{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:22:49Z","timestamp":1787066569020,"version":"build-2736575974"},"reference-count":50,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T00:00:00Z","timestamp":1640736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000844","name":"European Space Agency","doi-asserted-by":"publisher","award":["AO\/1-10314\/20\/NL\/AF"],"award-info":[{"award-number":["AO\/1-10314\/20\/NL\/AF"]}],"id":[{"id":"10.13039\/501100000844","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The contamination of ambulances with pathogenic agents represents a potential threat for the public health, not only for common pathogens but also for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this project was to exploits the germicidal effect of the UVC radiation at 254 nm to sanitize the patient\u2019s compartment of ambulances with an advanced UltraViolet SANitizing System (UV-SAN) and assess its relevance for avoiding the spread of COVID-19 and other drug resistant pathogens. Methods: The system is equipped with UVC lamps that are activated when the ambulance compartment is empty and sanitize the environment in less than 15 min. An Ozone sensor continuously monitors the gas concentration, ensuring it does not exceed threshold value harmful for patients and operators\u2019 health. The system is relying on GNSS data and a satellite communication link, which allow to monitor and record traceability (when, where and what) of all the sanitation operations performed. This information is real-time monitored from a dedicated web-application. Results: UVC irradiation efficiently reduced SARS-CoV-2 virus titer (&gt;99.99%), on inanimate surfaces such as plastic, stainless steel or rubber, with doses ranging from 5.5 to 24.8 mJ\/cm2 and the UV-SAN system is effective against multi drug resistant (MDR) bacteria up to &gt;99.99%, after 10 to 30 min of irradiation. Conclusions: UV-SAN can provide rapid, efficient and sustainable sanitization procedures of ambulances.<\/jats:p>","DOI":"10.3390\/ijerph19010331","type":"journal-article","created":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T08:12:15Z","timestamp":1640765535000},"page":"331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["UltraViolet SANitizing System for Sterilization of Ambulances Fleets and for Real-Time Monitoring of Their Sterilization Level"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6841-7396","authenticated-orcid":false,"given":"Zuleika","family":"Michelini","sequence":"first","affiliation":[{"name":"National Center Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6446-470X","authenticated-orcid":false,"given":"Chiara","family":"Mazzei","sequence":"additional","affiliation":[{"name":"National Center Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0394-7043","authenticated-orcid":false,"given":"Fabio","family":"Magurano","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-7599","authenticated-orcid":false,"given":"Melissa","family":"Baggieri","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Marchi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Andreotti","sequence":"additional","affiliation":[{"name":"National Center Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cara","sequence":"additional","affiliation":[{"name":"National Center Global Health, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Gaudino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Mazzalupi","sequence":"additional","affiliation":[{"name":"OMICA, 00143 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Antonelli","sequence":"additional","affiliation":[{"name":"OMICA, 00143 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Sommella","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Angeletti","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Razzano","sequence":"additional","affiliation":[{"name":"European Space Agency\u2014ECSAT, Harwell Campus, Didcot OX11 0FD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Runge","sequence":"additional","affiliation":[{"name":"European Space Agency\u2014ESTEC, 2201 AZ Noordwijk, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Petrinca","sequence":"additional","affiliation":[{"name":"OMICA, 00143 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"590041","DOI":"10.3389\/fpubh.2020.590041","article-title":"Aerosol transmission of SARS-CoV-2: Physical principles and implications","volume":"8","author":"Jarvis","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"106039","DOI":"10.1016\/j.envint.2020.106039","article-title":"Aerosol transmission of SARS-CoV-2? Evidence, prevention and control","volume":"144","author":"Tang","year":"2020","journal-title":"Environ. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1056\/NEJMc2004973","article-title":"Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1","volume":"382","author":"Bushmaker","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1016\/S2666-5247(20)30003-3","article-title":"Stability of SARS-CoV-2 in different environmental conditions","volume":"1","author":"Chin","year":"2020","journal-title":"Lancet Microbe"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/tbed.13707","article-title":"Stability of SARS-CoV-2 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: A review","volume":"68","author":"Aboubakr","year":"2021","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"655","DOI":"10.7326\/M20-6976","article-title":"The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review","volume":"174","author":"Oran","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_7","unstructured":"National Center for Immunization and Respiratory Diseases (U.S.) (2021, December 22). Division of Viral Diseases. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Coronavirus Disease 2019 (CoVID-19). 30 June 2020, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/89980."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"289.e5","DOI":"10.1016\/j.cmi.2020.10.034","article-title":"COVID-19 Study Group. SARS-CoV-2 infection: The environmental endurance of the virus can be influenced by the increase of temperature","volume":"27","author":"Magurano","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","unstructured":"Rutala, W.A., Weber, D.J., and The Healthcare Infection Control Practices Advisory Committee (HICPAC) (2021, December 22). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Update: May 2019. CDC, Available online: https:\/\/www.cdc.gov\/infectioncontrol\/guidelines\/disinfection\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10285","DOI":"10.1038\/s41598-020-67211-2","article-title":"Far-UVC light (222\u2009nm) efficiently and safely inactivates airborne human coronaviruses","volume":"10","author":"Buonanno","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.jmii.2017.08.017","article-title":"Effectiveness of an ultraviolet-C disinfection system for reduction of healthcare-associated pathogens","volume":"52","author":"Yang","year":"2019","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/BF01314577","article-title":"Principles of selective inactivation of viral genome. I. UV-induced inactivation of influenza virus","volume":"68","author":"Budowsky","year":"1981","journal-title":"Arch. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"148548","DOI":"10.1016\/j.scitotenv.2021.148548","article-title":"UVC-based photoinactivation as an efficient tool to control the transmission of coronaviruses","volume":"792","author":"Bhardwaj","year":"2021","journal-title":"Sci. Total Environ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"915","DOI":"10.2307\/3572296","article-title":"Chromosomes and cellular radiosensitivity. I. The relationship of D0 to chromosome volume and complexity in seventy-nine different organisms","volume":"32","author":"Sparrow","year":"1967","journal-title":"Radiat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3346\/jkms.2011.26.1.124","article-title":"Risk stratification-based surveillance of bacterial contamination in metropolitan ambulances","volume":"26","author":"Noh","year":"2011","journal-title":"J. Korean Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/10903120701205125","article-title":"Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet?","volume":"11","author":"Roline","year":"2007","journal-title":"Prehospital Emerg. Care."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.amj.2005.12.004","article-title":"An assessment of the prevalence of pathogenic microorganisms in the rotor wing air ambulance: One program\u2019s findings","volume":"25","author":"Galtelli","year":"2006","journal-title":"Air Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"304","DOI":"10.4172\/2165-7548.1000304","article-title":"A preliminary assessment of contamination of emergency service helicopters with MRSA and multi-resistant Staphylococcus aureus","volume":"6","author":"Makiela","year":"2016","journal-title":"Emerg. Med. Open Access"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1080\/10903120801906721","article-title":"Bacterial pathogens in ambulances: Results of unannounced sample collection","volume":"12","author":"Alves","year":"2008","journal-title":"Prehospital Emerg. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"176","DOI":"10.3109\/10903120903564480","article-title":"Prevalence of methicillin-resistant Staphylococcus aureus in ambulances in southern Maine","volume":"14","author":"Brown","year":"2010","journal-title":"Prehospital Emerg. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1136\/emj.20.5.479","article-title":"A preliminary investigation into bacterial contamination of Welsh emergency ambulances","volume":"20","author":"Nigam","year":"2003","journal-title":"Emerg. Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gidari, A., Sabbatini, S., Bastianelli, S., Pierucci, S., Busti, C., Bartolini, D., Stabile, A.M., Monari, C., Galli, F., and Rende, M. (2021). SARS-CoV-2 Survival on Surfaces and the Effect of UV-C Light. Viruses, 13.","DOI":"10.3390\/v13030408"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1056\/NEJMc2009324","article-title":"Droplets and Aerosols in the Transmission of SARS-CoV-2","volume":"382","author":"Meselson","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bueckert, M., Gupta, R., Gupta, A., Garg, M., and Mazumder, A. (2020). Infectivity of SARS-CoV-2 and other coronaviruses on dry surfaces: Potential for indirect transmission. Materials, 13.","DOI":"10.3390\/ma13225211"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.mfglet.2020.08.007","article-title":"Sars-CoV-2 (COVID-19) inactivation capability of copper-coated touch surface fabricated by cold-spray technology","volume":"25","author":"Hutasoit","year":"2020","journal-title":"Manuf. Lett."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.3201\/eid2609.201788","article-title":"Prolonged Infectivity of SARS-CoV-2 in Fomites","volume":"26","author":"Pastorino","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s12985-020-01418-7","article-title":"The effect of temperature on persistence of SARS-CoV-2 on common surfaces","volume":"17","author":"Riddell","year":"2020","journal-title":"Virol. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e00441-20","DOI":"10.1128\/mSphere.00441-20","article-title":"Increasing Temperature and Relative Humidity Accelerates Inactivation of SARS-CoV-2 on Surfaces","volume":"5","author":"Biryukov","year":"2020","journal-title":"mSphere"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/003335491012500105","article-title":"The history of ultraviolet germicidal irradiation for air disinfection","volume":"125","author":"Reed","year":"2010","journal-title":"Public Health Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"54","DOI":"10.2307\/3583551","article-title":"Physical and chemical changes induced in nucleic acids by ultraviolet light","volume":"6","author":"Smith","year":"1966","journal-title":"Radiat. Res. Suppl."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6260","DOI":"10.1038\/s41598-021-85425-w","article-title":"UV-C irradiation is highly effective in inactivating SARS-CoV-2 replication","volume":"11","author":"Biasin","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e10196","DOI":"10.7717\/peerj.10196","article-title":"Upper-room ultraviolet air disinfection might help to reduce COVID-19 transmission in buildings: A feasibility study","volume":"8","author":"Beggs","year":"2020","journal-title":"PeerJ"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101995","DOI":"10.1016\/j.pdpdt.2020.101995","article-title":"UV-C (254 nm) lethal doses for SARS-CoV-2","volume":"32","author":"Sabino","year":"2020","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1080\/22221751.2020.1796529","article-title":"Rapid inactivation of SARS-CoV-2 with Deep-UV LED irradiation","volume":"9","author":"Inagaki","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/j.ajic.2020.07.031","article-title":"Susceptibility of SARS-CoV-2 to UV irradiation","volume":"48","author":"Heilingloh","year":"2020","journal-title":"Am. J. Infect. Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.ijid.2020.08.077","article-title":"The effect of ultraviolet C radiation against different N95 respirators inoculated with SARS-CoV-2","volume":"100","author":"Ozog","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.3201\/eid2609.201524","article-title":"Effectiveness of N95 respirator decontamination and reuse against SARS-CoV-2 Virus","volume":"26","author":"Fischer","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/php.13391","article-title":"Ozone Generation by Ultraviolet Lamps","volume":"97","author":"Claus","year":"2021","journal-title":"Photochem. Photobiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2000305","DOI":"10.2807\/1560-7917.ES.2020.25.13.2000305","article-title":"Whole genome and phylogenetic analysis of two SARS-CoV-2 strains isolated in Italy in January and February 2020: Additional clues on multiple introductions and further circulation in Europe","volume":"25","author":"Stefanelli","year":"2020","journal-title":"Eurosurveillance"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/BF01863914","article-title":"Beitrag zur kollektiven Behandlung pharmakologischer Reihenversuche","volume":"162","year":"1931","journal-title":"Arch. Exp. Pathol. Pharmakol."},{"key":"ref_41","first-page":"227","article-title":"The Method of \u201cRight and Wrong Cases\u201d (Constant Stimuli) without Gauss\u2019s Formula","volume":"2","author":"Spearman","year":"1908","journal-title":"Br. J. Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.3168\/jds.2013-7601","article-title":"Evaluation of the effects of ultraviolet light on bacterial contaminants inoculated into whole milk and colostrum, and on colostrum immunoglobulin G","volume":"97","author":"Pereira","year":"2014","journal-title":"J. Dairy Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"572909","DOI":"10.3389\/fcimb.2020.572909","article-title":"Detection of Antibiotic-Resistance by MALDI-TOF Mass Spectrometry: An Expanding Area","volume":"10","author":"Florio","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/S0140-6736(16)31588-4","article-title":"Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): A cluster-randomised, multicentre, crossover study","volume":"389","author":"Anderson","year":"2017","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4007","DOI":"10.1016\/S0043-1354(00)00172-X","article-title":"Sensitivity of microorganisms to different wavelengths of UV light: Implications on modeling of medium pressure UV systems","volume":"34","author":"Giese","year":"2000","journal-title":"Water Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ijheh.2018.08.007","article-title":"Decreased efficacy of UV inactivation of Staphylococcus aureus after multiple exposure and growth cycles","volume":"222","author":"Shoults","year":"2019","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00284-006-0349-2","article-title":"Effects of Ultraviolet Radiation on the Gram-Positive Marine Bacterium Microbacterium maritypicum","volume":"55","author":"Williams","year":"2007","journal-title":"Curr. Microbiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"4573","DOI":"10.1016\/S0043-1354(03)00394-4","article-title":"Disinfection efficiency of peracetic acid, UV and ozone after enhanced primary treatment of municipal wastewater","volume":"37","author":"Ronald","year":"2003","journal-title":"Water Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1021\/acsphotonics.0c01245","article-title":"A Critical Review on Ultraviolet Disinfection Systems against COVID-19 Outbreak: Applicability, Validation, and Safety Considerations","volume":"7","author":"Raeiszadeh","year":"2020","journal-title":"ACS Photonics"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kowalsky, W. (2009). Ultraviolet Germicidal Irradiation Handbook, Springer.","DOI":"10.1007\/978-3-642-01999-9"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/1\/331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:55:19Z","timestamp":1760169319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/1\/331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,29]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["ijerph19010331"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19010331","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,29]]}}}