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Health hazard evaluation report: evaluation of environmental controls at a homeless shelter (Trinity Rescue Mission) associated with a tuberculosis outbreak - Florida.

Martin-SB Jr.; Mead-KR; Lawrence-RB; Beaty-MC
Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2012-0265-3183, 2013 Jul; :1-38
In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB disease transmission. During an on-site evaluation of the Trinity Rescue Mission homeless shelter in August 2012, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where shelter guests typically congregate or spend significant amounts of time. We recorded the make and model number of all air-handling units (AHUs) providing supply air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The ventilation systems in place could have contributed to airborne disease transmission among shelter guests. With the exception of some improper filter configurations and the use of inefficient filters in AHUs, the units typically used at the shelter appeared adequately maintained and were fully operational. Unfortunately, none of the AHUs provided fresh outdoor air to the occupied spaces, as required by the Florida Building Code and the American Society of Heating, Refrigerating and Air-Conditioning Engineers design standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, Trinity Rescue Mission reportedly has not made any significant improvements to their administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend that Trinity start working closely with Duval County Health Department to make improvements to the administrative controls at the shelter. From an environmental control standpoint, we suggest that all occupied spaces in the shelter are supplied adequate amounts of outdoor air based upon occupancy and room use. In addition, areas within the men's and women's facilities should be converted for use as respiratory separation areas, when necessary. These spaces could serve to separate guests suspected of having TB or other respiratory diseases from the remainder of the guest population, until medical evaluation or treatment could be obtained. To provide additional protection to the 104 guests typically housed in the men's sleeping area, we recommend installing an upper-room ultraviolet germicidal irradiation system. We also recommend developing a written infection control plan, HVAC operation and maintenance plan, and a written respiratory protection program for the shelter. Having these plans/programs in place will help Trinity Rescue Mission under normal operating conditions, and especially during future outbreaks of respiratory disease.
Infectious-diseases; Infection-control; Respiratory-system-disorders; Bacteria; Bacterial-disease; Bacterial-infections; Region-4; Ventilation; Ventilation-systems; Heating-equipment; Heating-systems; Air-conditioning-equipment; Air-contamination; Indoor-air-pollution; Indoor-environmental-quality; Disease-transmission; Disease-control; Disease-prevention; Environmental-control-equipment; Environmental-engineering; Environmental-exposure; Engineering-controls; Control-technology; Air-flow; Measurement-equipment; Airborne-particles; Equipment-design; Air-quality; Aerosols; Administration; Humans; Sociological-factors; Quality-standards; Respiratory-protection; Public-health; Germicides; Irradiation; Author Keywords: Temporary Shelters; tuberculosis; environmental controls; ventilation; homeless shelter; airborne infection; airborne transmission; respiratory
Publication Date
Document Type
Field Studies; Hazard Evaluation and Technical Assistance
Fiscal Year
NTIS Accession No.
NTIS Price
Identifying No.
HETA-2012-0265-3183; B20130805
NIOSH Division
Priority Area
Healthcare and Social Assistance; Transportation, Warehousing and Utilities
SIC Code
Source Name
National Institute for Occupational Safety and Health
Page last reviewed: September 2, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division