H2H avian flu transmission in Indonesia?

“Tell the truth. Just don’t tell the whole truth,” my AP English teacher said. It seems that The World Health Organization is following this advice in the wake of a recent Avian Flu outbreak in Indonesia.
A woman who worked selling vegetables contracted the H5N1 virus, possibly from live animals that were sold in the market where she worked. She brought the infection home and this resulted in the death of a total of six family members. A seventh family member was able to survive the infection.
In a conservative move the WHO has not explicitly stated that Human to Human (H2H) transmission is at play in this outbreak. Instead WHO said:

“no evidence that efficient human-to-human transmission has occurred”

Many Infectious Disease Professionals are arriving at the conclusion that H2H has occurred, although this transmission has not been efficient. So what’s the big deal? People who monitor H5N1 become suspicious when the WHO tells part of the truth. So when the WHO says genetic sequencing of this Indonesian flu strain shows no significant mutations in the virus, people may be skeptical. Especially since the sequencing is not freely shared with researchers.
The bottom line is that H5N1 has changed in this respect: it appears that people with no direct contact to poultry can become infected with the Avian Flu. This is a new development…or it is new because we are uncovering more of the whole truth?

DHS Designates our Biodefense Technology

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

We received DHS SAFETY Act Designation!

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

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

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

Our team spent more than 300 man hours in the compiling, writing and submission of the application. The months of hard work paid-off on Friday when we read the words in the letter from DHS Under Secretary Jeffrey Runge:

“I hereby designate the Technology as a Qualified Anti-terrorism Technology and issue a Designation…for the technology.”

We are in good company. Other enterprises that have successfully earned Designation include Lockheed-Martin, Boeing, Northrup-Grumman and IBM. We’re not as large as those companies…at least not yet!

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Bird Flu goes Hollywood

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

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Ohio Hospital Association

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

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MIT offers bird flu simulation

MIT researchers simulated the effects of an avian flu outbreak on the world’s economy. The results are sobering, and worth considering. The article also offers some good advice on preparing for business disruptions such as those that could occur with the bird flu. Among the hurdles for companies to overcome, mass absenteeism as workers stay home to avoid infection. Find the infoworld article published here.

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What is in a name?

There is a Chinese proverb that reminds us, “The beginning to wisdom is to call things by their right names.”

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

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

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

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

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The Myth of HEPA Filtration

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

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

If you have any comments on this paper, please post them here.

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Getting a Grip on Hand Sanitizers

A new report in the CDC’s March Edition of Emerging Infectious Disease found that some gel hand sanitizers do not do a good job of killing germs. Researchers found that the alcohol content of some gels in insufficient to kill fungi and bacteria.

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

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

UK Study: MRSA Higher in Crowded Hospital Wards

According to a study in the British Journal of Nursing, patients face a greater risk of contracting MRSA if they are treated in a ward with a high occupancy rate. The study by researchers at the University of Ulster found that more than half of the Northern Irish surgical wards exceed UK overcrowding guidelines.

The UK government recommends that bed occupancy rate of 82%. All 11 Northern Ireland wards tracked in the study had occupancy rates above 85%. Over utilization of the beds equals greater MRSA risk, according to the researchers:

“Their study suggests a relationship between percentage bed occupancy and MRSA rates: the higher the level of occupancy the higher the risk of MRSA infection and they are now investigating these factors in all the English acute and specialist hospital Trusts.
Individual acts, it is argued, such as hand washing, good hygiene, and the use of alcohol gels are important; but there may be structural and systems issues which may contribute to hospital acquired infections. Nurses, managers and Trust boards, they say, must address these macro as well as micro issues in the control of hospital infection.”

Hospitals are finally seeing the mounting evidence that infection issues are environmental and systemic. The chain of transmission has several links. We need to address all of them, including indoor air contamination to find a lasting solution.

(There is no link available to the original study text as the British Journal of Nursing as it does not publish on-line yet)

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The Skinny on Airborne MRSA

The Skinny on Airborne MRSA

In our discussions with infection control professionals, MRSA is a frequent topic. It appears that there is a strongly held belief that MRSA cannot be transmitted via the air. For the doubters, I humbly submit:

1. “Staphylococcus aureus, often referred to simply as "staph," is a bacteria commonly found on the skin and in the nose of healthy people” -CDC.
2. “Normally, skin cells are replaced every 28 to 30 days”-Cleveland Clinic

If MRSA is frequently found on your skin, and you completely shed the top layer of your skin once-a-month, isn’t it reasonable that MRSA is hitching a ride on some of those millions of shed skin cells? You know, those skin cells that form cobwebs hanging from your ceiling?

Finally, If we doctors typically test for MRSA using nasal swabs, how did the MRSA get there? Could it be that people inhaled the MRSA through their noses? Air transmission may not be the largest contributor in the spread of MRSA, but it seems likely that it should be considered as one of the links in the chain of transmission.
(MRSA image-University of Texas)

UPDATE: For more information on MRSA's airborne spread, including a list of peer reviewed studies on the topic, please visit this posting from our blog.

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H2H Avian Flu…Who Knew?

H2H Avian Flu…Who Knew?

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

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

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

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

From the CDC:

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

In reality, the medical world has known about H5N1 H2H for awhile. One of medicine’s most prestigious periodicals, The New England Journal of Medicine, featured this study in January of 2005:

Results: The index patient became ill three to four days after her last exposure to dying household chickens. Her mother came from a distant city to care for her in the hospital, had no recognized exposure to poultry, and died from pneumonia after providing 16 to 18 hours of unprotected nursing care. The aunt also provided unprotected nursing care; No additional chains of transmission were identified....
Conclusions: Disease in the mother and aunt probably resulted from person-to-person transmission of this lethal avian influenzavirus during unprotected exposure to the critically ill index patient."

Why aren’t we panicking? The rare cases of documented H2H for H5N1 prove that the chain of transmission is very short. It appears that the virus does not efficiently transfer between humans, leading to the rare H2H infections. As the virus changes, it could acquire the ability to spread easily between humans—or it may not. The only safe prediction is that this virus will change and that the best thing for us to do is to support the researchers who are tracking H5N1.

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

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Hoping for the Best, Preparing for the Worst

This month's Health Facilities Management Magazine has an excellent article on how hospitals can prepare for the surge capacity needed should a pandemic or similar infectious outbreak occur. Author Frank Zilm knows the subject matter well and succintly outlines challenges for protecting staff and patients, the hospital building and the Emergency Department.
New ideas in healthcare design, especially the ED, are essential to meet the challenges of infectious disease:

In most scenarios, the emergency service will be a primary entry point into the health care system and other components of the system (inpatient beds,physician offices, and clinics) will also quickly reach saturation.

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

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

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

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