Transcript The Role of Contaminated Air in Healthcare Acquired Infections

“My wife nearly died from a
MRSA infection…”
Creator of VidaShield
Role of Contaminated Air in Healthcare Acquired Infections
“At first sight, I knew this
product would help…”
Infection Preventionist
Role of Contaminated Air in Healthcare Acquired Infections
Maureen Spencer, RN, BSN, M.Ed, CIC
Corporate Director,
Infection Prevention
Universal Health Services
UHS has an Acute Care Division that provides high quality care at 26
hospitals in California, Florida, Nevada, Oklahoma, South Carolina, Texas
and Washington, DC.
UHS has a Behavioral Health Division that consists of over 300 centers/hospitals
in the U.S. and England.
Role of Contaminated Air in Healthcare Acquired Infections
Objective:
Understanding the Role of
Contaminated Air in
Healthcare Acquired
Infections
Role of Contaminated Air in Healthcare Acquired Infections
Have You Considered the Air?
Airborne dispersion may play a role in air and surface contamination
with MDROs, such as MRSA and Clostridium difficile, with subsequent
contact and cross contamination1
Study shows abundance of human bacteria in
indoor air, floor dust, and ventilation systems.2
1University
of Leeds, Superbugs ride air currents around hospital wards , M.
King, et al , 2Human Occupancy as a Source of Indoor Airborne Bacteria, April
18, 2012,
Role of Contaminated Air in Healthcare Acquired Infections
Pathogens Survive on Surfaces
Organism
Survival period
Clostridium difficile
35- >200 days.2,7,8
Methicillin resistant Staphylococcus aureus (MRSA)
14- >300 days.1,5,10
Vancomycin-resistant enterococcus (VRE)
58- >200 days.2,3,4
Escherichia coli
>150- 480 days.7,9
Acinetobacter
150- >300 days.7,11
Klebsiella
>10- 900 days.6,7
Salmonella typhimurium
10 days- 4.2 years.7
Mycobacterium tuberculosis
120 days.7
Candida albicans
120 days.7
Most viruses from the respiratory tract (eg: corona,
coxsackie, influenza, SARS, rhino virus)
Few days.7
Viruses from the gastrointestinal tract (eg: astrovirus, HAV,
polio- or rota virus)
60- 90 days.7
>7 days.5
Blood-borne viruses (e.g.: HBV or HIV)
1. Beard-Pegler et al. 1988.. J Med Microbiol. 26:251-5.
2. BIOQUELL trials, unpublished data.
3. Bonilla et al. 1996. Infect Cont Hosp Epidemiol. 17:770-2
4. Boyce. 2007. J Hosp Infect. 65:50-4.
5. Duckworth and Jordens. 1990. J Med Microbiol. 32:195-200.
6. French et al. 2004. ICAAC.
7. Kramer et al. 2006. BMC Infect Dis. 6:130.
8. Otter and French. 2009. J Clin Microbiol. 47:205-7.
9. Smith et al. 1996. J Med. 27: 293-302.
10. Wagenvoort et al. 2000. J Hosp Infect. 45:231-4.
11. Wagenvoort and Joosten. 2002. J Hosp Infect. 52:226-7.
Role of Contaminated Air in Healthcare Acquired Infections
High Touch Surfaces
Role of Contaminated Air in Healthcare Acquired Infections
Prior Room Occupancy Increases Risk
Study
Healthcare associated pathogen
Martinez 20031
VRE – cultured within room
2.6x
VRE – prior room occupant
1.6x
MRSA – prior room occupant
1.3x
VRE – cultured within room
1.9x
VRE – prior room occupant
2.2x
VRE – prior room occupant in
previous two weeks
2.0x
Huang 20062
Drees 20083
Shaughnessy 20084
Nseir 20105
C. difficile – prior room occupant
A. baumannii – prior room occupant
P. aeruginosa – prior room occupant
1.
2.
3.
4.
5.
Likelihood of patient acquiring
HAI based on prior room
occupancy (comparing a
previously ‘positive’ room with a
previously ‘negative’ room)
2.4x
3.8x
2.1x
Martinez et al. Arch Intern Med 2003; 163: 1905-12.
Huang et al. Arch Intern Med 2006; 166: 1945-51.
Drees et al. Clin Infect Dis 2008; 46: 678-85.
Shaughnessy. ICAAC/IDSA 2008. Abstract K-4194.
Nseir et al. Clin Microbiol Infect 2010 (in press).
Role of Contaminated Air in Healthcare Acquired Infections
Aerobiology and Its Role in the
Transmission of Infectious
Diseases
Journal of Pathogens
Volume 2013 (2013), Article ID 493960, 13 pages
Aaron Fernstrom1 and Michael Goldblatt2
Role of Contaminated Air in Healthcare Acquired Infections
Aerobiology and Its Role in the Transmission of
Infectious Diseases
Practitioners of all kinds agree that the airborne transmission of
infectious disease is a problem. Just how big or urgent a problem,
however, continues to be debated. For example, there is currently a
wide range in the reported frequencies of airborne transmission in
hospital-acquired infections (10–33%)
A better understanding of the true contribution of airborne
transmission to infection rates would allow hospital administrators to
determine the degree to which they should commit resources to
minimize this vector of disease transmission.
Role of Contaminated Air in Healthcare Acquired Infections
Environmental Reservoirs
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MRSA infected/colonized pts.
contaminate rooms, contribute to
endemic MRSA
Prospective study of 25 MRSA pts.
Sampling of isolation rooms
• 53.6% of surface samples positive
• 28% of air samples
• 40.6% of settle plates
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Isolates identical or closely related in
70% of patients
[Sexton et al, J Hosp Infect 2006]
Airborne Transmission
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MRSA counts remain
elevated for up to 15
minutes after bed making
Consider air ventilation &
filtration
Keep doors closed
[Shiomori et al, J Hosp Infect 2002]
Role of Contaminated Air in Healthcare Acquired Infections
Aerial Dissemination of
Clostridium difficile spores
BMC Infectious Diseases
Katherine Roberts, Caroline F. Smith, Anna M Snelling,
Kevin G. Kerr, Kathleen R. Banfield, Andrew sleigh and
Clive B. Beggs
Role of Contaminated Air in Healthcare Acquired Infections
Aerial Dissemination of Clostridium difficile spores
Role of Contaminated Air in Healthcare Acquired Infections
An Outbreak of Surgical Wound
Infections Due to Group A
Streptococcus Carried on the
Scalp
The New England Journal of Medicine
Timothy D. Mastro, M.D., Thomas A. Farley, M.D.,
John A. Elliott, Ph.D., Richard R. Facklam, Ph.D.,
Janet R. Perks, R.N., B.S., James L. Hadler, M.D., M.P.H.,
Robert C. Good, Ph.D., and James S. Pikka, M.D.
Role of Contaminated Air in Healthcare Acquired Infections
An Outbreak of Surgical Wound Infections Due to
Group A Streptococcus Carried on the Scalp
Role of Contaminated Air in Healthcare Acquired Infections
Evidence in Support of Covering
the Hair of OR Personnel
AORN Journal
John M. Boyce, M.D.
Role of Contaminated Air in Healthcare Acquired Infections
Evidence in Support of Covering the Hair of OR Personnel
Role of Contaminated Air in Healthcare Acquired Infections
Evidence in Support of Covering the Hair of OR Personnel
Role of Contaminated Air in Healthcare Acquired Infections
AORN Journal, January 2014
In one study, dispersal of S aureus in the air
increased sharply when staphylococcal
dispersers were present in the OR, and the
presence of nine dispersers were considered to
be the cause of 19 postoperative wound
infections.
Role of Contaminated Air in Healthcare Acquired Infections
AORN Journal, January 2014
Role of Contaminated Air in Healthcare Acquired Infections
Molecular Epidemiology of Microbial
Contamination in the Operating
Room Environment: Is There a Risk
for Infection?
Charles E. Edmiston, Jr, Ph.D., Gary R. Seabrook, M.D.,
Robert A. Cambria, M.D., Kellie R. Brown, M.D.,
Brian D. Lewis, M.D., Jay R. Sommers, Ph.D.,
Candace J. Krepel, M.S., Patti J. Wilson, BSN,
Sharon Sinski, B.S.N., and Jonathan B. Towne, M.D.,
Milwaukee, WI and Roswell, GA.
Role of Contaminated Air in Healthcare Acquired Infections
Molecular Epidemiology of Microbial Contamination
in the Operating Room Environment: Is There a Risk
for Infection?
Role of Contaminated Air in Healthcare Acquired Infections
Role of Contaminated Air in Healthcare Acquired Infections
Role of Contaminated Air in Healthcare Acquired Infections
Air Contamination and Infection Studies
Role of Contaminated Air in Healthcare Acquired Infections
Acquisition of MRSA on Hands After
Contact with Skin and Environment
•
Skin contact:
• 40% of hand cultures positive1
•
Environment contact:
• 45% of hand cultures positive2
1.
2.
Stiefel U, et al. SHEA, 2010; Donskey CJ,
Eckstein BC. N Engl J Med 2009;360:e3.
Role of Contaminated Air in Healthcare Acquired Infections
Contamination of Environmental Sites
Outside Patient Rooms with C. difficile
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Positive broth enrichment cultures
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33% physician workroom telephones
25% nursing workstation computers
33% physician portable computers
21% portable equipment
Hand imprint cultures
• 0% for C. difficile
Dumford D et al Am J Infect Control 2009;37:15-19
Role of Contaminated Air in Healthcare Acquired Infections
Risk of Hand or Glove Contamination After
Contact with VRE Patient or Environment
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Setting: Medical ICU
Contamination of HCWs
hands or gloves after caring
for VRE colonized patients
HCWs were nearly as likely
to contaminate their hands or
gloves after touching the
environment as after
touching the patient
Hayden MK et al Infect Cont. Hosp. Epid. 2008
Role of Contaminated Air in Healthcare Acquired Infections
UV has a History in Healthcare
Upper room air disinfection
UV “robots”
Biological
safety
cabinet
Air handlers & air
conditioning units
UV lamps in water treatment
Role of Contaminated Air in Healthcare Acquired Infections
Area Micro Particle Decontamination
Technologies – Labor Intensive Room Setup
Role of Contaminated Air in Healthcare Acquired Infections
Conclusions
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More and more studies indicating air as a potential source of
contamination that may result in healthcare-associated infections
Studies show that hospital air is a potential route for transmission
Individual air samples on average were 2-8 times more contaminated
than surfaces
Reducing the contamination in the air in some cases also reduces
the settling of bacteria on surfaces – thus less chance of cross
contamination on hands and equipment
Use of continuous UV-C “air scrubbing” has a positive effect on
reducing airborne bacteria and fungus
Healthcare industry needs to validate and invest in innovative
technology designed to treat the air
Role of Contaminated Air in Healthcare Acquired Infections
Introducing
• VidaShield is a patented system designed to eliminate
airborne pathogens and subsequent settlement on
surfaces.
• It is the only active system that draws the pathogens
into a UV Chamber that is positioned above the unit
in the ceiling.
• There is low maintenance beyond installation,
suggesting annual change of the UV-C bulb and
quarterly change of the MERV 6 filter.
• VidaShield functions 24/7/365 days with no
harm to individuals in the rooms or areas
where installed.
• Key areas include ICUs, NICUs,
respiratory therapy areas, soiled rooms,
isolation rooms, break rooms, pre and
post-op areas, and EDs.
• VidaShield is a standard 2”x4” fixture with
down light (optional no light).
• It has a UV-C chamber positioned above
the fixture in the ceiling, an unobtrusive use
of UV technology at room level.
• Air is drawn from the room through an
intake into the chamber at 50 cu. ft. per
minute, accomplishing a 99.8% kill rate on
most pathogens.
• The air recirculates back disinfected.
• For a 10x10 room with a standard ceiling,
there are four cycles per hour.
How VidaShield works
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VidaShield UV-C/UVGI mechanism is housed atop a
standard footprint (2’x4’) ceiling light fixture
Ultraviolet light is completely shielded, the room does not
need to be vacant and can operate 24/7 in an occupied
room
Each unit houses four small fans (like those in a laptop
computer) that pull room air into the system at 50 cubic feet
per minute
Air passes through the irradiation chamber, and then the
cleaned air is pushed back into the room. The intake and
exhaust vents are set at a 30 degree angle, which moves
the air in a pattern that avoids repeatedly recirculating the
same air
Dr. Linda D. Lee, DrPH, MBA,
Chief Science Officer
American Green Technology
Can using active UV-C
technology to treat the air
reduce surface
pathogens in a healthcare
setting?
Technology Overview
These environmental studies were designed to look at the relationship of surface and air
contamination compared to the control and challenge areas for total bacteria counts in
colony forming units.
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Sampling Process
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Environmental Study Details - Children’s Oncology Unit
• Patient room 425 is located in 4th Floor Oncology Unit.
• A positive pressure room that is approximately 220 sq.
feet, there are 2 UV units installed.
• Air conditions in Patient Room 425 (challenge area)
were the same pre- to post-test. The fan coil unit was
operating, moving air in the room and the bathroom
exhaust fan was operating as well.
• Air samples (surrounding area) were taken outside the
patient room. A hallway example is shown below at the
elevator lobby on the window ledge.
• The air environmental conditions in the surrounding
areas (hallways, nurse’s station and elevator lobby)
were very different pre- to post-testing.
• Room 425 was terminally clean prior to pre-installation
sampling and it was not cleaned in post-installation
sampling.
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Environmental Study Results - Children’s Oncology Unit
31
All units of measure are in raw colony forming units (cfu).
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Environmental Study Details - Long Term Acute Care Hospital
Evaluation Area
• Patient Rooms & Hallways in the
intensive care unit
• Most patients in this area are on
ventilators and contact isolation
• The unit is closed, protected by smoke
doors with limited public access
Hallway
Study Criteria
• Determine placement and number of
units (24 units)
• Take pre- and post-installation air and
surface samples for total bacteria counts
• Independent lab analyzed the samples
Patient Room
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Environmental Study Results - Long Term Acute Care Hospital
All Others
Environmental Study Details - Acute Care Hospital,
Psychiatric Holding ED
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Psychiatric unit (controlled access area) in emergency department
13 UV-C units to cover size of the room
Pre- and post-installation air and surface samples for total bacteria counts
Independent lab analyzed the samples
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Environmental Study Results - Acute Care Hospital,
Psychiatric Holding ED
All units of measure are in raw colony forming units (cfu).
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Conclusions
•
•
More and more studies indicating air
as a potential source of
contamination that may result in
healthcare-associated infections
The air has been ignored for far too
long and studies show that hospital
air is a potential route for
transmission
•
Individual air samples on average were
2-8 times more contaminated than
surfaces
•
Reducing the contamination in the air in
some cases also reduces the settling of
bacteria on surfaces
•
It is important to understand the
difference between the basis of design
vs actual operations of the healthcare
HVAC/Air Flow controls
•
The use of UV-C at room level has a
positive effect on reducing airborne
bacteria and fungus
•
Technology can make a positive impact
on peoples’ lives
•
The healthcare industry needs to
validate and invest in innovative
technology designed to treat the air
Can using active UV-C technology to treat the air reduce
surface pathogens in a healthcare setting?
Questions
Maureen, Linda and Jay