Removal of exhaled particles by ventilation and deposition in a multibed airborne infection isolation room

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Abstract
Removal of airborne particles in airborne infection isolation rooms is important for infection control of airborne diseases. Previous studies showed that the downward ventilation recommended by Centers for Disease Control and Prevention (CDC) could not produce the expected 'laminar' flow for pushing down respiratory gaseous contaminants and removing them via floor-level exhausts. Instead, upper-level exhausts were more efficient in removing gaseous contaminants because of upward body plumes. The conventional wisdom in the current CDC-recommended design is that floor-level exhausts may efficiently remove large droplets/particles, but such a hypothesis has not been proven. We investigated the fate of respiratory particles in a full-scale six-bed isolation room with exhausts at different locations by both experimental and computational studies. Breathing thermal manikins were used to simulate patients, and both gaseous and large particles were used to simulate the expelled fine droplet nuclei and large droplets. Gaseous and fine particles were found to be removed more efficiently by ceiling-level exhausts than by floor-level exhausts. Large particles were mainly removed by deposition rather than by ventilation. Our results show that the existing isolation room ventilation design is not effective in removing both fine and large respiratory particles. An improved ventilation design is hence recommended. Our findings of the relatively poor performance of fine-particle removal by the existing CDC design of isolation room ventilation suggests a need for improvement, and the findings of the removal of large particles by deposition, not by ventilation, suggest that floor-level exhausts are unnecessary, and that regular surface cleaning and disinfection is necessary, thus providing evidence for maintaining isolation room surface hygiene.