title: Aerosol distribution during open suctioning and long-term surveillance of air quality in a respiratory care center within a medical center.
abstract: BACKGROUND
  The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning.
  
  
  METHODS
  The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patient's head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers.
  
  
  RESULTS
  This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers.
  
  
  CONCLUSIONS
  RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings.
authors.affiliation: Department of Nursing, Chang Gung University of Science and Technology.
authors.forename: Fen-Fang
authors.initials: FF
authors.lastname: Chung
authors.affiliation: Department of Respiratory Therapy, College of Medicine, Chang Gung University.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Lin
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University.
authors.forename: Hsueh-Erh
authors.initials: HE
authors.lastname: Liu
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University.
authors.forename: Angela Shin-Yu
authors.initials: AS
authors.lastname: Lien
authors.affiliation: Department of Respiratory Therapy, College of Medicine, Chang Gung University Department of Respiratory Therapy, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Hsiu-Feng
authors.initials: HF
authors.lastname: Hsiao
authors.affiliation: Department of Respiratory Therapy, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Lan-Ti
authors.initials: LT
authors.lastname: Chou
authors.affiliation: Department of Respiratory Therapy, College of Medicine, Chang Gung University ghwan@mail.cgu.edu.tw.
authors.forename: Gwo-Hwa
authors.initials: GH
authors.lastname: Wan
mesh_terms: D000046:Academic Medical Centers; D000336:Aerosols; D016902:Air Pollution, Indoor / Q000032:analysis*; D001230:Aspergillus / Q000302:isolation & purification; D002245:Carbon Dioxide / Q000032:analysis; D015169:Colony Count, Microbial; D003352:Corynebacterium / Q000302:isolation & purification; D004784:Environmental Monitoring; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D006801:Humans; D006813:Humidity; D008837:Micrococcus / Q000302:isolation & purification; D003904:Mitosporic Fungi / Q000302:isolation & purification*; D016273:Occupational Exposure / Q000032:analysis* / Q000592:standards; D052638:Particulate Matter / Q000032:analysis; D010407:Penicillium / Q000302:isolation & purification; D012121:Respiration, Artificial; D012124:Respiratory Care Units; D060645:Scopulariopsis / Q000302:isolation & purification; D012621:Seasons; D013210:Staphylococcus / Q000302:isolation & purification; D013396:Suction; D013696:Temperature; D013997:Time Factors; D014242:Trichoderma / Q000302:isolation & purification; D055549:Volatile Organic Compounds / Q000032:analysis
chemical_list: D000336:Aerosols; D052638:Particulate Matter; D055549:Volatile Organic Compounds; D002245:Carbon Dioxide
keywords: bioaerosol; health-care workers; indoor air quality; mechanically ventilated patient; open suctioning; respiratory care center