fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2020-5-4-97-103fcmedicine-341Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESАэрогенный механизм передачи больничных патогеновAirborne transmission of hospital pathogenshttps://orcid.org/0000-0002-8616-3227БрусинаЕ. Б.BrusinaЕ. В.

Брусина Елена Борисовна, доктор медицинских наук, профессор, заведующий кафедрой эпидемиологии, инфекционных болезней и дерматовенерологии

650056, г. Кемерово, ул. Ворошилова, 22а

Elena B. Brusina, MD, DSc, Professor, Head of the Department of Epidemiology, Infectious Diseases, Dermatology and Venereology

22a, Voroshilova Street, Kemerovo, 650056

https://orcid.org/0000-0003-0770-0993ЧезгановаЕ. А.ChezganovaE. A.

Чезганова Евгения Андреевна, аспирант кафедры эпидемиологии, инфекционных болезней и дерматовенерологии

650056, г. Кемерово, ул. Ворошилова, 22а

Evgenia A. Chezganova, MD, PhD Student, Department of Epidemiology, Infectious Diseases, Dermatology and Venereology

22a, Voroshilova Street, Kemerovo, 650056

https://orcid.org/0000-0001-9380-0901ДроздоваО. М.DrozdovaО. M.

Дроздова Ольга Михайловна, доктор медицинских наук, профессор, профессор кафедры эпидемиологии, инфекционных болезней и дерматовенерологии

650056, г. Кемерово, ул. Ворошилова, 22а

Olga M. Drozdova, MD, DSc, Professor, Department of Epidemiology, Infectious Diseases, Dermatology and Venereology

22a, Voroshilova Street, Kemerovo, 650056

ФГБОУ ВО «Кемеровский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKemerovo State Medical UniversityRussian Federation2020241220205497103Copyright © Брусина Е.Б., Чезганова Е.А., Дроздова О.М., 20202020Брусина Е.Б., Чезганова Е.А., Дроздова О.М.Brusina Е.В., Chezganova E.A., Drozdova О.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/341

На протяжении десятилетий многие аспекты аэрогенной передачи больничных патогенов были и остаются предметом научных дискуссий. Пандемия COVID 19 со всей очевидностью показала необходимость обобщения современных знаний об аэрогенном механизме передачи возбудителей и поиска ответов на нерешенные вопросы.

Цель обзора − суммировать накопленные результаты исследований о биологических аэрозолях, медицинских технологиях, при которых возможна их генерация, особенностях распространения в больничной среде, закономерностях реализации аэрогенного механизма в зависимости от размера частиц аэрозоля, их формы, морфологического и химического состава, термо-и фотофоретического эффектов, эффекта коагуляции, особенностях распространения облака аэрозолей в больничной среде, содержащихся в нем патогенах и их концентрации.

Заключение. Один из наиболее важных вопросов заключается в том, почему некоторые частицы, выброшенные во время любой дыхательной деятельности, несут патогены, а некоторые − нет. Необходимо уточнить, зависит ли носительство от размера частиц, места заражения, места образования частиц (которое может отличаться от места заражения), концентрации патогена в слизи, изменений характера слизи, вирулентности самого патогена. Более того, похожи ли частицы, несущие вирус, на частицы, переносящие бактерии и грибы? Зависит ли сохранение резервуара внутрибольничных патогенов от морфологического и химического состава пыли. Эти вопросы имеют первостепенное значение для понимания роли дополнительных резервуаров патогенов в больничной среде, влияния поллютантов внешней среды, современных материалов, применяемых в уходе за пациентами и лечебном процессе, на реализацию воздушно-пылевого пути, роли физиологических ниш, которые патогены занимают в организме человека и во время передачи болезней.

For decades, there have been a number of controversial issues regarding the airborne transmission of hospital pathogens. Here we decided to perform a critical review on this topic in light of the current COVID-19 pandemic. We summarise the existing knowledge on biological aerosols including techniques of their generation, propagation of bioaerosol particles in a hospital environment, particle size-, shape- and composition-dependent airborne transmission, and microorganisms inhabitating such particles. It is still unclear which of the particles transfer the pathogens, which of the pathogens are capable of adhering to the particulate matter, and whether such adhesion affects pathogen virulence. Intriguingly, viruses, bacteria and fungi seemingly have distinct patterns of interactions with the bioaerosols. Moreover, particle formation and their colonization may be separated in time, further complicating the puzzle. Apparently, pathogen interactions with the particulate matter are of paramount importance to better understand the role of bioaerosol particles as a potential pathogen reservoir in the hospital environment and to properly assess the influence of environmental pollutants, novel biomedical materials and treatment technologies on airborne transmission of hospital pathogens.

больничные патогеныаэрозольчастицыаэрогенный механизм передачиhospital pathogensaerosolparticlesairborne transmissionReferencesSurgical operations and procedures statistics. Statistics Explained. Available at: https://ec.europa.eu/eurostat/ statisticsexplained/. Accessed: 10 Oct, 2020.Surgical operations and procedures statistics. Statistics Explained. Available at: https://ec.europa.eu/eurostat/ statisticsexplained/. Accessed: 10 Oct, 2020.Sattar SA, Ijaz MK. The Role of Indoor Air as a Vehicle for Human Pathogens: Summary of Presentations, Knowledge Gaps, and Directions for the Future. Am J Infect Control. 2016;44(9):144-146. https://doi.org/10.1016/j. ajic.2016.06.006Sattar SA, Ijaz MK. The Role of Indoor Air as a Vehicle for Human Pathogens: Summary of Presentations, Knowledge Gaps, and Directions for the Future. Am J Infect Control. 2016;44(9):144-146. https://doi.org/10.1016/j. ajic.2016.06.006Громашевский Л.В., ред. Механизм передачи инфекции: (Учение о механизме передачи возбудителей инфекционных болезней и его значение в эпидемиологии). 2-е изд., пересмотр. и доп. Киев: Госмедиздат УССР; 1962Gromashevskij LV, editor. Mehanizm peredachi infekcii: (Uchenie o mehanizme peredachi vozbuditelej infekcionnyh boleznej i ego znachenie v jepidemiologii). 2nd ed., revised and supplemented with new information. Kiev: Gosmedizdat USSR; 1962. (In Russ.).Башенин В.А. Курс общей эпидемиологии. 2-е изд., испр. и доп. М.; Л.: Наркомздрав СССР – Биомедгиз; 1938 (М. : 16 тип. треста «Полиграфкнига»).Bashenin VA. Kurs obshhej jepidemiologii. 2nd ed., revised and supplemented with new information. Moscow; Leningrad: Narkomzdrav SSSR – Biomedgiz; 1938 (Moscow: 16 tip. tresta «Poligrafkniga»). (In Russ.).Чекман И.С., Сыровая А.О., Андреева С.В., Макаров В.А. Аэрозоли – дисперсные системы. Киев-Харьков; 2013Chekman IS, Syrovaja AO, Andreeva SV, Makarov VA. Ajerozoli – dispersnye sistemy. Kiev-Kharkiv; 2013. (In Russ.).Slonim NB, Chapin JL. Respiratory Physiology. Saint Louis: The CV Mosby Company; 1967.Slonim NB, Chapin JL. Respiratory Physiology. Saint Louis: The CV Mosby Company; 1967.Ross BB. Physical dynamics of the cough mechanism. Journal of Applied Physiology. 1955;8(3):264-268. https://doi. org/10.1152/jappl.1955.8.3.264Ross BB. Physical dynamics of the cough mechanism. Journal of Applied Physiology. 1955;8(3):264-268. https://doi. org/10.1152/jappl.1955.8.3.264Gebhart J, Anselm A, Heyder J, Stalhofen W. The human lung as aerosol particle Generator. Journal of Aerosol Medicine. 1988;1:196-197.Gebhart J, Anselm A, Heyder J, Stalhofen W. The human lung as aerosol particle Generator. Journal of Aerosol Medicine. 1988;1:196-197.Holmgren H, Ljungstrom E, Almstrand A-C, Bake B, Olin AC. Size distribution of exhaled particles in the range from 0.01 to 2.0μM. Journal of Aerosol Science. 2010;41(5):439-446. https://doi.org/10.1016/j.jaerosci.2010.02.011Holmgren H, Ljungstrom E, Almstrand A-C, Bake B, Olin AC. Size distribution of exhaled particles in the range from 0.01 to 2.0μM. Journal of Aerosol Science. 2010;41(5):439-446. https://doi.org/10.1016/j.jaerosci.2010.02.011Haslbeck K, Schwarz K, Hohlfeld JM, Seume JR, Koch W. Submicron droplet formation in the human lung. Journal of Aerosol Science 2010;41(5):429-438. https://doi.org/10.1016/j. jaerosci.2010.02.010Haslbeck K, Schwarz K, Hohlfeld JM, Seume JR, Koch W. Submicron droplet formation in the human lung. Journal of Aerosol Science 2010;41(5):429-438. https://doi.org/10.1016/j. jaerosci.2010.02.010Morawska JG, Ristovski L, Hargreaves Z, Mengersen M., Chao K, Wan Ch, Li M-P, Xie Y, Katoshevski X, Corbett D, Shay. Modality of human expired aerosol size distributions. Journal of Aerosol Science - J AEROSOL SCI. 2011;42(12):839-851. https://doi.org/10.1016/j.jaerosci.2011.07.009Morawska JG, Ristovski L, Hargreaves Z, Mengersen M., Chao K, Wan Ch, Li M-P, Xie Y, Katoshevski X, Corbett D, Shay. Modality of human expired aerosol size distributions. Journal of Aerosol Science - J AEROSOL SCI. 2011;42(12):839-851. https://doi.org/10.1016/j.jaerosci.2011.07.009Sui Huang. COVID-19: Why we should all wear masks – there is new scientific rationale. Available at: https://medium.com/@ Cancerwarrior/covid-19-why-we-should-all-wear-masksthere-is-new-scientific-rationale-280e08ceee71 Accessed: 28 November, 2020.Sui Huang. COVID-19: Why we should all wear masks – there is new scientific rationale. Available at: https://medium.com/@ Cancerwarrior/covid-19-why-we-should-all-wear-masksthere-is-new-scientific-rationale-280e08ceee71 Accessed: 28 November, 2020.Wells WF. On airborne infection: study II. Droplets and droplet nuclei. American Journal of Hygiene. 1934;1934:611-618. https://www.cabdirect.org/cabdirect/abstract/19352700487Wells WF. On airborne infection: study II. Droplets and droplet nuclei. American Journal of Hygiene. 1934;1934:611-618. https://www.cabdirect.org/cabdirect/abstract/19352700487Hamburger M, Roberston OH. Expulsion of Group A hemolytic streptococci in droplets and droplet nuclei by sneezing, coughing and talking. Am J Med. 1948;4(5):690-701. https:// doi.org/10.1016/s0002-9343(48)90392-1Hamburger M, Roberston OH. Expulsion of Group A hemolytic streptococci in droplets and droplet nuclei by sneezing, coughing and talking. Am J Med. 1948;4(5):690-701. https:// doi.org/10.1016/s0002-9343(48)90392-1WHO. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. WHO/CDS/EPR/2007.6. Available at:http://www.who.int/ csr/resources/publications/WHO_CDS_EPR_2007_6c.pdf Accessed: 28 November, 2020.WHO. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. WHO/CDS/EPR/2007.6. Available at:http://www.who.int/ csr/resources/publications/WHO_CDS_EPR_2007_6c.pdf Accessed: 28 November, 2020.Siegel JD, Rhinehart E, Jackson M, Chiarello L, Committee HICPA. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings [cited 2008 December 8]. 2007. Available at: http://www.cdc.gov/ ncidod/dhqp/pdf/isolation2007.pdf. Accessed: 28 November, 2020.Siegel JD, Rhinehart E, Jackson M, Chiarello L, Committee HICPA. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings [cited 2008 December 8]. 2007. Available at: http://www.cdc.gov/ ncidod/dhqp/pdf/isolation2007.pdf. Accessed: 28 November, 2020.Nicas M, Nazaroff WW, Hubbard A. Toward understanding the risk of secondary airborne infection: emission of respirable pathogens. J Occup Environ Hyg. 2005;2(3):143-154. https:// doi.org/10.1080/15459620590918466Nicas M, Nazaroff WW, Hubbard A. Toward understanding the risk of secondary airborne infection: emission of respirable pathogens. J Occup Environ Hyg. 2005;2(3):143-154. https:// doi.org/10.1080/15459620590918466Stilianakis NI, Drossinos Y. Dynamics of infectious disease transmission by inhalable respiratory droplets. J R Soc Interface. 2010;7(50):1355-1366. https://doi.org/10.1098/ rsif.2010.0026Stilianakis NI, Drossinos Y. Dynamics of infectious disease transmission by inhalable respiratory droplets. J R Soc Interface. 2010;7(50):1355-1366. https://doi.org/10.1098/ rsif.2010.0026Gralton J, Tovey E, McLaws M-L, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: A review. J Infect. 2011;62(1):1-13. https://doi.org/10.1016/j. jinf.2010.11.010Gralton J, Tovey E, McLaws M-L, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: A review. J Infect. 2011;62(1):1-13. https://doi.org/10.1016/j. jinf.2010.11.010Parkhomchuk EV, Gulevich DG, Taratayko AI, Baklanov AM, Selivanova AV, Trubitsyna TA, Voronova IV, Kalinkin PN, Okunev AG, Rastigeev SA, Reznikov VA, Semeykina VS, Sashkina KA, Parkhomchuk VV. Ultrasensitive detection of inhaled organic aerosol particles by accelerator mass spectrometry. Chemosphere. 2016;159:80-88. https://doi. org/10.1016/j.chemosphere.2016.05.078Parkhomchuk EV, Gulevich DG, Taratayko AI, Baklanov AM, Selivanova AV, Trubitsyna TA, Voronova IV, Kalinkin PN, Okunev AG, Rastigeev SA, Reznikov VA, Semeykina VS, Sashkina KA, Parkhomchuk VV. Ultrasensitive detection of inhaled organic aerosol particles by accelerator mass spectrometry. Chemosphere. 2016;159:80-88. https://doi. org/10.1016/j.chemosphere.2016.05.078Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Aerosol emission and superemission during human speech increase with voice loudness. Sci Rep. 2019;9(1):2348. https://doi.org/10.1038/s41598-019-38808-zAsadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Aerosol emission and superemission during human speech increase with voice loudness. Sci Rep. 2019;9(1):2348. https://doi.org/10.1038/s41598-019-38808-zEggers J. Nonlinear dynamics and breakup of free-surface flows. Reviews of Modern Physics. 1997;69:865-929. https:// doi.org/10.1103/RevModPhys.69.865Eggers J. Nonlinear dynamics and breakup of free-surface flows. Reviews of Modern Physics. 1997;69:865-929. https:// doi.org/10.1103/RevModPhys.69.865Girod S, Zahm JM, Plotkowski C, Beck G, Puchelle E. Role of the physiochemical properties of mucus in the protection of the respiratory epithelium. Eur Respir J. 1992;5(4):477-487. PMID: 1563506Girod S, Zahm JM, Plotkowski C, Beck G, Puchelle E. Role of the physiochemical properties of mucus in the protection of the respiratory epithelium. Eur Respir J. 1992;5(4):477-487. PMID: 1563506Bourouiba L, Dehandschoewercker E, Bush J. (2014). Violent expiratory events: On coughing and sneezing. J Fluid Mech. 745:537-563. https://doi.org/10.1017/jfm.2014.88Bourouiba L, Dehandschoewercker E, Bush J. (2014). Violent expiratory events: On coughing and sneezing. J Fluid Mech. 745:537-563. https://doi.org/10.1017/jfm.2014.88Lloyd-Smith JO, Schreiber SJ, Kopp PE, Getz WM. Superspreading and the effect of individual variation on disease emergence. Nature. 2005;438:355-359. https://doi. org/10.1038/nature04153Lloyd-Smith JO, Schreiber SJ, Kopp PE, Getz WM. Superspreading and the effect of individual variation on disease emergence. Nature. 2005;438:355-359. https://doi. org/10.1038/nature04153Wong G, Liu W, Liu Y, Zhou B, Bi Y, Gao GF. MERS, SARS, and Ebola: The Role of Super-Spreaders in Infectious Disease. Cell Host Microbe. 2015;18(4):398-401. https://doi. org/10.1016/j.chom.2015.09.013Wong G, Liu W, Liu Y, Zhou B, Bi Y, Gao GF. MERS, SARS, and Ebola: The Role of Super-Spreaders in Infectious Disease. Cell Host Microbe. 2015;18(4):398-401. https://doi. org/10.1016/j.chom.2015.09.013Tiffany A, Riley S, Metcalf CJ, Grenfell BT. Spatial and temporal dynamics of superspreading events in the 2014- 2015 West Africa Ebola epidemic. Proc Natl Acad Sci USA. 2017;114(9):2337-2342. https://doi.org/0.1073/ pnas.1614595114Tiffany A, Riley S, Metcalf CJ, Grenfell BT. Spatial and temporal dynamics of superspreading events in the 2014- 2015 West Africa Ebola epidemic. Proc Natl Acad Sci USA. 2017;114(9):2337-2342. https://doi.org/0.1073/ pnas.1614595114Chauveaux D. Preventing surgical-site infections: measures other than antibiotics. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S77-83. https://doi.org/10.1016/j.otsr.2014.07.028Chauveaux D. Preventing surgical-site infections: measures other than antibiotics. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S77-83. https://doi.org/10.1016/j.otsr.2014.07.028Черемисин А.А., Кушнаренко А.В., Кузьмин Д.А. Черников С.В., Шнипов И.С. Параллельное моделирование фотофореза аэрозольных кластеров в разреженной газовой среде. Международный симпозиум «Атмосферная Радиация и Динамика»:тез. докл. СПб.: Изд-во СПбГУ;2015:180-181Cheremisin AA, Kushnarenko AV, Kuz'min DA. Chernikov SV, Shnipov IS. Parallel'noe modelirovanie fotoforeza ajerozol'nyh klasterov v razrezhennoj gazovoj srede. Mezhdunarodnyj simpozium «Atmosfernaja Radiacija i Dinamika»: tez. dokl. Saint Peterburg: Izd-vo SPbGU;2015:180-181 (In Russ.).Lee V, Waitukaitis S, Miskin M, Jaeger HM. Direct observation of particle interactions and clustering in charged granular streams. Nature Phys. 2015;11: 733-737. https://doi. org/10.1038/nphys3396Lee V, Waitukaitis S, Miskin M, Jaeger HM. Direct observation of particle interactions and clustering in charged granular streams. Nature Phys. 2015;11: 733-737. https://doi. org/10.1038/nphys3396Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797. https://doi.org/10.1371/ journal.pone.0035797Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797. https://doi.org/10.1371/ journal.pone.0035797Roberts K, Hathway A, Fletcher LA, Beggs C, Elliott M, Sleigh A. Bioaerosol production on a respiratory ward. Indoor and Built Environment. 2006;5:35-40. https://doi. org/10.1177/1420326X06062562Roberts K, Hathway A, Fletcher LA, Beggs C, Elliott M, Sleigh A. Bioaerosol production on a respiratory ward. Indoor and Built Environment. 2006;5:35-40. https://doi. org/10.1177/1420326X06062562Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS One. 2017;12(5):e0178007. https://doi.org/10.1371/journal. pone.017800Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS One. 2017;12(5):e0178007. https://doi.org/10.1371/journal. pone.017800Чезганова Е.А., Ефимова А.Р., Сахарова В.М., Ефимова А.Р., Созинов С.А., Исмагилов З.Р., Брусина Е.Б. Оценка роли пыли в формировании резервуара мультирезистентных госпитальных штаммов микроорганизмов в отделениях хирургического профиля. Фундаментальная и клиническая медицина. 2020;5(1):15-25 https://doi.org/10.23946/2500-0764-2020-5-1-15-25Chezganova EA, Efimova OS, Sakharova VM, Efimova AR, Sozinov SA, Ismagilov, ZR, Brusina EB. Particulate matter as a possible reservoir of multidrug-resistant microorganisms in surgical healthcare settings. Fundamental and Clinical Medicine. 2020;5(1):15-25. (In Russ.) https://doi.org/10.23946/2500-0764-2020-5-1-15-25

The authors declare that there are no conflicts of interest present.