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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?