Effectiveness of filtering or decontaminating air to reduce or prevent respiratory infections: A systematic review

Brainard, Julii, Jones, Natalia R. ORCID: https://orcid.org/0000-0003-4025-2985, Swindells, Isabel Catalina, Archer, Elizabeth J. ORCID: https://orcid.org/0000-0002-6760-9406, Kolyva, Anastasia, Letley, Charlotte, Pond, Katharine, Lake, Iain R. ORCID: https://orcid.org/0000-0003-4407-5357 and Hunter, Paul R. ORCID: https://orcid.org/0000-0002-5608-6144 (2023) Effectiveness of filtering or decontaminating air to reduce or prevent respiratory infections: A systematic review. Preventive Medicine, 177. ISSN 0091-7435

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Installation of technologies to remove or deactivate respiratory pathogens from indoor air is a plausible non-pharmaceutical infectious disease control strategy. Objective: We undertook a systematic review of worldwide observational and experimental studies, published 1970–2022, to synthesise evidence about the effectiveness of suitable indoor air treatment technologies to prevent respiratory or gastrointestinal infections. Methods: We searched for data about infection and symptom outcomes for persons who spent minimum 20 h/week in shared indoor spaces subjected to air treatment strategies hypothesised to change risk of respiratory or gastrointestinal infections or symptoms. Results: Pooled data from 32 included studies suggested no net benefits of air treatment technologies for symptom severity or symptom presence, in absence of confirmed infection. Infection incidence was lower in three cohort studies for persons exposed to high efficiency particulate air filtration (RR 0.4, 95%CI 0.28–0.58, p < 0.001) and in one cohort study that combined ionisers with electrostatic nano filtration (RR 0.08, 95%CI 0.01–0.60, p = 0.01); other types of air treatment technologies and air treatment in other study designs were not strongly linked to fewer infections. The infection outcome data exhibited strong publication bias. Conclusions: Although environmental and surface samples are reduced after air treatment by several air treatment strategies, especially germicidal lights and high efficiency particulate air filtration, robust evidence has yet to emerge that these technologies are effective at reducing respiratory or gastrointestinal infections in real world settings. Data from several randomised trials have yet to report and will be welcome to the evidence base.

Item Type: Article
Additional Information: Funding information: ICS, IRL, PRH, JB and EJA were funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with the UK Health Security Agency (UKHSA), in collaboration with the University of East Anglia. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, any of our employers, the Department of Health or the UKHSA.
Uncontrolled Keywords: respiratory infections,symptoms,indoor,air filtration,air sterilisation,air sterilisation,respiratory infections,indoor,symptoms,air filtration,public health, environmental and occupational health,epidemiology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2739
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Science
Faculty of Science > School of Environmental Sciences
University of East Anglia Research Groups/Centres > Theme - ClimateUEA
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
University of East Anglia Schools > Faculty of Science > Tyndall Centre for Climate Change Research
Faculty of Science > Research Centres > Tyndall Centre for Climate Change Research
Faculty of Science > Research Groups > Collaborative Centre for Sustainable Use of the Seas
Faculty of Science > Research Groups > Environmental Social Sciences
Faculty of Social Sciences > Research Centres > Water Security Research Centre
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 10 Nov 2023 03:23
Last Modified: 14 Dec 2023 03:37
URI: https://ueaeprints.uea.ac.uk/id/eprint/93616
DOI: 10.1016/j.ypmed.2023.107774


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