More Evidence of MRSA's Airborne Spread

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?

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

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

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

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

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?

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

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

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

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?

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

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 among the patients, the air, and the inamimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in 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

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

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

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

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!

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

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

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

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

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

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!