Swine Flu: time for planning, not panic

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.

UV offers green alternative for cleaning genome lab

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

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.

Physicians respond to changes in HAI reimbursement

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 Action UK-They Get it!

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.

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

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

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

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.

The war on hospital acquired infections, fighting on two fronts

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.

Keeping the Food Supply Safe

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.

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.

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

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

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%.

ASHRAE Meeting off to great start

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

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.

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.