Journal of Korean Society of Occupational and Environmental Hygiene (한국산업보건학회지)

Korean Industrial Hygiene Association (한국산업보건학회)
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An Assessment of Environmental Characteristics Associated with the Level of Endotoxin Concentration in Hospital Lobbies

일부 종합 병원 로비의 공기 중 엔도톡신 농도에 미치는 환경 요인 평가

  • Lee, Kyeong-Min (Occupational Lung Diseases Institute, Korea Worker's Compensation and Welfare Service) ;
  • Yeom, Jeongkwan (Hanbul Energy Management Co., Ltd.) ;
  • Lee, Wonjae (Department of Global Healthcare Management, Gachon University) ;
  • Ryu, Seung-Hun (Institute for Occupational and Environmental Health, Korea University) ;
  • Park, Dongjin (Occupational Safety & Health Research Institute, Korea Occupational Safety and Health Agency) ;
  • Park, Dong-Uk (Department of Environmental Health, Korea National Open University)
  • 이경민 (근로복지공단 직업성폐질환연구소) ;
  • 염정관 (한불에너지관리(주)) ;
  • 이원재 (가천대학교 헬스케어경영학과) ;
  • 류승훈 (고려대학교 환경의학연구소) ;
  • 박동진 (안전보건공단 산업안전보건연구원) ;
  • 박동욱 (한국방송통신대학교 환경보건학과)
  • Received : 2014.05.21
  • Accepted : 2014.08.18
  • Published : 2014.09.30
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Abstract

Backgrounds: Endotoxin, which found in the outer membrane of the gram-negative bacteria cell wall, makes up almost all of the lipopolysaccharide(LPS). When people are exposed to endotoxin,it can result in diverse health effects such as an airway irritation and inflammation, fever, malaise, bronchitis, allergic asthma, toxic pneumonitis, hypersensitivity lung disease. Cases among the elderly, children or pregnant can occur more frequently than a healthy adult if they are repeatedly exposed to the existing endotoxin. Therefore, we investigated and assessed the environmental characteristics associated with the airborne endotoxin concentration level in six hospital lobbies. Method: Endotoxin from indoor air in six hospital lobbies was measured by an area sampling method and analyzed according to American Society for Testing and Materials International(ASTM international) E2144-01. Total suspended particulate(TSP), carbon dioxide($CO_2$), temperature and humidity were also measured by using direct reading measurements or airborne sampling equipment at the same time. Environmental characteristics were appropriately divided into two or three groups for a statistics analysis. One-way analysis variable(one-way ANOVA) was used to examine a difference of the endotoxin concentration, depending on the environmental characteristics. In addition, only variables with p-value(p<0.25) were eventually designed to the best model by using multiple regression analysis. Results: The correlation analysis result indicated that TSP(p=0.003) and $CO_2$(p<0.0001) levels were significantly associated with endotoxin concentration levels. In contrast, temperature(p<0.068) and humidity(p<0.365) were not associated with endotoxin concentration. Levels of endotoxin concentration were statistically different among the environmental characteristics of Service time(p=0.01), Establishment of hospital(p<0.001), Scale of hospital(p=0.01), Day average people using hospital(p=0.03), Cleaning time of lobby(p=0.05), Season(p<0.001), and Cleaning of ventilation system(p<0.001) according to ANOVA. Finally, the best model(Adjusted R-square=72%) that we designed through a multiple regression test included environmental characteristics related to Service time, Area of lobby, Season, Cleaning of ventilation system, and Temperature. Conclusions: According to this study, our result showed a normal level of endotoxin concentration in the hospital lobbies and found environmental management methods to reduce the level of endotoxin concentration to a minimum. Consequently, this study recognized to be requirement for the management of ventilation systems and an indoor temperature in order to reduce the level of endotoxin concentration in the hospital lobbies.

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References

  1. Arturo B, Gwen W, Alan MD, Catherine LG, Cristina LH et al. School-based identification of asthma in a low-income population. Pediatric Pulmono 2000; 30(4):297-301 https://doi.org/10.1002/1099-0496(200010)30:4<297::AID-PPUL4>3.0.CO;2-#
  2. Bennett WD, Herbst M, Zeman KL, Wu J, Hernandez ML et al. Effect of inhaled endotoxin on regional particle deposition in patients with mild asthma. J Allergy Clin Immunol 2013;131(3):912-913 https://doi.org/10.1016/j.jaci.2012.09.010
  3. Bouillard L, Michel O, Dramaix M, Devleeschouwer M. Bacterial contamination of indoor air, surfaces, and settled dust, and related dust endotoxin concentrations in healthy office buildings. Ann Agric Environ Med 2005;12:187-192
  4. Cho HJ, Hong KS, Kim JH, Kim HW. Assessment of airborne bioaerosols among different areas in the hospitals. J Korea Soc Occup Environ Hyg 2000; 10(1):115-125
  5. Cox-Ganser JM, Rao CY, Park JH, Schumpert JC, Kreiss K. Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants. Indoor Air 2009;19:280-290 https://doi.org/10.1111/j.1600-0668.2009.00586.x
  6. Dales R, Miller D, Ruest K, Guay M, Judek S. Airborne endotoxin is associated with respiratory illness in the first 2 years of life. Environmental Health Perspectives 2006;114(4):610-614
  7. Dorneals DAA, Charpin D, Birnbaum J, Lanteaume A, Chapman M et al. Indoor allergen levels in day nurseries. J Allergy Clin Immunol 1995;95(6):1158-1163 https://doi.org/10.1016/S0091-6749(95)70071-4
  8. Dybendal T, Elsayed S. Dust from carpeted and smooth floors. V. Cat(Fel d I) and mite (Der p I and Der f I) allergen levels in school dust. Demonstration of the basophil histamine release induced by dust from classrooms. Clinical and Experimental Allergy 1992;22(12):1100-1106 https://doi.org/10.1111/j.1365-2222.1992.tb00136.x
  9. Galanos C, Freudenberg MA. Mechanisms of endotoxin shock and endotoxin hypersensitivity. Immunobiology 1993;187(3-5):346-356 https://doi.org/10.1016/S0171-2985(11)80349-9
  10. Jacobs JH, Krop EJ, Wind SD, Spithoven J, heederik DJ. Endotoxin levels in homes and classrooms of dutch school children and respiratory health. Eur Respir J 2013;42(2):314-322 https://doi.org/10.1183/09031936.00084612
  11. Jung SH, Paik NW. A study on airborne microorganism in hospital. J Korea Soc Occup Environ Hyg 1998; 8(2):231-241
  12. Kim KY, Kim YS, Kim DE. Distribution characteristics of airborne bacteria and fungi in the general hospital of Korea. Industrial Health 2010;48:236-243 https://doi.org/10.2486/indhealth.48.236
  13. Kotani S, Takada H. Structural requirements of lipid A for endotoxicity and other biological activities-an overview. Adv Exp Med Biol 1990;256(13):13-43 https://doi.org/10.1007/978-1-4757-5140-6_2
  14. Langevelde, P., Joop, K., Van Loon, J., Frolich, M., Groeneveld, P.H.P., Westendorp, R.G.J. et al. : Endotoxin, Cytokines, and Procalcitonin in febrile patients admitted to the hospital: Identification of subjects at high risk of mortality. Clin Infect Dis 2000;31:1343-1348 https://doi.org/10.1086/317480
  15. Lee CR, Kim KY, Kim CN, Park DU, Roh JH. Investigation on concentrations and correlations of airborne microbes and environmental factors in the general hospital. J Korea Soc Occup Environ Hyg 2005;15(1):45-51
  16. Liu LJS, Krahmer M, Fox A, Feigley CE, Featherstone A et al. Investigation of the concentration of bacteria and their cell envelope components in indoor air in two elementary schools. J Air & Waste Manage Assoc 2000;50:1957-1967 https://doi.org/10.1080/10473289.2000.10464225
  17. Loppnow H, Durrbaum I, Brade H et al. Lipid A, the immunostimulatory principle of lipopolysaccharides. Adv Exp Med Biol 1990;256:561-566 https://doi.org/10.1007/978-1-4757-5140-6_50
  18. Macher J, Ammann HA, Milton DK, Burge HA, Morey PR. Bioaerosol assessment and control, Cincinnati:American Conference of Governmental Industrial Hygienist.; 1999. p. 10-3
  19. Miller JD, Hausley PD, Reinhardt JH. Air sampling results in relation to extent of fungal colonization of building materials in some water-damaged buildings. Indoor Air 2000;10:146-151 https://doi.org/10.1034/j.1600-0668.2000.010003146.x
  20. Morey P. Use of hazard communication standard and general duty clause during remediation of fungal contamination. In: Indoor Air 1993;391-395
  21. Nielsen PV. Control of airborne infectious diseases in ventilated spaces. J R Soc Interface 2009;6:S747-S755 https://doi.org/10.1098/rsif.2009.0228.focus
  22. Park DU, Yeom JK, Lee WJ, Lee KM. Assessment of the levels of airborne bacteria, gram-negative bvacteria, and fungi in hospital lobbies. Int J Environ Res 2013;10:541-555
  23. Park JH, Spiegelman DL, Burge HA, Gold DR, Chew GL et al. Longitudinal study of dust and airborne endotoxin in the home. Environ Health Perspect 2000;108(11):1023-1028 https://doi.org/10.1289/ehp.001081023
  24. Park JH, Cox-Ganser J, Rao C, Kreiss K. Fungal and exdotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building. Indoor Air 2006;16:192-203 https://doi.org/10.1111/j.1600-0668.2005.00415.x
  25. Pasanen AL, Kalliokoski P, Pasanen P. Laboratory studies on the relationship between fungal growth and atmospheric temperature and humidity. Environ Intern 1991;17(4):225-228 https://doi.org/10.1016/0160-4120(91)90006-C
  26. Perzanowski MS, Miller RL, Thorne PS, Barr GR, Divjan A et al. Endotoxin in inner-city homes: Associations with wheeze and eczema in early childhood. J Allergy Clin Immunol 2006;117(5):1082-1089 https://doi.org/10.1016/j.jaci.2005.12.1348
  27. Reynolds SJ, Black DW, Borin SS, Breuer G, Burmeister LF et al. Indoor environmental quality in six commercial office buildings in the Midwest United states. App Occup Environ Hyg 2001;16(11):1065-1077 https://doi.org/10.1080/104732201753214170
  28. Rietschel ET, Kirikae T, Schade FU, Ulmer AJ, Hoist O et al. The chemical structure of bacterial endotoxin in relation to bioactivity. Immunobiology 1993;187:169-190 https://doi.org/10.1016/S0171-2985(11)80338-4
  29. Rylander R, Bake B, Fischer JJ et al. Pulmonary function and symptoms after inhalation of endotoxin. Am Rev Respir Dis 1989;140(4):981-986 https://doi.org/10.1164/ajrccm/140.4.981
  30. Rylander R. Evaluation of the risks of endotoxin exposure. Int J Occup Environ Heal 1997;3(1):S32-S36
  31. Schwartz DA, Thorne PS, Yagla SJ et al. The role of endotoxin in grain dust-induced lung disease. Am J Respir Crit Care Med 1995;152(2):603-608 https://doi.org/10.1164/ajrccm.152.2.7633714
  32. Standard Practice for Personal Sampling and Analysis of Endotoxin in Metalworking Fluid Aerosols in Workplace Atmospheres, The American Society for Testing and Materials International: E2144-01. 2007
  33. Teeuw KB, Vandenbrouche-Grauls CMJE, Verhoef J. Airborne gram-negative bacteria and endotoxin in sick building syndrome. Arch Intern Med 1994;154:2339-2345 https://doi.org/10.1001/archinte.1994.00420200095010
  34. Williams KL. Endotoxin : Pyrogens, LAL Testing, and Depyrogenation, 2nd ed. Indianapolis: Eli Lilly & Company; 2001. p. 15-16
  35. White LF, Dancer SJ, Robertson C. A microbiological evaluation of hospital cleaning methods. Int J Environ Heal Res 2007;17(4):285-295 https://doi.org/10.1080/09603120701372433