title: Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model.
abstract: BACKGROUND
  Although many infections that are transmissible from person to person are acquired through direct contact between individuals, a minority, notably pulmonary tuberculosis (TB), measles and influenza are known to be spread by the airborne route. Airborne infections pose a particular threat to susceptible individuals whenever they are placed together with the index case in confined spaces. With this in mind, waiting areas of healthcare facilities present a particular challenge, since large numbers of people, some of whom may have underlying conditions which predispose them to infection, congregate in such spaces and can be exposed to an individual who may be shedding potentially pathogenic microorganisms. It is therefore important to understand the risks posed by infectious individuals in waiting areas, so that interventions can be developed to minimise the spread of airborne infections.
  
  
  METHODS
  A stochastic Monte Carlo model was constructed to analyse the transmission of airborne infection in a hypothetical 132 m3 hospital waiting area in which occupancy levels, waiting times and ventilation rate can all be varied. In the model the Gammaitoni-Nucci equation was utilized to predict probability of susceptible individuals becoming infected. The model was used to assess the risk of transmission of three infectious diseases, TB, influenza and measles. In order to allow for stochasticity a random number generator was applied to the variables in the model and a total of 10000 individual simulations were undertaken. The mean quanta production rates used in the study were 12.7, 100 and 570 per hour for TB, influenza and measles, respectively.
  
  
  RESULTS
  The results of the study revealed the mean probability of acquiring a TB infection during a 30-minute stay in the waiting area to be negligible (i.e. 0.0034), while that for influenza was an order of magnitude higher at 0.0262. By comparison the mean probability of acquiring a measles infection during the same period was 0.1349. If the duration of the stay was increased to 60 minutes then these values increased to 0.0087, 0.0662 and 0.3094, respectively.
  
  
  CONCLUSIONS
  Under normal circumstances the risk of acquiring a TB infection during a visit to a hospital waiting area is minimal. Likewise the risks associated with the transmission of influenza, although an order of magnitude greater than those for TB, are relatively small. By comparison, the risks associated with measles are high. While the installation of air disinfection may be beneficial, when seeking to prevent the transmission of airborne viral infection it is important to first minimize waiting times and the number of susceptible individuals present before turning to expensive technological solutions.
authors: Bradford Infection Group, School of Engineering, Design and Technology, University of Bradford, Bradford, BD7 1DP, UK. c.b.beggs@bradford.ac.uk
authors: Clive B
authors: CB
authors: Beggs
authors: Simon J
authors: SJ
authors: Shepherd
authors: Kevin G
authors: KG
authors: Kerr
mesh_terms: D000391:Air Microbiology; D000392:Air Movements; D050936:Basic Reproduction Number; D003141:Communicable Diseases / Q000635:transmission*; D003441:Crowding; D018562:Disease Transmission, Infectious; D006268:Health Facilities; D006801:Humans; D007251:Influenza, Human / Q000635:transmission; D008457:Measles / Q000635:transmission; D015233:Models, Statistical; D018570:Risk Assessment; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000635:transmission