Evaluation of Interventions to Improve Ventilation in Households to Reduce Risk for Transmission of Severe Acute Respiratory Syndrome Coronavirus 2

Main Article Content

Wilson Ha
Mitchell A. Stiefel
Jeremy R. Gries
Jennifer L. Cadnum
Maria M. Torres-Teran
Brigid M. Wilson
Curtis J. Donskey

Abstract

Background: Inadequate ventilation may contribute to the high risk for household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 


Methods: We evaluated the effectiveness of several interventions recommended to improve ventilation in households. In 7 residential homes, carbon dioxide monitoring was conducted to assess ventilation in occupied open areas such as family rooms and in bedrooms and/or offices. Carbon dioxide levels above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present. In 1 of the 7 homes, various interventions to improve ventilation or to filter air were assessed in a kitchen area by measuring clearance of aerosol particles produced using an aerosol-based spray system and carbon dioxide generated by cooking with a gas stove.


Results: Carbon dioxide levels rose above 800 ppm in bedrooms and offices with 2 occupants when windows and doors were closed and in open areas during gatherings of 5 to 10 people; carbon dioxide levels decreased when windows or doors were opened. Clearance of carbon dioxide and aerosol particles significantly increased with interventions including running fans, operating portable air cleaners, and opening windows, particularly when there was a noticeable breeze or when a window fan was used to blow contaminated air outside. 


Conclusion: In households, several measures to improve ventilation or air filtration were effective in reducing carbon dioxide accumulation or enhancing clearance of carbon dioxide and aerosol particles. Studies are needed to determine if interventions to improve ventilation can reduce the risk for airborne transmission of SARS-CoV-2 in households.  

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Ha W, Stiefel M, Gries J, Cadnum J, Torres-Teran M, Wilson B, Donskey C. Evaluation of Interventions to Improve Ventilation in Households to Reduce Risk for Transmission of Severe Acute Respiratory Syndrome Coronavirus 2. PAI [Internet]. 2022 Dec. 10 [cited 2023 Feb. 3];7(2):120-3. Available from: https://www.paijournal.com/index.php/paijournal/article/view/553
Section
Articles

References

1. Thompson HA, Mousa A, Dighe A, Fu H, Arnedo-Pena A, Barrett P, Bellido-Blasco J, Bi Q, Caputi A, Chaw L, De Maria L, Hoffmann M, Mahapure K, Ng K, Raghuram J, Singh G, Soman B, Soriano V, Valent F, Vimercati L, Wee LE, Wong J, Ghani AC, Ferguson NM. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis. Clin Infect Dis. 2021;73(3):e754-e64. doi: 10.1093/cid/ciab100. PubMed PMID: 33560412; PMCID: PMC7929012.

2. Tsang TK, Lau LLH, Cauchemez S, Cowling BJ. Household Transmission of Influenza Virus. Trends Microbiol. 2016;24(2):123-33. doi: 10.1016/j.tim.2015.10.012. PubMed PMID: 26612500; PMCID: PMC4733423.

3. Singanayagam A, Hakki S, Dunning J, Madon KJ, Crone MA, Koycheva A, Derqui-Fernandez N, Barnett JL, Whitfield MG, Varro R, Charlett A, Kundu R, Fenn J, Cutajar J, Quinn V, Conibear E, Barclay W, Freemont PS, Taylor GP, Ahmad S, Zambon M, Ferguson NM, Lalvani A. Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study. Lancet Infect Dis. 2022;22(2):183-95. doi: 10.1016/s1473-3099(21)00648-4. PubMed PMID: 34756186; PMCID: PMC8554486.

4. Eyre DW, Taylor D, Purver M, Chapman D, Fowler T, Pouwels KB, Walker AS, Peto TEA. Effect of Covid-19 Vaccination on Transmission of Alpha and Delta Variants. N Engl J Med. 2022;386(8):744-56. doi: 10.1056/NEJMoa2116597. PubMed PMID: 34986294; PMCID: PMC8757571.

5. Kolodziej LM, van Lelyveld SFL, Haverkort ME, Mariman R, Sluiter-Post JGC, Badoux P, de Koff EM, Koole JCD, Miellet WR, Swart AN, Coipan EC, Meijer A, Sanders EAM, Trzciński K, Euser SM, Eggink D, van Houten MA. High Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Household Transmission Rates Detected by Dense Saliva Sampling. Clin Infect Dis. 2022;75(1):e10-e9. doi: 10.1093/cid/ciac261. PubMed PMID: 35385575; PMCID: PMC9047155.

6. Ventilation in Buildings: Centers for Disease Control and Prevention; [updated June 2, 2021; cited 2022 August 20]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html.

7. Allen JG, Ibrahim AM. Indoor Air Changes and Potential Implications for SARS-CoV-2 Transmission. Jama. 2021;325(20):2112-3. doi: 10.1001/jama.2021.5053. PubMed PMID: 33861316.

8. Ha W, Zabarsky TF, Eckstein EC, Alhmidi H, Jencson AL, Cadnum JL, Donskey CJ. Use of carbon dioxide measurements to assess ventilation in an acute care hospital. Am J Infect Control. 2022;50(2):229-32. doi: 10.1016/j.ajic.2021.11.017. PubMed PMID: 34848292; PMCID: PMC8627286.

9. Improving ventilation in your home: Centers for Disease Control and Prevention; [updated June 29, 2022; cited 2022 August 20]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/improving-ventilation-home.html.

10. Interactive Home Ventilation Tool: Centers for Disease Control and Prevention; [updated February 9, 2022; cited 2022 August 20]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/interactive-ventilation-tool.html.

11. Cadnum JL, Donskey CJ. If you can’t measure it, you can’t improve it: Practical tools to assess ventilation and airflow patterns to reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 and other airborne pathogens. Infect Control Hosp Epidemiol. 2022;43(7):915-7. doi: 10.1017/ice.2022.103. PubMed PMID: 35379373; PMCID: PMC9021581.

12. Huang Q, Marzouk T, Cirligeanu R, Malmstrom H, Eliav E, Ren YF. Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms. J Dent Res. 2021;100(8):810-6. doi: 10.1177/00220345211014441. PubMed PMID: 33973494; PMCID: PMC8120146.

13. Batterman S. Review and Extension of CO₂-Based Methods to Determine Ventilation Rates with Application to School Classrooms. Int J Environ Res Public Health. 2017;14(2). doi: 10.3390/ijerph14020145. PubMed PMID: 28165398; PMCID: PMC5334699.

14. Cadnum JL, Bolomey A, Jencson AL, Wilson BM, Donskey CJ. Effectiveness of commercial portable air cleaners and a do-it-yourself minimum efficiency reporting value (MERV)-13 filter box fan air cleaner in reducing aerosolized bacteriophage MS2. Infect Control Hosp Epidemiol. 2022:1-3. doi: 10.1017/ice.2022.5. PubMed PMID: 35098916.

15. The ‘Corsi / Rosenthal / Comparetto’ DIY Air Purifier Desig: Edge Collective; [updated August 8, 2021]. Available from: https://edgecollective.io/airbox.

16. Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace: United States Department of Labor; [updated June 10, 2021; cited 2022 November]. Available from: https://www.osha.gov/coronavirus/safework.

17. Jones LD, Chan ER, Zabarsky TF, Cadnum JL, Navas ME, Redmond SN, Kovach JD, Linger M, Rutala WA, Zimmerman PA, Donskey CJ. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Patient Transport Van. Clin Infect Dis. 2022;74(2):339-42. doi: 10.1093/cid/ciab347. PubMed PMID: 33893474; PMCID: PMC8135457.

18. Haq MF, Cadnum JL, Carlisle M, Hecker MT, Donskey CJ. SARS in Cars: Carbon Dioxide Levels Provide a Simple Means to Assess Ventilation in Motor Vehicles. Pathog Immun. 2022;7(1):19-30. doi: 10.20411/pai.v7i1.493. PubMed PMID: 35178491; PMCID: PMC8843085.

19. Cadnum JL, Jencson AL, Alhmidi H, Zabarsky TF, Donskey CJ. Airflow patterns in double occupancy patient rooms may contribute to roommate-to-roommate transmission of severe acute respiratory syndrome coronavirus 2. Clin Infect Dis. 2022. doi: 10.1093/cid/ciac334. PubMed PMID: 35476020; PMCID: PMC9129113.

20. Lu J, Gu J, Li K, Xu C, Su W, Lai Z, Zhou D, Yu C, Xu B, Yang Z. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(7):1628-31. doi: 10.3201/eid2607.200764. PubMed PMID: 32240078; PMCID: PMC7323555.

21. Hammond A, Khalid T, Thornton HV, Woodall CA, Hay AD. Should homes and workplaces purchase portable air filters to reduce the transmission of SARS-CoV-2 and other respiratory infections? A systematic review. PLoS One. 2021;16(4):e0251049. doi: 10.1371/journal.pone.0251049. PubMed PMID: 33914823; PMCID: PMC8084223.

Most read articles by the same author(s)