COVID-19 Outbreak and Hospital Air Quality: A Systematic Review of Evidence on Air Filtration and Recirculation

• Published in: Environmental science & technology 2021-04, Vol.55 (7), p.4134-4147
• Main Authors: Mousavi, Ehsan S, Kananizadeh, Negin, Martinello, Richard A, Sherman, Jodi D
• Format: Article
• Language: English
• Subjects: Air Pollution; Air quality; Air recirculation; Best practice; Coronaviruses; COVID-19; Disease Outbreaks; Documents; Ecotoxicology and Public Health; Filtration; Health care; Health care facilities; Health facilities; Hospitals; Humans; Indoor air pollution; Indoor air quality; Indoor environments; Infectivity; Literature reviews; Outbreaks; Pandemics; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Viral diseases
• ISSN: 0013-936X; 1520-5851
• DOI: 10.1021/acs.est.0c03247

The outbreak of SARS-CoV-2 has made us all think critically about hospital indoor air quality and the approaches to remove, dilute, and disinfect pathogenic organisms from the hospital environment. While specific aspects of the coronavirus infectivity, spread, and routes of transmission are still under rigorous investigation, it seems that a recollection of knowledge from the literature can provide useful lessons to cope with this new situation. As a result, a systematic literature review was conducted on the safety of air filtration and air recirculation in healthcare premises. This review targeted a wide range of evidence from codes and regulations, to peer-reviewed publications, and best practice standards. The literature search resulted in 394 publications, of which 109 documents were included in the final review. Overall, even though solid evidence to support current practice is very scarce, proper filtration remains one important approach to maintain the cleanliness of indoor air in hospitals. Given the rather large physical footprint of the filtration system, a range of short-term and long-term solutions from the literature are collected. Nonetheless, there is a need for a rigorous and feasible line of research in the area of air filtration and recirculation in healthcare facilities. Such efforts can enhance the performance of healthcare facilities under normal conditions or during a pandemic. Past innovations can be adopted for the new outbreak at low-to-minimal cost.