Almost all hospitals are equipped with air-conditioning systems to provide a comfortable environment for patients and staff. However, the accumulation of dust and moisture within these systems increases the risk of transmission of microbes and have on occasion been associated with outbreaks of infection. Nevertheless, the impact of air-conditioning on the transmission of microorganisms leading to infection remains largely uncertain. We conducted a scoping review to screen systematically the evidence for such an association in the face of the coronavirus disease 2019 epidemic. PubMed, Embase and Web of Science databases were explored for relevant studies addressing microbial contamination of the air, their transmission and association with infectious diseases. The review process yielded 21 publications, 17 of which were cross-sectional studies, three were cohort studies and one case−control study. Our analysis showed that, compared with naturally ventilated areas, microbial loads were significantly lower in air-conditioned areas, but the incidence of infections increased if not properly managed. The use of high-efficiency particulate air (HEPA) filtration not only decreased transmission of airborne bioaerosols and various microorganisms, but also reduced the risk of infections. By contrast, contaminated air-conditioning systems in hospital rooms were associated with a higher risk of patient infection. Cleaning and maintenance of such systems to recommended standards should be performed regularly and where appropriate, the installation of HEPA filters can effectively mitigate microbial contamination in the public areas of hospitals.

Carbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient’s left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.

Oxygen is the main treatment of carbon monoxide (CO) poisoning. In two simultaneous cases, the efficacy of conventional and continuous positive airway pressure (CPAP)-administered oxygen therapy was compared. A 63-year-old man and his 58-year-old wife were brought to the emergency department with complaints of dizziness, headache, and nausea. The man had a history of congestive heart failure and additionally had shortness of breath. Initial carboxyhemoglobin (COHb) values were 26% in the male patient and 24% in his wife. For the female patient, oxygen therapy was performed with a reservoir balloon mask; a CPAP device was used for the male patient. The COHb levels decreased below five percent after approximately two hours in the male patient and at the end of five hours in his wife. In follow-up, symptomatic relief was achieved in both patients and no additional complications were observed. According to our experience, CPAP ventilation can be a new and effective method for oxygen therapy in CO poisoning.

Carbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373–378)

The role of public health surveillance in disaster response continues to expand as timely, accurate information is needed to mitigate the impact of disasters. Health surveillance after a disaster involves the rapid assessment of the distribution and determinants of disaster-related deaths, illnesses, and injuries in the affected population. Public health disaster surveillance is one mechanism that can provide information to identify health problems faced by the affected population, establish priorities for decision makers, and target interventions to meet specific needs. Public health surveillance traditionally relies on a wide variety of data sources and methods. Poison center (PC) data can serve as data sources of chemical exposures and poisonings during a disaster. In the US, a system of 57 regional PCs serves the entire population. Poison centers respond to poison-related questions from the public, health care professionals, and public health agencies. The Centers for Disease Control and Prevention (CDC) uses PC data during disasters for surveillance of disaster-related toxic exposures and associated illnesses to enhance situational awareness during disaster response and recovery. Poison center data can also be leveraged during a disaster by local and state public health to supplement existing surveillance systems. Augmenting traditional surveillance data (ie, emergency room visits and death records) with other data sources, such as PCs, allows for better characterization of disaster-related morbidity and mortality. Poison center data can be used during a disaster to detect outbreaks, monitor trends, track particular exposures, and characterize the epidemiology of the event. This timely and accurate information can be used to inform public health decision making during a disaster and mitigate future disaster-related morbidity and mortality.

WolkinA, SchnallAH, LawR, SchierJ. Using Poison Center Data for Postdisaster Surveillance. Prehosp Disaster Med. 2014;29(5):1-4.

On September 13, 2008, Hurricane Ike made landfall in Texas, resulting in the mandatory evacuation of 8 counties before landfall and the declaration of disaster areas in 29 counties afterward. This study evaluated whether Hurricane Ike affected the pattern of Texas poison center calls. Texas poison center calls received from the disaster area counties were identified for 3 time periods: August 12 to September 10, 2008 (preevacuation), September 11 to 13, 2008 (evacuation and hurricane landfall), and September 14 to 30, 2008 (postevacuation). For selected types of calls, the mean daily call volume during time periods 2 and 3 was compared with a baseline range (BR) derived from the mean daily call volume during time period 1. During the evacuation and landfall period, gasoline exposure calls were higher than expected (mean 3, BR −1 to 2). During the postevacuation period, higher than expected numbers of calls were observed for gasoline exposures (mean 5, BR −1 to 2) and carbon monoxide exposures (mean 3, BR –1–1). During an evacuation, certain calls such as those involving gasoline exposures may increase. After a hurricane, calls such as those involving carbon monoxide and gasoline exposures may increase. (Disaster Med Public Health Preparedness. 2009;3:151–157)

Background: Drive-through mass vaccination clinics are an increasingly popular component of public health emergency response plans. One potential disadvantage, however, is the exposure of clinicians, volunteers, public health responders, and the public to carbon monoxide (CO) from vehicle exhaust emissions when clinics are held within garages or other enclosed structures.

Methods: CO levels were monitored during indoor drive-through clinics held on the same day at 2 separate locations in a rural upstate New York county. Each clinic was operated for 2 hours during which seasonal influenza vaccines were administered to county residents as they remained within their vehicles. At each location, vehicle engines remained operating indoors within multiple lanes of traffic. No mechanical ventilation was used, but wind speeds through the buildings were relatively strong and consistent. CO was measured at breathing-zone height throughout the clinic sessions using direct-reading instruments.

Results: CO levels remained below detection for the majority of the clinic sessions. Short-term, high CO exposures, however, were found to be associated with a small number of individual vehicles that were in apparent disrepair.

Conclusions: The findings from this study indicate that CO exposures may be minimized by identifying and separately processing problematic vehicles before they enter the clinic. Direct reading CO monitors can help to identify these vehicles. (Disaster Med Public Health Preparedness. 2009;3:158–162)

Objective: We evaluated emergency department (ED) data, emergency medical services (EMS) data, and public utilities data for describing an outbreak of carbon monoxide (CO) poisoning following a windstorm.

Methods: Syndromic ED data were matched against previously collected chart abstraction data. We ran detection algorithms on selected time series derived from all 3 data sources to identify health events associated with the CO poisoning outbreak. We used spatial and spatiotemporal scan statistics to identify geographic areas that were most heavily affected by the CO poisoning event.

Results: Of the 241 CO cases confirmed by chart review, 190 (78.8%) were identified in the syndromic surveillance data as exact matches. Records from the ED and EMS data detected an increase in CO-consistent syndromes after the storm. The ED data identified significant clusters of CO-consistent syndromes, including zip codes that had widespread power outages. Weak temporal gastrointestinal (GI) signals, possibly resulting from ingestion of food spoiled by lack of refrigeration, were detected in the ED data but not in the EMS data. Spatial clustering of GI-based groupings in the ED data was not detected.

Conclusions: Data from this evaluation support the value of ED data for surveillance after natural disasters. Enhanced EMS data may be useful for monitoring a CO poisoning event, if these data are available to the health department promptly.

(Disaster Med Public Health Preparedness. 2011;5:37-45)

Background and aims: This study examined whether providing smokers with a personal monitor for measuring expired-air carbon monoxide (CO) concentrations would be a feasible method of achieving a reduction in smoke intake. Methods: Ten smokers were given a CO monitor and asked to use it regularly throughout the day for 6 weeks with the aim of maintaining their CO reading below 10 ppm. They were advised to use nicotine replacement therapy, but this was not provided. At baseline and follow-up, smokers were asked to comment on their use of the monitors and motivation to stop smoking. Demographic characteristics, cigarette consumption, and nicotine dependence, was also assessed. Additionally, during the first 2 weeks participants were instructed to record how often they used their CO monitor, their average readings and cigarette consumption. Results: Eight smokers had an average daily CO concentration below their baseline on at least 93% of the days in the 2 weeks of daily monitoring, while three had CO levels below 10 ppm on 36% of the days. At the 6-week follow-up, all participants’ CO concentrations were below their baseline value; two were below 10 ppm. Average daily cigarette consumption reduced from 14.1 (SD 6.03) at baseline to 9.8 (SD 4.95) during the 2 weeks of daily CO monitoring (t = 2.46, df 9, p = 0.036) and 9.5 (SD 5.50) at 6 weeks follow-up (t = 1.73, df 7, p = 0.127). Use of the CO monitors was generally found to be acceptable and to increase motivation to stop smoking completely. Five smokers attempted to quit smoking. Conclusions: Regular personal CO monitoring may be a useful method for reducing smokers’ cigarette intake and increasing their motivation to stop completely. A controlled trial with long-term follow up is warranted.