title: The Cough Cylinder: a tool to study measures against airborne spread of (myco-) bacteria.
abstract: BACKGROUND
  'Covering your cough' reduces droplet number, but its effect on airborne pathogen transmission is less clear. The World Health Organization specifically recommends cough etiquette to prevent the spread of Mycobacterium tuberculosis, but implementation  is generally poor and evidence supporting its value is lacking.
  
  
  METHODS
  We constructed a model to assess 'real life' transmission risk by counting viable pathogens from aerosols produced by coughing patients, thus allowing the assessment of outward protection measures in a  standardised fashion. During the validation process, we focused on rod-shaped bacteria as surrogates for M. tuberculosis.
  
  
  RESULTS
  The Cough Cylinder enabled us to sample Pseudomonas aeruginosa, Escherichia coli and mycobacteria from aerosols produced by patients with  cystic fibrosis, primary ciliary dyskinesia and tuberculosis. Pathogens in droplets and in airborne particles could be sampled. Delayed air sampling allowed specific measurement of persistent airborne particles.
  
  
  CONCLUSIONS
  This novel experimental system allows measurement of aerosol pathogen  spread in a highly standardised fashion. It also offers the possibility to assess the impact of different interventions to limit aerosol transmission.
authors.affiliation: Department of Pediatric Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Koen@ESCapeTB.org
authors.forename: K
authors.initials: K
authors.lastname: Vanden Driessche
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.forename: M
authors.initials: M
authors.lastname: Wattenberg
authors.forename: C
authors.initials: C
authors.lastname: Magis-Escurra
authors.forename: M
authors.initials: M
authors.lastname: Reijers
authors.forename: I L
authors.initials: IL
authors.lastname: Tuinman
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeree
authors.forename: D
authors.initials: D
authors.lastname: van Soolingen
authors.forename: R
authors.initials: R
authors.lastname: de Groot
authors.forename: M F
authors.initials: MF
authors.lastname: Cotton
mesh_terms: D000328:Adult; D000368:Aged; D000391:Air Microbiology; D001419:Bacteria / Q000302:isolation & purification*; D001431:Bacteriological Techniques / Q000295:instrumentation; D003371:Cough / Q000382:microbiology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D055815:Young Adult