Wednesday, February 20, 2008

Why the Space Shuttle needs VIGILAIR®

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...

Thursday, February 14, 2008

Killer in the NICU

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.

Friday, February 08, 2008

Echos in the media

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.