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Licensed Unlicensed Requires Authentication Published by De Gruyter August 3, 2018

A review of the chemical and biological pollutants in indoor air in hospitals and assessing their effects on the health of patients, staff and visitors

  • Fatemeh Ghanizadeh and Hatam Godini EMAIL logo

Abstract

Indoor air quality in hospitals has been specifically considered in terms of its impact on health. Air quality is an important risk factor influencing the health of staff and patients who are in contact with indoor air inhaled in hospitals. Over the past two decades, hundreds of studies have been developed to assess pollution in hospital environment. Two hundred and fitfy papers from around the world, from the last two decades, were identified and reviewed. Recent studies have found that the presence of various chemical and biological pollutants affected the health of patients, staff and visitors. Nearly all the reports agree that chemical and biological pollutants in the hospital environment have adverse effects. In most of the reviewed papers, analysis of health hazards was conducted for personnel and patients to toxic metals, chlorine, fine (PM2.5) and coarse (PM2.5−10) particles, and bio-aerosol in the inhaled air of the hospital environment. Some papers showed that some of the metals are carcinogens and others do not have a carcinogenic risk. Bio-aerosols as a biological pollutant are usually defined as airborne bacteria, fungi, viruses, pollen and their by products. These biological pollutants are associated with a wide range of health effects in hospital environments. This review can serve as an introduction and as the statement of the problem for more original research in this regard.

  1. Research funding: Authors state no funding involved.

  2. Conflict of interest: Authors state no conflict of interest.

  3. Informed consent: Informed consent is not applicable.

  4. Ethical approval: The conducted research is not related to either human or animal use.

References

1. Spengler J, McCarthy J, Samet J. Indoor air quality handbook. New York, San Francisco, Washington, D.C., Auckland, Bogotá, Caracas, Lisbon, London, Madrid, Mexico City, Milan, Montreal, New Delhi, San Juan, Singapore, Sydney, Tokyo, Toronto: McGraw-Hill; 2001.Search in Google Scholar

2. Huisman ERCM, Morales E, van Hoof J, Kort HSM. Healing environment: a review of the impact of physical environmental factors on users. Build Environ 2012;58:70–80.10.1016/j.buildenv.2012.06.016Search in Google Scholar

3. Slezakova K, Morais L. Trace metals in size-fractionated particulate matter in a Portuguese hospital: exposure risks assessment and comparisons with other countries. Environ Sci Pollut Res 2014;21:3604–20.10.1007/s11356-013-2316-3Search in Google Scholar

4. Hsu Y-C, Kung P-Y, Wu T-N, Shen Y-H. Characterization of indoor-air bio aerosols in Southern Taiwan. Aerosol Air Qual Res 2012;12:651–61.10.4209/aaqr.2012.03.0070Search in Google Scholar

5. Eames I, Tang JW, Li Y, Wilson P. Airborne transmission of disease in hospitals. J R Soc Interface 2009;6:S697–702.10.1098/rsif.2009.0407.focusSearch in Google Scholar

6. Tang JW, Noakes CJ, Nielsen PV, Settles GS. Observing and quantifying airflows in the infection control of aerosol and airborne-transmitted diseases: an overview of approaches. J Hosp Infect 2011;77:213–22.10.1016/j.jhin.2010.09.037Search in Google Scholar

7. Loupa G, Zarogianni A-M, Karali D, Kosmadakis I, Rapsomanikis S. Indoor/outdoor PM2.5 elemental composition and organic fraction medications, in a Greek hospital. Sci Total Environ 2016;550:727–35.10.1016/j.scitotenv.2016.01.070Search in Google Scholar

8. Hart JE, Liao X, Hong B, Puett RC, Yanosky JD, Suh H, et al. The association of long-term exposure to PM 2.5 on all-cause mortality in the Nurses’ Health Study and the impact of measurement-error correction. Environ Health 2015;1:14–38.Search in Google Scholar

9. Harrison RM, Yin J. Particulate matter in the atmosphere: which particle properties are important for its effects on health? Sci Total Environ 2000;249:85–101.10.1016/S0048-9697(99)00513-6Search in Google Scholar

10. Mostofsky E, Schwartz J, Coull BA, Koutrakis P, Wellenius GA, Suh HH, et al. Modeling the association between particle constituents of air pollution and health outcomes. Am J Epidemiol 2012;176:317–26.10.1093/aje/kws018Search in Google Scholar PubMed PubMed Central

11. Rohr AC, Wyzga RE. Attributing health effects to individual particulate matter constituents. Atmos Environ 2012;62: 130–52.10.1016/j.atmosenv.2012.07.036Search in Google Scholar

12. Janssen NA, Hoek G, Simic-Lawson M, Fischer P, Van Bree L, Ten Brink H, et al. Black carbon as an additional indicator of the adverse health effects of airborne particles compared with PM10 and PM2.5. Environ Health Perspect 2011;19(12):1691–9.10.1289/ehp.1003369Search in Google Scholar PubMed PubMed Central

13. Gralton J, Tovey E, McLaws M-L, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: a review. J Infect 2011;62(1):1–13.10.1016/j.jinf.2010.11.010Search in Google Scholar PubMed PubMed Central

14. Jung C-C, Wu P-C, Tseng C-H, Su H-J. Indoor air quality varies with ventilation types and working areas in hospitals. Build Environ 2015;85:190–5.10.1016/j.buildenv.2014.11.026Search in Google Scholar

15. Bessonneau V, Mosqueron L, Berrube A, Mukensturm G, Buffet-Bataillon S, Gangneux JP, et al. VOC contamination in hospital, from stationary sampling of a large panel of compounds, in view of healthcare workers and patients exposure assessment. PLoS One 2013;8(2):55535.10.1371/journal.pone.0055535Search in Google Scholar PubMed PubMed Central

16. Ferro AR, Kopperud RJ, Hildemann LM. Source strengths for indoor human activities that resuspend particulate matter. Environ Sci Technol 2004;38(6):1759–64.10.1021/es0263893Search in Google Scholar PubMed

17. Huboyo HS, Tohno S, Cao R. Indoor PM2.5 characteristics and CO concentration related to water-based and oil-based cooking emissions using a gas stove. Aerosol Air Qual Res 2011;11:401–11.10.4209/aaqr.2011.02.0016Search in Google Scholar

18. Yurtseven E, Erdogan MS, Ulus T, Sahin UA, Onat B, Erginoz E, et al. An assessment of indoor PM2.5 concentrations at a medical faculty in Istanbul, Turkey. Environ Prot Eng 2012;38(1):115–27.Search in Google Scholar

19. World Health Organization (WHO). WHO guidelines for indoor air quality: selected pollutants. Copenhagen: WHO Regional Office for Europe; 2010.Search in Google Scholar

20. Klepeis NE, Nelson WC, Ott WR, Robinson JP, Tsang AM, Switzer P, et al. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants. J Expo Anal Environ Epidemiol 2001;11(3):231–52.10.1038/sj.jea.7500165Search in Google Scholar PubMed

21. Bernstein JA, Alexis N, Bacchus H, Bernstein IL, Fritz P, Horner ELN, et al. The health effects of nonindustrial indoor air pollution. J Allergy Clin Immunol 2008;121(3):585–91.10.1016/j.jaci.2007.10.045Search in Google Scholar PubMed

22. Brunekreef B, Beelen R, Hoek G, Schouten L, Bausch-Goldbohm S, Fischer P, et al. Effects of long-term exposure to traffic-related air pollution on respiratory and cardiovascular mortality in the Netherlands: the NLCS–AIR study. Res Rep Health Eff Inst 2009;139:5–71, discussion 73–89.Search in Google Scholar

23. Hoek G, Krishnan RM, Beelen R, Peters A, Ostro B, Brunekreef B, et al. Long-term air pollution exposure and cardiorespiratory mortality: a review. Environ Health 2013;12(1):43.10.1186/1476-069X-12-43Search in Google Scholar PubMed PubMed Central

24. Li P, Xin J, Wang Y, Wang S, Li G, Pan X, et al. The acute effects of fine particles on respiratory mortality and morbidity in Beijing, 2004–2009. Environ Sci Pollut Res 2013;20(9): 6433–44.10.1007/s11356-013-1688-8Search in Google Scholar PubMed

25. Polichetti G, Cocco S, Spinali A, Trimarco V, Nunziata A. Effects of particulate matter PM10, PM2.5 and PM1 on the cardiovascular system. Toxicology 2009;264:1–8.10.1016/j.tox.2009.04.035Search in Google Scholar PubMed

26. Mitchell CS, Zhang JJ, Sigsgaard T, Jantunen M, Lioy PJ, Samson R, et al. Current state of the science: health effects and indoor environmental quality. Environ Health Perspect 2007;115: 958–64.10.1289/ehp.8987Search in Google Scholar

27. Valavanidis A, Fiotakis K, Vlachogianni T. Airborne particulate matter and human health: toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2008;26:339–62.10.1080/10590500802494538Search in Google Scholar

28. Evolution of WHO air quality guidelines: past, present and future. Copenhagen: WHO Regional office for Europe; 2017.Search in Google Scholar

29. Slezakova K, Alvim-Ferraz MC, Pereira MC. Elemental characterization of indoor breathable particles at a Portuguese urban hospital. J Toxicol Environ Health A 2012;75:909–19.10.1080/15287394.2012.690707Search in Google Scholar

30. Birkett S. Investigation finds few hospitals comply with indoor air quality standards. Clean Air in London, 2016. hvnplus.co.uk.Search in Google Scholar

31. EN 13779. Ventilation for non-residential buildings — performance requirements for ventilation and room-conditioning systems, 2007. pr EN16798–3:2014(E).Search in Google Scholar

32. ISO 16890-1:2016. Air filters for general ventilations – part1: Technical specifications, requirements and classification. system based upon particulate matter efficency (ePM).Search in Google Scholar

33. Nasir ZA, Colbeck I, Sultan S, Ahmed S. Bioaerosols in residential microenvironments in low income countries: a case study from Pakistan. Environ Pollut 2012;168:15–22.10.1016/j.envpol.2012.03.047Search in Google Scholar

34. Faridi S, Hassanvand MS, Naddafi K, Yunesian M, Nabizadeh R, Sowlat MH, et al. Indoor/outdoor relationships of bioaerosol concentrations in a retirement home and dormitory. Environ Sci Pollut Res Int 2015;22(11):8190–200.10.1007/s11356-014-3944-ySearch in Google Scholar

35. Mentese S, Rad AY, Arisoy M, Gullu G. Seasonal and spatial variations of bioaerosols in indoor urban environments, Ankara, Turkey. Indoor Built Environ 2012;21:797–810.10.1177/1420326X11425965Search in Google Scholar

36. Jones AM, Harrison RM. The effects of meteorological factors on atmospheric bioaerosol concentrations e a review. Sci Total Environ 2004;326:151–80.10.1016/j.scitotenv.2003.11.021Search in Google Scholar

37. Cordeiro RA, Brilhante RSN, Pantoja LDM, Moreira RE, Vieira PRN, Rocha MFG, et al. Isolation of pathogenic yeasts in the air from hospital environments in the city of Fortaleza, northeast Brazil. Braz J Infect Dis 2010;14:30–4.10.1016/S1413-8670(10)70007-6Search in Google Scholar

38. Sautour M, Sixt N, Dalle F, L’Ollivier C, Fourquenet V, Calinon C, et al. Profiles and seasonal distribution of airborne fungi in indoor and outdoor environments at a French hospital. Sci Total Environ 2009;407:3766–71.10.1016/j.scitotenv.2009.02.024Search in Google Scholar PubMed

39. Hameed AAA, Khoder MI, Yuosra S, Osman AM, Ghanem S. Diurnal distribution of airborne bacteria and fungi in the atmosphere of Helwan area, Egypt. Sci Total Environ 2009;407:6217–22.10.1016/j.scitotenv.2009.08.028Search in Google Scholar PubMed

40. Sorooshian A, Csavina J, Shingler T, Dey S, Brechtel FJ, Saez AE, et al. Hygroscopic and chemical properties of aerosols collected near a copper smelter: implications for public and environmental health. Environ Sci Technol 2012;46:9473–80.10.1021/es302275kSearch in Google Scholar

41. Ruzer LS, Harley NH. Aerosols handbook: measurement, dosimetry, and health effects. Boca Raton, London, New York: CRC Press, 2012.10.1201/b12668Search in Google Scholar

42. Pastuszka JS, Paw UKT, Lis DO, Wlazlo A, Ulfig K. Bacterial and fungal aerosol in indoor environment in Upper Silesia, Poland. Atmos Environ 2000;34:3833–42.10.1016/S1352-2310(99)00527-0Search in Google Scholar

43. National Institutes of Health. Cancer and the environment: what you need to know, what you can do [Internet]. Washington (DC): Department of Health and Human Services; 2003 Aug [cited 2011 Apr 11]. Available from: http://www.niehs.nih.gov/health/scied/documents/Cancer Environment.pdf.Search in Google Scholar

44. National Center for Health Statistics. Health, United States, 2010: with special feature on death and dying [Internet]. Hyattsville (MD): The Center; 2011 [cited 2011 Apr 11]. Available from: http://www.cdc.gov/nchs/data/hus/hus10.pdf.Search in Google Scholar

45. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, Hauser R, Prins GS, Soto AM, et al. Endocrine- disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev 2009;30(4):293–342.10.1210/er.2009-0002Search in Google Scholar PubMed PubMed Central

46. Kedjarune U, Kukiattrakoon B, Yapong B, Chowanadisai S, Leggat P. Bacterial aerosols in the dental clinic: effect of time, position and type of treatment. Int Dent J 2000;50:103–7.10.1002/j.1875-595X.2000.tb00807.xSearch in Google Scholar

47. Krajewska-Kułak, Łukaszuk C, Tsokantaridis C, Hatzopoulu A, Theodosopoyloy E, Hatzmanasi D, et al. Indoor air studies of fungi contamination at the Neonatal Department and Intensive Care Unit an Palliative Care in Kavala Hospital in Greece. Adv Med Sci 2007;52:11–4.Search in Google Scholar

48. Okten S, Asan A. Airborne fungi and bacteria in indoor and outdoor environment of the Pediatric Unit of Edirne Government Hospital. Environ Monit Assess 2012;184:1739–51.10.1007/s10661-011-2075-xSearch in Google Scholar PubMed

49. Kuchen E, Fisch MN, Leao M, Leao EB. Indoor air quality defined by measurements and questionnaires in office buildings. Bauphysik 2009;31:313–8.10.1002/bapi.200910041Search in Google Scholar

50. Verma N, Taneja A. Particulate matter exposure in hospitals of urban city located in northern central India. Indian J Environ Prot 2011;31:627–34.Search in Google Scholar

51. Mui KW, Wong LT, Hui PS, Chan WY. Formaldehyde exposure risk in air conditioned offices of Hong Kong. Build Serv Eng Res Technol 2009;30:279–86.10.1177/0143624409339613Search in Google Scholar

52. Ongwandee M, Moonrinta R, Panyametheekul S, Tangbanluekal C, Morrison G. Concentrations and strengths of formaldehyde and acetaldehyde in office buildings in Bangkok, Thailand. Indoor Built Environ 2009;18:569–75.10.1177/1420326X09349897Search in Google Scholar

53. Zuraimi MS, Tham KW, Chew FT, Ooi PL. The effects of ventilation strategies of child care centers on indoor air quality and respiratory health of children in Singapore. Indoor Air 2007;17:317–27.10.1111/j.1600-0668.2007.00480.xSearch in Google Scholar PubMed

54. Zhang XY, Ahmadi G, Qian J, Ferro A. Particle detachment, resuspension and transport due to human walking in indoor environments. J Adhes Sci Technol 2008;22:591–621.10.1163/156856108X305624Search in Google Scholar

55. Loupa G, Fotopoulou S, Tsagarakis KP. A tool for analysing the interdependence of indoor environmental quality and reported symptoms of the hospitals personnel. J Risk Res 2015;5(20):678–91.10.1080/13669877.2015.1119182Search in Google Scholar

56. Jung CC, Wu PC, Tseng CH, Su HJ. Indoor air quality varies with ventilation types and working areas in hospitals. Build Environ 2015;85:190–5.10.1016/j.buildenv.2014.11.026Search in Google Scholar

57. Wang X, Bi X, Sheng G, Fu J. Hospital indoor PM10/PM2.5 and associated trace elements in Guangzhou, China. Sci Total Environ 2006;366:124–35.10.1016/j.scitotenv.2005.09.004Search in Google Scholar PubMed

58. Fernández E, Martínez C, Fu M, Martínez-Sánchez JM, López MJ, Invernizzi G, et al. Second-hand smoke exposure in a sample of European hospitals. Eur Respir J 2009;34:111–6.10.1183/09031936.00180708Search in Google Scholar PubMed

59. Saad SG. Integrated environmental management for hospitals. Indoor Built Environ 2003;12:93–8.10.1177/1420326X03012001015Search in Google Scholar

60. Apte MG, Buchanan ISH, Mendell MJ. Outdoor ozone and building-related symptoms in the BASE study. Indoor Air 2008;18:156–70.10.1111/j.1600-0668.2008.00521.xSearch in Google Scholar PubMed

61. Barraza-Villarreal A, Escamilla-Nunez MC, Hernandez-Cadena L, Texcalac-Sangrador JL, Sienra-Monge JJ, del Rio-Navarro BE, et al. Elemental carbon exposure and lung function in schoolchildren from Mexico City. Eur Respir J 2011;38:548–52.10.1183/09031936.00111410Search in Google Scholar PubMed

62. Bell ML, Ebisu K, Peng RD, Samet JM, Dominici F. Hospital admissions and chemical composition of fine particle air pollution. Am J Respir Crit Care Med 2009;179:1115–20.10.1164/rccm.200808-1240OCSearch in Google Scholar PubMed PubMed Central

63. Reynolds SJ, Black DW, Borin SS, Breuer G, Burmeister LF, Fuortes LJ, et al. Indoor environmental quality in six commercial office buildings in the midwest United States. Appl Occup Environ Hyg 2001;16:1065–77.10.1080/104732201753214170Search in Google Scholar PubMed

64. Pilidis GA, Karakitsios SP, Kassomenos PA, Kazos EA, Stalikas CD. Measurements of benzene and formaldehyde in a medium sized urban environment. Indoor/outdoor health risk implications on special population groups. Environ Monit Assess 2009;150:285–94.10.1007/s10661-008-0230-9Search in Google Scholar

65. Sarnat JA, Marmur A, Klein M, Kim E, Russell AG, Sarnat SE, et al. Fine particle sources and cardiorespiratory morbidity: an application of chemical mass balance and factor analytical source-apportionment methods. Environ Health Perspect 2008;116:459–66.10.1289/ehp.10873Search in Google Scholar

66. Oeder S, Dietrich S, Weichenmeier I, Schober W, Pusch G, Jörres RA, et al. Toxicity and elemental composition of particulate matter from outdoor and indoor air of elementary schools in Munich, Germany. Indoor Air 2012;22:148–58.10.1111/j.1600-0668.2011.00743.xSearch in Google Scholar

67. Kelly FJ, Fussell JC. Size, source and chemical composition as determinants of toxicity attributable to ambient particulate matter. Atmos Environ 2012;60:504–26.10.1016/j.atmosenv.2012.06.039Search in Google Scholar

68. Slezakova K, Pereira MC, Reis MA, Alvim-Ferraz MC. Influence of traffic emissions on the composition of atmospheric particles of different sizes – part 1: concentrations and elemental characterization. J Atmos Chem 2007;58:55–68.10.1007/s10874-007-9078-6Search in Google Scholar

69. Slezakova K, Pereira MC, Alvim-Ferraz MC. Influence of tobacco smoke on the elemental composition of indoor particles of indoor sizes. Atmos Environ 2009;43:486–93.10.1016/j.atmosenv.2008.10.017Search in Google Scholar

70. Senlin L, Zhenkun Y, Xiaohui C, Minghong W, Guoying S, Jiamo F, Paul D. The relationship between physicochemical characterization and the potential toxicity of fine particulates (PM2.5) in Shanghai atmosphere. Atmos Environ 2008;42:7205–14.10.1016/j.atmosenv.2008.07.030Search in Google Scholar

71. Habil M, Massey DD, Taneja A. Exposure of children studying in schools of India to PM levels and metal contamination: sources and their identification. Air Qual Atmos Health 2013;6:575–87.10.1007/s11869-013-0201-3Search in Google Scholar

72. Hassan SKM. Metal concentrations and distribution in the household, stairs and entryway dust of some Egyptian homes. Atmos Environ 2012;54:207–15.10.1016/j.atmosenv.2012.02.013Search in Google Scholar

73. Chattopadhyay G, Lin KC, Feitz AJ. Household dust metal levels in the Sydney metropolitan area. Environ Res 2003;93:301–7.10.1016/S0013-9351(03)00058-6Search in Google Scholar

74. Kebede K, Kefeni KK, Okonkwo JO. Trace metals, anions and polybromodiphenyl ethers in settled indoor dust and their association. Environ Sci Pollut Res 2013;20:4895–905.10.1007/s11356-013-1469-4Search in Google Scholar

75. Paoletti L, De Berardis B, Arrizza L, Granato V. Influence of tobacco smoke on indoor PM10 particulate matter characteristics. Atmos Environ 2006;40:3269–80.10.1016/j.atmosenv.2006.01.047Search in Google Scholar

76. Taner S, Pekey B, Pekey H. Fine particulate matter in the indoor air of barbeque restaurants: elemental compositions, sources and health risks. Sci Total Environ 2013;454–455:79–87.10.1016/j.scitotenv.2013.03.018Search in Google Scholar

77. Chen LC, Lippmann M. Effects of metals within ambient air particulate matter (PM) on human health. Inhal Toxicol 2009;21:1–31.10.1080/08958370802105405Search in Google Scholar

78. Song F, Gao Y. Size distributions of trace elements associated with ambient particular matter in the affinity of a major highway in the new Jersey – New York metropolitan area. Atmos Environ 2011;45(37):6714–23.10.1016/j.atmosenv.2011.08.031Search in Google Scholar

79. Greene NA, Morris VR. Assessment of public health risks associated with atmospheric exposure to PM2.5 in Washington, DC, USA. Int J Environ Res Public Health 2006;3:86–97.10.3390/ijerph2006030010Search in Google Scholar

80. World Health Organization (WHO). Health risks of heavy metals from long-range transboundary air pollution. Copenhagen: WHO Regional Office for Europe; 2007.Search in Google Scholar

81. Banse JP. IAQ, infection control in hospitals. Consult Specif Eng 2013;50(1):28–32.Search in Google Scholar

82. Barnett R, Barnett P. “If you want to sit on your butts you’ll get nothing!” Community activism in response to threats of rural hospital closure in southern New Zealand. Health Place 2003;9:59–71.10.1016/S1353-8292(02)00019-9Search in Google Scholar

83. Brown KB, Sarnat JA, Koutrakis P. Concentrations of PM2.5 mass and components in residential and non-residential indoor microenvironments: the sources and composition of particulate exposures study. J Expo Sci Environ Epidemiol 2012;22:161–72.10.1038/jes.2011.41Search in Google Scholar PubMed

84. Woodruff TJ, Zeise L, Axelrad DA, Guyton KZ, Janssen S, Miller M, et al. Meeting report: moving upstream—evaluating adverse upstream end points for improved risk assessment and decision-making. Environ Health Perspect 2008;116(11):1568–75.10.1289/ehp.11516Search in Google Scholar PubMed PubMed Central

85. United States Environment Protection Agency (USEPA). Users’ guide and background technical document for USEPA regions 9′S preliminary remediation goals. 2013. http://www.epa.gov/region9/superfund/prg/files/04usersguide.pdf. Accessed 7 Jan 2013.Search in Google Scholar

86. Wan G-H, Chung F-F, Tang C-S. Long-term surveillance of air quality in medical center operating rooms. Am J Infect Control 2011;39(4):302–8.10.1016/j.ajic.2010.07.006Search in Google Scholar PubMed

87. Wang Y-T, Chiu J-C, Hsu Y-C, Wu T-N, Shen Y-H, Wen S-B. Investigation on indoor air quality of public sites in Tainan area. Adv Mater Res 2011;255–260:1413–7.10.4028/www.scientific.net/AMR.255-260.1413Search in Google Scholar

88. Nardini S, Cagnin R, Invernizzi G, Ruprecht A, Boffi R, Formentini S. Indoor particulate matter measurement as a tool in the process of the implementation of smoke-free hospitals. Monaldi Arch Chest Dis 2004;61:183–92.10.4081/monaldi.2004.701Search in Google Scholar PubMed

89. Sureda X, Fu M, López MJ, Martínez-Sánchez JM, Carabasa E, Saltó E, et al. Second-hand smoke in hospitals in Catalonia (2009): a cross-sectional study measuring PM2.5 and vapor-phase nicotine. Environ Res 2010;110(8):750–5.10.1016/j.envres.2010.09.008Search in Google Scholar PubMed

90. United States Environmental Protection Agency (USEPA). Risk-based concentration table. 2013. http://www.epa.gov/reg3hwmd/risk/human/index.htm. Accessed 12 January 2013.Search in Google Scholar

91. Sulaiman N, Abdullah M, Chieu PLP. Concentration and composition of PM10 in outdoor and indoor air in industrial area of Balakong Selangor, Malaysia. Sains Malays 2005;34:43–7.Search in Google Scholar

92. Abdel Hameed AA, Yasser IH, Khoder IM. Indoor air quality during renovation action: a case study. J Environ Monit 2004;6:740–4.10.1039/b402995jSearch in Google Scholar PubMed

93. Slezakova K, Pires JCM, Martins FG, Pereira MC, Alvim-Ferraz MC. Identification of tobacco smoke components in indoor breathable particles by SEM–EDS. Atmos Environ 2011;45(4):863–72.10.1016/j.atmosenv.2010.11.019Search in Google Scholar

94. Begonha A. Meteorização do granito e deterioração da pedra em monumentos e edifícios da cidade do Porto. FEUP–Edições–Colecção Monografias, Porto. 1997. http://hdl.handle.net/10216/12403.Search in Google Scholar

95. Cole DC, Koehoorn M, Ibrahim S, Hertzman C, Ostry A, Xu F, et al. Regions, hospitals and health outcomes over time: a multilevel analysis of repeat prevalence among a cohort of health-care workers. Health Place 2009;15(4):1046–57.10.1016/j.healthplace.2009.05.004Search in Google Scholar PubMed

96. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. J Am Med Assoc 2003;290:1173–8.10.1001/jama.290.9.1173Search in Google Scholar PubMed

97. National Academy of Sciences. Science and decisions: advancing risk assessment. Washington (DC): National Academies Press; 2009.Search in Google Scholar

98. Woodruff TJ, Janssen SJ, Guillette LJ Jr, Giudice LC, editors. Environmental impacts on reproductive health and fertility. New York (NY): Cambridge University Press; 2010.10.1017/CBO9780511674686Search in Google Scholar

99. Lunder S, Hovander L, Athanassiadis I, Bergman A. Significantly higher polybrominated diphenyl ether levels in young U.S. children than in their mothers. Environ Sci Technol 2010;44(13):5256–62.10.1021/es1009357Search in Google Scholar PubMed

100. Calafat AM, Ye XY, Wong LY, Reidy JA, Needham LL. Exposure of the US population to bisphenol A and 4-tertiary- octylphenol: 2003–2004. Environ Health Perspect 2008;116(1):39–44.10.1289/ehp.10753Search in Google Scholar PubMed PubMed Central

101. Nadeau K, McDonald-Hyman C, Noth EM, Pratt B, Hammond SK, Balmes J, et al. Ambient air pollution impairs regulatory T-cell function in asthma. J Allergy Clin Immunol 2010;126(4):845–52.10.1016/j.jaci.2010.08.008Search in Google Scholar

102. Annesi-Maesano I, Agabiti N, Pistelli R, Couilliot MF, Forastiere F. Subpopulations at increased risk of adverse health outcomes from air pollution. Eur Respir J Suppl 2003;40:57–63.10.1183/09031936.03.00402103Search in Google Scholar

103. National Academy of Sciences. Copper in drinking water. Washington (DC): National Academies Press; 2000.Search in Google Scholar

104. International Commission on Radiological Protection. Genetic susceptibility to cancer. Ann ICRP 1999;28(1–2).10.1016/S0146-6435(98)00007-3Search in Google Scholar

105. Centers for Disease Control and Prevention. National report on human exposure to environmental chemicals [Internet]. Atlanta (GA): CDC; 2009 [cited 2011 Apr 11]. Available from: http://www.cdc.gov/exposurereport/.Search in Google Scholar

106. Woodruff TJ, Zota AR, Schwartz JM. Environmental chemicals in pregnant women in the US: NHANES 2003–2004. Environ Health Perspect 2011;119(6):878–85.10.1289/ehp.1002727Search in Google Scholar PubMed PubMed Central

107. Woodruff TJ, Burke TA, Zeise L. The need for better public health decisions on chemicals released into our environment. Health Aff (Millwood) 2011;30(5):957–67.10.1377/hlthaff.2011.0194Search in Google Scholar PubMed PubMed Central

108. Crump KS, Chen C, Louis TA. The future use of in vitro data in risk assessment to set human exposure standards: challenging problems and familiar solutions. Environ Health Perspect 2010;118(10):1350–4.10.1289/ehp.1001931Search in Google Scholar PubMed PubMed Central

Received: 2018-02-14
Accepted: 2018-06-07
Published Online: 2018-08-03
Published in Print: 2018-09-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

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