(6): 304
[Pubmed] | [DOI]
39 Aeromycological study at the intensive care unit of the “Dr. Manuel Gea Gonzalez” General Hospital
José Manuel Ríos-Yuil,Roberto Arenas,Ramón Fernández,María Calderón-Ezquerro,Raymundo Rodriguez-Badillo
The Brazilian Journal of Infectious Diseases. 2012; 16(5): 432
[Pubmed] | [DOI]
40 Fungal pollution of indoor environments and its management
A.A. Haleem Khan,S. Mohan Karuppayil
Saudi Journal of Biological Sciences. 2012; 19(4): 405
[Pubmed] | [DOI]
41 Aerobacteriology of laboratories and offices: Evidence of high risk exposure to immune complex formation in Nigeria
MC Ezeani, MI Agba, CC Onyenekwe, I Anahalu, CC Azikiwe, BE Unaezeb, UU Ezeani
Asian Pacific Journal of Tropical Disease. 2011; 1(2): 131
[VIEW] | [DOI]
42 The mycological analysis of air in selected public rooms. Preliminary study [Analiza mikologiczna powietrza wybranych pomieszczeń użytku publicznego. Doniesienie wstepne]
Ogórek, R. and Plaskowska, E.
Mikologia Lekarska. 2011; 18(1): 24-29
[Pubmed]
43 Nanoparticles in artesian waters
V. V. Goncharuk, V. B. Lapshin, O. V. Karpov, E. V. Lesnikov, D. M. Balakhanov, D. A. Dan’kin, A. V. Syroezhkin
Journal of Water Chemistry and Technology. 2011; 33(3): 135
[VIEW] | [DOI]
44 Demonstration that methadone is being present in the exhaled breath aerosol fraction
Olof Beck, Sören Sandqvist, Johan Franck
Journal of Pharmaceutical and Biomedical Analysis. 2011;
[VIEW] | [DOI]
45 Development of an optimized method for the detection of airborne viruses with real-time PCR analysis
Panos G Ziros, Petros A Kokkinos, Euaggelia Legaki, Apostolos Vantarakis
Virology Journal. 2011; 8(1): 369
[VIEW] | [DOI]
46 An investigation on bio-aerosol concentrations in the different wards of hospitals of Isfahan University of medical sciences
Nourmoradi, H. and Nikaeen, M. and Amin, M.M. and Hatamzadeh, M.
Journal of Isfahan Medical School. 2011; 29(149)
[Pubmed]
47 Molecular and immunological detection of bacteria applied to bio-terrorism [Détection moléculaire et immunologique des bactéries dans le cadre du bioterrorisme]
Pelletier, N. and La Scola, B.
Medecine et Maladies Infectieuses. 2010; 40(9): 506-516
[Pubmed]
48 Feasibility of using real-time optical methods for detecting the presence of viable bacteria aerosols at low concentrations in clean room environments
Jim Ho, Nicholas J. Stanley, Thomas H. Kuehn
Aerobiologia. 2010;
[VIEW] | [DOI]
49 Laser technologies for detection nanoparticles in environmental media
Ulyantsev, A.S., Lesnikov, E.V., Matveeva, I.S., Karpov, O.V., Lapshin, V.B., Syroeshkin, A.V.
Chemical Engineering Transactions. 2010; 22: 221-226
[Pubmed]
50 Hospital indoor airborne microflora in private and government owned hospitals in Sagar city, India
Bhatia, L., Vishwakarma, R.
World Journal of Medical Sciences. 2010; 5(3): 65-70
[Pubmed]
51 Détection moléculaire et immunologique des bactéries dans le cadre du bioterrorisme
N. Pelletier,B. La Scola
Médecine et Maladies Infectieuses. 2010; 40(9): 506
[Pubmed] | [DOI]
52 Exposure to indoor fungi in different working environments: A comparative study
Dhruba Sharma, B. K. Dutta, A. B. Singh
Aerobiologia. 2010; 26(4): 327
[VIEW] | [DOI]
53 Assessment of microbiological indoor air quality in an Italian office building equipped with an HVAC system
Sa. Bonetta, Si. Bonetta, S. Mosso, S. Sampò, E. Carraro
Environmental Monitoring and Assessment. 2010; 161(1-4): 473-483
[Pubmed] | [DOI]
54 Molecular and immunological detection of bacteria applied to bio-terrorism | [Détection moléculaire et immunologique des bactéries dans le cadre du bioterrorisme]
Pelletier, N., La Scola, B.
Medecine et Maladies Infectieuses. 2010; 40(9): 506-516
[Pubmed]
55 Indoor air quality in hospitals: A case study and a critical review of current standards | [Qualidade do ar em ambientes internos hospitalares: Estudo de caso e análise crítica dos padrões atuais]
Quadros, M.E., Lisboa, H.M., de Oliveira, V.L., Schirmer, W.N.
Engenharia Sanitaria e Ambiental. 2009; 14(3): 431-438
[Pubmed]
56 Assessment of mold concentrations in Singapore shopping centers using mold-specific quantitative PCR (MSQPCR) analysis
Jennifer Yap,Zhen Ann Toh,Vivien Goh,Lee Chen Ng,Stephen Vesper
Indian Journal of Microbiology. 2009; 49(3): 290
[Pubmed] | [DOI]
57 Assessment of mold concentrations in Singapore shopping centers using mold-specific quantitative PCR (MSQPCR) analysis
Yap, J., Toh, Z.A., Goh, V., Ng, L.C., Vesper, S.
Indian Journal of Microbiology. 2009; 49(3): 290-293
[Pubmed]
58 Indoor air quality in hospitals: A case study and a critical review of current standards [Qualidade do ar em ambientes internos hospitalares: Estudo de caso e análise crítica dos padrões atuais]
Quadros, M.E. and Lisboa, H.M. and de Oliveira, V.L. and Schirmer, W.N.
Engenharia Sanitaria e Ambiental. 2009; 14(3): 431-438
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

© 2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04