Airborne Infection Prevention

Flu Fatigue

2009-05-08T10:29:00.008-04:00

One of the most subtle, yet most dangerous symptoms of the recent H1N1 flu outbreak is Flu Fatigue. Flu Fatigue is weariness brought on by media hype fed through a 24-hour news cycle that is constantly seeking its next crisis. Flu fatigue results in a built-up immunity to care about future epidemics and a general malaise regarding pandemic preparedness. Assuming that this most recent outbreak is over and should be forgotten is dangerous. History has shown that pandemic diseases are likely to quietly die-down, only to emerge more virulent than ever a few months later. This phenomenon is known as the ‘second wave’.

Second Wave
The three major pandemics over the past 100 years have shared a common epidemiology. The Spanish Flu (1918), Asian Flu (1957) and the Hong Kong Flu (1968) each began as mild illnesses in the springtime. Each of the three pandemics emerged in the autumn as much more virulent killers.1,2 Will the recent H1N1 shift into a more deadly strain this Fall? Pandemic experts such as the World Health Organization’s Director General Margaret Chan are preparing for the worst. “We hope the virus fizzles out, because if it doesn’t we are heading for a big outbreak. I’m not predicting the pandemic will blow up, but if I miss it and we don’t prepare, I fail. I’d rather over-prepare than not prepare.”3

Age of Pandemics
Epidemiologist and Chairman of the National Biosurveillance Advisory Subcommittee Lawrence Brilliant says we’re heading into an ‘Age of Pandemics’. “The 2009 swine flu will not be the last and may not be the worst pandemic that we will face in the coming years. Indeed, we might be entering an Age of Pandemics. In our lifetimes, or our children's lifetimes, we will face a broad array of dangerous emerging 21st-century diseases, man-made or natural, brand-new or old, newly resistant to our current vaccines and antiviral drugs. You can bet on it.”4

Betting on the outcome of a particular epidemic is risky. But amidst the uncertainty, experts agree that humanity will face a deadly pandemic in the future. Hospitals, and especially Emergency Departments, will be inundated by the sick and their families. The time to prepare is now, and several measures must be integrated to provide the maximum protection against transmission of pandemic disease.

Clearing the air
Increasingly, scientists are unraveling the secrets of viral disease transmission. New research has determined that air plays an important role in how we ‘catch’ respiratory diseases.5,6,7 Exhaustive studies following the SARS outbreak in 2003 indicate that this virus was airborne and that it is likely to have spread via a ventilation system within an apartment building.8,9

Recognizing the role air plays in disease transmission, architects, engineers, hospital administrators and building managers are looking to VIGILAIR® technology to reduce airborne pathogens. Installed within a building’s Heating Ventilation and Air Conditioning (HVAC) system, VIGILAIR® technology incorporates Ultraviolet Germicidal Irradiation (UVGI) and filtration to inactivate and remove pathogens within the HVAC air stream. UVGI damages the DNA/RNA of viruses, bacteria and fungi, preventing the microorganisms from reproducing and becoming infectious.

By disinfecting the air as it passes through the HVAC system, VIGILAIR® significantly reduces the amount of infectious microorganisms that are circulated throughout the building. Multiple hospital studies verify VIGILAIR® drastically reduces microbial contamination resulting in reduced infection rates.

VIGILAIR Systems, Inc. is the only UVGI manufacturer that has performed UVGI irradiation tests with live infectious agents including Anthrax, Avian flu (H5N1) and the SARS virus. The VIGILAIR® Biodefense system is the only UVGI technology to earn the Department of Homeland Security’s ‘designation’ as a Qualified Anti-terror Technology.

Fighting Flu Fatigue
Complacency can be costly--the time to make pandemic preparations is now. While no single measure can prevent disease transmission, VIGILAIR® is a technology that is proven to significantly reduce airborne pathogens. VIGILAIR® can play an important role in your comprehensive pandemic preparations. More information on pandemic preparations can be found at www.VIGILAIRsystems.com .

References

1. Pandemics and Pandemic Threats since 1900. PandemicFlu.gov. Retrieved May 6, 2009 from http://www.pandemicflu.gov/general/historicaloverview.html
2. .Hellerman, C. April 30, 2009. Scientists dig for lessons from past pandemics. CNNHeath.com. Retrieved May 6, 2009 from http://www.cnn.com/2009/HEALTH/04/30/swine.flu.1918.lessons/index.html
3. Jack, A.. May 3, 2009. Chan hits back at WHO critics. Financial Times. Retrieved May 6, 2009 from http://www.ft.com/cms/s/0/e6260d9a-37d4-11de-9211-00144feabdc0,dwp_uuid=819fc44c-33e2-11de-9eea-00144feabdc0.html?nclick_check=1
4. Brilliant, L. May 2, 2009. The Age of Pandemics. The Wall Street Journal. Retrieved May 6, 2009 from http://online.wsj.com/article/SB124121965740478983.html
5. Li Y, et al. Role of ventilation in airborne transmission of infectious agents in the built environment—a multidisciplinary systematic review. Indoor Air 2007; 17: 2-18.
6. Tellier, R. Review of aerosol transmission of influenza A virus. Emerging Infectious Diseases 2006; 12: 1657-1662.
7. Beggs, CB. The airborne transmission of infection in hospital buildings: fact or fiction? Indoor and Built Environment 2003; 12: 9-18.
8. Li, Y, et al. Multi-zone modeling of probable SARS virus transmission by airflow between flats in Block E, Amoy Gardens. Indoor Air 2004; 15: 96-111
9. Yu, I. Evidence of airborne transmission of the severe acute respiratory syndrome virus. New England Journal of Medicine 2004; 350, 1731–1739
Flu Chart- Taubenberger, J, Morens, D. 1918 Influenza: the Mother of All Pandemics. Emerging Infect Dis. Volume 12, Number 1, January 2006. Retrieved from http://www.cdc.gov/ncidod/eid/vol12no01/05-0979-G1.htm

Swine Flu Facts for Architects and Engineers

2009-04-30T14:46:00.008-04:00

UV-C destroys Swine Flu virus in the air stream
Swine Flu is caused by an influenza A virus subtype known as H1N1. Influenza A viruses are highly susceptible to the germicidal effects of ultraviolet light in the ‘C’ band. Technically speaking, UV-C does not kill the virus; UV-C inactivates the virus. Inactivated viruses have irreparable DNA damage caused by UV-C and are unable to reproduce and are therefore, rendered non-infectious.

Is Swine Flu airborne?
Existing research on influenza transmission is not definitive. However, there is a growing consensus amongst scientists that influenza viruses are transmitted through the air. All research agrees that influenza viruses are airborne as they are expelled by infected people via coughs, sneezes and normal respiration. Some of these infectious droplets settle on surfaces, some of the droplet nuclei travel through the air. Swine Flu is transmitted when a person inhales the infectious nuclei or touches the droplets and then transfers the virus to the body through the nose, mouth or eye. So the real issue isn’t if influenza is airborne, the debate focuses on how the virus enters the body either by inhaling flu aerosols or by contact and transfer to the body. Most researchers say airborne and contact transmission both play a role, but are not certain of each mode’s relative contribution to human infection.

The VIGILAIR® Solution
When it comes to pandemic planning, there is no panacea. The best strategies involve a comprehensive approach to reducing pathogens in the built environment and preventing transmission of disease. VIGILAIR® is a proven technology that is currently used for pathogen control and bio-defense in hospitals, research labs and other high profile government buildings. VIGILAIR® captures and destroys pathogens such as A(H1N1) as the microorganisms circulate through the HVAC system. Each VIGILAIR® system is designed to yield a predictable kill rate on specific pathogens. Engineering and design are crucial for VIGILAIR® Pathogen Control and Biodefense systems. Airborne inactivation of viruses such as A(H1N1) requires a specific energy intensity and exposure time (also known as the ‘dose’). Without proper scientific design, UV systems will not deliver a strong enough dose to have any effect on the A(H1N1) virus. VIGILAIR Systems, Inc. is the only UVGI manufacturer that has performed UVGI irradiation tests with live infectious agents including Anthrax, Avian flu (H5N1) and the SARS virus. The VIGILAIR® Biodefense system is the only UVGI technology to earn the Department of Homeland Security’s ‘designation’ as a Qualified Anti-terror Technology.

For Architects and Engineers
In light of the recent Swine Flu outbreak, you may be asked if there are any engineering controls to help prevent or lessen exposure to A(H1N1). While no one individual tactic can eliminate virus transmission, there are steps to lessen exposure to the virus. VIGILAIR® is a proven technology that reduces the concentration of infectious microorganisms within buildings. VIGILAIR® is an evidence based design tool that you can recommend to your clients as they seek innovation solutions to the challenges caused by A(H1N1).

Swine Flu: time for planning, not panic

2009-04-28T15:04:00.001-04:00

First, an update on the current state of swine flu infection across the world. Here's a Google map listing all known and suspected swine flu cases worldwide:

View H1N1 Swine Flu in a larger map
Now, what to do about it!
Many of our clients are calling, asking about the protection VIGILAIR offers against the current swine flu virus. The good news is that influenza A (H1N1) virus is highly susceptible to UV. Both our Pathogen Control Systems (PCS) and Biodefense Systems (BDS) are designed to provide the proper dose of UV energy to inactivate the swine flu virus in the air stream.
Now the not-so-good news. No single technology or drug will provide 100% protection against contracting swine flu. VIGILAIR is an excellent component in a comprehensive strategy to reduce infection risk.
For a realistic statement of what VIGILAIR offers in protection against swine flu, click here.

UK Terrorism Experts say Dirty Bomb Threat Increasing

2009-04-01T14:19:00.003-04:00

Britain's Home Secretary couldn't be more direct. She said that the threat of of terrorists using a dirty bomb is, "...severe..."

Secretary Jacqui Smith made this assessment as her government launches a new and aggressive effort to combat terrorism that includes a much greater role for citizens. The new effort is described as "extremely broad ranging" and includes training 60,000 citizens in terrorism prevention and response.

Apparently new intelligence has raised concerns over the use of a chemical, biological or nuclear dirty bomb that could contaminate a wide area, endangering thousands, if not millions of people. British Government reports say that the dirty bomb threat is elevated because it has become easier for terrorists to obtain necessary materials from rogue and failed states, as well as from hospitals.

Ms. Smith warns, "Changing technology and the theft and smuggling of chemical, biological, radiological, nuclear and explosive materials make this aspiration more realistic than it may have been in the recent past."

Britain's counter-terrorism forces have grown from 1,700 officers in 2003, to 3,000 in 2009.

UV offers green alternative for cleaning genome lab

2009-02-02T08:36:00.005-05:00

Although VIGILAIR is known for disinfecting air circulated through hospitals, our UV technology has several other applications. VIGILAIR Systems has partnered with the Memorial Sloan Kettering Cancer Center to create a UV sterilization system used in a genome lab.
Find the media release here.
Labs that research human DNA require extremely clean environments. Tiny molecular contamination can ruin weeks of hard work by lab techs. Traditionally, workers had to use caustic chemicals and cleaning materials to 'scrub down' the lab. This process has several disadvantages:

Maintenance staff needed specialized training to complete the task
Results were mixed
Chemicals and cleaning materials used in the process are 'hazardous waste' and must be disposed of properly
Costs associated with manual cleaning are high

After conferring with Sloan Kettering, we went on-site to measure the lab room and to begin our calculations on how to safely and effectively irradiate all the surfaces in the room. We designed an in-room system consisting of UV emitter lamps that were strategically placed in the lab's ceiling. The system produces a predetermined dose of UV capable of inactivating target organisms by a minimum of 99.999%.

The system's controls initiate the lights when the room is unoccupied and shuts-off the lights should anyone enter the room. This prevents any exposure to UV radiation.

We are proud of our partnership with Sloan Kettering, an institution recognized as a world leader in research and patient care.

EPA BASE study suggests HVAC plays a role in Sick Building Syndrome

2008-09-11T11:02:00.006-04:00

A newly released analysis of the US EPA BASE study shows that improperly maintained HVAC systems may cause symptoms associated with Sick Building Syndrome (SBS). The study's authors (representing Lawrence Berkeley, Harvard University, Helsinki University and the US EPA) assessed data collected from 97 representative US office buildings that use air conditioning.
The findings that interested us most dealt with SBS symptoms that may be attributed to moisture with the HVAC systems. From the study's abstract (text emphasis added by me):

"Humidification systems with poor condition/maintenance were associated with significantly increased upper respiratory symptoms, eye symptoms, fatigue/difficulty concentrating, and skin symptoms, with OR = 1.5, 1.5, 1.7, and 1.6. Less frequent cleaning of cooling coils and drain pans was associated with significantly increased eye symptoms and headache, with OR = 1.7 and 1.6. Symptoms may be due to microbial exposures from poorly maintained ventilation systems and to greater levels of vehicular pollutants at air intakes nearer the ground level. Replication and explanation of these findings is needed."

Also from the study's Discussion section:

"These findings support current beliefs that moisture-related HVAC components such as cooling coils and humidification systems, when poorly maintained, may be sources of contaminants that cause adverse health effects in occupants, even if we cannot yet identify or measure the causal exposures."

Limitations
The authors caution that these findings need replication before suggestions or guidelines are advocated. While researchers were able to quantify the risks associated with poorly maintained humidification systems, they were unable to "...identify important (symptom) benefits from well-maintained humidification systems."

The study's findings are important because they demonstrate and elevate the need for Ultraviolet Germicidal Irradiation (UVGI) in all air conditioned buildings. Our experience has shown that if you have dirty or inefficient cooling coils, your HVAC is likely a reservoir for microorganisms. These microorganisms can cause symptoms associated with SBS, in hospitals these pathogens can promote Hospital Acquired Infections (HAI).

This study is a small but important piece in the puzzle that surrounds Indoor Air Quality. Its importance lies in the fact that yet another credible group of scientists have found evidence that HVAC systems can be linked to airborne pathogens that cause health problems.

Learn Something New Everyday

2008-08-28T08:09:00.003-04:00

I learned something new today about the Center for Medicare and Medicaid Services' (CMMS) plan to change reimbursement for some Hospital Acquired Infections (HAI). The new item appears in the Consumers Reports Blog:

"Medicare has listed eight preventable conditions (above) for which it will not reimburse hospitals after Oct. 1, 2008, and is proposing nine more conditions to be added in 2009. The effects could widen as private insurers and state-funded health insurance programs begin to follow Medicare's lead.

Some of the eight have been dubbed "never events" because they should never happen. They include leaving sponges or implements in a patient after surgery and giving the wrong type of blood. Several hospital-acquired infections are also on the list. In 2007, almost 500,000 hospitalized Medicare patients were hurt by the eight preventable events.

While the new rule bars hospitals from passing the bill on to the patient, it addresses only charges accrued in the initial hospital stay. But patients might need continuing treatment that adds up to a bundle. Consumers Union has asked Medicare to clarify that patients who are harmed by these preventable conditions will not be billed for any of the additional care they need."

I didn't realize that the continuing costs of treatment following a hospital acquired condition were not addressed by the legislation. So...stay tuned. When Consumers Reports dot Org receives an update, I will pass it on.

Physicians respond to changes in HAI reimbursement

2008-08-27T10:31:00.002-04:00

Former NY Lt. Governor Betsy McCaughey wages her crusade against HAI in the media. You will frequently find her opinions on television, in newspapers and on-line. A recent example is this Wall Street Journal opinion piece from August 14:

"We have the knowledge to prevent infections. What has been lacking is the will. A recent survey from the patient-safety organization Leapfrog found that 87% of hospitals fail to consistently practice infection prevention measures. Insurance companies that sell liability coverage to hospitals could change that by offering lower premiums to hospitals that rigorously follow infection-prevention protocols.

To be sure, lawsuits are not the best way to improve patient care. Many verdicts are unjustified, and few truly injured patients find a lawyer to take their case. Still, the coming wave of lawsuits, as well as financial incentives from Medicare and insurers, will fight complacency about hospital hygiene."

Physicians are responding to the article, maintaining that HAI rates must be reduced--while maintaining that not all HAI can be prevented:

"Regarding Betsy McCaughey's "Hospital Infections: Preventable and Unacceptable" (op-ed, Aug. 14): Strengthened measures to stimulate hospitals to prevent methicillin-resistant Staphylococcus aureus (MRSA) acquired in-house are certainly well-intentioned. The germs outsmarted everyone. What nobody predicted was the continuous evolution of new threats to patients and hospital personnel. I well recall our fervor, and idealism, in reporting prophylactic and control tactics to deal with sequential explosions of Legionnaires' disease, AIDS, intestinal infections as a side effect of antibiotic usage, drug-resistant tuberculosis, hepatitis B (followed by C), etc.

It is noble posturing for Medicare to proclaim it won't pay hospitals for treating infections acquired on the premises, but how does that policy stand up when the bacterium was heretofore unknown or not foreseen as a danger to patients or staff?

Leslie Norins, M.D., Ph.D.
Naples, Fla.

If such a standard is imposed, rational surgeons will try very hard to avoid patients most at risk. Such flight to the good-risk patient already occurs in states with aggressive cardiac surgical-reporting requirements. In addition, surgeons and hospital administrators will work even harder to game the system in their reporting, and will become even more incautious in their use of prophylactic antibiotics, further promoting the emergence of resistant strains of bacteria.

Aggressive harassment from insurance companies, government agencies, hospital administrators and ignorant non-medical persons is doubtless a major factor in the early burnout and decline of cardiac surgery as a "hot" specialty; residency slots, coveted a generation ago, now go begging, and fewer than half which are taken are filled by American graduates.

Ronald M. Becker, M.D.
Sacramento, Calif.

A deep and serious breast bone infection following open-heart operations currently occurs in approximately 1% of patients. Patients who are obese and diabetic are at a substantially higher risk for such an infection. The proportion of individuals in the U.S. who are obese or diabetic (or commonly both) is increasing in epidemic proportions, as is the number of such patients who require open-heart surgery or other invasive procedures to treat their heart conditions. Many patients who enter hospitals for treatment are already colonized by MRSA, further increasing their risk of infection. The combined threat of no reimbursement and a lawsuit will result in a refusal by physicians and hospitals to perform invasive procedures in many of these high-risk patients. This scenario will also play out for patients who require major orthopedic procedures, such as joint replacement. It is totally unrealistic to assume that these complex procedures can be performed with zero risk of infection.

Nicholas Kouchoukos, M.D.
Michael C. Murphy, M.D.
St. Louis, Mo.
Dr. Kouchoukos is a past president of the Society of Thoracic Surgeons.

We live in a sea of bacteria. We have 10 times more bacteria in our gastrointestinal tract then we have cells in our bodies. We cannot eliminate all of these bacteria from our body before surgery. We can be clean, but not sterile. Many years ago, a study demonstrated that at least 50% of "hospital-acquired" infections arose from bacteria that patients carried into the hospital with them."

Gary L. Simon, M.D., Ph.D.
Director, Division of Infectious Diseases
George Washington
University Medical Center
Washington

It is likely that the Medicare guidelines will be adjusted after they are used for awhile. I can see both sides of the story here. Perhaps the truth is that both sides are right and HAI will be significantly reduced, lives will be saved, costs will be cut.

MRSA deep clean a waste? Not really.

2008-06-30T15:08:00.005-04:00

The headline blared, PATIENTS STILL AT RISK FROM MRSA DESPITE 57 MILLION POUND DEEP CLEAN'. The entire premise, I thought, was so bizarre. The idea that a one-time cleaning of something would prevent the return of contamination. If this was true, my 5 year old son would be overjoyed. He could take a bath in June and be set for the entire summer.
MRSA infection is a complex problem that is not to be eradicated with a one shot effort. Simple solutions, those sometimes promoted by press and politicians, are part of the answer, but not the entire answer. Maybe that's because staph bugs don't read the newspaper or listen to political speeches. Otherwise they would know to completely leave the hospital and never return following the 'deep clean'.
The headline in question appeared in the UK's Independent, written by Brian Brady and Jane Merrick:

Thousands of patients will remain at risk from superbugs, despite a £57m "deep clean" of hundreds of hospitals, because a vital screening programme will not be put in place for at least a year.
One of the world's leading experts on hospital-acquired infections (HAIs) warned yesterday that every one of the hospitals cleaned under Gordon Brown's flagship health policy will be back to square one as soon as the cleaners finish, because no one is stopping bacteria such as MRSA and Clostridium difficile from coming into the buildings.
Professor Hugh Pennington of Aberdeen University said the deep-clean programme would be "an expensive waste of resources".

The thought that a one time deep cleaning would end Hospital acquired Infections is naive at best, dangerous at worst. Professor Pennington' s assertion that MRSA infections are not "...environmental..." depends on what your definition of environmental is.

"Professor Pennington said: "Politicians get hung up on cleaning, but the major issue isn't environmental; it is people bringing the bugs into hospitals. Once the bacteria hit the floor they die off. The natural home of MRSA is either in infected patients or up the noses of the rest of us, so that is what they should be attacking."

At VIGILAIR we stress that all infections are environmental. A good example of MRSA as an environmental pathogen
is found in an article published in the journal of the Hospital infection Society-- 'Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital', (1998) 39: I 27-I 33).
This article showed how MRSA was being distributed in a hospital via the ventilation system. While it is true that most MRSA is introduced into the hospital by visitors, patients and staff, environmental controls are key in removing these pathogens from the environment. Pennington's statement that MRSA bacteria die when they hit the floor is contradicted by a large body of research. The November 2006 issue of Infection Control and Hospital Epidemiology contains a report on MRSA survival that is typical of this research:

"We examined the duration of survival of 2 strains of methicillin-resistant Staphylococcus aureus (MRSA) on 3 types of hospital fomites. MRSA survived for 11 days on a plastic patient chart, more than 12 days on a laminated tabletop, and 9 days on a cloth curtain."

Ignoring the care environment in the fight against MRSA is short sighted. The strategy that we recommend acknowledges that the environment plays a significant role in hospital acquired infection and that several tactics must be employed together to be successful.
We've been able to culture Staph from the cooling coils of hospital HVAC units. Psuedomonas, Staph and many other bacteria are taken from patient care areas, and then find an excellent breeding ground in the dark, cool and food rich home in hospital ventilation systems.
VIGILAIR technology removes the HVAC as a reservoir for pathogens by disinfecting the HVAC system. VIGILAIR UVGI deactivates bacteria, fungi and viruses on surfaces as well as in the air. Importantly, this protection is constant. Unlike one time cleanings the germicidal irradiation of cooling coils continues 24 hours a day, VIGILAIR technology is no silver bullet, either. It must be used in tandem with hand washing and 'deep cleaning'. The combination of these efforts is the best way to remove these pathogens. Any one of these tactics used in isolation will provide only a temporary relief, because hospital acquired infections are environmental by nature.

MRSA Action UK-They Get it!

2008-06-05T06:09:00.004-04:00

Over on our other site we highlighted a new report on anti-bacterial wipes yesterday. This morning we see that MRSA Action UK agrees with our sentiments:

MRSA Action UK: Antibacterial wipes are not the panacea for healthcare infections
Wednesday, 04 Jun 2008 08:46
MRSA Action UK’s contention has always been that to eliminate bacteria from the healthcare environment a systematic, comprehensive policy of eradication must be employed. In today’s medical arena the battle against infections is not just against MRSA and Clostridium difficile, but also against the others waiting in the wings. As a Charity that has been campaigning for safer hospitals in this country all the initiatives that have been introduced to reduce infections in our hospitals will fail, if this systematic and comprehensive approach is not taken.

Hospital cleanliness is paramount for the safety of patients in the NHS, and using antibacterial wipes as a policy to keep our hospitals clean is doomed to failure.

Antibacterial wipes can be effective against pathogens such as MRSA but only if used in the right way. They should only be used once for one surface, however there is no substitute for proper cleaning and decontamination performed by staff that are properly educated and trained in this process, using the appropriate equipment and techniques. The cleaning process should be comprehensive, and we believe monitored on its efficacy, and compliant in all ways. To be successful in this decontamination process it must be supported by regular environmental testing.

Controlling the infections in our hospitals cannot be solved by any single method, there are many ways for these pathogens to be transmitted on hands, uniforms, contaminated equipment and by the airborne route. The abject failure of this government to introduce a comprehensive system of infection prevention and control has ensured that as a nation we will stay bottom of the league with the numbers of healthcare infections in our hospitals, and until they tackle this problem head-on we will not have the safe, clean care of our neighbours in Northern Europe, where eradication of the bacteria remains a top priority.

As a Charity we have always maintained that whilst antibacterial wipes may help to prevent a patient contracting a healthcare infection, they are no guarantee, only thorough regular decontamination, and strict adherence to comprehensive infection prevention and control policies will do this.

Derek Butler
Chair
MRSA Action UK
Registered Charity No. 1115672
Telephone: 07762 741114
http://mrsaactionuk.net

Eureka! They really get it.

Pilot study reinforces use of portable anteroom HEPA filtration

2008-05-07T10:57:00.002-04:00

A new study from a leader in airborne disease research indicates that Operating Room HEPA filtration is not a guarantee against nosocomial infection. Dr. Russel Olmstead led a team that looked at airborne contamination inside of the OR environment.

Pilot study reinforces use of portable anteroom HEPA filtration

To prevent perioperative transmission of airborne microorganisms

Washington, DC, May 6, 2008 – Amidst an increase in new tuberculosis cases, researchers have begun investigating the effectiveness of new operating room filtration systems designed to protect staff and patients. According to pilot study findings published in the May issue of the American Journal of Infection Control, a supplemental portable anteroom high-efficiency particulate air (PAS- HEPA) filter unit placed outside operating room suites may prevent secondary transmission of airborne microorganisms like Mycobacterium tuberculosis (M. tuberculosis).

“The rate of decline in newly reported tuberculosis cases in the U.S. has slowed,” said lead study investigator Russell N. Olmsted, MPH, CIC, epidemiologist from Saint Joseph Mercy Hospital in Ann Arbor, MI. “This, coupled with the worldwide emergence of even more drug-resistant tuberculosis, reinforces the need for renewed vigilance and surveillance from healthcare professionals. In particular, study results reinforce the need for measures to optimize air particle removal.”

Olmsted and colleagues compared the efficiency of freestanding HEPA filtration units to a new portable anteroom system (PAS)-HEPA combination unit in removing harmful airborne infectious pathogens. Freestanding HEPA units were evaluated in the operating room, while the PAS-HEPA unit was placed outside over the main operating room door. Both smoke plume and non-infectious particles similar in size to M. tuberculosis were used to mimic movement of airborne pathogens within highly pressured environments.

“We observed interruption of normal patterns of airflow with freestanding HEPA units placed inside the operating room,” said Olmsted, adding that instead of being captured by the air-filtration system, smoke plume traveled upward from the operating room table and into the breathing zone of personnel who might be present during a typical surgical procedure.

“This suggests an increased potential for occupational exposure to airborne microorganisms as well as an unwanted introduction of contaminants into the patient’s open surgical site,” he explained.

In contrast, deployment of the PAS-HEPA combination unit pulled the smoke downward, away from the operating room table and toward the floor and main door. The second phase of the study (which involved simulated microscopic particles) mirrored these observations; within 20 minutes, over 94% of submicron particles were cleared from the operating room.

“The results of Mr. Olmsted’s study reinforce the Centers for Disease Control and Prevention (CDC) 2003 guidelines for environmental infection control as well as 2005 guidelines for preventing the transmission of M. tuberculosis in healthcare settings,” said Janet E. Frain, RN, CIC, CPHQ, CPHRM, APIC 2008 President and Director, Integrated Services, Sutter Medical Center in Sacramento, CA. “These findings should be considered for integration into an overall infection prevention and control program to help ensure both patient and healthcare personnel safety.”

These findings substantiate results we've discovered in our testing of Operating Rooms. Recently we found microbial contamination (including fungi) immediately downstream from HEPA filtration units installed in ORs. The contamination was found one week after the filters were certified for efficiency compliance.
Filters are great for trapping microorganisms, but they do not 'kill'. Eventually filters can become colonized and act as a breeding ground for pathogens. Thinking that you have 100% protection because you have HEPA filtration is a false sense of security.
We suggest a balance between UV and filtration to provide a better strategy for reducing environmental pathogens in critical care areas of your hospital. E-mail us to find out more about a recent study in which VIGILAIR provided better protection than laminar flow for operating suites in a large urban hospital.

A Common Killer

2008-05-07T10:30:00.002-04:00

Here's a quick question for our readers:

What is the #1 world wide killer for children five and under?

smallpox
measles
AIDS
malaria
pneumonia

If you chose #5, pneumonia, you're correct. Many of those other disease have a higher profile and get more attention. But a recent report released by the World Health Organization says that Pneumonia kills more than 2 million kids under the age of five each year. It is the #1 killer for that age group, responsible for nearly 1 in 5 deaths for little ones.
I mention it so that we raise awareness on emerging and somewhat exotic disease, we should not forget those common killers who destroy so many young lives, albeit with a low profile.

Hospitals struck by new killer bug | Metro.co.uk

2008-05-07T09:30:00.002-04:00

UK Newspaper continue to examine (and exploit) news on infectious disease. The latest cause for concern is Stenotrophomonas, nick-named 'Steno' for popular consumption.

Hospitals struck by new killer bug | Metro.co.uk
Tuesday, May 6, 2008
A new hospital superbug resistant to all antibiotics could be killing hundreds of patients, experts have warned.

The infection, known as 'Steno', is on the increase and could be harder to tackle than MRSA and C.difficile.

The bug spreads almost exclusively in hospitals through wet areas such as taps and shower heads, and is thought to kill a third of the people it infects after entering the bloodstream.

Chemotherapy patients, including children, are among those most in danger, because the infection spreads through ventilation tubes and catheters.

There are about 1,000 reports of Steno blood poisoning in Britain each year, according to today's study by the Wellcome Trust Sanger Institute, near Cambridge.

Research leader Dr Matthew Avison said: 'This is the latest in an ever-increasing list of antibiotic-resistant hospital superbugs.

'The degree of resistance it shows is very worrying. Strains are now emerging that are resistant to all available antibiotics.'

MRSA is thought to have caused 1,652 deaths in 2006, up from 51 in 1993. Clostridium difficile was mentioned on 6,480 death certificates in 2006, a 72 per cent rise on 2005.

Steno sticks to catheters or medical tubes and grows into a so-called 'biofilm'. When the catheter is next flushed, the bug enters the patient's bloodstream and can cause septicaemia, especially if their immune system has already been weakened.

The onus is on both patients and healthcare professionals to do more to keep equipment clean, Dr Avison told the Genome Biology journal.

Stenotrophomonas is another pathogen that we've isolated from the hospital environment. In our study, we were able to culture Stenotrophomonas from surfaces in the Heating Ventilation and Air Conditioning (HVAC), surfaces in NICU as well as in the tracheal aspirates of the patients. As mentioned in the article, this bug likes water--and that is where we found it, in the water of the HVAC drain pan.

As we look to decrease Hospital Acquired Infections (HAI), we should consider all the reservoirs for pathogens. Neutralizing the source of an infectious agent is the key to long term success in infection prevention. Is the Stenotrophomonas in the HVAC water making its way into the care areas? It's hard to say and expensive to prove.

So, we focus a lot of attention on 'end of the pipe' solutions such as hand washing. This is a good thing. But at the same time we should eradicate the factories where pathogens are generated and distributed within a health care facility. Our research has shown that one such factory is the HVAC system. We've also shown that VIGILAIR® can eliminate this reservoir as a potential source.

Ionic air purifiers' dirty little secret: They don't get rid of dust - Los Angeles Times

2008-04-22T08:01:00.002-04:00

Do home air purifiers work?

During a Q and A session following a presentation at an OSHA conference in Harrisburg, PA, a familiar question was asked, "Can VIGILAIR be installed in a home?" While we do not serve the consumer market, there are alternatives such as in-room air purifiers. However, in order to find one that works, you need to find the science and get beyond the marketing of these devices. I found this LA Times article accurate and informative:

"Ionic air purifiers' dirty little secret: They don't get rid of dust

By Chris Woolston, Special to The Times
April 21, 2008

The product: Dust, cigarette smoke, pollen and pet dander: With so many irritants floating around our homes and work places, clean air is a hot commodity. Americans spend hundreds of millions of dollars on furnace filters and air cleaners each year. Though some consumers are simply trying to bring a little extra freshness into their lives, many others hope that their investment will help relieve their asthma or allergies.

If you've ever shopped for an air cleaner -- or if you've ever idly flipped through a SkyMall catalog -- you've undoubtedly seen ads for ionic air purifiers, devices that take an unusual approach to clearing the air. Instead of relying on fans to move air through filters, the machines release a steady stream of negatively charged ions that electrify the bits of dust, dander or other flotsam. The airborne particles pick up the negative charge and become strongly attracted to positively charged collection plates inside the machine. (In many cases, they also become attracted to other charged surfaces such as walls, table tops and TV screens.)

Except for a few models that use fans to help suck in the charged particles, most ionic air purifiers work silently. And, as ads are quick to point out, the devices generally don't have any motors or moving parts, and there are no filters to replace.

There's another thing that separates ionic air purifiers from other technologies: To varying degrees, all ionic air purifiers release ozone, a potential pollutant. A 2006 study by researchers at UC Davis found that one popular brand, the Ionic Breeze Quadra, released about 2.2 milligrams of ozone per hour, or about as much as a constantly running photocopier. (Ionic purifiers shouldn't be confused with ozone generators that are marketed as "air cleaners." By design, these devices can release 50 to 200 milligrams of ozone per hour.)

The claims: According to the Sharper Image web site, the Ionic Breeze is "proven effective at reducing airborne allergens and irritants -- with no fan, no motor and no noise." The Heaven Fresh web site says that its purifiers can provide relief from "asthma, bronchitis, hay fever and other respiratory diseases." Heaven Fresh also claims that the ozone emitted by its machines helps clean the air. According to the site, "ozone is one of the purest and most powerful oxidants and germicides known."

The bottom line: Ionic air purifiers have undeniable appeal, but there's a problem: They don't really improve air quality, says Dr. James Sublett, a clinical professor at the University of Louisville; a fellow at the American College of Allergy, Asthma & Immunology; and co-chair of the 2007 ACAAI Healthy Indoor Environment conference. "We [allergists and immunologists] generally don't recommend them," he says. "This is a windmill that I've been tilting at for a number of years."

According to Sublett, the devices don't effectively remove dust, dander and other irritants from a room. Without fans, he explains, they can't collect airborne particles from more than a few feet away. And when even small amounts of dust enter the device, the plates inside quickly lose much of their power to attract more particles. Meanwhile, the charged particles that stick to walls or TV screens haven't left the room and can always billow up again to cause trouble.

The ozone released from the devices is another deal-breaking shortcoming, Sublett says. "Ozone is a pollutant and an irritant. Even small amounts are too much." People who use several units at a time are especially likely to get an ozone overload, he says. One of Sublett's patients noticed a great improvement in her breathing when she turned off the six ionic purifiers in her home."

Air purification for homes should involve both capture and 'kill'. Filters capture and remove irritants, while technologies such as Ultraviolet light destroy pathogens. FIlters take care of the big airborne contaminants, UV deactivates the microorganisms that elude the filters. The balanced approach is best.

WHO | Avian influenza – situation in Pakistan - update 2

2008-04-04T12:23:00.002-04:00

The two best kept secrets in Pakistan

The first secret is, 'Where is Osama bin Laden?'. Secret number two is that there was confirmed Human-to-Human (H2H) spread of Avain flu in Pakistan more than 5 months ago. Here's the complete info release from the WHO:

WHO | Avian influenza – situation in Pakistan - update 2

3 April 2008

Two additional H5N1 cases were confirmed by serological testing, thus providing final H5N1 infection test results on a previously reported family cluster in Peshawar.

These tests were conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and the WHO Collaborating Centre for Reference and Research on Influenza in Atlanta, USA. The table below summarises the testing results of the confirmed/probable cases in the family cluster.

The preliminary risk assessment found no evidence of sustained or community human to human transmission.

All identified close contacts including the other members of the affected family and involved health care workers remain asymptomatic and have been removed from close medical observation.

These laboratory test results support the epidemiological findings from the outbreak investigation in December 2007, and the final risk assessment that suggested limited human to human transmission likely occurred among some of the family members which is consistent with some human-to-human transmission events reported previously. This outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections.

Relationship Onset Date Outcome Exposure Status

Case 1 (Index case) 29 Oct 07 Fully recovered Direct contact sick/dead poultry Confirmed (serology)

Case 2 12 Nov 07 Dead (19 Nov 07) Close contact with Case 1, no known direct contact with sick/dead poultry Probable
(No sample available)

Case 3 21 Nov 07 Dead (28 Nov 07) Close contact with Case 1 and 2, no known direct contact with sick/dead poultry Confirmed (PCR)

Case 4 21 Nov 07 Fully recovered Close contact with Case 1 and 2, no known direct contact with sick/dead poultry Confirmed (serology)

It is great news that the H2H transmission burned out before it hit the wider community. But many aspects of this news are troubling. First and foremost is the credibility of the WHO reporting. It seems that we hear complete details if a single duck shows up with H5N1 in Eureka-stan; why such a delay for major news such as H2H?

Speaking of credibility, contrast today's news with this Reuters article on December 28, 2007:

No proof of human-to-human bird flu in Pakistan No evidence that bird flu passed between relatives, WHO says

Reutersupdated 1:10 p.m. ET, Fri., Dec. 28, 2007

GENEVA -The World Health Organization said on Thursday it had established a single case of human infection of the H5N1 bird flu virus in a sick family in Pakistan but there was no apparent risk of it spreading further.

A statement from the U.N. agency said tests in its special laboratories in Cairo and London had established the “human infection” through presence of the virus “collected from one case in an affected family.”

But it said a WHO team invited to Pakistan to look into an outbreak involving up to nine people from late October to December 6 had found no evidence of sustained or community human-to-human transmission.

No identified close contacts of the people infected, including health workers and other members of the affected family, had shown any symptoms and they had all been removed from medical observation, the WHO added.

The outbreak followed a culling of infected chickens in the Peshawar region, in which a veterinary doctor was involved. Subsequently he and three of his brothers developed proven or suspected pneumonia.

The brothers cared for one another and had close personal contact both at home and in hospital, a WHO spokesman in Geneva said. One of them, who was not involved in the culling, died on November 23, but the cause of death was not known.

On November 28 another brother who had not been involved in the culling died, and tests on him — in Pakistan as well as in Cairo and London — had established the presence of the H5N1 virus.

(snip)

The WHO spokesman told Reuters on Thursday all the evidence ”suggests that the outbreak within this family does not pose a broader risk. He added: “But there is already heightened surveillance and there is a need for ongoing vigilance.”

Truth delayed, is none the less the truth. But going forward it is harder to accept what the WHO says is the truth.

Doctors Frustrated over Acinetobacter Infections

2008-04-02T08:37:00.003-04:00

All the healthcare professionals that I know are good hearted people with a great capacity for compassion and a desire to heal. Doctors are, at heart, 'fixers'. So you can understand the frustration infection control professionals feel when they run out of treatment options. Consider the plight of physicians dealing with drug resistant Acinetobacter, as referenced in this article fron the UK's Telegraph:

"Pandemic fear over resistant superbug
By Stephen Adams
Last Updated: 2:20am BST 02/04/2008

Doctors have warned that if a superbug which is known to be even more resistant to antibiotics than clostridium difficile and MRSA takes hold in hospitals, the country could face a pandemic.
The acinetobacter bug is being treated with older antibiotics because newer ones do not work. There are fears that injured soldiers returning from Iraq and Afghanistan have passed the infection on in civilian hospitals.
Prof Matthew Falagas, an expert in hospital-acquired infections, said: "In some cases, we have simply run out of treatments and we could be facing a pandemic with public health implications."
He warned delegates at the Society for General Microbiology conference in Edinburgh: "Doctors in many countries have gone back to using old antibiotics that were abandoned 20 years ago because their toxic side-effects were so frequent and so bad.
"But superbugs like acinetobacter have challenged doctors all over the world by becoming resistant to these older medicines.
"Even Colistin, an antibiotic discovered 60 years ago, has recently been used. But now it occasionally fails as the bacteria has become resistant."
There are more than 1,000 reports of acinetobacter infections every year in the UK, according to the Health Protection Agency (HPA). Some strains can cause death through blood poisoning and pneumonia."

Acinetobacter is particularly difficult to remove from the environment of care because it is hearty and can survive for nearly a month in dry conditions. Healthcare providers will do their best to fight this bacterium, but turning back the clock to use older antibiotics is not a good long term strategy.

Because Acinetobacter has been proven to be transmitted via the air in several hospital studies, it is prudent to consider that the airborne route of transmission may play a role. While UVGI systems designed by VIGILAIR can help reduce environmental contamination, they are not a silver bullet. Like antibiotics, VIGILAIR is one part of a multi-faceted infection control strategy. VIGILAIR's strength lies in its ability to eliminate environmental reservoirs where microorganisms proliferate.

A VIGILAIR white paper on Acinetobacter is available here.

Nosocomial Infections, the next Rainmaker for Personal Injury Attorneys?

2008-03-26T09:07:00.002-04:00

If you live where I do, you'd think that Personal Injury (PI) attorneys are doing quite well for themselves. They dominate the media here, pitching their services on TV, radio, billboards, bus benches, etc. While medical malpractice is a staple for attorneys, we now see an effort to find clients who've suffered from a Hospital Acquired Infection (HAI). Here's an example of PI marketing targeting nosocomial infections:

"Hospitals Are Profiting From Their Mistakes at Our Expense | Colorado Personal Injury Lawyers

In no other business that I know of, can you turn a profit when you sell a defective product or service. If the television set you purchased at your local electronics store doesn’t work when you get home, you take it back to the store and get a refund or exchange. When the mechanic doesn’t repair the brakes on your car properly, you don’t pay him until they’re fixed. If the bread you buy at the grocery store is moldy you take it back and get fresh loaf.

Back what if you can’t take it back? What if there are no exchanges? Suppose you go to the hospital and they cut off the wrong limb or operate on the wrong body part. You can’t take that back. You can’t get an exchange. What if not only did the hospital provided inferior care but charged you for it as well? It happens all the time at hospitals all over the United States.

An article in the Journal of American Medical Association focuses on a common but mostly preventable medical error, urinary tract infections associated with the use of a catheter. In a perverse twist, the hospitals are actually rewarded for bad care.

Urinary catheters are the most commonly used medical devices in hospitals, and account for approximately one million infections annually. That’s 40 percent of all hospital-acquired infections. A urinary tract infection can add a day to a hospital stay; and it can lead to a more serious infection and even death.

(snip)

“All too often, clinicians, hospitals, and payers conclude that some harms are part of the price of doing business. But in many cases they are not,” write Dr. Wald and Dr. Kramer. “When properly designed, financial incentives should provide rewards for desired clinical outcomes, not hospital-acquired harms.’”

Not rewarding hospitals for inferior care? All I can say is, it’s about time!"

Will HAI litigation be the next rain maker for PI lawyers? Before attorneys start the assault, they would be wise to consult epidemiologists. While many HAI can be prevented, proving negligence on the part of a hospital may prove elusive. Take a recent study from the American Journal of Infection Control(1) in which researchers looked at a database of more than 1,500 documented nosocomial outbreaks, with an eye on finding the source of the infection.

I mention this because I would think that attorneys must find the source or cause of a HAI in order to punish the responsible party. Among the findings: the source of the pathogen was unknown for a significant proportion of the outbreaks. Below are outbreak pathogens, followed by the percentage of times their source in an outbreak could not be determined:

Pathogen	Source of pathogen outbreak not known (%)
Staphylococci	43.5%
Pseudomonas	37.2%
Klebsiella	58.3%
Acinetobacter	36.2%
Serratia	31.9%

Clearly, the study has limitations, but if anything it is biased in favor of outbreaks that have a reported source, as those are more likely to be the subject of a published study.

Consider MRSA. According to the CDC, in 2005:

"Approximately 18,650 persons died during a hospital stay related to these serious MRSA infections.

Serious MRSA disease is still predominantly related to exposures to healthcare delivery:

About 85% of all invasive MRSA infections were associated with healthcare, and of those, about two-thirds occurred outside of the hospital, while about one third occurred during hospitalization.

About 14% of all the infections occurred in persons without obvious exposures to healthcare."

Trying pointing the finger of blame at a hospital when two-thirds of the MRSA appears to be contracted in the community and then brought into the hospital. Who do you sue?

The bit that I understand about epidemiology tells me that in regards to litigation over HAI, large paydays are not in the cards for PI attorneys. Even with all our diagnostic tools, it is expensive and labor intensive to prove empirically that this bug caused that infection and can from this place. Not impossible, but PI lawyers are going to go where the easy money is. Hospitals are likely to defend themselves with credible medical experts who will educate jurors that infections involve microbiology, epidemiology and the physical environment. Modeling these diverse disciplines is science and art.

Having said the above, I would image that the threat of lawsuits will have more of an impact on healthcare. When you couple that threat and impending regulation changes in reimbursement, hospital administrators are doing the right thing and trying to reduce HAI. Our product, VIGILAIR, is on an excellent resource to help them achieve that goal.

I would be remiss if I didn't comment on the attorney article that opened this piece. The author says that consumers should not pay for services with a negative outcome. I wish all attorneys worked on this premise.

1. Gastmeier, S. Stamm-Balderjahn, S. Hansen, I. Zuschneid, D. Sohr, M. Behnke, R. Vonberg, H. Rüden. Where should one search when confronted with outbreaks of nosocomial infection?. American Journal of Infection Control, Volume 34, Issue 9, Pages 603-605 P.

The war on hospital acquired infections, fighting on two fronts

2008-03-25T10:40:00.002-04:00

Ok, so it's an old analogy, but it works. Imagine being at war. You're a general tasked with disrupting the enemy's supply chain. The enemy has trains, boats and trucks that carry supplies, but it also has factories where supplies are built and depots, camps and ports where large quantities of supplies are stored.

What is your bombing strategy? Do you hit the individual vessels of supplies, or do you attack where the supplies are produced and stored?

The answer is you bomb both.

And so it goes for infection control. Enforcing hand washing protocols is a good start. Hands are like the boats and trains; they're vessels that deliver supplies (infections). But if you only attack the supply carriers, some are likely to get through and new routes will open as soon as the old ones are closed.

That's why it is important to also attack the factories and staging places for supplies. For infection control, this means looking at the source of pathogens and the reservoirs in which they hide. Individually each of these tactics are good, but together, their strategic value is much greater.

I thought of this tired analogy after reading a study (1) that says previous contamination of a hospital care area is an excellent predictor of future infection. Here's an overview of the study from infectious disease dot com:

Patients may be at an increased risk for vancomycin-resistant enterococci in health care settings if they are treated in areas where contamination with vancomycin-resistant enterococci has previously occurred, according to the results of a new study, which were published in Clinical Infectious Diseases.

Prior room contamination is highly predictive of vancomycin-resistant enterococci (VRE) acquisition, according to the study’s researchers, who stressed that increased attention to environmental disinfection is warranted to help reduce the risk for VRE infection.

“Everyone on the health care team — from doctors, to nurses, to medical students, to technicians — needs to take personal responsibility for preventing infections,” Marci Drees, MD, from the Center for Outcomes Research at Christiana Care Health System in Newark, Del., and one of the study’s researchers, told Infectious Disease News. “I think for too long we’ve had the attitude that these infections ‘just happen’ and are bad luck, but we now know that many are preventable. Preventing infections comes down to the basics: universal handwashing, wearing gowns and gloves when appropriate and thorough environmental cleaning. It’s easy to cut a corner here and there when you’re busy taking care of patients, but that’s how these infections happen.”
(snip)
Three of the most significant factors associated with the risk for a VRE infection included sharing a room with a VRE-colonized patient, being treated in a room where a VRE-colonized patient had been treated within the past two weeks and being treated in a room with previous positive culture results.

To put a fine point on it, infection control professionals are fighting on several fronts. Hand washing is an important tactic. We should remember, however, that hands don't produce many pathogens--although they do a fine job of transporting them.

Where are the microorganism 'factories'? Among the places in a hospital where microorganisms are produced is the Heating Ventilation and Air Conditioning (HVAC) system. Our staff members have hundreds of data points taken from microbial swabbing of hospital HVAC surfaces. We find that the same microorganisms that cause infection are found thriving on cooling coils, drain pans and water inside hospital air handlers. Pathogens that are commonly cultured on hospital cooling coils include:

Pseudomonas
Acinetobacter
Staphylococcus

VIGILAIR is like a carpet bomber for these pathogens. But unlike bombing, whose effects are transitory, VIGILAIR eliminates reservoirs for microbial growth and prevents them from returning.

Now, onward infection control soldier!

1. Drees M, Snydman DR, Schmid CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008;46:678-685.

Study: MRSA Screening Fails to Lower Infection Rates

2008-03-12T08:37:00.002-04:00

A new study published in the Journal of the American Medical Association says that universal MRSA screening upon admission to a hospital may not lead to fewer MRSA infections. The study compared two sets of surgery patients who received services at a Swiss hospital.

One group of more than 10,000 patients were screened for MRSA prior to surgery. If they tested positive for MRSA they were isolated and treated with disinfectant and antibiotics. The control group was of similar size and was not screened. Results from the study show no significant differences in the infection rates between the two groups.

From the Chicago Tribune:

"This is what we've been saying all long," said Kathy Warye, chief executive officer of the Association for Professionals in Infection Control and Epidemiology, a group that opposes efforts to mandate MRSA testing.

While screening patients can be a valuable, it's not a "magic wand" and it's not always the best way to deploy a medical institution's resources, said Dr. Stephen Weber, director of infection control at the University of Chicago Hospitals

Critics of the report's findings say the study may've overlooked some pre-existing MRSA reservoirs:

"Dr. Barry Farr, a MRSA expert, noted the Swiss hospital didn't screen patients on medical wards, who probably served as a reservoir of MRSA infections within the institution and skewed the study's results.

About one-third of surgery patients at the Swiss hospital had surgery before measures could be taken to control potential MRSA infections; that may have contributed to the findings, said Dr. Karen Kaul, chair of molecular pathology at Evanston Northwestern Healthcare."

Responses from both sides (pro and con) augment a central argument in VIGILAIR's infection control (IC) strategy.

We believe that IC is dynamic and multifaceted
There is no one strategy to eliminate infection
There are many reservoirs of infection including patients, healthcare workers and the environment
A prudent IC policy attacks pathogen reservoirs on several fronts simultaneously; bundling strategies works best

So, Now What?

MRSA screening has resulted in significant benefit for other facilities, notably Scandinavian hospitals that have virtually eliminated nosocomial MRSA infection after implementing 100% screening upon admission. This new study is not enough justification for a wholesale discrediting of MRSA screening. It is, however, more evidence that IC is more like a web than a chain. Breaking one link of transmission rarely does the trick.

Keeping the Food Supply Safe

2008-03-05T15:41:00.003-05:00

packaging disinfection

New UVGI Tunnel Keeps Food Supply Safe

In addition to controlling contaminants for healthcare and bio-defense clients, VIGILAIR is also involved in nutraceutical manufacturing.

Companies that produce food want to keep pathogens such as e. sakazakii, salmonella and e.coli out of their products. Our research and development team has been hard at work, creating a customized solution to this problem.

Our answer comes in the form of a UVGI Tunnel. Each tunnel is custom designed to integrate into an existing or new production line. Our high intensity UV Tunnels disinfect packaging materials as they pass along the conveyor line. Our tunnels have demonstrated exceptional results, earning a 7 log kill on pathogens that are problematic for nutritional manufacturers.

Find out more by downloading our media release.

Why the Space Shuttle needs VIGILAIR®

2008-02-20T08:04:00.002-05:00

Remember the Michael Crichton thriller 'The Andromeda Strain'? The story focuses on the efforts of scientists who investigate a deadly microbe from outer space that came to earth via a satellite that crashed in a small US town, killing all but two of the residents.

That's the first thing that came to mind when I read the abstract for a study published in the Proceedings of the National Academy of Sciences, entitled Space flight alters bacterial gene expression and virulence and reveals a role for global regulator Hfq. Researchers discovered that strains of Salmonella that were sent into outer space changed and became more virulent.

Here's a bit of the study's findings via Natural News, by reporter David Gutierrez:

"Researchers placed strains of Salmonella typhimurium, a common food-poisoning agent, into two separate containment canisters. One of the canisters was sent into outer space for 12 days, while the other remained in the Orbital Environmental Simulator at Kennedy Space Center. The environmental simulator remained in constant communication with the space shuttle, immediately replicating in real-time whatever temperature and humidity conditions were being experienced in the vessel. This allowed the two groups of bacteria to be exposed to identical conditions, except for the fact that one group was under microgravity conditions in outer space."

The Salmonella taken into space returned with changed expression of 167 different genes, a sign that microorganisms adapted to the zero gravity environment. Although the Andromeda Strain dealt with extraterrestrial bugs, and this study examines terrestrial bugs, imaginative people could find parallels.

How does this relate to airborne infection? This research confirms that nature will always try to adapt to survive in its environment. Antibiotics have worked well for many years, but now nature has adapted yielding 'multidrug resistant organisms, AKA Super Bugs. VIGILAIR® inactivates viruses, bacteria and fungi by corrupting the genetic map that organisms need to reproduce.

So, NASA, call whenever you're ready, operators are standing by...

Killer in the NICU

2008-02-14T09:50:00.003-05:00

From my adopted college town of Manchester, the sad story of a NICU death likely caused by airborne aspergillus:

"Baby ward hit by fatal infection

A Greater Manchester hospital has temporarily closed its neo-natal unit after a baby died and another suffered a potentially fatal infection.
A premature baby developed an infection from aspergillus, a common airborne fungus, and died in December at Salford Royal Hospital.

A second pre-term baby tested positive for skin aspergillus last week.

The hospital said it had closed the ward as a precaution to establish any "common contributory factors".

The aspergillus fungus is very common and can be found in homes and buildings everywhere, but can cause infections."

Many studies have shown that aspergillus is ubiquitous in the environment. Healthy people can be exposed to it without serious consequences. That is not true for immune compromised patients in ICU areas. So, what to do about it?

How about filtering the air? Hospitals already do that and yet aspergillus persists. How about letting in more fresh air? This strategy will introduce more and potentially different types of aspergillus into the hospital. What about cleaning the HVAC frequently to get rid of pathogens?

Studies have shown that traditional cleaning is not effective, as this report(1) from the ECMM shows:

"It appears that fungal spores are not necessarily removed by cleaning the fans. Even scratching and painting them, to eliminate rust and restore a smooth surface on which fungal spores cannot be retained, does not permit decontamination."

In fact, servicing the HVAC can exacerbate the problem(2):

"Our observations suggest that localized, short-term exposures resulting from disturbance of (aspergillus) reservoirs are comparable to or may even greatly exceed maximum expected routine exposures. Further, these reservoirs may be disturbed not just during construction or renovation, but even during routine maintenance activities (telecommunications cabling, HVAC filter replacement) that require access to ceiling spaces."

It is clear that the unique needs of ICU areas need unique solutions. That's where VIGILAIR® comes in. VIGILAIR® Systems combine filtration and the germicidal effect of UVC. Rather than just trapping aspergillus spores, VIGILAIR® is designed to provide enough UVC exposure (dose) to destroy aspergillus. UV technology disinfects HVAC surfaces and then keeps those areas clean by continuously radiating the reservoirs where microorganisms can thrive.

Once again, we need to be aware than Infection Control is an environmental issue. Diligent IC professionals must recognize and remove all reservoirs for pathogen growth within the hospital. Unfortunately, the HVAC system is frequently overlooked as a reservoir despite the fact that it houses the largest untreated water supply within a health care facility.

1. European Confederation of Medical Mycology Conference 1996. S. Heinemann, G. Van. houte, N. Nolard. Contamination of indoor environment and air conditioning.

2. European Confederation of Medical Mycology Conference 2008. Khan M, Gonsoulin T, Simpson S, Horner WE. Exposure levels of aspergillus fumigatus from various indoor reservoirs in health care facilities.

Echos in the media

2008-02-08T08:39:00.000-05:00

It is encouraging to see response from the press over the recent report on hand washing and infection control. The argument that infection control is dynamic and environmental is being heard in the media, and from APIC! See the recent article from US News and World Reports:

Wringing Our Hands Over Infection Control

February 07, 2008 05:19 PM ET | Avery Comarow |
A number of thoughtful comments arrived concerning my January 23 hand-washing post, about a study showing that a much-increased rate of hand-washing is no guarantee that a hospital's infection rate will budge, let alone dive. A couple of correspondents (notably anesthesiologist-blogger Counting Sheep and hospital-CEO-blogger Paul Levy of "Running a Hospital") contributed thoughts that might prevent a few infections here and there.

The following came as a real letter, if also as an E-mail attachment, from Kathy Warye, another CEO. She runs the Association for Professionals in Infection Control and Epidemiology, whose obvious interest in this subject makes her note very welcome.

"Mr. Comarow makes a critical point that even the single most effective intervention (in this instance, hand hygiene) alone can't solve the problem of healthcare-associated infections. Certainly, even the best hand hygiene compliance only gets us so far.

Lessons learned from our 12,000 members who manage infection prevention programs in healthcare facilities around the world tell us that to reduce the risk of infection and protect people coming into hospitals means adopting a full range of strategies. The first step, from a facility-wide perspective, is conducting a proper risk assessment. Good infection prevention and control professionals don't just know their patients—they know their hospital, they know which areas are at high risk and where there may be hidden reservoirs of bacteria, be it the ER or the OR.

System-wide adoption of proper hand hygiene, contact precautions including use of gloves and gowns, and the "checklist" for device-related care that is receiving so much attention of late are among the tools known to be effective in preventing healthcare-associated infections."

Amen! The single largest source of untreated water in any hospital is its HVAC system. For Critical Care Units aerving the most immune compromised patients, we must eliminate the HVAC as a reservior for pathogens. While VIGILAIR is not a panacea, neither is washing hands. Our technology needs to complement other technologies and institutional efforts for infection control.

Hand washing just one part of infection control, medical experts say

2008-01-29T09:06:00.001-05:00

An excellent common sense approach to the hype surrounding hand washing hygiene. This article is excerpted from the Grand Island Independent, a newspaper published in Nebraska:

"Widespread use of antibacterial hand gels has helped make it easier for healthcare workers to comply with hand hygiene policies, which is especially important during cold and flu season.

The gels, which have been proven as effective at killing germs as soap and water, are also less drying to the skin an important quality for those who work in the medical field and may cleanse their hands up to 50 times per day.

Recent studies and local experience have proven, however, that increasing compliance to hand-washing policies is not always enough to reduce the rates of hospital-acquired infections.

A study published by the University of Nebraska Medical Center this month showed that while use of antibacterial hand gels in two UNMC adult intensive care units helped the units increase their hand-washing rate from 38 percent to 70 percent, there was no corresponding reduction in hospital-acquired infections.

But a similar experiment at St. Francis Medical Center has had different results.

At St. Francis, the use of hand sanitizer and the creation of a hand hygiene improvement committee has nearly doubled the rate of hand-washing policy compliance for the entire hospital, said Laura Mader, St. Francis infection control coordinator.

The hospital's current 76 percent compliance rate is above the national average. It has also led to a decrease in St. Francis' incidence of hospital-acquired infections, Mader said.

While UNMC and St. Francis had different results in similar experiments, officials from both facilities agree that hand washing, while highly important, is only one component of infection control.

"There are many factors that influence the development of hospital-acquired infection," said Dr. Mark Rupp, professor of infectious diseases at UNMC. "It would be naive to think that a single, simple intervention would fix this problem."

The lack of a correlation between increased hand hygiene and lower incidence of infections could be attributed to many factors, including UNMC's already low infection rate in the ICU."

Infection Control professionals fight disease transmission on many fronts. While hand washing has drawn much attention, it is merely one weapon in the arsenal. We believe that a comprehensive approach to infection control should include air disinfection, especially in critical care units.

Case Fatality Rate for Avian Flu is 80.6% in Indonesia

2008-01-29T08:33:00.001-05:00

Disturbing news from the Indonesian Ministry of Health that says 80% of the people who contract H5N1 Avian Influenza (AI), will die from from the infection:

"Four AI New Cases at the End of January

29 Jan 2008

Entering last week in January 2008, there are 4 more AI cases, based on RT PCR (Real Time Polimerase Chain Reaction) test in laboratories of National Institute of Health Research & Development (Balitbangkes) MOH and Eijkman Molecular Biological Institute. Those 4 cases are Nas (Tangerang District, Banten), MIY (Depok, West Java), and Res and Vir (both from East Jakarta).

Since the first case found in mid July 2005, number of AI cases in Indonesia by January 28, 2008 reaches 124 cases with 100 of them dead. The Case Fatality Rate (CFR) is 80.6%."

Some have argued that the CFR for AI is skewed because there may be many instances where nonfatal AI is not reported or mistakenly diagnosed as seasonal influenza. Dr. Niman @ Recombinomics has stated that high CFR rates for AI are not inflated and presents an elegant argument here.

Putting these numbers in perspective:

A 2003 study of SARS in Hong Kong (1,755 SARS cases and 299 deaths) says that the CFR for SARS was approximately 17%.
A recent WHO report that analyzed H5N1 infections from December 2003 thru April 2006 found a CFR of 56% (203 cases, 113 deaths).
The total WHO CFR for all H5N1 cases confirmed since 2003 is 63%.

How does this relate to a possible pandemic? Nobody knows for sure, but informed calculations project that assuming a clinical attack rate of 25%, a pandemic could kill 1.7 million Americans. The assumed CFR for this projection is 2.3%.

Reporting Live From AHR EXPO 2008

2008-01-23T21:41:00.001-05:00

The AHR Expo is in full swing here in New York City. We are among 1,800 exhibitors that are presenting booths at this show. The technical programs have been outstanding, especially the programs dealing with Ultraviolet light.
As a whole the industry seems to be maturing. As compared to previous years when people asked, “What is UV?”, this year they know what it can do and are asking more questions regarding applications. The field of UV manufacturers is well represented here at the Expo and at the technical committee level. Although we are competitors there is an agreement that we have shared interests as an industry.
This spirit was evident at a symposium entitled, ‘Applying UV Without Getting Burned’. Moderated by Steve Martin, the forum discussed the safety implications of applying UV to HVAC. Altru V’s VP of Technology Dave Witham demonstrated how his company is testing the effects of UV on HVAC components such as filters, insulation and wiring. His company has created a testing chamber to help quantify those effects.
Richard Vincent, the author of many journal articles on UVGI, also touched upon the safety aspects of applying UV. Dr. Vincent is a recognized expert in the field and discussed the conclusions of a 7 year study on the effects of UV in homeless shelters.
The always entertaining Dave Marciniak of the GSA round-out the forum. His use of humor livened the sometimes dry details of government safety guidelines and regulations. Being the last speak in a forum is always tough but Dave did it with memorable style. My kind of bureaucrat!
Another highlight was a presentation made by Kathryn Worrilow Ph.D of Leigh Valley Hospital. Her talk was part of the TC 2.9 (thanks for the update, Mr. Bahnfleth) series, AKA Control of Infectious Diseases with UVGI. Dr. Worrilow, an embryologist, explained how the use of UVGI air disinfection led to better clinical outcomes in her lab. Her study, The Impact of UVC Radiation on Clinical Pregnancy and Miscarriage Rates in ISO 5 Cleanroom In Vitro Fertilization Laboratory was well received and is the latest in a growing body of evidence linking UV air sanitation with positive clinical outcomes.
Among the contacts VIGILAIR made at AHR is Ponkamon Aumpansub, a graduate student at Penn State. Her studies at the prestigious Penn State Indoor Environment Center deal with the complex issues surrounding the modeling and mitigation of contaminants in large buildings. AHR is first and foremost an expo to promote business. It is also important to recognize that tomorrow innovations will come from today’s engineering students such as Ms. Aumpansub. It is imparative for commercial entities to foster the relationship between research and commercial applications as their goals are connected.
The theme that seemed to resonate throughout the 1,800 exhibits this year is the emerging importance of IAQ in all aspects of HVAC. There is an awareness from front line mechanical contractors to multi-national manufacturers that HVAC is all about creating an environment of comfort and safety indoors. VIGILAIR and our partners at Steril-Aire are at the vanguard of implementing UV to meet those goals.

ASHRAE Meeting off to great start

2008-01-20T21:30:00.000-05:00

It's cold here in New York City as the annual winter meeting ASHRAE lives up to its name. With so many forums to attend, where do you begin.
This morning we attended an excellent seminar titled, "Hazardous Biological Agents in Hospital Air: When the HVAC Plant exacerbates rather than mitigates against HAI". Dr. Bob Scheir of Steril-Aire led the discussion on why Health Care Facilities pose unique challenges to HVAC engineers. The seminar was well attended reflecting the increased interest in airborne transmission of disease.
Tim Keane, a consulting engineer to Health Care clients, talked about the importance of maintenance programs, and how simple measurements can indicate if your system is fouled by microorganisms.
William McCoy, PhD of the life sciences company Phigenics, focused on Legionella in the Health Care setting. Dr. McCoy enlightened us on the unique relationship between protozoa and legionella. He also said that while our understanding of this pathogen has increased, much more research needs to be done.
The afternoon was spent in a lively technical meeting (TC 9.6-the subcommittee on Infectious Diseases). A spirited discussion ensued, led by Mike Keen. While much ground was covered, the meeting also highlighted how much more science is needed. But the good news is that the engineering community is starting to accept the idea that HVAC can prevent/cause nosocomial infection. The seminar was a good mix of experienced members and many younger engineers who are interested in this emerging topic.
That's all for tonight!

Hand washing no panacea

2008-01-16T02:36:00.000-05:00

I was delighted to hear the ABC song drifting from my bathroom last night. It meant that my five year old son was following the instructions he learned in school to properly guage the amount of time he should wash his hands with soap and water. Will he do this everytime? Probably not, but it is important to try.

The situation in my house is much like the situation in many healthcare facilities, according to an LA Tines article on the MRSA Watch blog site:

30 studies show hand washing neglect

Link: Beating the staph superbug - Los Angeles Times.

But, with a few exceptions, hospitals and public agencies have been slow to gear up against MRSA. More than 30 studies have shown, for example, that healthcare workers wash their hands about half as often as they're supposed to, even though washing before and after seeing each patient would drastically cut down on infection rates. Hospital surfaces and equipment aren't cleaned as often as they should be, and careless habits -- like touching potentially contaminated surfaces after hands have been washed but before touching the patient -- contribute to the spread. The first order of business should be to get a clear picture of MRSA. Where is it and how prevalent? An upcoming bill by state Sen. Elaine Alquist (D-Santa Clara) would make MRSA a reportable disease and require hospitals and nursing homes to report their infection rates. In Tennessee, which tracks MRSA, it quickly became the third most common reportable disease in the state, behind chlamydia and gonorrhea. A similar bill was vetoed in 2004 by Gov. Arnold Schwarzenegger, but the recent news from the CDC should make him rethink his position, despite the almost certain opposition of hospitals.

http://tahilla.typepad.com/mrsawatch/2008/01/30-studies-show.html

I bring this to your attention to demonstrate that infection control is dynamic. There is no silver bullet. Infection control requires multi-layers and some redundancies. Our technology, VIGILAIR®, does not replace other sanitary efforts--it complements and enhances them. Like hand washing, VIGILAIR® is not a cure all. It is a prudent and effective way to reduce the airborne environmental pathogens within your facility.

Brits love a healthy debate...

2008-01-09T08:19:00.001-05:00

From Britain's Telegraph, news on a new government program to reduce antibiotic prescriptions as a way to reduce the superbug cycle. I've included a snippet of the article. It is the responses to the article that are just as interesting. In response to this topic, readers blame doctors, politicians and patients for the problem. These comments show the complexity of the issue and the passion of those seeking a solution. My favorite response is listed below in which the writer tells people to stop being wimps, suck it up and go to the doctor's office less.

Stop giving antibiotics for colds, doctors told

By Rebecca Smith, Medical Editor
Last Updated: 12:09pm GMT 09/01/2008

Doctors are to be told to stop prescribing antibiotics for coughs, colds and sore throats because over-use of the drugs is fuelling the spread of killer hospital superbugs.

Alan Johnson, the Health Secretary, says it is time to end the unnecessary use of penicillin and other commonly-prescribed pills, which cost the NHS £1.7 billion a year.

Using antibiotics too liberally has led to bugs such as MRSA becoming resistant to treatment with the drugs. Most colds, coughs and flu are caused by viruses, which cannot be treated with antibiotics anyway, Mr Johnson points out.

Announcing a £270 million campaign against superbugs, to be launched next month, he says it is vital that doctors adopt "less of a knee-jerk reaction to prescribing".

The campaign, called Clean, Safe Care, will also include an extra £45 million for hospitals to spend on infection control nurses or antibiotic specialist pharmacists. All patients going into hospital will be screened for MRSA by 2009.

COMMENTS:

Antibiotics fight "bugs", not viruses, so the basic premise is absolutely correct. Do not give antibiotics merely for colds or flu. BUT post viral conditions such as chest infection, infected sinuses and catarrh (and real sore throats) DO need antibiotics and I hope this will not change under the new guidelines. Perhaps doctors could prescribe a placebo antibiotic to anyone insisting on antibiotics who merely has a viral infection.
Posted by graham wagner on January 9, 2008 9:59 AM

Antibiotics are not the cure for superbugs, cleanliness is - and the hospitals simply aren't clean enough in the UK. Accountability is needed, not money, run a hospital like a fast food joint. "Clean as you go" and it is all staff's responsibilty to clean up, not delegated to the lowest bidder.
Posted by Craig Douglas on January 9, 2008 9:55 AM

So what is Alan Johnson's next big idea? Now wash your hands? Make sure you're wearing your face-mask? Or is he going to go round every surgery and tell the doctors what medicine to prescribe? What a joke! The trouble is this joker is in charge of the health service! That is more frightening than any superbug.
Posted by Pinkie on January 9, 2008 9:27 AM

The best solution for colds and viruses is to stop giving them to everyone else!
If people stayed at home and looked after themselves when they became ill there would be a lot less general illness in the community, rather than battling on and infecting all and sundry.
Surely we all know by now that antibiotics are not given out by GPs for colds - that has been common knowledge for decades - hence the barrage of cold 'cures' on the shelves.
Posted by Annie on January 9, 2008 9:25 AM

I am a GP and we know that we should not give antibiotics in the circumstances described; the patients do not always know this and it does not matter how many times we inform them they will keep coming back until they get them, in these circumstances another approach needs to be adopted and a debate needs to be taken on what this might be.
Posted by Jonathan Allcock on January 9, 2008 8:50 AM

Simple - don't go to your doctor - it's dangerous. I've been telling my patients this for years. The whole ludicrous thing is compounded by several factors: the great unwashed believe it's their god given right to be ill on a regular basis, a health service that is free at the point of delivery (if you offer free beer there's a queue that stretches round the corner and up the road), and a partially educated, disinterested and overpaid workforce.
Posted by Andrew Renaut, Associate Professor of Surgery, Brisbane on January 9, 2008 8:36 AM

The crux of the issue lies in the fact that many people are greedy and want immediate satisfaction. I have wrestled with people who demanded antibiotics for simple viral illnesses. The the patient wants to leave with something in his/her pocket and they are willing to go to any means to acquire it.
There are also legal implications that are caused by the system. If a patient complains of not receiving the desired medication or a rationalized "standard of care", the legal system automatically demonizes the medical practitioner.
I am all for placebo's in this instance.
Posted by James on January 9, 2008 7:51 AM

Yes suck it up. It is called illness. We are made of flesh and blood and mortal. It is normal for people to get sick off and on. You must endure illness sometime. If you find yourself going to the doc everytime you feel unwell then you likely are a mental case ie "nervous nelly". Anxiety /depression are a big reason why folks can't cope w/ minor illnesses. Quick being a wimp
Posted by ER doc on January 9, 2008 6:59 AM

Again the real cause of hospital infection is ignored. Unsustainable bed occupancy ratios, and out- sourcing of hospital cleaning. Blaming GPs is an irrelevant political ploy. Fight the real battle please.
Posted by John Powell on January 9, 2008 6:47 AM

Most experts talk around the Problem of Antibiotic Resistance. Your article headlines should say "ALL COLDS ARE VIRUSES, ANTIBIOTICS DO NOT KILL VIRUSES, THEREFORE YOU(DOCTORS) MUST NOT USE/ ANTIBIOTICS and start from there. Bacteria and viruses are as different as Gold and Lead. It is possible that a virus can make a person sick and that because of a compromised Immune System bacterial Infections can follow which can then require antibiotics to heal, It should also be pointed out that antibiotics tend to kill many neccessary bacterial species in the body and so lead to further problems-(example,life on the toilet) and Candida infections
Posted by declan mansfield on January 9, 2008 6:13 AM

Source: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/09/nbiotic109.xml

Airborne Germs and Handwringing — Sciencebase Science Blog

2008-01-08T02:20:00.000-05:00

An excellent blog that shows the growing understanding of the role that airborne transmission plays in disease. The blog, www.sciencebase.com, is an excellent source for interesting debate on many scientific fronts.

Airborne Germs and Handwringing — Sciencebase Science Blog

Jan 7, 2008

Airborne Germs and Handwringing

Posted in Health at 1:00 pm by David Bradley -- 7 Comments

Just before the Christmas break, right as my annual winter festival cold kicked in and I was up to my neck in end of year deadlines, I posted a link to a press release in my Geeky Bits science extra column. That page is a repository of the less worthy, but hopefully interesting stuff I come across. Occasionally, I see an intriguing headline, give it a click, give the text a quick read through, add the item to the Bits, and thinking nothing more of it, just as one might with a del.icio.us or StumbleUpon post.

However, one regular Sciencebase reader, Churchill Fellow Grace Filby, was somewhat taken aback by my highlighting a timely press release from the London School of Hygiene and Tropical Medicine (University of London) - and described it as “a load of misguided nonsense”. Unfortunately, there is no online feedback or comments form on that LSHTM press release through which we could open a public debate on its content.

The press release was entitled - “If you don’t want to fall ill this Christmas, then share a festive kiss but don’t shake hands” - not the snappiest of titles but almost certainly one attempting to catch the wave of festive spirit seeing as it was released on December 19. However, both the title and the subheading of the press release (”The fight against all types of infections, from colds and flu to stomach bugs and MRSA, begins at home, with good hand hygiene, says first review of hand hygiene in the community.”) perhaps places too much emphasis on hand hygiene as opposed to the problem of airborne pathogens, believes Filby.

First off, Filby says that the press release “deflects the public’s attention away from a major source of germs which is the air we breathe…handwashing is only a part of it.” She adds that, “It is the germs arriving in the air that need disinfecting or freshening before the germs land on surfaces that could be touched by hands and passed to other people.” Even the British government appears to be acknowledging this to some degree, according to The Times on Christmas Eve in a bulleted item on how air disinfection

The press release states: “But a report just published warns that we may be far more at risk of passing on an infection by shaking someone’s hand than in sharing a kiss.” As far as we can see, the full text of the original 38-page report cited in the release the word kiss or kissing occurs only once. It’s almost as if the press office hoped to catch media attention with the mistletoe and seasonal kissing theme regardless of the science reported in the report itself. Moreover, there is nothing much about handshakes or shaking hands either.

There are several other dubious details about handwashing: “but we believe that this targeted approach to home hygiene…” Is “believe” valid in a heavyweight scientific document of this sort, asks Filby.

The press release concludes that, “Handwashing with soap is probably the single most important thing you can do to protect yourselves and your loved ones from infection this Christmas.” Probably - that’s good, but we also need to deal with airborne germs. Whatever would Florence Nightingale have said?

Regardless, the main problem is that the press release ignores the primary source of respiratory infection which occurs from carrier to the next victim before pathogens ever fall onto a surface. In the case of many winter bugs, they spread quickly through sneezes or coughs when people don’t cover their noses and mouths.

Of course, Filby and I could put on our cynical hats at this point and come up with some kind of plausible explanation as to why hand hygiene as opposed to air hygiene is considered important. “Perhaps it is worth noting that funding for research on air hygiene wasn’t forthcoming whereas for hand hygiene there are plenty of interested parties - soap manufacturers, handwash products and water companies,” says Filby.

Hand hygiene is obviously part of the story and in the pre-Xmas rush for headlines one could forgive the LSHTM for highlighting it, but a broader perspective on all-round hygiene education and the promotion of other aspects of hygiene, as opposed to simple hand-wringing in the washroom, would have made more sense.

Minor editing. Source, http://www.sciencebase.com/science-blog/airborne-germs-and-handwringing.html:

More Evidence of MRSA's Airborne Spread

2007-10-24T08:05:00.000-04:00
Epidemiologists are like medical detectives. They analyze an outbreak and then use their knowledge and tools to identify the outbreak source. Below is an excellent study from the Medical School in Kitakyushu, Japan. The study took place in a hospital area that housed 37 patients recovering from head and neck surgery. Three patients in single occupancy rooms became infected with MRSA after surgery.
Were all three patients colonized by the same strain of MRSA? If so, what was the source and how could patients in three separate rooms become infected with the same pathogen?
Researchers used air sampling machines and surface swabs to collect MRSA samples. Then the samples were analyzed using polymerase chain reaction and pulsed-field gel electrophoresis. The result?
"An epidemiological study demonstrated that clinical isolates of MRSA in our ward were of one origin and that the isolates from the air and from inanimate environments were identical to the MRSA strains that caused infection or colonization in the inpatients."
The conclusions of this study indicate that disinfecting the air circulated within their ward could help reduce colonization of patients (bold emphasis added by me).
"In this study, we confirmed that MRSA could be acquired by medical staff and patients through airborne transmission. The findings suggest the importance of protecting patients against cross-infectious agents existing in aerosols. Although measures for prevention and control of nosocomial infection with MRSA include handwashing with an antimicrobial agent; wearing a gown, gloves, and a mask; and removing MRSA from the nasal vestibule, few measures have been established to control airborne bacteria. Laminar unidirectional airflow, air ventilation, and air filtration could also be beneficial in hospital environments and should be considered. Further studies will be needed to assess the levels of MRSA contamination of air and to develop more effective means of controlling and removing airborne MRSA."
Once again we see that there is no silver bullet for infection control. Disease transmission is not all contact, nor is it all airborne, rather it is a dynamic combination of many things. In this hospital ward, airborne transmission took on increased importance because the patients in this care unit lack typical host defense mechanisms in their upper respiratory tracts.
VIGILAIR® systems are proven to reduce pathogen load within the air stream by destroying microorganisms with UVGI, and removing the microorganisms with filtration. You may download the research article in its entirety here.

Reference:
Teruo Shiomori, MD, PhD; Hiroshi Miyamoto, MD, PhD; Kazumi Makishima, MD, PhD. Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit. Arch Otolaryngol Head Neck Surg. 2001;127:644-648

MRSA Airborne?

2007-10-23T11:44:00.001-04:00
Over the past few weeks this blog and its sister site have seen an increase in traffic fueled by the following search terms:
MRSA is airborne
How is MRSA transmitted
MRSA airborne ultraviolet light
MRSA UVGI
MRSA airborn
Since there seems to be an interest in our point-of-view on MRSA and airborne transmission, I put together a White Paper that briefly reviews evidence supporting airborne MRSA. The links in the pdf file are active, so please feel free to click through to the supporting documentation.

The truth is that MRSA is on our skin, is in the air and is on surfaces and fomites. Clearly, contact transmission predominates, but we ignore other sources (such as airborne) at our own peril. We view pathogenic microorganisms as opportunistic--they find any avenue to reproduce. When we eliminate one vector of transmission, they find others. We have cultured Staph, Pseudomonas, Klebsiella, Serratia and Acinetobacter from the cooling coils and drain pans of hospitals that we've tested. Our studies have shown that when the cooling coils are irradiated with UV, the pathogens are eradicated in the HVAC. This also corresponds to a lower environmental load for those pathogens in patient care areas.

Airborne's exact contribution to MRSA disease transmission is not known. However, we have seen that when you eliminate the pathogen reservoir inside the HVAC, there are less microorganisms downstream, where patients receive care.
Using VIGILAIR in a hospital complements existing Infection Control strategies; it does not replace them.
If you're interested in MRSA's airborne links, download this pdf for more information.

H5N1 Beautiful and Deadly

2007-10-12T15:30:00.001-04:00
New images of the H5N1 virus were released this week. The images are the work of science photographer Lennart Nilsson, who is well known for his imaging of human conception and development of the baby within the womb. These images were first printed in Swedish daily Dagens Nyeter. Nilsson originally asked the US government for H5N1 virus samples but was turned away. He was able to obtain the virus from the World Health Organization and used a scanning electron microscope to make the images. The virus is strangely beautiful in these images, seen as blue orbs attacking healthy pink cells. But keep in mind that it is deadly, as the samples came from a father and daughter in Hong Kong who died after being infected two years ago. I combined the images with a photo of Nilsson (credit Jacob Forsell) and a music bed by Silvermay.

When E. coli, Salmonella or E. sakazakii is on the menu

2007-10-12T10:07:00.001-04:00
Food producers are always vigilant to prevent pathogens from contaminating the products that you and I consume. But lately it seems that there have been some high profile recalls of foods that were tainted by harmful microorganisms. What does this have to do with airborne infection? The link is UVGI.
The mechanics of VIGILAIR® reducing contamination in hospitals can be applied to the food production industry. UVGI can inactivate pathogens such as:
E. coli
Salmonella
E. sakazakii

VIGILAIR® technology can help keep food production clean by:
inactivating microorganisms in the air used in food production
inactivating microorganisms on the surfaces of food products
inactivating microorganisms on the surfaces of packaging
Our technology is proving effective in keeping food safe and is used in production facilities in the US, Canada, Mexico and Asia. For more information on how VIGILAIR® is used in the food production industry, click here.
A concise primer to the role of UVGI in food production can be found here.

HAI-an explanation

2007-10-10T11:06:00.000-04:00
Looking for an excellent overview of Hospital Acquired Infections? Than look no further than this video clip from Dr. David Nash of Thomas Jefferson University. Dr. Nash is at the vanguard of medical educators who are examining health care and health care policies.
Dr. Nash is involved in Pennsylvania's aggressive Health Care Cost Containment Council. PHC4 is considered a model for the public reporting of information on hospital acquired infections.

How to build HVAC business relationships

2007-09-24T11:16:00.000-04:00
You can always tell the innovators for any industry. They are bold, creative and do things that their competitors only dream of doing.
ThermalNetics is one of those innovators. Already regarded as a progressive distributor of HVAC products, ThermalNetics furthered its reputation with a spectacular marketing event.

Billed as the 2007 Open House and Product Show Tailgate Party, the company hosted more that 400 customers at its new headquarters in Auburn Hills, MI.

President Rick Sutkiewicz designed the event around a sports/tailgate theme. Guests were invited to try their hand at basketball free throws to win prizes. Three professional basketball players from the Detroit Pistons joined the party to share stories and sign autographs. As if that wasn’t enough the Piston’s cheerleaders, The Automotion Dance Team also performed for guests. Add live music and great food and you have an excellent draw.

The festive atmosphere provided the perfect platform for some serious business and networking. In addition to VIGILAIR, McQuay Industrial was on site to meet and greet potential customers. McQuay brought 2 tractor trailers to the event, each displaying its latest offering in commercial HVAC.

But in an environment where the bottom drives many purchases, how can this event make sense? The answer to that question is found in ThermalNetics’ approach to the market place.

Rick Sutkiewicz knows that each customer represents a relationship. Before the customer invests in ThermalNetics, ThermalNetics invests in the customer, gaining trust, demonstrating expertise and innovation.

Sure this event was a ton of fun, but it was also money and time well spent. VIGILAIR reps at the event made important contacts and were able to reach out to valuable decision makers.
As I write this the sun is warm and more than 300 people are enjoying live music, a cold drink and Bar-B-Q. Not one contract was signed, but millions in business was secured - one relationship at a time. And if you can’t see the value in that, you’re not an innovator.

Check out more pictures from ThermalNetics' 2007 event by clicking on the image below:

ThermalNetics Open House

Is Ebola Airborne?

2007-09-12T15:32:00.000-04:00
World Health Organization (WHO) officials are rushing to the Democratic Republic of Congo, desperately trying to contain the spread of the Ebola virus. As of this writing, five people are known to have died from Ebola in the southern province of DR Congo, and the WHO says 166 more deaths since April may be linked to the virus.

Among the problems facing health care workers is the virus’ ability to remain asymptomatic for up to 21 days. Furthermore, researchers do not know why some people recover from Ebola hemorrhagic fever, while most do not. There is no standardize treatment for Ebola and researchers do not yet know the natural reservoir for the virus.
Is Ebola transmitted via the air? In primates the Ebola virus was transmitted through the air in a research facility in Reston, Virginia. Apparently the mutations that allowed the virus to easily transmit via the air also changed its effect on humans. Tests showed that four lab workers tested positive for Ebola Reston virus, but this strain of the virus caused only minor health problems (although all the monkeys in the Reston facility were destroyed to prevent the outbreak from spreading).

According to existing literature, Ebola does not spread through the air in natural settings, although it can be spread via aerosols in lab experiments. How the virus knows when it is in a lab, I’m not certain. Viruses rely on sugars and proteins that allow them to bind to cells they’d like to infect. Small changes, such as the mutation that permitted airborne transmission, probably changed the lethality for humans infected by Ebola Reston, even though it retained its virulence in monkeys.

There are claims, however, that airborne human to human transmission of Ebola occurred in 1976. Reports say that Mayinga N'Seka (seen as the patient in the image to the right), a nurse in Zaire may have contracted the virus via the air. Evidence is thin, and even if it was true, Nurse Mayinga did not infect any other humans before she died.

Ebola is a mysterious and deadly microorganism. We’ve come far in understanding this killer, but as with so many viruses, we are just one shift, drift or mutation away from a potential pandemic.
(This 1976 photograph shows two nurses standing in front of Kinshasa case #3 (Nurse Mayinga) who was treated and later died in Ngaliema Hospital, in Kinshasa, Zaïre - CDC/Dr. Lyle Conrad)

Hospitals Battle MRSA: Why Infection Control Arsenals Need Many Weapons

2007-08-31T15:32:00.000-04:00
If you read UK newspapers you get the impression that MRSA is public health enemy #1. Fortunately the public’s focus on MRSA has helped to raise awareness and resources to reduce infections caused by this bacterium.
An excellent study of technology designed to eradicate MRSA is found in a recent issue of the Journal of Hospital Infection. Researchers assessed the short and long term effects of cleaning a hospital ward with Hydrogen Peroxide Vapor (HPV). Due to its oxidative properties, hydrogen peroxide is effective at eliminating many types of bacteria.

During the five month study, researchers measured MRSA contamination for the three months prior, and four weeks after an ICU was cleaned using HPV. Scientists used a machine like this one to create the vapor that was released inside the sealed, nine bed ICU. Previous studies have noted that HPV is considered a ‘big gun’ in disinfection, affording significant reduction of bacteria when combined with surface cleaning.

In the months prior to the HPV treatment, MRSA was isolated from 11.2% of sample sites. In the hours immediately following the HPV, no MRSA was isolated from the environment. The HPV did its job, end of story. Not quite.

The researchers wanted to look for MRSA after the HPV treatment, when real patients populated the ward. In less than 24 hours, the MRSA was back in the ICU:

“Twenty-four hours after the readmission of patients, MRSA was isolated from five environmental sites. All of the strains were indistinguishable from the strain with which the patient in bed space 8 was colonized, but the environmental contamination was not confined within that bed space.”

Despite the effectiveness of the ‘big guns’ (HPV), MRSA returned. In fact, detected MRSA surpassed the pre-HPV levels (11.2% v. 16.3%). Use of HPV is a great idea, but it cannot be the Infection Control Practitioner’s only weapon. Disinfection is an ongoing battle fought everyday, in every ward. Vigilance and multi-faceted approaches are the keys to long term success.

VIGILAIR® can be an important part of that strategy. Deployed within the Hospital’s air handlers, VIGILAIR® constantly disinfects the air through a combination of ultraviolet germicidal irradiation (UVGI) and high efficiency filtration. The technology is more than infection control, it is infection prevention.

As we always say, there is no panacea in the fight against MRSA, H5N1 and HAI. There needs to be a cross-discipline, evidence based strategy to identify, and eradicate all pathogen reservoirs within a hospital. With changes looming on the reimbursement horizon, this strategy will keep patients and hospitals healthy.
A white paper on airborne pathogens is available here.
Original Study:

K.J. Hardy, et al. Rapid recontamination with MRSA of the environment of an intensive care unit after decontamination with hydrogen peroxide vapour. Journal of Hospital Infection (2007) 66, 360-368
Image:
Bioquell

UK University Leeds the way in Airborne Infection Research

2007-08-23T13:30:00.000-04:00

Some of the most compelling and important research in airborne contamination control originates from a progressive university in the resilient city of Leeds. Known as a manufacturing center (or is it centre?), Leeds has managed to diversify itself, evolving into a hub for international banking and business services.

Researchers at the University of Leeds are proving that hospital design plays a major role in healthcare, specifically the growing problem of hospital acquired infections. Perhaps the key to their success is an understanding of the role that the indoor environment plays in disease transmission. According to Leeds professor Andrew Sleigh, “There is evidence that 10 to 20% of infections are spread through the air, but until now, their role in the infection chain has been largely overlooked, as doctors tend to emphasise the importance of washing hands and avoiding physical contact.” I guess being open to new ideas can lead to new discoveries.

Another key could be the University’s cross-disciplinary approach to learning. Leeds University prides itself on innovative study programs that give students creative options:
“Many of its research initiatives cross traditional subject boundaries and Leeds currently promotes projects through 58 inter-disciplinary centres and seven research schools.”

This approach is apparent in the Pathogen Control Engineering Research Group within Leeds’ School of Civil Engineering:
"Our multi-discipline approach brings together investigators from a variety of backgrounds including public health engineering , fluid mechanics , building services engineering and microbiology . This has produced a team with the all-round strengths required to undertake rigorous research in the field of aerobiology and indoor air quality.

Leeds’ advances demonstrate both the challenge and the promise of airborne infection research. Research in this field requires the talents and intelligence of participants from several disciplines. This approach was taken by scientists who reviewed research papers published between 1960 and 2005 on airborne disease transmission (1). More than 200 papers were assessed by a team of 15 experts in epidemiology, virology, environmental health and engineering. This study, and the work at Leeds, shows that greatest discoveries are found at the nexus of divergent technologies.

Recent Leeds Research

Although not entirely complete, Leeds researchers released some results from recent airborne pathogen testing. According to Professor Sleigh's research, infectious particles are distributed within hospital wards.

“Although diseases such as tuberculosis are widely accepted as being airborne, others may also be spread this way. Numerous bacteria-carrying particles - such as tiny flakes of human skin - can be widely dispersed into the air within hospital wards through routine activities, and potentially contribute to the risk of infection for patients.”

PhD students Abigail Hathway and Katherine Roberts used a laser counter to assess the particle concentration of hospital ward air. Their data indicate that normal staff operations such as making rounds, closing drapes and changing patient beds significantly affected concentrations of airborne particles.

These findings add important new insight to the role of the airborne route in infection transmission. This research will be used by the UK’s National Health Service to update guidelines for ventilation and infection control. According to Ms. Hathaway, more research will be done in the upcoming months, with an eye on possible publication in 2008.

Diverse curriculum, public-academic partnerships and accomplished professors are among the reasons why Leeds attracts more undergraduate applications than any other UK university. Plus, any school that Mark Knopfler attended has got to be way cool!

1. Li Y, et al. Role of ventilation in airborne transmission of infectious agents in the built environment—a multidisciplinary systematic review. Indoor Air 2007; 17: 2-18.

Best of the web

2007-08-22T08:10:00.000-04:00
Keeping track on how states are dealing with legislation on Hospital Acquired Infection reporting? Then check out this blog:
About Health Transparency
You can easily see the status of legislation that mandates the reporting of quality measures. While you're there, you may find the 'Cost Measures' link interesting. You can see the disparity in costs/payments for various procedures in several communities. As far as I can tell, the site is a public/private partnership that is legit, not a shell shill for an industry group.

Doctors as terrorists: A potential bio-threat?

2007-07-05T13:24:00.000-04:00
All eight people arrested in connection with the recent terror attacks in London and Glasgow are medical professionals employed by the UK’s National Health Service (NHS). Seven of the eight are medical doctors or medical students and the final suspect is a lab technician. This sad chapter casts a cloud over Muslim MDs who are speaking out against the recent violence.
But the attacks also illuminate the concern over the use of biological weapons by extremists. Physicians and those training to become physicians have access research facilities in hospitals and universities. While exotic pathogens such as anthrax and smallpox are difficult to obtain, healthcare professionals may have access to other 2^nd tier agents that can be used as, or refined into, a bio-weapon. The CDC enumerated some of these ‘B & C’ level threats:

Category B

Second highest priority agents include those that

are moderately easy to disseminate;
cause moderate morbidity and low mortality; and
require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.

Category B agents include

Coxiella burnetti (Q fever);
Brucella species (brucellosis);
Burkholderia mallei (glanders);
alphaviruses,
Venezuelan encephalomyelitis,
eastern and western equine encephalomyelitis;
ricin toxin from Ricinus communis (castor beans);
epsilon toxin of Clostridium perfringens; and
Staphylococcus enterotoxin B.

A subset of List B agents includes pathogens that are food- or waterborne.
These pathogens include but are not limited to

Salmonella species,
Shigella dysenteriae,
Escherichia coli O157:H7,
Vibrio cholerae, and
Cryptosporidium parvum.

Category C

Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of

availability;
ease of production and dissemination; and
potential for high morbidity and mortality and major health impact.

Category C agents include

Nipah virus,
hantaviruses,
tickborne hemorrhagic fever viruses,
tickborne encephalitis viruses,
yellow fever, and
multidrug-resistant tuberculosis.

Could doctors bent on jihad create and release a biological agent? While there are many technical hurdles inhibiting such attacks, physicians are among the few who can overcome these obstacles. The recent attacks in the UK indicate that terrorists have not surmounted the technical barriers to obtain, process and disseminate a biological agent. If they had such a weapon, they probably would’ve used it. The fact remains, however, that terrorist groups can recruit people who are highly educated and highly motivated to use whatever means available to kill Westerners.

Terror organizations have relied on scientists in the past. A Pakistani scientist with an advanced degree in microbiology is reported to have obtained anthrax spores under the guise of legitimate research. Papers uncovered by coalition forces in Afghanistan in December 2001 showed that the scientist corresponded directly to al-Qaeda's No. 2 commander, Ayman al-Zawahiri. Al-Zawahiri is a doctor by training, having worked as a surgeon.

More recent developments are also cause for concern as this NPR story notes:

“But a worrying, almost prophetic, story emerged Wednesday from Baghdad: a Church of England clergyman, Andrew White, who is president for the Foundation of Reconciliation in the Middle East, based in Iraq, said he was at a conference in Amman, Jordan in April when he was taken aside by a Sunni religious leader.

"I listened to him for 40 minutes, and he went on about how they were going to destroy Britons and Americans and how they were going to be doing more in the U.K. and U.S., and he finished by saying 'those who cure you will kill you,'" White said. “

Now is not the time for fear mongering. But we should be aware that terrorists are able to attract and radicalize even the most educated in the community. It’s a reminder that we must remain vigilant on many fronts in order to protect ourselves from threats of terrorists.

APIC’s MRSA Study: a good start

2007-06-26T15:31:00.000-04:00

The Association for Professionals in Infections Control (APIC), has just released a comprehensive study that found MRSA rates may be much higher than earlier thought. Results showed that MRSA infection and/or colonization rates are at least 8 times greater than the results of previous studies. You can find the study on APIC’s web site here.

The study is significant because it surveyed a broader spectrum of hospitals and patients than any earlier study. So now that you know the prevalence of MRSA, what to do about it? APIC has some direction there as well. Health care workers can download the Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings. This resource is another good start, although it only devotes 2 pages to environmental transmission of MRSA. A quick check of the text finds 62 mentions of the word ‘contact’, as in ‘contact transmission’. There are zero mentions of the term ‘airborne’, as in ‘airborne transmission’.

Why the omission? Could it be that there is no science to back-up the assertion that MRSA is spread via the air? Perhaps these studies were overlooked:

Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit¹
In this 2001 study, Japanese doctors attempted to measure if MRSA could be found in the air of a surgical hospital ward. The rooms of three patients who acquired MRSA after surgery were monitored with air samplers and surface swabbing.
Results:
MRSA was detected in all three rooms in the air and on surfaces. 20% of the MRSA particles were within the respirable range, of less than 4 µm.
From the study:
“Methicillin-resistant S aureus was recirculated amongthe patients, the air, and the inamimate environments, especiallywhen there was movement in the rooms. Airborne MRSA may playa role in MRSA colonization in the nasal cavity or in respiratorytract MRSA infections. Measures should be taken to prevent thespread of airborne MRSA to control nosocomial MRSA infectionin hospitals.”

Reduction in MRSA environmental contamination with a portable HEPA-filtration unit.²

In 2006 microbiology researchers in the UK wanted to know if filtering the air in a hospital would lead to a decrease in MRSA found on horizontal surfaces. Ward rooms housing “…heavy MRSA dispensers…” were supplied with portable HEPA filtration units.
Results:
95% of settle plates placed in the wards showed MRSA contamination. Plates were placed in a variety of locations, mostly along the perimeter of the room. When HEPA filtration was introduced, measurable MRSA decreased between 73%-95%. This study makes a direct link between air and the dispersion of viable MRSA.

From the study:
“Although this cannot replace standard infection control measures (e.g. isolation, hand hygiene, protective clothing and cleaning), it is likely to reduce cross-infection risks significantly and could provide a relatively cost effective method for enhancing MRSA control.”

The relationship between airborne colonization and nosocomial infections in the intensive care unit.³
In 2005 Turkish researchers used more than 900 data points to measure airborne pathogens and the colonization of those pathogens in hospital patients. The study tracked 179 patients and found that MRSA is definitely airborne.
Results:
Researchers proved that MRSA was airborne through the use of air samplers. The two most common airborne pathogens were MRSA and Acinetobacter baumannii. Furthermore, the study says there is a link between the concentration of these airborne pathogens and colonization in patients.
From the study:
“It can be concluded that, total number of airborne viable particles in the critical areas such as operating theatres and intensive care units, seems to be a significant risk factor for the development of nosocomial infections in immuno-compromised patients.”

An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir.⁴

A deadly outbreak of S. marcescens vexed the staff members of a NICU located in the United Arab Emirates (UAE). In total 36 infants were infected, leading to the death of five babies. Concerned healthcare workers desperately worked to find the source of the outbreak.

Results:

Researchers determined that the reservoir of the deadly pathogen was the air conditioning system that fed the NICU. Despite many typical infection control interventions such as staff education, environmental cultures, isolation of colonized patients, compliance with aggressive infection control measures and recognition of the role of cross contamination the colonization of infants grew. When environmental sampling suggested that contamination was emanating from the air conditioning system, the hospital thoroughly sanitized the system. After this measure the 20 week outbreak ended.

From the study:

“…the growth of serratia from airflow samples suggested that the primary source of
this outbreak was the AC duct.”
“In conclusion, we have documented in this report the results of extensive surveillance and the importance of the AC duct site as a reservoir of nosocomial pathogens in the SCBU of a community hospital. The possibility of airborne transmission in nosocomial spread should not be underestimated.”

Although there is ample evidence that MRSA and other pathogens are transmitted via the air, most infection control measures focus on contact precautions. Data indicate that contact transmission predominates, so the emphasis on contact precautions is warranted.

It is reasonable, however, to also address other environmental contributors to infection. As we’ve learned recently in reducing VAP, a bundling approach yielded impressive infection rate reductions. Bundling recognizes that infection control is multifaceted and requires new thinking and new strategies. Bundling’s success proves that infection control is achieved through a system of evidence based measures.

Instead of thinking about infection control as breaking a single link in the ‘chain of transmission’, consider infection as a web with many avenues of opportunity. One of those avenues, the airborne route, deserves greater attention.

References

1. Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit
Teruo Shiomori, MD, PhD; Hiroshi Miyamoto, MD, PhD; Kazumi Makishima, MD, PhD
Arch Otolaryngol Head Neck Surg. 2001;127:644-648.

2. Reduction in MRSA environmental contamination with a portable HEPA-filtration unit
TC Boswell; PC Fox
Journal of Hospital Infection 2006 May;63(1):47-54
3. The relationship between airborne colonization and nosocomial infections in the intensive care unit
G Dürmaz, et al
Mikrobiyol Bul. October 2005 (article in Turkish)

4. An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir
S. A. Uduman, et al
Journal of Hospital Infection (2002) 52: 175±180

Taking the fight against hospital acquired MRSA into your own hands

2007-05-21T15:37:00.000-04:00
Think of it as a ‘Do it Yourself’ kit for preventing hospital acquired infections (HAI). The kit is a collection of disinfecting wipes, hand rubs and other products designed to prevent patients from catching a bug while they’re in the hospital.
The “PatientPak’ is marketed in the UK for about $43. The web site for the product is long on promises short on specifics (www.patientpak.com). Consider this text from the company’s press release:

“The PatientPak Hand Sanitiser and Sanitising Wipes are the only products available that are tested and proven to kill and clean away MRSA and at least 99.999% of all bacteria, including dangerous viruses, Norovirus and Bird Flu. Combining a cleaning detergent and bacteria-killing disinfectant in one, harmful bacteria are killed in just 10 seconds. PatientPak’s Hand Sanitiser and Sanitising Wipes, the most extensively tested products on the market, are also the only MRSA-killing products that are hand safe with just 5% alcohol, meaning that food can be eaten after application with no need to re-wash hands.”

Maybe I’m reading this wrong, but the first sentence indicates that viruses are a subset of bacteria (see bold text). A quick scan of the web site reveals no corroborating case studies or published data on germicidal efficacy. If the products are indeed the most, “…extensively tested…” shouldn’t the test results be available?

I’d like to know how the sellers know that the products ‘kill’ bird flu? Was it tested against H5N1, or was it a surrogate? Or does it work against Influenza A, and therefore it is assumed to likely be effective against bird flu?

I’m also sceptical of the germicidal effects of a detergent that is used for 10 seconds. To the best of my knowledge, detergents do not ‘kill’ or deactivate microorganisms. Detergents help water remove and dilute contaminants. It is generally accepted that washing your hands with a detergent (soap) requires a good 20 seconds or so. I may be wrong, but since the company does not provide an explanation of their technology or other scientific studies, we are forced to use the information that we have.

On the positive side, I like the idea of empowering people to actively participate in their healthcare. Bringing the PatientPak to the hospital is not necessarily a sign that a hospital is not doing its job. To me it is an indication that HAIs are environmental issues requiring a broad-based strategy. While hospitals need to do more, I wouldn’t bet my life on it.

So, would I buy the PatientPak? No, not based upon what I know of the kit so far. I do not believe, however, that it will cause any harm. It might actually help. There’s a lot of sizzle in this product promotion, but not much science. It is always wise to remember that there are no panaceas for HAI.

New study shows UV effective against H5N1

2007-04-09T14:58:00.000-04:00
One of the things that differentiates my firm from others doing the same thing is that we are committed to real science. When concerns began to mount over the potential of pandemic influenza, many competitors jumped on the bandwagon and claimed they could 'kill' the H5N1 virus.

That's until you read the small print and determined that they tested their systems against a 'surrogate' virus. Why a surrogate? It's a lot cheaper and easier to test a pathogen that is 'like' highly pathogenic H5N1. But when you cut corners in this manner, it prevents you from truly designing your system to provide the proper dose of UV needed to deactivate the target microorganism.

That's why I am proud to announce the results of our testing involving UVGI deactivation of H5N1. Yes, it took extra time and resources, but the pursuit of predictable outcomes makes all our efforts worth while. In a nutshell, VIGILAIR was effective in deactivating live H5N1 viruses (the Vietnam strain). Although we are unable to share all the results at this time, we can say that the real H5N1 virus differs from influenza A, in respects to UV-C. This is the first time that such testing has been performed. VIGILAIR has also successfully deactivated SARS and anthrax...the real stuff, not just surrogates.

A meeting of creative minds

2007-03-12T15:47:00.000-04:00

I was privileged last week to attend the evidence based design and a passion for improving the environment of care in health facilities world wide. The Center is known for matching new design technology with progressive hospital administrators who are looking for innovative ways to improve patient care.
Environment Standards Committee (ESC) members volunteer their time to bring evidence based ‘best practices’ to such organizations such as the American Institute of Architects (AIA).
ESC members tend to be recognized leaders in architecture and design who are simultaneously extremely creative and pragmatic. They marry their expertise with a hunger for innovation to produce solutions that are aesthetically, environmentally and economically beneficial.
Following the meeting, we were given a tour of the building. Richard Smith was kind enough to show us the newly designed structure of 1305 York Avenue, a part of the Weill Cornell Medical College. Mr. Smith demonstrated how attention to design details have yielded a significantly better care experience for patients who receive ambulatory outpatient services here.
Many of the innovations stemmed from a patient survey that highlighted patient perceptions about care. Changes in design to floor plans and internal procedures have produced a streamlined admissions process that reduces waiting time, assures HIPPA privacy and eliminates paper records. It would be difficult to review all the innovations of this building, so I will share some images of the tour.

Center For Health Design

Healthcare takes a new look at airborne pathogens

2007-02-26T15:40:00.000-05:00

The concept of airborne disease transmission was well accepted in the early to mid 1900's. It was frequent that you would see UV lights in hospital wards for upper air disinfection. UV lights were a standard form of infection control in TB wards.
But then times changed. Aggressive measures helped to eradicate TB from our country. Drugs such as vaccines proved effective and immediate. Hospitals, like all buildings, began to have ventilation to exhaust contaminated air while bringing in fresh air. Scientists and researchers turned away from studying airborne transmission and moved on to newer issues.
Since the advent of SARS, pandemic influenza and a resurgence in TB, scientists are once again turning their attention to airborne transmission. We've prepared a new white paper that examines some of the findings of these new studies. Like all good research it answers some questions and raises some more! Hopefully this spark new interest in studying airborne transmission.

UV Destroys DNA in a Flash!

2007-02-23T17:29:00.000-05:00

Readers here know that we discuss the germicidal aspects of Ultraviolet Irradiation. We know that a specific wavelength of UV damages a microorganism's DNA, which neutralizes the pathogen. We also know that UV does this pretty quickly from lab experiments and published papers. But now we know just how fast it takes.
Researchers have now clocked the effects of UV on DNA in real time. It turns out UV does its work in less than a picosecond.
For more on what a picosecond is, and what this development means to scientist, check out this link to Science A-go-go. It's a great site for science with a little twist!

South Africa Fights XDR-TB with UVGI

2007-02-07T10:31:00.000-05:00
Multi and Extreme Drug Resistrant TB strains are ravaging parts of Africa, mainly preying upon HIV+ patients whose immune systems are weakened. While TB was nearly eradicated from Western countries, it is a serioud health threat elsewhere, especially in South Africa.
Because TB is airborne, UVGI systems are an effective way to stop transmission of the disease. The article below mentions how UV is used in a new TB unit in a hospital about 2 hours north of Pretoria.
The Minister of Health, Dr Manto Tshabalala-Msimang and Limpopo Health MEC Seaparo Sekoati visited a newly upgraded Tuberculosis (TB) unit at the FH Odendaal Hospital in the town of Modimolle in Limpopo today.
The visit comes after the Department of Health spent about R2, 5 million to upgrade the unit to accommodate more drug-resistant TB patients.

The unit is designed to prevent hospital acquired TB infection and improves patient care and treatment outcomes.

The hospital has 38 beds, 17 Multi-Drug (MDR) TB patients and three Extreme Drug Resistant (XDR) TB patients are accommodated in the hospital.

The unit is fitted with extractor fans and ultraviolet light filters which remove and kill bacteria and thereby prevent cross infection in the hospital.

"For extra protection, respirator masks are issued to all health workers and visitors in the hospital and patients are provided with surgical masks," Dr Tshabalala-Msimang.

She said MDR TB Units are being improved countrywide to deal with infection control.
UV systems were routinely used in this country to treat TB, starting in the 1930's. As more effective drugs were crafted, and TB's threat waned in the US, so did the use of UV in hospitals. It now appears that UV technology is once again needed to help stop the TB killer from spreading.

US Military Magazine Reviews UVGI

2007-02-01T08:44:00.001-05:00

Arthur S. Hughes knows a thing or two about terrorism, national security and airborne pathogens. To start, he served in the Navy during the Vietnam era. Now he is a Master Sergeant in the National Guard's 128th Chemical Company and is a PA (Physician's Assistant). In his civilian life he works for the New Jersey Department of Environmental Protection.

So, when it comes to biodefense, he's got the credentials!

In the most recent issue of the journal Army Chemical Review, Master Sergeant Hughes provide a neat overview of what Ultraviolet Germicidal Irradiation (UVGI) is, and how it can help protect buildings from attack. To read the article, click here.

To find archive issues of Army Chemical Review, click here.

In researching this article, I discovered that the Army has several publications that are available for us civilians. The list is extensive and interesting, whether you're researching the latest in defense technology or interested in military history. In typical Army creative style, the library is called the Army Professional Writing Collection and can be found here.

A New Flu View

2007-01-22T13:17:00.000-05:00
Here’s an update of avian influenza from around the globe:
Indonesia reported its 62^nd avian flu fatality last week. Only 18 Indonesians who have contracted the disease survived.

Of the 19 confirmed cases of avian flu in Egypt, 11 have been fatal. An Egyptian woman who had exposure to sick and dead poultry became the 19^th fatality last week.

Vietnam has suffered the greatest number of H5N1 infections. To date 93 people in that country contracted avian flu, resulting in 42 deaths

Other countries with reported avian deaths include China, Cambodia Thailand, Turkey and Iraq.

Another excellent way to get a snap shot of avian influenza as it develops is on Google Earth. Researchers have created an excellent map of bird and human outbreaks. In order to view the map, you need to have Google Earth installed on your PC. The map overlays for avian flu are available here.

UV 911

2007-01-15T12:14:00.000-05:00
From the Journal of Emergency Medical Services, word of an excellent application of UV—disinfection of ambulance interiors.
UV’s germicidal action makes it a perfect tool to sanitize the surfaces in an ambulance. After all, ambulance crews are our first responders and are likely to transport ill people in the case of an epidemic or pandemic. The article notes that UV-C is more effective on deactivating viruses than chlorine.

The article points out many of UV's benefits:

“UV-C lights have many advantages. They're environmentally friendly with no dangerous materials to handle or store, so employees won't need to handle any toxic chemicals. The lights are also immediately effective, economical and operator friendly. (Just flip a switch.) Maintenance is easy—periodic cleaning and annual lamp replacement should do it. Installation involves only simple wiring, timer switches and a power connection.”

Check out the complete article by clicking here. Although we do not design such application, the principle is the same for VIGILAIR HVAC protection systems.

Video Shows Iraqi Insurgents Firing Chemical Rockets

2007-01-11T10:08:00.000-05:00

A video that surfaced on the internet today appears to show Iraqi Insurgents arming and firing chemical rockets. The minute long video ends with four of the alleged 'chemical' rockets being fired from a makeshift launcher. Is is just propaganda, or a legitimate video? So far there has been no independent confirmation of the attack. The rockets are believed to have been launched in the Samarra region of Iraq, which is about 124 kilometers north of Baghdad. Samarra was used as the primary facility for producing mustard gas and nerve agents during the Saddam Hussein regime, according to Iraqwatch.org.
Should this attack prove legitimate, it raises concerns that such chemical weapons could be used more widely in Iraq, and elsewhere. We will keep you posted on this developing story!

Editorial-Pennsylvania's Infection Reporting

2006-11-21T11:27:00.000-05:00

Here is an open letter to the editor about the mandatory reporting of HAI's in Pennsylvania hospitals. It accurately reflects our feelings on the issue:

Editor,
Pennsylvania has a rich history of trail blazing in healthcare. The first medical school in America opened in our state in 1765. The first medical school for female students opened here as well, in 1850.

Building on this history of innovation, Pennsylvania is the first state to mandate thorough public reporting of hospital acquired infections (HAIs) for all hospitals within the Commonwealth. Now that the first year’s worth of results are published, hospital officials are justifiably concerned that people will misinterpret the information. As a person who works with hospitals in Pennsylvania to reduce HAIs, I understand their unease.

Under the current reporting rules:

-some honest hospitals that scrutinize and report all HAIs may face an unfavorable comparison with hospitals that are not as diligent in their reporting.

-the types of infections that hospitals were mandated to track changed during the year; these rule changes may’ve caused errors and confusion.

-mortality rates are skewed for hospitals that provide palliative care for terminally ill patients who, by request, do not seek aggressive interventions.

In the hospitals’ defense, defining the source of an infection can be elusive.

Difficulty in finding an infection’s source is reflected in a study published in the November 2006 issue of the American Journal of Infection Control. Researchers reviewed medical reports of more than 1,500 outbreaks of HAIs. In 37% of the outbreaks no source could be identified.

Where does this leave Pennsylvania healthcare consumers? The answer is that we are in a better position than any other state to monitor and improve the quality of medical care. Here are some things to keep in mind as you review the new statistics on HAIs:

-knowledge is power! Some measure of quality is better than none. HAI statistics are certain to evolve with time and become clearer and fairer.

-HAI rates are just one indicator of quality. Speak to your physician, or better yet, speak to a nurse who works in a hospital you’re considering for a procedure. Another great source of hospital information is available on the web through the Joint Commission on Accreditation of Healthcare Organizations (www.jointcommission.org).

-all healthcare is local. Many effective hygiene techniques occur right inside your hospital room. Thanks to HAI awareness, you can prevent infections by insisting on rigorous adherence to hand washing procedures (don’t be shy about asking physicians, nurses and visitors to wash their hands).

In Pennsylvania we should be proud that we are able to gather and view information on HAIs. In many other states political pressure has prevented citizens from having access to this important data. We must be aware that infection control is dynamic—numbers can only tell part of the story. But at least we are telling the story here in Pennsylvania and we are beginning a dialogue on how to break the chain of pathogen transmission within hospitals.

Once again Pennsylvania is a pioneer in healthcare.

Highlights of Healthcare Conference in Harrisburg

2006-10-29T21:03:00.000-05:00
The Pennsylvania Society of Healthcare Facility Engineers (PSHFE) chose to meet in Harrisburg, PA this past week, and I think I know why. The region is exploding with autumn colors this time of year, especially as you approach from the north, as I did. The vivid leaves contrasted the dark shades of the mountains, the granites and limestones that thrust skyward in this region. If the light is right the Susquehanna River provides a pastel mirror of the scene as it leads you to Harrisburg, the commonwealth’s capitol.

The day long conference brings together professionals who are prime audience for VIGILAIR Systems, Inc. Attendees tend to be progressive and active men and women who manage the physical plants of regional hospitals. Among the participants were several current customers who have VIGILAIR® installed inside their facilities.

The conference’s first speaker provided an update on the ‘Environment of Care.’ Michael Rudolf explained changes in JACHO programs, how to prepare for a survey and how to respond should you face a ‘Recommendation For Improvement’. Mike proved to be one of the most thoroughly prepared and well researched presenters I’ve heard in a long time. He is the Director of Improvement Services for VHA East Coast.

The Director of KTH Architects provided compelling information on AIA’s new Guidelines for Design and Construction of Health Care Facilities. John Adams not only knows what the changes are, he also knows why they changed them and how the guideline authors arrive at decisions. I had a chance to talk to John about one of those changes, the move to design all new patients rooms as single bed. According to John there are several reasons for this change:
reduce nosocomial infections
patient comfort
HIPPA/privacy concerns

It is encouraging to see guidelines that recognize the relationship between Hospital Acquired Infections (HAI) and a hospital’s design. As John explained, decisions are based upon scientific literature. It in incumbent upon entities such as VIGILAIR® to provide the AIA with the growing body of evidence that links air quality and infection transmission. The AIA wants to make timely recommendations and is strongly considering instituting periodic findings to address emerging problems. Wholesale guideline reviews will continue on a four year cycle.

PSHFE President Jim Kelley presented several awards to delegates and reviewed the group’s improving fiscal health.

So you arrive at the hospital that you work at one day. Patients are lined-up out the ED’s door. 70 of them need ventilators. You have ten. You need extra staff, but 1/3 of your workers cannot or will not report to work. What do you do?

That was the question poised by Melissa Speck, the Director of Policy Development at the Hospital & Healthsystem Association of Pennsylvania (HAP). Ms. Speck focused on the issues hospitals face should a pandemic strike. Then she broadened to topic to include any emergency incident that causes the need for surge capacity. Ms. Speck was careful to stress preparation, rather than panic in such situations. She urged delegates to become involved in planning and warned them not to expect the Federal government to come to the rescue. Following her presentation, she spoke to my colleague and me at our display booth. Ms. Speck seemed particularly interested in the fact that several of our Pennsylvania VIGILAIR® installations were funded by HERSA grants.

A quick recognition of the other vendors who were working hard:

Rachel and Len from Hayes Large Architects.

Jennifer who teamed-up with John Adams to represent KTH Architects.

The always outgoing Leslie (sadly, mostly hidden in this shot) and her colleague James kept things interesting throughout the conference.

Here's Tom Leach (VIGLAIR System's NYC Sale Representative) at our booth chatting with Tim Robb.
This conference featured excellent speakers and interesting people. I'm certain that next year's conference will be even better!

It is nice to be recognized

2006-10-24T14:32:00.000-04:00
Not me, my boss!
The CEO of my company was recognized by a prestigious trade journal to be the key speaker for an on-line forum on infection control.
The magazine, Faciltity Care, is well respected by those of us who market technology to the healthcare sector. Tim, our CEO, will discuss various aspects of aerosols and airborne infection. The forum is a 2-way discussion so I'm certain that he will take questions from the audience on UVGI and its application in the HVAC system of hospitals.
For more information on the forum, click here.
Vigilair UVGI HAI infectious disease bird flu

Financing the global village’s healthcare. Are we doing enough?

2006-09-26T21:26:00.000-04:00
Health economist Ruth Levine (a member of the think tank Center for Global Development) makes an interesting analogy in a recent essay entitled, “A Cure for the Asian Flu.” In the article Ms. Levine notes the global response to economic crises in third world and emerging nations. In this world economy, when Asia sneezes. Wall Street can quickly get a cold.
When these situations arise the US, World Bank, IMF and other entities are there to lend financial support. Ms. Levine’s premise is that such interventions are not charity, but preventive medicines to isolate and ‘cure’ an ailing economy before the red ink washes upon our shores.
The essay proposes that we treat global health problems as we do global financial problems and drastically increase aid. Ms. Levine suggests that spending more on health care for developing nations will act as an investment that keeps such problems away from us.
Agreed. Better healthcare in China equals better healthcare in the West–remember SARS? But redistributing wealth on a grand scale to achieve this goal is not the sole answer. Let’s look at AIDS as a global health problem.
AIDS awareness spending is higher than ever. Few Americans (3% in a recent poll) know that the Bush administration has pledged $15 billion to fight HIV over a five year period ($8.4 billion has already been spent). AIDS is not a new issue, and it must be assumed that most people in the world are aware of what it is and how to prevent it. The good news is that with increased spending we’ve seen HIV infection rates decrease or stabilize for the most part. But despite all the awareness and spending, 40,000 Americans become infected with HIV each year. World wide 14,000 new HIV infections happen everyday, totaling 5 million new HIV infections each year. Money is part of the solution, but not the only solution for this problem.
Sometimes aid is ineffective, and it is not because the donor countries are not giving enough. Economics Professor William Easterly discusses the issue in his book, The White Man’s Burden; Why the West’s Efforts to Aid the Rest have Done So Much Ill and so Little Good, (Penguin Press, 2006), NY Times book review here.

[A tragedy of the world’s poor has been that] the West spent $2.3 trillion on foreign aid over the last five decades and still had not managed to get twelve-cent medicines to children to prevent half of all malaria deaths. The West spent $2.3 trillion and still had not managed to get four-dollar bed nets to poor families. The West spent $2.3 trillion and still had not managed to get three dollars to each new mother to prevent five million child deaths.

… It is heart-breaking that global society has evolved a highly efficient way to get entertainment to rich adults and children, while it can’t get twelve-cent medicine to dying poor children.
Rational people can agree that more should be done to better the healthcare of all who inhabit this interconnected planet. For altruistic or self-centered reasons, those who are blessed with more should share with those who have less. But it is unfair to characterize the developed world in general and the US in particular as uncaring, short sighted and cheap. In a world of limited resources and seemingly unlimited need it is reasonable that donor countries seed money where it is effectively spent. It is incumbent upon recipient nations to make the most of the funding. Frequently governments and individuals, for political and personal reasons, corrupt the process. If Ms. Levine wants healthcare aid to have the same stipulations (e.g. insistance on positive outcomes) as other aid, then I'm all for it. But it should be done intelligently.
In fighting global health issues donor countries can supply some meager tools. It is up to the recipient countries to build the best systems that they can with those tools. Yes more needs to be done, but it is not from a lack of trying by more developed nations.
As Professor Easterly says in his book, judging the success of aid programs by the amount of money spent is like reviewing hollywood movies based on their budgets.

pandemic global+infection aid healthcare AIDS Easterly

XDR-TB, S.A. and UVGI

2006-09-25T21:38:00.000-04:00

Extensively Drug Resistant TB (XDR-TB) is an emerging killer that is virtually untreatable. World wide, 9 million people contract TB each year, and 1.7 million of them die. Typically TB is treated with first and second line drugs. XDR-TB is resistant to the first line drugs as well as most of the second line drugs. There are no third line drugs for TB at this time. This new strain is found in many countries, including the US. Right now it is preying upon HIV positive patients in South Africa. In one South African ward, 52 of 53 patients infected with XDR-TB died. And they died quickly, within 25 days of diagnosis.

Part of the problem is the nature of South Africa's inadequate health care. 50% of South Africans treated for TB will find themselves back at the hospital again because their treatment failed. The longer these people stay in the hospital, the more likely they are to come in contact with, and contract, XDR-TB. In essesnce, the South African situation appears to be an instance of Hospital Acquired Infection. That's where Ultraviolet Germicidal Irradiation could play a role.

UVGI was a regular method of TB control in the US for many years. Upper room UV deactivates TB and prevents the virulent bacteria from infecting people via the air. As effective drugs were developed, UV fell out of vogue. But UVGI plays a unique role in fighting infectious disease. Virulent viruses and bacteria are programmed to find ways to adapt to medicines that stop them. Over time, drugs lose their effectiveness and contribute to creation of drug resistant microorganisms.

UVGI is a prophylactic barrier. The use of UV radiation to prevent DNA and RNA from being able to replicate is not something that a microorganism can adapt to and circumvent. Of course, certain organisms are more resistant to UV and take a larger dose for inactivation (e.g. spores). However, an organism's suseptibility to UV doesn't change or grow more resistant. Once engineers know the dose needed to inactivate a microorganism, UV systems can be designed with sufficient exposure to get the job done.

So far we are unable to find any reports of the use of UV in South Africa to fight XDR-TB. Given that doctors involved in this crisis say XDR-TB is a nosocomial phenomenon, it would appear that UVGI could help contain a threat that is more immediate and more deadly than exisitng strains of H5N1.
XDR-TB TB South+ Africa UVGI UV Vigilair airborne+transmission

Old Flu News is New Again

2006-09-13T10:25:00.000-04:00
How did Americans deal with the ‘Spanish Influenza’ outbreak during WW I? The following is taken from a memo by the US Army Surgeon General. It appears as if some of these suggestions remain valid to this day:

Memorandum, Surgeon General’s Office, for camp and division surgeons, September 27, 1918. Personal Defense Against Spanish Influenza. It is desired that the following 12 suggestions for avoiding influenza be given all possible publicity in your camp, by placarding and other proper means of bringing it to the attention of the command.

HOW TO STRENGTHEN OUR PERSONAL DEFENSE AGAINST SPANISH INFLUENZA.
Avoid needless crowding; influenza is a crowd disease.
Smother your coughs and sneezes; others do not want the germs which you would throw away.
Your nose, not your mouth, was made to breathe through; get the habit.
Remember the three C’s—a clean mouth, clean skin, and clean clothes.
Try to keep cool when you walk and warm when you ride and sleep.
Open the windows—always at home at night; at the office when practicable.
Food will win the war if you give it a chance; help by choosing and chewing your food well.
Your fate may be in your own hands; wash your hands before eating.
Don’t let the waste products of digestion accumulate; drink a glass or two of water on getting up.
Don’t use a napkin, towel, spoon, fork, glass, or cup which has been used by another person and not washed.
Avoid tight clothes, tight shoes, tight gloves; seek to make nature your ally not your prisoner.
When the air is pure, breathe all of it you can; breathe deeply.
If anyone can tell me the link between infection and tight clothes, please do so. The material above is from Office of the Army Surgeon General, Public Affairs, and the Directorate of Information Management, Fort Detrick, Md. Their web site is quite informative.
Image info: Emergency hospital during influenza epidemic, Camp Funston, Kansas.
Source: National Museum of Health and Medicine
Bird flu Spanish flu Pandemic 1918 flu history VIGILAIR

Avian Flu Fighters use GPS for Wild Swan Chase

2006-09-07T15:44:00.000-04:00
This is tangential to our normal topics, but it's cool to see how man evolves and adapts to evolving threats from nature--namely H5N1. If you think the first image looks like people putting a backpack on a bird, you are correct. Researchers are carefully attaching tiny solar powered GPS sending units to 10 Whooping Swans.
The swans are migrating now from their homes in Mongolia, to their wintering grounds in Europe. The swans' journeys will be mapped by the researchers who are tracking the GPS information transmitted by the tiny GPS units. The hope is that this information will help is better understand the role that migratory birds play in the spread of bird flu.
These swans were chosen for two reasons:
Highly Pathogenic Avian Influenza has alreadybeen found in this bird, so it could be an infection spreader
Thousands of the swans mysteriously died in Mongolia and China in 2005 and 2006 in areas where few chickens are present.
Check out complete information from the scientists involved in the study by clicking here.
The second image shows a swan heading back into the wild with its tiny GPS backpack. The units are designed to eventually fall off the birds after the migration season.
Let's hope that our knowledge continues evolving just as pandemic threats evovle in the world.
bird+flu Avian+flu H5N1 Virus Research Vigilair

Hygiene Expert: Reduce Harmful Bacteria by Changing Your Culture!

2006-09-06T14:40:00.000-04:00

A novel idea is proposed by Virologist Dr. John Oxford of the Royal London Hospital. Dr. Oxford suggests that governments can change public hygiene behavior by changing public perception. In other words, let’s treat hygiene issues the same way we’ve attacked smoking and seatbelt use.

A coordinated public PR campaign taught in schools and broadcast as PSA’s could change the way people think about hand washing, house keeping and other hygiene issues. Dr. Oxford chairs the Hygiene Council, a think tank that promotes better understanding of the role microorganisms play in infectious disease. The Hygiene Council is funded by Reckitt Benckiser marketers of such brands as Calgon, Lysol, Woolite and Spray-N-Wash.

The Hygiene Council has just conducted a survey of Canadian hygiene practices that found:
36% of respondents did not properly wash hands after sneezing
37% of respondents didn’t wash hands after petting animals
9% of respondents failed to wash their hands after using the restroom

Back to the war on germs. Oxford’s recommendations are an excellent start to reduce infections such as colds and flu. I see it as an important part of disrupting the chain of transmission, an idea that recognizes infectious disease is an environmental issue which includes all modes of transmission.
Health disease airborne Vigilair blog

H2H avian flu transmission in Indonesia?

2006-05-24T15:53:00.000-04:00
“Tell the truth. Just don’t tell the whole truth,” my AP English teacher said. It seems that The World Health Organization is following this advice in the wake of a recent Avian Flu outbreak in Indonesia.
A woman who worked selling vegetables contracted the H5N1 virus, possibly from live animals that were sold in the market where she worked. She brought the infection home and this resulted in the death of a total of six family members. A seventh family member was able to survive the infection.
In a conservative move the WHO has not explicitly stated that Human to Human (H2H) transmission is at play in this outbreak. Instead WHO said:
“no evidence that efficient human-to-human transmission has occurred”
Many Infectious Disease Professionals are arriving at the conclusion that H2H has occurred, although this transmission has not been efficient. So what’s the big deal? People who monitor H5N1 become suspicious when the WHO tells part of the truth. So when the WHO says genetic sequencing of this Indonesian flu strain shows no significant mutations in the virus, people may be skeptical. Especially since the sequencing is not freely shared with researchers.
The bottom line is that H5N1 has changed in this respect: it appears that people with no direct contact to poultry can become infected with the Avian Flu. This is a new development…or it is new because we are uncovering more of the whole truth?

DHS Designates our Biodefense Technology

2006-05-16T12:32:00.000-04:00

With as much emotion as engineers and researchers can muster, everyone at our firm celebrated an important achievement last Friday.

We received DHS SAFETY Act Designation!

In order to understand why this was so important to us, you’ll probably need to know what the SAFETY Act is. In 2002 the US Congress passed the Support Anti-Terrorism by Fostering Effective Technologies (SAFETY) Act. The law aimed to help bring anti-terrorism technology to the market place. Law makers were concerned that issues surrounding liability would prevent much needed security technology from being developed and deployed.

The SAFETY Act set predetermined liability limits for the manufacturers and users of Qualified Anti-Terrorism Technologies (QATT) for claims arising out of a terror attack. The SAFETY Act effectively removes many of the barriers facing new defense technologies. As those barriers decrease, adoption of critical infrastructure protection technology increases.

Why are we so happy?
The Designation recognizes all of the exhaustive efforts of our staff. DHS requires comprehensive data during the application process. Once compiled, the application is scrutinized by a group of technical experts empanelled by the DHS.

Our team spent more than 300 man hours in the compiling, writing and submission of the application. The months of hard work paid-off on Friday when we read the words in the letter from DHS Under Secretary Jeffrey Runge:
“I hereby designate the Technology as a Qualified Anti-terrorism Technology and issue a Designation…for the technology.”
We are in good company. Other enterprises that have successfully earned Designation include Lockheed-Martin, Boeing, Northrup-Grumman and IBM. We’re not as large as those companies…at least not yet!

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Bird Flu goes Hollywood

2006-05-09T13:06:00.000-04:00
ABC is airing a 2 hour made for TV movie dramatizing the outbreak of a deadly pandemic flu. “Fatal Contact: Bird Flu in America” is certain to start people talking about the pandemic problem, but some health experts are concerned the drama may inaccurately portray the real situation.
In a breaking of precedence, the US Federal Government is prepared for a flood of potential inquiries from Americans who watch the movie. Health and Human Services has issued ‘talking points’ for staff who may encounter bird flu related questions.
While some health care experts are panning the pandemic thriller for hype, tv critics seem to agree it is good television. The Hollywood report recommends the movie!
Hopefully the movie will cause conversations about the bird flu, and maybe, just maybe it will lead to better understanding of infectious disease. For that reason alone, I would give the effort two thumbs up!
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Ohio Hospital Association

2006-05-03T15:45:00.000-04:00
Ohio Hospital Association
We just returned from attending a seminar in Dublin, Ohio (just northwest of Columbus). VIGILAIR Systems was there due to our relationship with the Ohio Hospital Association. More than 100 delegates from across Ohio gathered to learn more about the rigorous Joint Commission Environment of Care survey methodology and standards
Our company President and I met many committed professionals who typically work behind the scenes at hospitals, yet are critical for healthcare to function.. We were pleasantly surprised at the level of delegate awareness regarding hospital acquired infection and possible contributing environmental factors.
Seminar moderator Ed Snyder kept the day long tutorial fast paced, fresh and interesting. I would strongly recommend him and his organization (OSHFM.org), to anybody in healthcare who wants to exceed JACHO’s expectations.
Expanding on our recent successes in the Pennsylvania market, we look to work closely with many of healthcare professionals in Ohio, such as those who attended the ‘Practical Answers to the Tough EC Questions’ seminar hosted by the OHA.
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MIT offers bird flu simulation

2006-04-21T08:16:00.000-04:00
MIT researchers simulated the effects of an avian flu outbreak on the world’s economy. The results are sobering, and worth considering. The article also offers some good advice on preparing for business disruptions such as those that could occur with the bird flu. Among the hurdles for companies to overcome, mass absenteeism as workers stay home to avoid infection. Find the infoworld article published here.
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What is in a name?

2006-04-03T21:56:00.000-04:00
There is a Chinese proverb that reminds us, “The beginning to wisdom is to call things by their right names.”

With that in mind, the company that I work for has changed its name. The venerable company, founded in 1959, was named FP Technologies when I joined the team. As of April 1, 2006 we are now known as VIGILAIR Systems, Inc.

The new name is appropriate in that a majority of our clients know us for VIGILAIR, our HVAC decontamination product. Our product began eclipsing our company’s name recognition over the past two year when we noticed that some clients identified our company as VIGILAIR on payment checks. To eliminate any confusion, and to insure prompt processing of payments, the change was made.

We added the word ‘Systems’ because we feel that it takes a systemic approach to solve our clients’ problems. In the market place we’ve found many companies that sell one component (e.g. a filter or a UVGI fixture) as an air purification solution. The real world is more complex. The solutions to environmental contamination are multi-faceted and demand a multi-disciplinary approach.

So we glance over our shoulder and say farewell to FP Tech, as we look to the future and say hello to VIGILAIR Systems, Inc. And we are wiser for making the change.
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The Myth of HEPA Filtration

2006-03-28T15:04:00.000-05:00
HEPA filters have been on the job protecting environments since the days of the Manhattan Project. HEPA's reputation as an effective filtration measure is well deserved, but some people believe that if they have a HEPA filter, they are completely free from contamination concerns.

From years of utilizing HEPA filters in cleanrooms and hospitals, we know that this notion is false. Please review our White Paper on this topic (The Myth Of HEPA).

If you have any comments on this paper, please post them here.
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HEPA blog Vigilair filtration

Getting a Grip on Hand Sanitizers

2006-03-27T13:30:00.000-05:00
A new report in the CDC’s March Edition of Emerging Infectious Disease found that some gel hand sanitizers do not do a good job of killing germs. Researchers found that the alcohol content of some gels in insufficient to kill fungi and bacteria.

The FDA recommends a 60% to 95% formula of ethanol or isopropanol for hand sanitizers. One commercial hand cleaning gel that was tested promised a 99.9% reduction in “germs and harmful bacteria.” Lab experiments showed that this gel, with a 40% ethanol concentration, yielded no significant reduction in microbial load, which makes it as effective as washing your hands with tap water.

While having some effect on fungi, the gel actually increased bacterial load. Results showed that the most common bacteria found on the hands were staphylococci, including those with characteristics of Staphylococcus aureus.

UK Study: MRSA Higher in Crowded Hospital Wards

2006-03-23T15:34:00.000-05:00

According to a study in the British Journal of Nursing, patients face a greater risk of contracting MRSA if they are treated in a ward with a high occupancy rate. The study by researchers at the University of Ulster found that more than half of the Northern Irish surgical wards exceed UK overcrowding guidelines.
The UK government recommends that bed occupancy rate of 82%. All 11 Northern Ireland wards tracked in the study had occupancy rates above 85%. Over utilization of the beds equals greater MRSA risk, according to the researchers:
“Their study suggests a relationship between percentage bed occupancy and MRSA rates: the higher the level of occupancy the higher the risk of MRSA infection and they are now investigating these factors in all the English acute and specialist hospital Trusts.
Individual acts, it is argued, such as hand washing, good hygiene, and the use of alcohol gels are important; but there may be structural and systems issues which may contribute to hospital acquired infections. Nurses, managers and Trust boards, they say, must address these macro as well as micro issues in the control of hospital infection.”
Hospitals are finally seeing the mounting evidence that infection issues are environmental and systemic. The chain of transmission has several links. We need to address all of them, including indoor air contamination to find a lasting solution.
(There is no link available to the original study text as the British Journal of Nursing as it does not publish on-line yet)

Technorati Tags
MRSA,blog,vigilair, hospital, nosocomial

The Skinny on Airborne MRSA

2006-03-18T20:41:00.000-05:00
The Skinny on Airborne MRSA
In our discussions with infection control professionals, MRSA is a frequent topic. It appears that there is a strongly held belief that MRSA cannot be transmitted via the air. For the doubters, I humbly submit:
“Staphylococcus aureus, often referred to simply as "staph," is a bacteria commonly found on the skin and in the nose of healthy people” -CDC.
“Normally, skin cells are replaced every 28 to 30 days”-Cleveland Clinic
If MRSA is frequently found on your skin, and you completely shed the top layer of your skin once-a-month, isn’t it reasonable that MRSA is hitching a ride on some of those millions of shed skin cells? You know, those skin cells that form cobwebs hanging from your ceiling?
Finally, If we doctors typically test for MRSA using nasal swabs, how did the MRSA get there? Could it be that people inhaled the MRSA through their noses? Air transmission may not be the largest contributor in the spread of MRSA, but it seems likely that it should be considered as one of the links in the chain of transmission.
(MRSA image-University of Texas)
UPDATE: For more information on MRSA's airborne spread, including a list of peer reviewed studies on the topic, please visit this posting from our blog.
MRSA blog vigilair

H2H Avian Flu…Who Knew?

2006-03-14T11:13:00.000-05:00
H2H Avian Flu…Who Knew?

‘H2H’ may soon join our lexicon much in the way ‘Y2K’ did at the turn of our last global crisis. If H2H is new to you, it is shorthand for ‘Human to Human’, as in Human to Human transmission of the bird flu. The term H2H is spreading just like the bird flu. In February, the term was searched on Yahoo 471 times; bloggers enter H2H into Technorati’s search engine about eight times a day.

H2H is important because it represents the next big step in the evolution of the H5N1 virus. The question is, when will H5N1 go H2H? The answer is, it already has! With all the hype surrounding bird flu, why don’t more people know about this development? Why aren’t the CDC and WHO telling us?

It turns out that they are, in a muted way. Here’s the alert level posted on WHO’s site:

Note we are in phase 3, “No, or LIMITED H2H transmission”.

From the CDC:
“While H5N1 does not usually infect people, human cases of H5N1 infection associated with these outbreaks have been reported Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few rare cases of human-to-human spread of H5N1 virus have occurred, though transmission has not continued beyond one person.”

In reality, the medical world has known about H5N1 H2H for awhile. One of medicine’s most prestigious periodicals, The New England Journal of Medicine, featured this study in January of 2005:
Results: The index patient became ill three to four days after her last exposure to dying household chickens. Her mother came from a distant city to care for her in the hospital, had no recognized exposure to poultry, and died from pneumonia after providing 16 to 18 hours of unprotected nursing care. The aunt also provided unprotected nursing care; No additional chains of transmission were identified....
Conclusions: Disease in the mother and aunt probably resulted from person-to-person transmission of this lethal avian influenzavirus during unprotected exposure to the critically ill index patient."
Why aren’t we panicking? The rare cases of documented H2H for H5N1 prove that the chain of transmission is very short. It appears that the virus does not efficiently transfer between humans, leading to the rare H2H infections. As the virus changes, it could acquire the ability to spread easily between humans—or it may not. The only safe prediction is that this virus will change and that the best thing for us to do is to support the researchers who are tracking H5N1.

While there is no cause for panic, there is one fact surrounding H5N1 that is of concern. The most recent great pandemic in 1918 killed upwards of 50 million people worldwide, according to the CDC. Its mortality rate (number of deaths as a percentage of total people who got infected) was under 2.5%.
Today’s H5N1has infected a total of 177 people, killing 98. Its mortality rate is 55%.
Let’s hope that like Y2K, H2H will become a footnote in history, rather than a chapter of global suffering.

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Hoping for the Best, Preparing for the Worst

2006-03-10T15:17:00.000-05:00
This month's Health Facilities Management Magazine has an excellent article on how hospitals can prepare for the surge capacity needed should a pandemic or similar infectious outbreak occur. Author Frank Zilm knows the subject matter well and succintly outlines challenges for protecting staff and patients, the hospital building and the Emergency Department.
New ideas in healthcare design, especially the ED, are essential to meet the challenges of infectious disease:
In most scenarios, the emergency service will be a primary entry point into the health care system and other components of the system (inpatient beds,physician offices, and clinics) will also quickly reach saturation.

Of equal importance are the high-risk patients that present on a daily basis. “If you plan for these special-risk situations, it will help with interrupting the chain of transmission,” says Craig Feied, M.D., FACEP, director of the Institute for Medical Informatics, MedStar Health, Washington Hospital Center, Washington, D.C. “Traditional design does nothing to reduce risk.”

Disease can be spread through airborne particles, direct contact with an infected patient and contact with a surface (fomite) that harbors a reservoir of active virus or bacteria. Among these, airborne contamination and fomite contact have clear implications for health care facility design professionals.

Dr. Feied's comment "breaking the chain of transmission" is right on the money. We need to spread awareness that hand washing alone will not prevent the spread of disease. Additional measures of cleaning the environment, especially the airborne route of transmission are important links in the chain.
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Airborne Infection Prevention

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1. European Confederation of Medical Mycology Conference 1996. S. Heinemann, G. Van. houte, N. Nolard. Contamination of indoor environment and air conditioning.

2. European Confederation of Medical Mycology Conference 2008. Khan M, Gonsoulin T, Simpson S, Horner WE. Exposure levels of aspergillus fumigatus from various indoor reservoirs in health care facilities.

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Last Updated: 12:09pm GMT 09/01/2008