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.

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

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

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

Tuesday, May 6, 2008

A new hospital superbug resistant to all antibiotics could be killing hundreds of patients, experts have warned.

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.