Transcript Infection Control by Cleaner Air

The microorganisms that cause nosocomial infections have
been well cataloged and the infections they cause are fairly
well understood, but the traditional solutions, cleaning,
scrubbing, disinfectants, ventilation, filtration, management
and procedural controls, etc., have failed to completely
eliminate the problem.
Kowalski, Wladyslaw. Hospital Airborne Infection Control. CRC Press, 12/2011.
Surgical Site Infections are often the most problematic and fatal type infection that can
occur in hospital settings.
Many SSIs are thought to be transmitted only by direct contact, either hand to patient or
hand to equipment, or equipment to patient, but this view over looks the fact that both
hands and equipment may pick up contamination from elsewhere, and that may include
settling from the air.
Once settled, they may be resuspended by activity.
Although direct contact is regarded as being the primary mode of contamination of
surgical sites, airborne transmission can occur.
Mangram etal. 1999
Section 5001(c) of Deficit Reduction Act of 2005 requires the
Secretary to identify conditions that are: (a) high cost or high
volume or both, (b) result in the assignment of a case to a DRG
that has a higher payment when present as a secondary
diagnosis, and (c) could reasonably have been prevented
through the application of evidence-based guidelines.
On July 31, 2008, in the Inpatient Prospective Payment System
(IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10
categories of conditions that were selected for the HAC payment
provision. Payment implications began October 1, 2008, for
these Hospital Acquired Conditions.
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html
The Affordable Care Act of 2010 established the Hospital VBP
Program, which applies to payments beginning in Fiscal
Year (FY) 2013, on or after October 1, 2012, and affects payment
for inpatient stays in 2,985 hospitals across the country.
What CMS is doing: Since October 1, 2007, hospitals have been required to report on their Medicare claims
if any of the first eight selected conditions were present at the time the patient was admitted to the hospital,
and beginning October 1, 2008, will have to report on the remaining conditions as well. If at discharge, there
is a selected condition that was either not identified by the hospital as present on admission, or could not be
identified based on data and clinical judgment at admission, it is considered hospital-acquired.
To encourage hospitals to avoid hospital-acquired conditions, beginning October 1, 2008, Medicare will no
longer pay hospitals at a higher rate for the increased costs of care that result when a patient is harmed by one
of the listed conditions if it was hospital-acquired. Medicare prohibits the hospital from billing the
beneficiary for the difference between the lower and higher payment rates.
Medicare will pay for physician and other covered items or services that are
needed to treat the hospital-acquired condition, including the costs of
post-acute care that would not have been needed for the patient’s initial
medical problem, but are needed because of the hospital-acquired
condition.
http://www.cms.gov/apps/media/press/factsheet.asp
The Hospital Value-Based Purchasing (VBP) Program
is a Centers for Medicare & Medicaid Services (CMS)
initiative that rewards acute-care hospitals with
incentive payments for the quality of care they
provide to people with Medicare.
The Affordable Care Act of 2010 established the Hospital VBP Program,
which applies to payments beginning in Fiscal Year (FY) 2013,
on or after October 1, 2012, and affects payment for inpatient stays
in 2,985 hospitals across the country
Average cost of a Healthcare Acquired Condition
in the US, the annual economic impact of HAIs was
approximately $6.5 billion in 2004 . Recently
Zimlichman and colleagues conducted a systematic review
of the literature for the years 1986 through 2013 for an
updated estimate of costs associated with the most
significant and targetable HAIs in the US. These were CLABSI, VAP, SSI, CR-UTI,
and C. difficile infection (CDI). On a pair case basis, CLABSI were found to be the
most costly at $45,814 (95% CI, $30,919-$65,245), followed by VAP at $40,144 (95%
CI,$36,286-$44,220), SSI at $20,785 (95% CI, $18,902-$22,667), CDI at $11,285 (95%
CI, $9,118-$13,574), and CR-UTI at $896 (95% CI, $603-$1,189).
Based on 2009 data where approximately 34.7 million adults received inpatient
care in US hospitals (totaling 165 million patient days), the total annual cost of the
5 infections was $9.8 billion (95% CI, $ 8.3-11.5 billion) with SSI and CDI being
the most frequent (36% and 30% respectively).
CMS new “value” vs. old “fee-based” reimbursement
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Hospital Value-Based
Purchasing Program
The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards
acute-care hospitals with incentive payments for the quality of care they provide to people with Medicare.
How Does Hospital Value-Based Purchasing Work?
CMS rewards hospitals based on the quality of care provided to Medicare patients, how closely best clinical practices are followed,
and how well hospitals enhance patients’ experiences of care during hospital stays. Hospitals are no longer paid solely based on the
quantity of services they provide.
The Affordable Care Act of 2010 established the Hospital VBP Program, which applies to payments beginning in Fiscal Year (FY)
2013, on or after October 1, 2012, and affects payment for inpatient stays in 2,985 hospitals across the country.
Under the Hospital VBP Program, Medicare makes incentive payments to hospitals based on either:
1) How well they perform on each measure, or
2) How much they improve their performance on each measure compared to their performance during a baseline period.
“Changing the way we pay hospitals will improve the quality of care for seniors and save money. Under this initiative,
Medicare will reward hospitals that provide high quality care and keep their patients healthy. It’s an important part of our
work to improve the health of our nation and drive down costs.”
Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS)
April 29, 2011
ICN 907664 March 20132
If we consider the fact that most fomite contamination of
surfaces, especially horizontal surfaces like floors, must
arrive via the air, then we must admit that airborne transport
plays a role in surface contamination.
Kowalski, Wladyslaw. Hospital Airborne Infection Control. CRC Press, 12/2011.
 Settling rates in still air
 Turbulence from fans, people
moving will increase settling
times
 <.1 micron particles stay
suspended indefinitely
Particle Settling Velocities
Particle Size
µm
Settling time from a
height of 4 ft.
100.0
4.0 seconds
10.0
6.8 minutes
5.0
19.2 minutes
1.0
9.4 hours
0.5
34.3 hours
0.3
17.8 days
0.1
42.5 days
It is assumed that hospital ventilation systems are designed in accordance with
appropriate guidelines and codes, and are not subject to internal mold growth
and excessive condensation, and that they do not have outside air intakes too
close to roof exhausts or cooling towers.
Dilution Ventilation removes all airborne pathogens at approximately equal
rates if complete mixing occurs, but some larger microbes and spores may
settle out and remain on surfaces. Ventilation air may also add microbes from
outdoor air if there is no filtration or filtration is inadequate.
HEPA filtration effectiveness has been examined to determine the most penetrating microorganisms. For
a single pass through a HEPA 99.97% filter, the number of
penetrations per million for each microbe in Table 1 was
calculated. Figure 9 shows the results of this analysis,
where only those microbes that experienced penetration
above about 30 per million are listed. All of the microbes
between H. influenzae and Varicella experienced
penetrations greater than 1 in 10,000. This may be
insignificant, especially for a single pass through
the filter, but it depends on the airborne concentration
and the infective dose for each microorganism.
The infective dose for M. tuberculosis is
1-10 bacilli.
An intriguing aspect of Figure 9 is that
almost all of the most penetrating
microorganisms are agents of nosocomial
infections.
ASHRAE Transactions: Research
Filtration of Airborne Microorganisms:
Modeling and Prediction
W.J. Kowalski, M.S., P.E. William P. Bahnfleth, Ph.D., P.E. T. S. Whittam, Ph.D.
ASHRAE Position Paper, June, 2009
Acknowledges that HVAC systems play a
role in the dissemination of diseases in
buildings.
Key points:
Infectious diseases can be transmitted
via an airborne path
Designers have a responsibility to
minimize that potential
Dilution
ventilation
Building pressure control
Filtration
Oxidative technologies,
UVGI,
PCO
ACTIVE TECHNOLOGIES PASSIVE TECHNOLOGY
Ionization: Broadcast ions creating hydroxyl radicals
Photo Catalytic Oxidation: Creates hydroxyl s
in the occupied breathing space.
Bi-polar ionization: Broadcast ions creating hydroxyl
radicals in the occupied breathing space.
Photohydroionization: Broadcast hydrogen peroxide
into the occupied breathing space.
Ozone generators: Broadcast ozone into the occupied
breathing space.
PASSIVE TECHNOLOGY
Photo Catalytic Oxidation: Creates hydroxyl
radicals in a contained location, does not broadcast into
occupied breathing space.
Using Passive Reactive Oxygen Species to destroy contaminants
Like the atmosphere, Genesis works apart from where living creatures
breathe
Genesis Panel Kill Zone
Treated
Air
Total Contaminants Various Sources
Off
Walls
Exhaled Breath
Invisible
Airborne
contaminants
Significantly
reduced viruses,
mold, bacteria
&
TVOC’s
Floors &
Furnishings
Working away from the occupied space:
Passive Safe
Fresh
Air
Chamber Testing
Testing performed by RTI International
Clean Air Delivery Rate
(CADR) is a figure of
merit that is the cubic
feet per minute (CFM)
of air that has had all
the particles of a given
size distribution
removed. CADR rating
were developed by the
Association of Home
Appliance
Manufactures (AHAM)
and are measured
according to a
procedure specified by
ANSI/AHAM AC-1. The
CDRm numbers in the
graph are based off
microbiologic
Genesis Panels have been challenge with TB, Anthrax, Bacteria, Staph, E Coli,
endotoxins, mycotoxins, viruses and VOCs.
Single Pass
Testing performed by RTI International
Inactivation Efficiency Single Pass No Filtration
Test Organism
mean
Std.dev
Staphylococcus epidermidis
99.9
0.02
Mycobabterium
parafortuitum
88.7
2.7
MS2
43.6
4.7
Bacillus globigii
34.6
8.9
Aspergillus versicolor
11.4
5.5
There were no pre-filters
this test and there was no
recirculation of the air.
These results reflect the
efficacy of the Genesis Air
PCP Standard panel alone in
a single pass at a standard
HVAC air speed
1. Genesis Air PCO units either as standalone or in AHUs reduce the levels of CFUs in the air
stream and a space.
2. Genesis Air units in a single pass application at a removal rate of 99.9% for MRSA and 88.7%
for Tuberculosis are a must for areas where high CFU levels would lead to higher infection
and mortality rates from TB, MRSA and other nosocomial infections.
3. In either single pass or in recirculating systems Genesis Air equipment alone (without
filtration) will reduce bio-aerosol microbial contaminants.
Genesis Panels have been challenge with TB, Anthrax, Bacteria, Staph, E Coli,
endotoxins, mycotoxins, viruses and VOCs.
Day 2
• Mark off 6x6 area on wall
with wax pen
• Hang sign for maintenance
to not clean area
• Swab surface in the 3”
center of the square with
Healthlink Transporter
• After sample was taken the
area was cleaned with
Wexcide as per instructions
from manufacture
• Genesis Air Off being
serviced
Day 2
• Swab area
• No surface cleaning took place
• Genesis Air Off
Day 6
• Swab sample area
• Clean surface with Wexcide as
per manufacture instructions
• Turn Genesis Air system on
Day 7
• Swab sample area
7 total areas were sampled
No viable bacteria was found in
the surface testing area after
Genesis Air Panels were turned
on.
AHU Retrofit or New Construction:
Curb Mounted RTU
New Construction or Retrofit in Curb Adaptor
During your unit change outs
why not improve your air
quality.
2008 CU
Inline or plenum mounted:
Scalable fits all sizes of split systems
Both horizontal & vertical
Recirculating for
Individual Spaces
Self-Contained
IAQ Solution out of sight & out of mind.
Inlet
Ducted
Attached
to
Filter
grilles
Mounted
Above the
Ceiling
Supply
Out
2008 DT FP
2006 D & L
Small spaces wall mount or desktop