Transcript Presentation - TOMI Environmental Solutions, Inc.

Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29th 2013
Riyadh, Saudi Arabia
Presenters:
Sheik Abdullah Zaid Al-Meleihi
Dr. Halden Shane
Mark Futrovsky, Esq
John Koerner, MPH, CIH
Norris Gearhart, CR
Jenny Andrawis
Outline
1. The problem the world is
facing
2. The problem confronting the
GCC
3. Viruses and Bacteria
Confronting the Indoor
Environment
4. Ways to Prevent and Limit
Emerging Infections
5. Challenges in Infection
Control Associated with
Terminal Cleaning
Outline
6.
7.
8.
9.
10.
Cleaning Types
Definitions of types of Cleaning
Pitfalls of Today’s Cleaning Practices
Touch VS. No-touch Cleaning Methods
Survival of Organism Outside of the
Human Body
11. Response to Bio-Terrorism
12. Types of Decontamination
Outline
13.
14.
15.
16.
17.
18.
19.
20.
21.
What is SteraMist?
Who is TOMI?
Introduction to the technology
Reactive oxygen species
How SteraMist Works
Efficacy Studies
How to use Steramist
The simplicity of the Technology
Maintenance
Outline
22.
23.
24.
25.
26.
27.
28.
2 Minute Video
Safety
Protocols
Training
Demo
SteraMist Patents
Save Lives, Produce jobs
Outline
29.
30.
31.
32.
33.
34.
Current uses
Other Applications
Bug Without Borders
Summary
Conclusion
Questions and Answers
Lecture Objectives
1. Understand the Problem and
causes of Emerging Infections
2. Learn the Types of cleaning
3. Better understand the Pitfalls
of Terminal cleaning
4. Touch vs. No-Touch
Decontamination
4. Bio-Terrorism measures
6. Learning about ROS, SteraMist
and its applications
The Problems the World is Facing
 As the world evolves, the problems we face
the world become more complex and
evolve.
 Population, Political, and Cultural issues will
always change with time.
 Infectious disease will always be at the
forefront of and an issue to be dealt with.
 The potential disaster that the world is
facing is due to emerging infections
Statistics Relevant to the HAI Problem
In the United States:
 CDC reports over 2 Million Healthcare
Associated Infections (HAIs) cases annually.
 1 in 20 will contract an HAI which will cost
the U.S. Healthcare system over 40 Billion
dollars this year.
 271 deaths per day means over 100,000
fatalities per year.
Internationally
 A worldwide HAI problem exists today.
A Deadly Problem
The World Health Organization
says the superbug crisis is one of
the top three health threats to
the world!
103, 000 die annually in the U. S.
from hospital acquired
infections.
Who Are These Bacterial
Superbugs Referred to as ESKAPE?
ESKAPE bacteria are resistant to multiple medications:
E-> Enterococcus-> VRE
S-> Staphylococcus aureus-> MRSA, VRSA, VISA
K-> Klebsiella-> KPC
A-> Acinetobacter baumannii-> AB
P-> Pseudomonas aeruginosa-> PA
E-> Enterobacter species-> E. cloacae
All these bacteria have resistance to multiple
ABX’s , which is defined as resistance to three
or more ABX classes and have a high MIC.
Who are These New and Emerging Viruses ?
H7N9
H2N3
MERS-CoV
HPV-16 and 18
All these viruses have resistance to multiple
viral drugs, have impacted immune
compromised person really hard, usually
come from a zoomatic source and have a
high percentage of fatalities.
Lack of Awareness and the Asymptomatic Carrier
Colonization (Person & Environment)
Infected Carrier
Infected Patient
More Common
Less Common
Asymptomatic
Symptomatic
No ID Protocol
ID Protocol
Both are Contagious and Test Positive
Middle East Respiratory Syndrome (MERS-CoV)
Human coronaviruses are a group of enveloped
positive strand RNA viruses. There have been 6
human coronaviruses identified to date, including
SARS and MERS-CoV.
Person-to-person transmission is possible
(droplet) and surface (fomite) transmission
cannot be ruled out.
Infection control is a critical component of
containment of MERS-CoV and the WHO and the
U.S. CDC have issued infection control guidance
for hospitals.
MERS-CoV Possible Vectors and Transmission
MERS – Infection Control Recommendations
Standard, contact, and airborne precautions are
recommended for management of hospitalized patients.
Patients should be placed in Airborne Infection Isolation
Rooms (AIIR) and should wear masks when not in isolation
room.
Minimal staff should be involved with patient care.
Gloves, gowns, eye protection, and N95 respiratory
protection.
Environmental surfaces and equipment, textiles and
laundry, and food utensils and dishware should be
disinfected.
Environmental Pathogens
Order of Susceptibility to decontamination
Hardest
Difficulty to Kill/Inactivate
Spores
Easiest
Anthrax, C-diff
Myco-Bacteria
T.B.
Viruses (Small)
Non-Lipid, Non Encapsulated
Norovirus, Hep. A
Fungi
Bacteria (gram -)
Stachybotrys,
Cryptococcus Gattii
A.B., E. coli, Klebsiella
Viruses (Large)
Non-Encapsulated,
Hep. B
Bacteria (gram +)
MRSA, Clostridium
Viruses, Lipid,
(med size)
Enveloped, Herpes,
Roto
5 Steps For the Prevention of HAIs
Requires a multi-model approach and updated protocols
for:
1. Environmental hygiene and effective terminal cleaning:
(decontamination goes a lot further than disinfection)
2. Personal hygiene including hand washing and proper
gloving
3. Antibiotic stewardship
4. Proper sterile technique
5. Early diagnosis of infections and proper isolation
Antibiotic Stewardship
 Hot topic today due to the rise of C.diff.
 Due to stronger C.diff strains deaths have increased
by 400% between 2000-2007.
 Antibiotic stewardship is great but we cannot have
the best of outcomes unless we improve our
terminal cleaning.
 “C-diff spores can survive in the environment for
months”.
 “Environmental cleaning and disinfection are
critical to prevent the transmission of C.diff”.
Jennie Mayfield, BSN, MPH, CIC
President-Elect APIC
**Superbugs either have a natural resistance or a acquired resistance,
acquired resistance is ABX induced or from an external mutagen.
Who Cleans These Surfaces Today?
Sanitization Protocol for Nail salons

The process of making something
(usually an inanimate object) clean.

Typically defined as a 3-log reduction
and 99.9% effective.
On an object that contains millions of
bacteria, ten of thousands are not killed.

Disinfection Protocol for Food Service

Killing germs and bacteria or rendering them harmless.

A chemical agent that destroys most pathogens but
may not kill bacterial spores.
This is typically defined as a 4 log reduction and 99.99%
effective.
 That means an object that contains millions of cells
thousands of those bacteria are not killed,
 All it takes is one cell to infect you or possibly kill you.

Sterilization Protocol for Hospitals

Completely eliminating microbial viability,
killing all non-pathogenic and pathogenic
spores, fungi and viruses.

Defined as a 6-log reduction and 99.9999%
effective.

An object that contains millions of bacteria,
all are killed.
Current Hospital Terminal Cleaning Methods
are Ineffective

In a room occupied by a VRE patient that tested
positive for VRE was 94% contaminated before
cleaning
and
after cleaning was 71% positive for VRE.

A C. diff-associated disease (CDAD) rooms tested
100% positive before cleaning.
and
78% tested positive after cleaning*
*B.C. Eckstein et al, 2007
**carling et al, 2008.
Current Hospital Terminal Cleaning Methods
are Ineffective

In 23 acute care hospitals, only 49% of surfaces
evaluated were actually clean.**

A separate study of 49 New England hospitals
found 25% of OR surfaces were overlooked by
current cleaning teams.
*B.C. Eckstein et al, 2007
**carling et al, 2008
Privacy Curtains
Privacy curtains are a source of
infectious bacteria.
 Scientists swabbed 43 hospital curtains
twice a week for 3 weeks.
-They analyzed 180 samples and
found germs on 119.
- 26% of curtains tested positive for
the potentially deadly antibioticresistant MRSA.
- 44% tested positive for a form
of Enterococcus bacteria - some of
which were antibiotic resistant.
 Researchers also placed 13 new
curtains in a hospital for the study.
Within a week, 12 were contaminated.

HAIs in the News
Studies at John Hopkins show:
- 26% of supply cabinets have
been contaminated with MRSA.
- 21% of supply cabinets have
contamination with VRE.
Without decontamination, surfaces
such as cabinets or keyboards
easily play host to deadly bacteria.
Are Our Present Terminal Cleaning
Techniques Adequate?
Answer:
Hospitals are leaving 30% - 60% of surface microorganisms after current terminal cleaning
procedures.*
*Multiple JAMA articles
Pitfalls of Today’s Terminal Cleaning
1. The increasing demand for beds require rooms to be
cleaned quicker.
2. Sensitive medical equipment & computers are almost
impossible to clean without damage.
3. In fact today’s delicate high tech equipment scares
most janitorial team members so they move equipment
to the halls.
4. In the late 1970’s U.S. building codes changed
mandating tighter building structures, net result less
energy loss and more microbial growth!
Pitfalls of Today’s Terminal Cleaning Cont.
4. Chemicals/wipes are expensive and not effective;
they disinfect and not sterilize. There is lag time
(dwell time) before wiping.
5. The touch technique is time consuming. It is
extremely labor intense and still impossible to reach
hard to reach places this causes a costly delay in
room turnover.
6. Cleaning products are hazardous to health. The
health impact of cleaning products are asthma, HA,
eye damage, etc.
Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29, 2013
Riyadh, Saudi Arabia
Touch VS. No-touch Cleaning Methods
 SHOULD WE CONCENTRATE ON “HIGH
TOUCH” OR “HIGH RISK” OBJECTS ?
 No, not only “high risk” or “high touch”
(all surfaces). “High touch” objects has
been only recently defined and “high
risk” objects not scientifically defined.
Rutala WA, DJ. ICHE 2010;31:850-853
Touch (Elbow Grease) Wipes & Solutions
 The Touch System of cleaning is “elbow grease” using old
school cleaning methods and materials, basically spray and
wipe (with no dwell time) and moping, resulting in the
spread of pathogens.
 But with rapidly changing pathogens, superbugs, and
increased demand for room turnover, this method has
failed in today’s healthcare environments.
Elbow Grease VS (No Touch) Mechanical
Results





Before cleaning -89.5% (111/124)
After cleaning (elbow grease) -66.1% (82/124)
Before HPV -71.8% (61/85)
After HPV (mechanical) -1.2% (1/85)
Environmental Disinfection: What Works Best
 Microbial Reduction: Elbow grease-23.4% vs.
Mechanical -70.6%
we can be successful in decreasing HAIs and
cost by considering “Mechanical
Decontamination” technology.
Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29, 2013
Riyadh, Saudi Arabia
Survival of Organism Outside of the Human Body
Survival of Pathogens On Environmental Surfaces
Pathogen
Lifespan
C. Difficile
Staphylococci
>5 months
7 months
VRE
Acinetobacter
Norovirus
Adenovirus
4 months
5 months
3 weeks
3 months
Rotavirus
SARS,MERS-CoV, HIV etc.
3 months
Days to weeks
MDR’s Survival Rate Causes Havoc

MRSA can survive 9 months outside of the
human body:

Being admitted to a room in which the
prior occupant had MRSA, C-Diff or VRE
increases your chance of getting MRSA, CDiff or VRE by 40%.

Seven out of eight healthcare workers
who were MRSA carriers infected their
home.
*(R. Huang, Mehta, Weed and Price, 2006).
Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29, 2013
Riyadh, Saudi Arabia
Response to Bio-Terrorism
Probability vs. Potential Impact
BIOLOGICAL
AGENT
NUCLEAR
WEAPON
IMPROVISED
NUCLEAR
DEVICE
POTENTIAL
IMPACT
CHEMICAL AGENT
OR TOXIC
INDUSTRIAL
CHEMICAL
RADIOACTIVE
MATERIAL
PROBABILITY/LIKELIHOOD
Incubation Periods of Selected Biological
Agents
•
•
•
•
•
•
•
•
•
Anthrax
Plague
Q Fever
Tularemia
Smallpox
Viral encephalitides
VHFs
Botulinum toxin
Staph. enterotoxin B
1-5 Days++
2-3 Days
10-40 Days
2-10 Days
7-17 Days
V(2-6d); E&W (7-14 d)
4-21 Days
1-5 Days
1-6 Hours
Definition of Decontamination
• Definition of Decontamination:
Decontamination is gross cleaning +
disinfection+ sterilization.
• Decontamination is not accomplished with
disinfection (log-4) alone, need
sterilization (>log-6) to accomplish
decontamination.
• When choosing a no-touch technology
that is a Sporicide/Sterilant (>log-6) you
can achieve decontamination (>log-6).
No Touch / Mechanical Decontamination
A. Ultra-Violet; a specific wave length, UVA,
UVB, UVC, hospital disinfection units use UVCgermicidal short wave 280-100 nm. Usually 253nm.
Lamps deliver light either continuously or pulsed.
B. Vaporized Hydrogen Peroxide; gaseous form,
dehumidify ambient air and circulate vapour
produced by generator throughout room usually
high concentration of hydrogen peroxide or lower
concentration mixed with silver ions. Certain
technologies create sterilization.
C. Activated Hydrogen Peroxide; a low level of
hydrogen peroxide that is physically converted by
electricity into a reactive oxygen species Sterilant.
ACTIVATED HYDROGEN PEROXIDE
BIT (Binary Ionization Technology) Used to create activated
hydrogen peroxide, a very low concentration of hydrogen
peroxide and is turned into ROS's that are activated/ionized
Destroys proteins, lipids and carbohydrates on contact (via
oxidation)
Results in killing bacteria, bacteria spores, viruses, molds and
mold spores, thus biological sterility
Characteristics of the Ideal Room
Decontamination System
1. Effective with the Highest possible kill and
inactivation of all relevant organisms especially
MERS, C. difficile spores, TB, AB and MRSA
2. Fast will create a six-log log kill without having to
establish high ppm’s in a room, bottom line fast
dwell time.
3. Not effected by relative humidity, does not need
extra steps to humidify and than dehumidify room
before and after.
4. Safe to deploy, not caustic, relatively hazard free,
minimal PRP for user.
Characteristics of the Ideal Room
Decontamination System
5.Easy and simple to perform the decontamination
goal using remote control or aim and shoot.
6. Cost effective by reducing chemical use, reducing
two and three person cleaning crew and reducing risk
management.
7. A green effect, little or no ozone and
environmental footprint. Leaves no residues, a green
technology, no wipe, converts to water (humidity)
and oxygen.
8. High clinical outcome that ultimately reduces
incidence of Healthcare Infections and any other
infections.
Advantages of AHP
(Activated Hydrogen Peroxide) Technology
 Time tested, multiple
military contracts.
 Sporicidal/sterilant –kills
bed bugs.
 Safe on delicate medical
equipment.
 Safe on plastic.
 Inexpensive.
 Non-combustible.
Advantages of AHP
(Activated Hydrogen Peroxide) Technology
 15 second dwell time.
 Quick, achieves 6-log kill on
contact.
 Not effected by humidity.
 Electrostatically charged so
adheres to all surfaces.
 Leaves NO residue.
 Surface hand held applicator
NOT necessary to disable HVAC
or seal room.
 Green - converts to Oxygen and
Water (green technology)!
Comparison SteraMist to the World
Cost to Treat
pH Dependency
Temperature Dependency
Chemical Compatibility
Corrosion
Biodegradability
Sanosil
Moderate
Low
Low
Good
Moderate
Low
Chlorine, Hypochlorite
Moderate
Ultra High
Ultra High
Poor
High
Low
Ozone
Very High
Moderate
Moderate
Good
Moderate
Low
Bromine
Moderate
High
Moderate
Poor
Very High
Low
Peracetic Acid
Moderate
High
High
Poor
Very High
Moderate
Chlorine Dioxide
Very High
Low
High
Poor
Very High
Low
Quatenary Compounds
Moderate
High
Low
Poor
Low
Moderate
Bioquell
Very High
High
Moderate
Poor
High
Moderate
Low
Low
Low
Good
Low
High
Products
SteraMist (BIT™)
Comparison SteraMist to the World
Products
Disinfecting by-products
Percent-kill
Spore log Kill
Treatment Time for all Surfaces
Residue
Sanosil
Silver Cations, Oxygen and Water
99.99%
Zero
2-4 Hours
Silver Anions
Chlorine, Hypochlorite
Chlorites, Chlorates, Chloroamines, THM
99.90%
One
Fifteen Minutes
Chlorites
Ozone
Ozone to Oxygen
>99.9999%
Six
24-36 Hours
None
Bromine
Bromamines, Bromoform
99.90%
Algae Only
Hours
Bromide
Peracetic Acid
Acetic Acid
>99.9999%
Six
Fifteen Minutes
Phenol
Chlorine Dioxide
Chlorites, Chlorates
>99.999%
Five
Fifteen Minutes
Clorine &
Oxygen
Quatenary Compounds
Benzyl chloride used to manufacture
>99.999%
Five
Ten Minutes
Salts with Anion
Bioquell
Evaporated Oxygen and Water
>99.9999%
Six
3-4 Hours
None
SteraMist (BIT™)
Evaporated Oxygen and Water
> 99.9999%
Six
15 Sec. SurfaceTreatment
None
Bottom Line
 There are challenges facing todays world
when it comes to infections and HAIs.
 Today’s terminal cleaning has failed for the
following reasons:
I. To costly
II. To time consuming
III. Leaves to many pathogens behind
IV. Does not clean all surfaces
V. Chemicals are dangerous to your
health
Bottom Line
 We can be successful in dealing with this
problem in a cost-effective way.
 Today’s standards need to be changed.
 Elbow grease works for gross cleaning.
 When it comes to terminal and maxi
cleaning no touch or mechanical has
been shown to be more effective.
Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29, 2013
Riyadh, Saudi Arabia
What is SteraMist?
What is TOMI’s BIT (SteraMist) Technology
 The SteraMist System is an
innovative, patented no-touch
technology utilizing a charged
hydrogen peroxide (H2O2) aerosol
to effectively address biodecontamination situations on
ALL microorganisms.
 This no-touch technology increases the oxidation
potential of a low concentration hydrogen peroxide
solution through conversion to the more oxidative
hydroxyl radical (OH) to achieve high level
decontamination.
Who is TOMI?
 TOMI is an International Decontamination Company.
 Publically listed on the United States Stock Exchange under the
symbol TOMZ.
 TOMI was incorporated in Florida in 1978.
 TOMI lectures internationally on infectious disease control.
Who is TOMI?
 Writes building protocols and infectious disease protocols for
healthcare systems.
 TOMI owns certain worldwide patents covering state of the art
decontamination technology.
 TOMI manufactures and services its technology along with the
direct servicing of healthcare systems, civil defenses, border
protection along with giving an additional asset to help protect
the most valuable assets of a country its homeland.
World Class Decontamination
TOMI Environmental Solutions, a full service international
decontamination company, offers a range of products and
services:
• EVS and Infection Control Training
• Building Health Protocols
• Building Health Assessment
What is TOMI’s BIT (SteraMist) Technology
 The plasma arc also imparts an electrostatic
charge to the aerosolized H2O2. This
improves the dispersive characteristics of
the fog by making the individual droplets
repel each other.
 Surface coverage the charged droplets are attracted to the
reversely charged items in the area being decontaminated
(wrap around phenomena).
 An activated hydrogen peroxide is created by passing a
mist of less than 8% H2O2 through a high voltage
plasma arc that has 17,000 volt potential. The process
is referred to as “activation” or “Ionized”, thus the
term: Activated Hydrogen Peroxide (AHP) or Ionized
Hydrogen Peroxide (IHP).
History of BIT (Binary Ionization Technology®)
What is Bit? Developed by a U.S. leading defense
company for the Dept. of Defense to answer a domestic
terrorist anthrax attack in 2001.
Since discovering BIT’s capability to eradicate anthrax
spores it has been designated as the quickest and most
potent technology for decontamination of air and
surfaces by current commercial and military uses.
Currently being used to sterilize un-manned space craft
prior to returning to U.S. Air Force Base.
SteraMist Plasma Systems is Used by the Military
 Successful use in the Biological
Combat Assessment System program
and the Airborne Warning and
Control System Program.
 Safe for human exposure with
minimal PPE.
 Safe for use on sensitive electronic
equipment.
 Highly effective against a wide range
of biological and chemical agents.
The Human Immune Response
Courtesy of the U.S. National Institutes of Health
The First Line of Defense
Courtesy of the U.S. National Institutes of Health
The Weapons of Choice
O2•−
H2O2
HO•
- superoxide
- hydrogen peroxide
- hydroxyl radical
Courtesy of the Lawrence Berkeley Laboratories
Activated Hydrogen Peroxide
BIT( Binary Ionization Technology)
 Used to create activated hydrogen peroxide, a very low
concentration of hydrogen peroxide and is turned into
ROS's that are activated/ionized
 Destroys proteins, lipids and carbohydrates on contact
(via oxidation)
 Results in killing bacteria, bacteria spores, viruses,
molds and mold spores, thus biological sterility
Binary Ionization Technology®
Binary Ionization Technology ®
Generation of Reactive Oxygen Species
(1) <8% Hydrogen
Peroxide Solution
(5) Plasma Arc
(6) Activated
Hydrogen Peroxide
Mist
Reactive Oxygen
Species
(2) Nozzle
(3) Hydrogen
Peroxide Mist
(4) Electrodes
How does it work?
 Destroys proteins, carbohydrates
and lipids on contact (via
oxidation) and killing biological
agents including bacteria,
bacteria spores, viruses, molds
and mold spores.
 Reacts with chemical bonds in
chemical agents destroying their
activity.
SteraMist (BIT™) in Action
How ROS Kill Bacteria
 ROS contact with the cell wall.
 As ROS molecules make contact with the cell
wall they react with double bonds in proteins
and fats, destroying their ability to maintain
shape.
 This literally creates tiny holes in the cell wall
and also makes enzymes and other proteins
non-functional.
 The physical and functional damage injures the
bacterium.
 Once cellular function and physical structures
are damaged, after awhile the cell dies.
SteraMist (BIT™) in Action
Destroying Chemicals
 As ROS molecules react with available reactive
bonds.
 This destroys the molecular bonds via oxidation.
 The chemical is then neutralized.
 The by-products of the activated hydrogen
peroxide are oxygen and water and
by-products are far safer to handle
than those left by conventional
methods.
SteraMist Also Reduces Chemical
& Biological Agents
 SteraMist (BIT) achieved a 97.7%
to 98.7% reduction in less than 30
seconds on three agents, HD
(Blister Agent Sulfur Mustard Gas),
GD (Nerve Agent Soman), and VX (
VX Nerve Gas).
 SteraMist (BIT) also achieved a
7.6 log reduction on weaponized
Anthrax spores.
Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29, 2013
Riyadh, Saudi Arabia
Efficacy Studies on SteraMist
BIT(SteraMist)In-House and Multiple Third Party Tests
1. University of South Florida Center for
Biological Defense.
2. Microbial Insight Inc. Rockford , TN.
3. l-3 Defense Company, San Diego, CA.
4. MICROBIOTEST a division of Microbac
Labs, Sterling, VA.
5. Beckman Coulter, Inc. Brea, CA.
6. ATS (EPA certified Testing Lab) Mlps,MN
BIT(SteraMist) Test Results
 Exposure times kills on contact
 Kills up to 9 logs
 Effective against bacteria, bacteria spores, viruses,
mold and mold spores
 Demonstrated direct killing of ESKAPE & Clostridium
difficile spores
BIT(SteraMist) In-house and
Multiple Third Party Tests, Cont.
 Exposure
times 15-90
seconds
 Killing up to 9
logs
 Effective
against mold,
spores, viruses
and bacteria
 Demonstrated
direct killing of
Clostridium
difficile spores
SteraMist Efficacy against Microbial Pathogens
Organism
Bacillus atrophaeus2
Bacillus stearothermophilus
Bacillus subtilis
Clostridium difficle
Escherichia coli
Pseudomonas aeruginosa
Salmonella choleraesuis
Serratia marcescens
Bacillus atrophaeus vegative
cells2
Staphylococcus aureus
Aspergillus species
Cladosporium species
Pencillium species
Stachybotrys chartarum3
Trichophyton mentagrophytes
Bacteriophase P22 HT 105
Human rhinovirus 164
Feline calicivirus5
Classification
Log reduction
Bacterial Spore
Bacterial Spore
Bacterial Spore
Bacterial Spore
Gram Negative Bacterial
Cells
Gram Negative Bacterial
Cells
Gram Negative Bacterial
Cells
Gram Negative Bacterial
Cells
Gram Positive Bacterial
Cells
Gram Positive Bacterial
Cells
Mold
Mold
Mold
Mold
Mold
Virus
Virus
Virus
>8.3
>6.3
>6.0
>5.0
>7.4
>8.4
>4.0
>6.0
>9.0
>7.4
>7.0
>7.0
>7.0
>7.0
>6.0
>5.6
>6.8
>5.5
1 Staphylococcus aureus is equivalent to MRSA (Methecillin Resistan Staphylococcus Aureus)
2 Bacillus atrophaeus is a surrogate for Bacillus anthracis (Anthrax)
3 S. chartarum, commonly referred to as "Black Mold", produces a toxin making people sick in contaminated
buildings
4 Human Influenza virus (Flu) surrogate
5 US EPA accepted human Norovirus surrogate
Chemical Efficacy
VX – Oily liquid that is very slow to evaporate. Exposure by inhalation,
ingestion, or skin contact.
Summary of Test Results – VX
Solution Concentration
Cycle Time
Average Agent Reduction
6%
30 sec
99.89%
6%
1 min
99.999%
6%
2 min
100.00%
6%
4 min
100.00%
Sulfur mustard (HD) – A vapor or oily, persistent on surfaces.
Summary of Test Results - HD
Solution Concentration
Average Agent
Cycle Time
Reduction
6%
90 sec
83.5%
6%
90 sec
84.7%
6%
<120 sec
98.1%
Results Reduction of Fungi Spores
SURFACE
CONDITI
ONS
ORGANISM
LOG
REDUCTI
ON
COMMENTS Testi
Exposure
ng
Duration
Lab
Glass
Aspergillus
Expansum
>7.0
(<15
seconds)
Two
(2)
Glass
Aspergillus
Restrictus
>7.0
(<15
seconds)
Two
(2)
Glass
Cladosporium
Cladosporiode
>7.0
Two
(<15 Seconds) (2)
Glass
Cladosporiuum
Herbarum
>6.0
(<15
seconds)
Two
(2)
Glass
Cladosporium
Sphaerosper
>7.0
(<15
seconds)
Two
(2)
Glass
Penicillium
Atramentosum
>7.0
(<15
seconds)
Two
(2)
Glass
Penicillum
Chrysogenum
>7.0
(<15
seconds)
Two
(2)
ATS LABS Sporicidal Field Test Results For EPA
Using BIT (SteraMist)
Project No. A12986—Protocol Number LCo02031412.
Test
Sample
Number of SubTable
3:
Test
Results
Substance
Dilution cultures
EXPOSED SHOW
GROWTH
Geobacillus
Stearothermophil
us
(ATCC 12980)
BIT Solution Ready to
Batch
Use
Number
110911
Geobacillus
Sterothermophilu
s
(ATCC 12980)
BIT Solution Ready to
Batch
Use
Number
110911
Geobacillus
Sterothermophilu
s
(ATCC 12980)
BIT Solution Ready to
Batch
Use
Number
110911
*number of carriers showing growth as test specimen
62
0
*
62
0
*
62
0
*
Environmental Micro Solution, S.A
 The following study in Panama was performed by
Environmental Micro-Solution under strict guidelines
and completely independent to all parties.
 Guidelines for Environmental Infection Control in
Health-Care Facilities.
 Recommendations of CDC and the Healthcare Infection
Control Practices Advisory Committee (HICPAC).
 U.S. Department of Health and Human Services.
 Centers for Disease Control and Prevention (CDC).
 Atlanta, GA 30333. 2003.
 Compendium of Methods for the Microbiological
Examination of Foods, Fourth Edition. Chapter 34.
Metropolitan Hospital Complejo
“Arnulfo Arias Madrid”, Panama
MUESTRA:
Interruptor de luz
LIGHT SWITCH
PARAMETROS
Klepsiella
pneumoniae
Acinetobacter
baumanii
Recuento de
Mesófilos Aerobios
PRE-STERAMIST
TREATMENT
POSTSTERAMIST
TREATMENT
Código 108
Código 115
REULTADOS
RESULTADOS ANTES
DESPUES
STERAMIST
STERAMIST
Ausencia/50
Ausencia/50 cm2
cm2
Ausencia/50
Ausencia/50 cm2
cm2
Método de
Método de Petrifilm
Petrifilm
<1 ufc/50
20ufc/50 cm2
cm2
Cleveland VA Hospital Study
 The results in the next four slides are
from an ongoing clinical trial from
Louis Stokes Cleveland VA Hospital,
Case Western Reserve Hospital under
the direction of Curtis Donskey, M.D.
 These are the finding that will be
submitted as a peer review article in a
major U.S. journal.
Insights and Solutions for Emerging
Viruses and Infection Diseases
August 29, 2013
Riyadh, Saudi Arabia
Spore Efficacy Predicts
Excellent Virus Efficacy
Environmental Pathogens
Order of Susceptibility to decontamination
Hardest
Difficulty to Kill/Inactivate
Spores
Easiest
Anthrax, C-diff
Myco-Bacteria
T.B.
Viruses (Small)
Non-Lipid, Non Encapsulated
Norovirus, Hep. A
Fungi
Bacteria (gram -)
Stachybotrys,
Cryptococcus Gattii
A.B., E. coli, Klebsiella
Viruses (Large)
Non-Encapsulated,
Hep. B
Bacteria (gram +)
MRSA, Clostridium
Viruses, Lipid,
(med size)
Enveloped, Herpes,
Roto
Designed To Meet Your Needs
 SteraMist SURFACE: The world’s only fully
portable point and pull decontamination system
that does not require the HVAC system to be
turned off.
Steramist's (BIT) Single Pod Surface
decontamination unit.
All surfaces including high touched
surfaces and electronic equipment
can be de-contaminated in a typical
hospital room in 7 minutes. There is
no dwell time thus treatment time
is short with a quick room turnover.
The space is safe to enter within 2-3
minutes after activated
aerosolization has been terminated.
A Game Changer!
Designed To Meet Your Needs
 SteraMist ENVIRONMENT: Consisting of 3 fixed pods. Each
pod can be placed in a position of advantage to treat
1,500 cubic feet or a total of 4,500 cubic feet for complete
air and surface decontamination.
 SteraMist ENVIRONMENT unit is
currently being used in the Hospital,
Clean Room, Allograft Companies,
Professional Remediation and
Pharmaceutical Industries.
SteraMist™ Complete is Part of a
Green Hospital Solution
SteraMist™ Complete by TOMI™ is the
only hospital green solution for an
environment free of ESKAPE,
MRSA, C.diff,Viruses, Mold Spores
and Bed Bugs
To save lives, the Hospitals of the
Future will have the patented
SteraMist™ Complete Binary
Ionization Technology®
as a part of their
Hospital Systems
TOMI Custom Design Team – Step 1
TOMI’s healthcare
architects and engineers
will work with the
Hospital’s design team to
incorporate the
SteraMist™
Complete System
to run side by side
the HVAC system
SteraMist™ Complete In Green
TOMI Custom Design Team – Step 2
TOMI’s healthcare
architects and
engineers will
work with the
Hospital’s design
team to
incorporate the
SteraMist™
System in the
Hospital interior
plan
POD
Technology
Patient Room
Operating Room
Additional Uses Also Include
 All discharge rooms
 Nursing and doctor lounges
 ID rooms
 Durable medical equipment
 Tissue banks
 Hallways
 Transplant rooms
 Cafeterias
 Wound centers
 Any other area or room with known air contamination
*SteraMist™ works in both positive and negative air flow rooms
Safe?*
• Dry treatment, produces No Residue
• Micron level decontamination
• Green
• Can be used on all surfaces:
• Medical equipment
• Computer keyboards
• Privacy curtains
• Remote controls
• Telephones
• Light switches
• Beds
• Toilets
• Bed side tables
• All surfaces including all high touch surfaces
*TOMI Certification Program focuses on the safe, efficient use of SteraMist.
TRAINING PROGRAMS
Current Uses of SteraMist
 U.S. Military (Various Contracts)
 Wayne Campbell, M.D. Head of I.D.-271 beds, MedStar Union Memorial
Hospital, Baltimore, Maryland
 Curtis Donskey, M.D.- 660 beds, Louis Stokes Cleveland VA Medical Center, 480
beds, St. Vincent’s Hospital, Cleveland, Ohio
 467 beds, Sinai Hospital of Baltimore, Maryland
 422 beds, Geisinger Medical Center, Danville, Pennsylvania
 703 beds, Baptist Hospital, Little Rock, Arkansas
 374 beds, St. Mary Medical Center in Langhorne, Pennsylvania, (Catholic Health
East)
 230 beds, North West Hospital, Randallstown, Maryland

41 acute care facilities-CSS Medical System of Panama, Medicare System of
Panama
 9 hospitals and 131 Medical Centers, Minister of Health Hospitals, Panama City,
Panama
 Civil Defense of Singapore
Current Uses of SteraMist, Cont.
Service Providers:
 Six-Log Corporation – Life Sciences,
Pharmacology, Cleanrooms, food
processing
 Control Contamination Systems – Life
Sciences, Offices, Vivarium's,
Pharmacology
 Rolyn Companies – Building remediation
and restoration company in 40 states (fire,
flood, mold)
 DKI Restoration First Responders ( Illinois
and South Carolina)
 Atlantic Restoration, Inc., Atlanta, Georgia
 Degmor New York - environmental
restoration company
Current Uses of SteraMist, Cont.
Pharmaceutical Industry
 Merck Pharmaceutical
 Pfizer Pharmaceutical
 RTI Biologics, Alachua, Florida
(Allograft Company)
Summary
 There are challenges facing todays
healthcare when it comes HAI’s.
 Today’s terminal cleaning has failed for the
following reasons:
I. To costly
II. To time consuming
III. leaves to many pathogens behind
IV. Does not clean all surfaces
V. Chemicals are dangerous to your
health
Conclusion
 We can be successful in dealing with this
problem in a COST effective way
 Today’s standards needs to be changed
 Elbow grease works for gross cleaning
 But when it comes to terminal and maxi
cleaning no touch or mechanical has been
shown to be more effective.
 What will work in the future and continue
to be cost effective?