Pace found both the curtains and the showerheads teeming with bacterial life. “That soap scum on the shower curtain isn’t soap scum,” he says. “It’s a microbial biofilm. And it’s also living in the showerhead.” Most of the life in those biofilms was benign, made up of the kinds of microbes commonly associated with soil or water. But a distressing number of showerheads contained significant loads of Mycobacterium avium, a bacterium that can cause nontuberculous mycobacteria disease, or NTM, a pulmonary infection that can feel like an unshakable flu. “That steam you’re breathing in the shower isn’t just steam,” Pace says. “It’s full of aerosolized bacteria, and you’re sucking it deep into your airways.”
Inspired by Pace’s findings, the Sloan Foundation’s Paula Olsiewski put out a call for proposals for a full-scale indoor environments project. She was ready to put the foundation’s financial muscle behind the nascent field. But she did not want the funding limited to microbiologists; Olsiewski wanted architects in on the research too. “If biologists are just sampling the buildings, they’re missing the point,” she says. “We want to know what’s in a building, but we also want to know what those microbes do, how they evolve and react to changes in the built environment.”
Hospitals were at the top of Olsiewski’s list of research targets. “Most people are now aware of hospital infections and how they can kill us,” she says. “Whatever strategies hospitals have been using to address the problem have not been working.” The Centers for Disease Control and Prevention (CDC) reports that 1.7 million patients pick up harmful microbes—most commonly staph infections, named for the Staphylococcus aureus bacterium—in American hospitals every year. And while millions of dollars go into hospital-associated pathogen research every year, until now no one had studied the hospital as an ecosystem, looking at the biodiversity of the total microbial population instead of just pathogens in isolation.
Jessica Green was eager to take on the challenge. A rising star in the microbiology world, Green is known as an adventurous scientist and a fearless athlete. In her younger days she competed in Roller Derby under the nom de guerre Thumper Biscuit. She had spent her career collecting microbes in the wild, but the notion of switching her focus to indoor microbes appealed to her. “I’ve always been interested in the forces that organize ecological systems, what affects the distribution and abundance of species,” she says. “This was a way to ask those questions in an almost completely uncharted environment.”
Across campus, Green had a secret weapon: G. Z. “Charlie” Brown. A leading expert on sustainable buildings, Brown directs the University of Oregon’s Energy Studies in Buildings Laboratory, where researchers test ways to make structures, including hospitals, radically more energy efficient. “Buildings account for 40 percent of energy use in the developed world,” Brown says. “Hospitals are a big part of that. They require an enormous amount of energy. A little improvement in their energy use can make a big difference.”
Ventilation systems in particular are notorious energy hogs. “Hospitals often try to solve problems of indoor air quality and infection transmission with high ventilation rates,” Brown says. In other words: Crank up the fans, flush the bad bacteria. If architects knew more about the bacteria in hospitals, Brown thought, they could design less energy-intensive ways of keeping the air clean. But the available data were sparse. “We’ve got a lot of material on airflow,” he says, “but very little on microorganisms.”
Brown had already collaborated with some of the nation’s major hospital designers, like ZGF Portland, so he could make sure that new data and ideas would not languish in unread academic papers. He wanted to directly influence the construction of the next generation of hospitals. With Brown on board, Green persuaded the Sloan Foundation to put some start-up money behind a first-of-its-kind collaboration between architects and microbiologists.
The BioBE Center was born.
Fighting the Ick Factor
“Is nobody going to touch the pastries?” asks Jessica Green. “Come on!”
At the BioBE Center’s weekly Monday meeting, a full box of bagels and Danishes sits on the conference table like an untold joke. Bring a bunch of microbiologists together, set food before them, and watch them wonder what kind of microscopic menagerie is scuttling around the raisins and sugar glaze. Brendan Bohannan cracks wise. “Maybe we’re still full from that mouthful of microbial yogurt that came out of the showerhead this morning.”
Mild amusement all around. In this room, Norman Pace’s study has attained a subcultural notoriety. Physicists joke about the Higgs boson particle; microbiologists riff on Pace’s showerhead slime. It’s not all microbiologists here, of course. Sitting around the table are evolutionary ecologists, energy physicists, and architects. “Part of BioBE is simply learning to speak each other’s language,” Bohannan says.
Charlie Brown, the architect, pipes up. “In their microbiology studies, they’ll often report that they sampled ‘a room’ or ‘a classroom.’ What? That means nothing to someone working in the built environment. Give us dimensions! Windows, doors, airflow, temperature, materials.” To that end, the BioBE Center’s microbiologists have begun working on more rigorous ways to sample the air and various surfaces of their two test buildings, the Lillis Complex and Providence Milwaukie Hospital in a suburb of Portland.
Steven Kembel, a research biologist, shows the team his latest microbial sampler. It looks like a plastic document box with a microphone sticking out of it. The microphone is actually a filter-tipped vacuum. Its big advantage over current devices is not accuracy but unobtrusiveness. “We need to sample the air in rooms where people are studying and lecturing,” Kembel says. “If the Shop-Vac motor is too loud, they just throw the box out of the room.” So he packed his latest model with noise-muffling foam. He clicks a switch and it runs at a low brrr. Green nods her approval. “Sampling a building makes people uncomfortable,” she says. “They’re afraid of what you might find.” Kembel’s quiet air sampler should open more doors to her researchers.
“We call it the ick factor,” Bohannan explains to me. “It’s something we’re constantly having to overcome.”
Speaking of ick: Jeff Kline, a forensic architect, follows with a slide show of the Lillis Complex’s unique ventilation system. The classrooms are stair-stepped, like an amphitheater, and ducts between the risers allow outside air to flow into the building. Kline displays an under-the-floor photograph revealing a filthy duct full of candy wrappers, pens, paper, and dust drifts. The microbiologists perk up. They love dust. “Dust is a historical record of all that’s lived there,” Bohannan says. Looking at the dirty floor in Kline’s photo, he says, “Behold the Burgess Shale of microbiology.”
Next up in the meeting, Kembel wonders if the presence of humans in a room affects which microbes flourish and which die out. Green mentions a recent study by bioengineer Jordan Peccia at Yale, who sampled microbes in a Yale Law School classroom. When it was unoccupied, microbes settled out of the air onto the floor, desks, and walls. When people entered, they acted like tornadoes, resuspending those settled microbes. “And we still have a lot to learn about the microbes we’re contributing ourselves by being in the room,” she says.
“Right,” Bohannan adds. “How much we flux from our bodies.”
I ask for a clarification. “Flux—you mean shed? Slough from our skin?”
Bohannan smiles. “I prefer flux,” he says. “It’s a less value-laden term.”
This year the BioBE team will start testing that human microbial flux in a chamber now under construction in a Portland office building. A giant clean room with more than 150 installed sampling devices, it will give scientists the ability to precisely control temperature, airflow, humidity, and other variables. Once it is running, the team will be able to determine how many and what kind of microbes humans contribute to the indoor environment. “We know more about soil microbes than we do about those on our own body,” Bohannan says.
As the meeting breaks up, one of the microbiologists takes a bagel. Others follow her lead. Hunger overcomes the ick factor.
Next Page: The Microbe-Friendly Hospital