Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio

A. Roderick Escombe, David A J Moore, Robert H Gilman, Marcos Navincopa, Eduardo Ticona, Bailey Mitchell, Catherine Noakes, Carlos Martinez, Patricia Sheen, Rocio Ramirez, Willi Quino, Armandoe Gonzalez, Jon S. Friedland, Carlton A. Evans

Research output: Contribution to journalArticle

Abstract

Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper- room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Peru, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p <0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p <0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p <0.0001) and by UV lights (log-rank 46; p <0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings.

Original languageEnglish (US)
Pages (from-to)312-323
Number of pages12
JournalPLoS Medicine
Volume6
Issue number3
DOIs
StatePublished - Mar 2009

Fingerprint

Air Ionization
Ultraviolet Rays
Tuberculosis
Air
Guinea Pigs
Infection
Control Groups
Infection Control
Autopsy
Extensively Drug-Resistant Tuberculosis
HIV

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Escombe, A. R., Moore, D. A. J., Gilman, R. H., Navincopa, M., Ticona, E., Mitchell, B., ... Evans, C. A. (2009). Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio. PLoS Medicine, 6(3), 312-323. https://doi.org/10.1371/journal.pmed.1000043

Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio. / Escombe, A. Roderick; Moore, David A J; Gilman, Robert H; Navincopa, Marcos; Ticona, Eduardo; Mitchell, Bailey; Noakes, Catherine; Martinez, Carlos; Sheen, Patricia; Ramirez, Rocio; Quino, Willi; Gonzalez, Armandoe; Friedland, Jon S.; Evans, Carlton A.

In: PLoS Medicine, Vol. 6, No. 3, 03.2009, p. 312-323.

Research output: Contribution to journalArticle

Escombe, AR, Moore, DAJ, Gilman, RH, Navincopa, M, Ticona, E, Mitchell, B, Noakes, C, Martinez, C, Sheen, P, Ramirez, R, Quino, W, Gonzalez, A, Friedland, JS & Evans, CA 2009, 'Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio', PLoS Medicine, vol. 6, no. 3, pp. 312-323. https://doi.org/10.1371/journal.pmed.1000043
Escombe, A. Roderick ; Moore, David A J ; Gilman, Robert H ; Navincopa, Marcos ; Ticona, Eduardo ; Mitchell, Bailey ; Noakes, Catherine ; Martinez, Carlos ; Sheen, Patricia ; Ramirez, Rocio ; Quino, Willi ; Gonzalez, Armandoe ; Friedland, Jon S. ; Evans, Carlton A. / Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio. In: PLoS Medicine. 2009 ; Vol. 6, No. 3. pp. 312-323.
@article{90a9d6b24aa14ff7921446454e1d460a,
title = "Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio",
abstract = "Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper- room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Peru, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35{\%} (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14{\%} (43/303) by ionizers, and to 9.5{\%} (29/307) by UV lights (both p <0.0001 compared with the control group). TB disease was confirmed in 8.6{\%} (26/304) of control group animals, and this was reduced to 4.3{\%} (13/303) by ionizers, and to 3.6{\%} (11/307) by UV lights (both p <0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p <0.0001) and by UV lights (log-rank 46; p <0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60{\%} of TB infection and 51{\%} of TB disease, and that UV lights prevented 70{\%} of TB infection and 54{\%} of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings.",
author = "Escombe, {A. Roderick} and Moore, {David A J} and Gilman, {Robert H} and Marcos Navincopa and Eduardo Ticona and Bailey Mitchell and Catherine Noakes and Carlos Martinez and Patricia Sheen and Rocio Ramirez and Willi Quino and Armandoe Gonzalez and Friedland, {Jon S.} and Evans, {Carlton A.}",
year = "2009",
month = "3",
doi = "10.1371/journal.pmed.1000043",
language = "English (US)",
volume = "6",
pages = "312--323",
journal = "Nature Clinical Practice Oncology",
issn = "1759-4774",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmissio

AU - Escombe, A. Roderick

AU - Moore, David A J

AU - Gilman, Robert H

AU - Navincopa, Marcos

AU - Ticona, Eduardo

AU - Mitchell, Bailey

AU - Noakes, Catherine

AU - Martinez, Carlos

AU - Sheen, Patricia

AU - Ramirez, Rocio

AU - Quino, Willi

AU - Gonzalez, Armandoe

AU - Friedland, Jon S.

AU - Evans, Carlton A.

PY - 2009/3

Y1 - 2009/3

N2 - Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper- room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Peru, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p <0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p <0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p <0.0001) and by UV lights (log-rank 46; p <0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings.

AB - Background Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upper- room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Peru, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p <0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p <0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p <0.0001) and by UV lights (log-rank 46; p <0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings.

UR - http://www.scopus.com/inward/record.url?scp=63449137536&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63449137536&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1000043

DO - 10.1371/journal.pmed.1000043

M3 - Article

C2 - 19296717

AN - SCOPUS:63449137536

VL - 6

SP - 312

EP - 323

JO - Nature Clinical Practice Oncology

JF - Nature Clinical Practice Oncology

SN - 1759-4774

IS - 3

ER -