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A direct approach to limit airborne viral transmissions is to inactivate them within a short time of their production. Germicidal ultraviolet light, typically at 254 nm, is effective in this context but, used directly, can be a health hazard to skin and eyes. By contrast, far-UVC light (207–222 nm) efficiently kills pathogens potentially without harm to exposed human tissues. We previously demonstrated that 222-nm far-UVC light efficiently kills airborne influenza virus and we extend those studies to explore far-UVC efficacy against airborne human coronaviruses alpha HCoV-229E and beta HCoV-OC43. Low doses of 1.7 and 1.2 mJ/cm2 inactivated 99.9% of aerosolized coronavirus 229E and OC43, respectively.

As all human coronaviruses have similar genomic sizes, far-UVC light would be expected to show similar inactivation efficiency against other human coronaviruses including SARS-CoV-2. Based on the beta-HCoV-OC43 results, continuous far-UVC exposure in occupied public locations at the current regulatory exposure limit (~3 mJ/cm2/hour) would result in ~90% viral inactivation in ~8 minutes, 95% in ~11 minutes, 99% in ~16 minutes and 99.9% inactivation in ~25 minutes. Thus while staying within current regulatory dose limits, low-dose-rate far-UVC exposure can potentially safely provide a major reduction in the ambient level of airborne coronaviruses in occupied public locations.

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has emerged as a serious threat to human health worldwide. Efficient disinfection of surfaces contaminated with SARS-CoV-2 may help prevent its spread. This study aimed to investigate the in vitro efficacy of 222-nm far-ultraviolet light (UVC) on the disinfection of SARS-CoV-2 surface contamination.

Methods: We investigated the titer of SARS-CoV-2 after UV irradiation (0.1 mW/cm2) at 222 nm for 10-300 seconds using the 50% tissue culture infectious dose (TCID50). In addition, we used quantitative reverse transcription polymerase chain reaction to quantify SARS-CoV-2 RNA under the same conditions.

Results: One and 3 mJ/cm2 of 222-nm UVC irradiation (0.1 mW/cm2 for 10 and 30 seconds) resulted in 88.5 and 99.7% reduction of viable SARS-CoV-2 based on the TCID50 assay, respectively. In contrast, the copy number of SARS-CoV-2 RNA did not change after UVC irradiation even after a 5-minute irradiation.

Conclusions: This study shows the efficacy of 222-nm UVC irradiation against SARS-CoV-2 contamination in an in vitro experiment. Further evaluation of the safety and efficacy of 222-nm UVC irradiation in reducing the contamination of real-world surfaces and the potential transmission of SARS-CoV-2 is needed.

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Airborne-mediated microbial diseases such as influenza and tuberculosis represent major public health challenges. A direct approach to prevent airborne transmission is inactivation of airborne pathogens, and the airborne antimicrobial potential of UVC ultraviolet light has long been stablished; however, its widespread use in public settings is limited because conventional UVC light sources are both carcinogenic and cataractogenic. By contrast, we have previously shown that far-UVC light (207–222 nm) efficiently inactivates bacteria without harm to exposed mammalian skin. This is because, due to its strong absorbance in biological materials, far-UVC light cannot penetrate even the outer (non living) layers of human skin or eye; however, because bacteria and viruses are of micrometer or smaller dimensions, far-UVC can penetrate and inactivate them. We show for the first time that far-UVC efficiently inactivates airborne aerosolized viruses, with a very low dose of 2 mJ/cm2 of 222-nm light inactivating >95% of aerosolized H1N1 influenza virus. Continuous very low dose-rate far-UVC light in indoor public locations is a promising, safe and inexpensive tool to reduce the spread of airbornemediated microbial diseases.

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Objective: To demonstrate the efficacy of the SafeZone UVC (Ushio Inc., Japan) 222 nm ultraviolet C (UVC) light to reduce bacterial burden in pressure ulcers (PUs) in human patients. This research is the first human clinical trial using 222 nm UVC in eradicating bacteria in human wounds.

Method: Patients with Stage 2 or 3 (as defined by the revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System) sacral or gluteal pressure ulcers (PUs) were subjected to four sessions of 222 nm UVC light therapy over two weeks. Pre- and post-UVC therapy, wound cultures were taken and quantitative analysis of bacterial colony forming units (CFU) were performed.

Results: A total of 68 UV light sessions across 16 different patients were conducted. Of these sessions, 59 (87.0%) sessions showed a reduction in CFU counts, with 20 (29.4%) showing complete eradication of bacteria. Bacteria identified included meticillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella Pneumoniae. The overall median reduction in CFU of the 68 sessions was 78.9%. No adverse events were reported in any of the UV sessions.

Conclusion: In this study, 222 nm UVC light was safe and effective in reducing bacterial CFU counts in sacral and gluteal PUs across numerous different species of bacteria.

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There are increased risks of contracting COVID-19 in hospitals and long-term care facilities, particularly for vulnerable groups. In these environments aerosolised coronavirus released through breathing increases the chance of spreading the disease. To reduce aerosol transmissions, the use of low dose far-UVC lighting to disinfect in-room air has been proposed. Unlike typical UVC, which has been used to kill microorganisms for decades but is carcinogenic and cataractogenic, recent evidence has shown that far-UVC is safe to use around humans. A high-fidelity, fully-coupled radiation transport and fluid dynamics model has been developed to quantify disinfection rates within a typical ventilated room. The model shows that disinfection rates are increased by a further 50-85% when using far-UVC within currently recommended exposure levels compared to the room’s ventilation alone. With these magnitudes of reduction, far-UVC lighting could be employed to mitigate SARS-CoV-2 transmission before the onset of future waves, or the start of winter when risks of infection are higher. This is particularly significant in poorly-ventilated spaces where other means of reduction are not practical, in addition social distancing can be reduced without increasing the risk.

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UVC radiation is known to be highly germicidal. However, exposure to 254-nm-UVC light causes DNA lesions such as cyclobutane pyrimidine dimers (CPD) in human cells, and can induce skin cancer after long-term repeated exposures. It has been reported that short wavelength UVC is absorbed by proteins in the membrane and cytosol, and fails to reach the nucleus of human cells. Hence, irradiation with 222-nm UVC might be an optimum combination of effective disinfection and biological safety to human cells. In this study, the biological effectiveness of 222-nm UVC was investigated using a mouse model of a skin wound infected with methicillin-resistant Staphylococcus aureus (MRSA). Irradiation with 222-nm UVC significantly reduced bacterial numbers on the skin surface compared with non-irradiated skin. Bacterial counts in wounds evaluated on days 3, 5, 8 and 12 after irradiation demonstrated that the bactericidal effect of 222-nm UVC was equal to or more effective than 254-nm UVC. Histological analysis revealed that migration of keratinocytes which is essential for the wound healing process was impaired in wounds irradiated with 254-nm UVC, but was unaffected in 222-nm UVC irradiated wounds. No CPD-expressing cells were detected in either epidermis or dermis of wounds irradiated with 222-nm UVC, whereas CPD-expressing cells were found in both epidermis and dermis irradiation with 254-nm UVC. These results suggest that 222-nm UVC light may be a safe and effective way to reduce the rate of surgical site and other wound infections.

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Ultraviolet (UV) devices emitting UVC irradiation (200–280 nm) have proven to be effective for virus disinfection, especially on surfaces and in air, due to their rapid effectiveness and limited to no material corrosion. Numerous studies of UV-induced inactivation focused on nonenveloped viruses. Little is known about UVC action on enveloped viruses across UVC wavelengths. In this study, we determined inactivation efficiencies of two coronaviruses (ssRNA) and an enveloped dsRNA bacteriophage surrogate in buffered aqueous solution (pH 7.4) using five commonly available UVC devices that uniquely emit light at different wavelengths spanning 222 nm emitting krypton chloride (KrCl*) excimers to 282 nm emitting UVC LEDs. Our results show that enveloped viruses can be effectively inactivated using UVC devices, among which the KrCl* excimer had the best disinfection performance (i.e., highest inactivation rate) for all three enveloped viruses. The coronaviruses exhibited similar sensitivities to UV irradiation across the UVC range, whereas the bacteriophage surrogate was much more resistant and exhibited significantly higher sensitivity to the Far UVC (<230 nm) irradiation. This study provides necessary information and guidance for using UVC devices for enveloped virus disinfection, which may help control virus transmission in public spaces during the ongoing COVID-19 pandemic and beyond.

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The International Ultraviolet Association (IUVA) has released a white paper titled "Far UV-C Radiation: Current State-of Knowledge," which is a scientific review of Far UV-C technology and the state-of-the-art research featuring key conclusions made through analysis of published literature and collation of expert knowledge.

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Hudsikkerhed

Biological response and DNA damage following irradiation with shorter wavelengths in the UV-C range were evaluated to investigate the safety at three wavelengths because of the recent emergence of germicidal equipment emitting short-wavelength UV-C for various purposes, including medical uses. To estimate an acceptable safety dose for human skin in the UV-C range, especially short UV-C, we studied the biological effects of 207 nm, 222 nm, and 235 nm UV-C using albino hairless mice and evaluated the inflammatory reactions in the skin. To explore an appropriate indicator to evaluate the biological response, we employed determination of the minimal perceptible response dose (MPRD), by which any subtle cutaneous response; erythema, edema, and scale could be observed by visual inspection. Erythema was rarely observed, but edema and scale formation were evident for short UV-C wavelengths. The MPRD at 207, 222, and 235 nm was determined to be > 15 kJ/m2, 15 kJ/m2, and 2.0 kJ/m2, respectively. These values could be thresholds and indicators for possible safety assessments. Our data suggest that the current human exposure limits for short UV-C wavelengths below 254 nm are overly restrictive and should be reconsidered for future disinfection lamps with short UV-C wavelengths.

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Far-UVC devices are being commercially sold as “safe for humans” for the inactivation of SARS-CoV-2, without supporting human safety data. We felt there was a need for rapid proof-of-concept human self-exposure, to inform future controlled research and promote informed discussion. A Fitzpatrick Skin Type II individual exposed their inner forearms to large radiant exposures from a filtered far-UVC source. No visible skin changes were observed at 1,000 mJcm-2, whereas skin pigmentation that appeared around 2 hours and resolved within 24 hours occurred with an 8,000 mJcm-2 exposure. These results combined with Monte Carlo Radiative Transfer computer modelling suggest that filtering longer ultraviolet wavelengths is critical for the human skin safety of far-UVC devices.

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Introduction: Surgical site infection is one of the most severe complications of surgical treatments. However, the optimal procedure to prevent such infections remains uninvestigated. Ultraviolet radiation C (UVC) with a short wavelength has a high bactericidal effect; however, it is cytotoxic. Nonetheless, given that UVC with a wavelength of 222 nm reaches only the stratum corneum, it does not affect the skin cells. This study aimed to investigate the safety of 222-nm UVC irradiation and to examine its skin sterilization effect in healthy volunteers.

Methods: This trial was conducted on 20 healthy volunteers. The back of the subject was irradiated with 222-nm UVC at 50–500 mJ/cm2, and the induced erythema (redness of skin) was evaluated. Subsequently, the back was irradiated with a maximum amount of UVC not causing erythema, and the skin swabs before and after the irradiation were cultured. The number of colonies formed after 24 hours was measured. In addition, cyclobutene pyrimidine dimer (CPD) as an indicator of DNA damage was measured using skin tissues of the nonirradiated and irradiated regions.

Results: All subjects experienced no erythema at all doses. The back of the subject was irradiated at 500 mJ/cm2, and the number of bacterial colonies in the skin swab culture was significantly decreased by 222-nm UVC irradiation. The CPD amount produced in the irradiated region was slightly but significantly higher than that of the non-irradiated region.

Conclusion: A 222-nm UVC at 500 mJ/cm2 was a safe irradiation dose and possessed bactericidal effects. In the future, 222-nm UVC irradiation is expected to contribute to the prevention of perioperative infection.

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Far-UVC (200 - 220 nm) has been proposed as an effective disinfection radiation that is safe to humans5. In 2014, Woods et al. undertook a first-in-person study to assess the effect on skin of a 222 nm UVC emitting device … Woods et al. hypothesised that a small amount of longer wavelength UVC radiation above 250 nm (<3%) may be contributing to the observed effects. We wished to determine why these results contrast with other published studies investigating far-UVC sources.

Our results demonstrate that whilst a percentage of far-UVC radiation at 222 nm penetrates to the upper epidermis, there is minimal reaches the mid-epidermis and none in the basal layer. Direct CPD formation in the basal layer observed by Woods et al. is likely to have arisen from very low intensity source emissions above 230 nm, in particular the 270 nm to 310 nm wavelength range, where the spectral emissions are not visualised without plotting incident irradiance on a logarithmic scale. Careful filtering of UVC spectral emissions, to remove unwanted longer wavelengths, has been shown not to induce tissue inflammation or increase pre-mutagenic DNA lesions in both mammalian skin and an in-vitro human skin model 2,5. This supports our conclusion that the longer wavelength ultraviolet radiation was responsible for the effects seen by Woods et al.

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Joint research between Kobe University and Ushio Inc. has provided proof for the first time in the world that direct and repetitive illumination from 222-nm ultraviolet radiation C (UVC), which is a powerful sterilizer, does not cause skin cancer. This suggests that 222-nm UVC is also safe for human eyes and skin.

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Germicidal lamps that emit primarily 254 nm ultraviolet radiation (UV) are routinely utilized for surface sterilization but cannot be used for human skin because they cause genotoxicity. As an alternative, 222 nm-UVC have been reported to exert sterilizing ability comparable to that of 254 nm-UVC without producing cyclobutane pyrimidine dimers (CPDs), the major DNA lesions caused by UV. However, there has been no clear evidence for safety in chronic exposure to skin, particularly with respect to carcinogenesis. We therefore investigated the long-term effects of 222 nm-UVC on skin using a highly photocarcinogenic phenotype mice that lack xeroderma pigmentosum complementation group A (Xpa-) gene, which is involved in repairing of CPDs. CPDs formation was recognized only uppermost layer of epidermis even with high dose of 222 nm-UVC exposure. No tumors were observed in Xpa-knockout mice and wild-type mice by repetitive irradiation with 222 nm-UVC, using a protocol which had shown to produce tumor in Xpa-knockout mice irradiated with broad-band UVB. Furthermore, erythema and ear swelling were not observed in both genotype mice following 222 nm-UVC exposure. Our data suggests that 222 nm-UVC lamps can be safely used for sterilizing human skin as far as the perspective of skin cancer development.

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We have previously shown that 207-nm ultraviolet (UV) light has similar antimicrobial properties as typical germicidal UV light (254 nm), but without inducing mammalian skin damage. The biophysical rationale is based on the limited penetration distance of 207-nm light in biological samples (e.g. stratum corneum) compared with that of 254-nm light. Here we extended our previous studies to 222-nm light and tested the hypothesis that there exists a narrow wavelength window in the far-UVC region, from around 200–222 nm, which is significantly harmful to bacteria, but without damaging cells in tissues.We used a krypton-chlorine (Kr-Cl) excimer lamp that produces 222-nm UV light with a bandpass filter to remove the lower- and higher-wavelength components. Relative to respective controls, we measured: 1. in vitro killing of methicillin-resistant Staphylococcus aureus (MRSA) as a function of UV fluence; 2. yields of the main UV-associated premutagenic DNA lesions (cyclobutane pyrimidine dimers and 6-4 photoproducts) in a 3D human skin tissue model in vitro; 3. eight cellular and molecular skin damage endpoints in exposed hairless mice in vivo. Comparisons were made with results from a conventional 254-nm UV germicidal lamp used as positive control. We found that 222- nm light kills MRSA efficiently but, unlike conventional germicidal UV lamps (254 nm), it produces almost no premutagenic UV-associated DNA lesions in a 3D human skin model and it is not cytotoxic to exposed mammalian skin. As predicted by biophysical considerations and in agreement with our previous findings, far-UVC light in the range of 200–222 nm kills bacteria efficiently regardless of their drugresistant proficiency, but without the skin damaging effects associated with conventional germicidal UV exposure.

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It is well understood that ultraviolet‐C (UVC) radiation is effective for the destruction of micro‐organisms and drug‐resistant bacteria and is being investigated for its effectiveness at destroying the virus responsible for the current Covid‐19 global pandemic.

Far‐UVC (200 ‐ 220 nm) has been proposed as an effective disinfection radiation that is safe to humans. In 2014, Woods et al. undertook a first‐in‐person study to assess the effect on skin of a 222 nm UVC emitting device (Sterilray disinfectant wand, Healthy Environment Innovations, Dover, NH, USA).

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In this issue, Yamano et al. provide further evidence that germicidal 222‐nm far UV light has no immediate and delayed harmful effects on the skin and ocular tissue of rats. The safety of 222‐nm krypton–chlorine excimer lamps, highlighted in the commentary article, has already received relevant applications in the treatment of surgical site infections and in the control of airborne and foodborne pathogens.

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The ongoing coronavirus pandemic requires new disinfection approaches, especially for airborne viruses. The 254 nm emission of low-pressure vacuum lamps is known for its antimicrobial effect, but unfortunately, this radiation is also harmful to human cells. Some researchers published reports that short-wavelength ultraviolet light in the spectral region of 200–230 nm (far-UVC) should inactivate pathogens without harming human cells, which might be very helpful in many applications.

Methods: A literature search on the impact of far-UVC radiation on pathogens, cells, skin and eyes was performed and median log-reduction doses for different pathogens and wavelengths were calculated. Observed damage to cells, skin and eyes was collected and presented in standardized form.

Results: More than 100 papers on far-UVC disinfection, published within the last 100 years, were found. Far-UVC radiation, especially the 222 nm emission of KrCl excimer lamps, exhibits strong antimicrobial properties. The average necessary log-reduction doses are 1.3 times higher than with 254 nm irradiation. A dose of 100 mJ/cm2 reduces all pathogens by several orders of magnitude without harming human cells, if optical filters block emissions above 230 nm.

Conclusion: The approach is very promising, especially for temporary applications, but the data is still sparse. Investigations with high far-UVC doses over a longer period of time have not yet been carried out, and there is no positive study on the impact of this radiation on human eyes. Additionally, far-UVC sources are unavailable in larger quantities. Therefore, this is not a short-term solution for the current pandemic, but may be suitable for future technological approaches for decontamination in rooms in the presence of people or for antisepsis.

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We performed human skin irradiation in two settings using a filtered KrCl far‐UVC source (SafeZoneUVC, Ushio Inc., Tokyo, Japan): firstly, in a novel ex vivo full‐thickness human skin model cultured at tension (manuscript in preparation) and secondly, using in vivo self‐exposures.

This first‐in‐human demonstration of CPD location from filtered far‐UVC confirms the results of our previous in silico model and indicates that the peak KrCl excimer emission wavelength of 222 nm does not penetrate beyond the most superficial epidermal layers. … However, to date, the evidence is overwhelmingly in favour of using filtered far‐UVC as a safe, effective germicidal technology.

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Surgical site infections (SSIs) represent an important clinical problem associated with increased levels of surgical morbidity and mortality. UVC irradiation during surgery has been considered to represent a possible strategy to prevent the development of SSI. 254-nm UVC induces marked levels of DNA damage by generating cyclobutyl pyrimidine dimers (CPD) in microorganisms. However, this effect is elicited not only in microorganisms, but also in human cells, and chronic exposure to 254-nm UVC has been established to represent a human health hazard. In contrast, despite short wavelength-UVC light, especially 222-nm UVC, having been demonstrated to elicit a bactericidal effect, single irradiation with a high dose of 222-nm UVC energy has been reported to not induce mutagenic or cytotoxic DNA lesions in mammalian cells. However, the effect of chronic irradiation with a high dose of 222-nm UVC to mammalian cells has not been determined. In this study, it was demonstrated that large numbers of CPD-expressing cells were induced in the epidermis of mice following treatment with a small amount of single exposure 254-nm UVC, and then less than half of these cells reduced within 24 h. Chronic 254-nm UVC irradiation was revealed to induce sunburn and desquamation in mouse skin. Histological analysis demonstrated that small numbers of CPD-expressing cells were detected only in hyperkeratotic stratum corneum after chronic irradiation with a high dose of 254-nm UVC, and that significant hyperplasia and intercellular edema were also induced in the epidermis of mice. In contrast, chronic irradiation with 222-nm UVC light was revealed not to induce mutagenic or cytotoxic effects in the epidermis of mice. These results indicated that 222-nm UVC light emitted from the lamp apparatus (or device), which was designed to attenuate harmful light present in wavelengths of more than 230 nm, represents a promising tool for the reduction of SSI incidence in patients and hospital staff.

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The COVID‐19 pandemic has greatly heightened interest in ultraviolet germicidal irradiation (UVGI) as an important intervention strategy to disinfect air in medical treatment facilities and public indoor spaces. However, a major drawback of UVGI is the challenge posed by assuring safe installation of potentially hazardous short‐wavelength (UV‐C) ultraviolet lamps. Questions have arisen regarding what appear to be unusually conservative exposure limit values in the UV‐C spectral band between 180 and 280 nm. We review the bases for the current limits and proposes some adjustments that would provide separate limits for the eye and the skin at wavelengths less than 300 nm and to increase both skin and eye limits in the UV‐C below 250 nm.

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Øjens sikkerhed

Two hundred twenty-two nanometres ultraviolet (UV) light produced by a krypton–chlorine excimer lamp is harmful to bacterial cells but not skin. However, the effects of 222-nm UV light exposure to the eye are not fully known. We evaluated acute corneal damage induced by 222- and 254-nm UV light in albino rats. Under deep anaesthesia, 6-week-old Sprague–Dawley albino rats were exposed to UV light. The exposure levels of corneal radiation were 30, 150, and 600 mJ/cm2. Epithelial defects were detected by staining with fluorescein. Superficial punctate keratitis developed in corneas exposed to more than 150mJ/cm2 of UV light, and erosion was observed in corneas exposed to 600mJ/cm2 of UV light. Haematoxylin and eosin staining also showed corneal epithelial defects in eyes exposed to 254-nm UV light. However, no damage developed in corneas exposed to 222-nm UV light. Cyclobutane pyrimidine dimer-positive cells were observed only in normal corneas and those exposed to 254-nm UV light. Although some epithelial cells were stained weakly in normal corneas, squamous epithelial cells were stained moderately, and the epithelial layer that was detached from the cornea exposed to 600mJ/cm2 of light was stained intensely in corneas exposed to 254-nm UV light. In the current study, no corneal damage was induced by 222-nm UV light, which suggested that 222-nm UV light may not harm rat eyes within the energy range and may be useful for sterilising or preventing infection in the future.

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Forskrifter

The International Organization for Standardization 15858 was developed to highlight the minimum specifications on UV-C safety for products and equipment utilizing UV-C lamp fixtures. The ISO 15858 mainly addresses safety information regarding the use of 254 nm wavelengths and does not mention the use of 222 nm. The ISO sets the maximum permissible UV-C exposure for radiation at 254 nm at 6 mJ/cm2 during an 8h workday, 40h work week. All UVC devices utilizing 254 nm UV-C light must be installed to keep below this limit. To ensure UV-C lamps keep within the safe range of exposure, the ISO states all devices must be installed and checked by trained personal wearing appropriate personal protective equipment.

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The American Conference of Governmental Industrial Hygienists (ACGIH) is a scientific, private, non-profit, and nongovernmental corporation. They publish the guidelines Threshold Limit Values (TLVs) and Biological Exposure Indices (BEIs) for use by industrial decision makers regarding safety levels of exposure of various chemical and physical agents.

In this report, TLVs for Ultraviolet (UV) radiation can be found from page 152 to 157. Here, ACGIH states conditions in which they believe healthy workers can be repeatedly exposed without acute adverse health effects. Using a delicate formula, they set forth the Threshold Limit Value of UV254 at 6 mJ/cm2 with UV220 at 25 mJ/cm2 and UV225 at 20 mJ/cm2.

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