Download SARS - IoM

SARS – Clearing the Air
Jerome J Schentag, PharmD
University at Buffalo
[email protected]
FailSafe Air Safety Systems Corp
[email protected]
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SARS

Transmission:
• Person to Person via Aerosol droplets
• Health care workers have high rates of
infection, especially ER, ICU, Procedures
• Up to 25% of SARS cases are HC
workers
• Masks prevent transmission if worn
continuously, and no hand to mouth
contact…
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SARS Inf Control- Points
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Spread from infected patients to health care
workers is a primary concern
Clearly, at least some Viral elements pass
through or around surgical masks, N95
Masks and HEPA filters
Personal Negative Pressure units extract
live virus from air and lower the inoculum.
With UV light concomitantly, the virus
extracted is completely eliminated.
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Problem: Making Preparations
for SARS’ Return
Vaccine Development
 More N-95 Masks; protective clothing
 Infected Patient Cohorting strategies
 More Isolation Rooms

• ER Patients
• Clinical presentation non-specific
– Personal Isolation for Unknown Respiratory
Infections, immediately upon presentation.
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Dual Approach to
decontamination and containment
Portable/Mobile Air
Scrubbing Systems
Bedside and Mobile
Isolation Systems
Model 77
Model 07
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Model 07 and 77: Personal
Isolation...Where You Need it
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Technical Specifications
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Air changes every six seconds
(with each breath a patient takes)
Continuous Removal of all viral particles from
air via HEPA/UV light
Greater than 100 feet per minute fume hood
velocity at curtains (varying with opening
during treatment)
Quiet Operation, soothing background whitenoise for patient comfort
Cleaned Air is vented back into the room
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Airborne Infection Control:
Filtration Technology
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Prefilter
– Dust, Pollen,
Smoke
– Vapor
Filter
– Fungi, Bacteria
– HEPA > 0.1 micron
@ 99.97% reduction
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Airborne Infection Control:
UV Technology
Kills active and
spore forms of
microbial growth
 UV on both sides
of the HEPA filter
 Cleans surfaces
 Cleans air

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SARS Infection ControlPoints

With personal Isolation Units:
•
•
•
•
UV light on both sides of HEPA filters
Air Changes at 700 CFM at every breath
Cleaned Air is returned to the Room
FDA equivalence 510K as Isolation Room
– Unlike Isolation Rooms, the entire room is not
contaminated when using these devices; All
viral particles ejected by the patient are
cleaned from the Room Air.
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Negative Pressure rooms..
With current
methods, the
entire room is
potentially
contaminated
by infectious
droplets
SARS Infection Control Points

Isolation Rooms: Problems
• Everything inside the room is contaminated
by droplets and aerosols
– Patient may take off mask, spreading droplets
– Cleaning is labor intensive and must cover a
large area
• Forces great reliance by Health Care
Workers on protective gear.
• Venting to outside, vents live virus
• Filters without UV are contaminated with
viral particles.
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Comparisons with
Negative Pressure Isolation Rooms
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Major planning & construction
efforts; esp. retrofitting
Cleaning and maintenance of a
wide area during & between
patients
Does not protect staff who must
treat patient, unless patient
always wears a mask
Requires complete protective
gear for staff & visitors
Room costs for construction
average $40,000 to $80,000 +
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No external venting or
construction required
Minimal cleaning protocol,
7000 hrs of continuous use
on HEPA & UV lights
Confines virus to area inside
the hood, protecting staff;
covers a break in mask use.
Does not require protective
gear to visit or enter room
FailSafe products average
$3,500 to $29,500
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Hospital wing or ER
77 Portable Isolation
07 Transportable Isolation
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Problem: Procedures
performed on SARS Patients
Intubation, bronchoscopy, airway
manipulation, cleaning.
 Use of O2 via mask or T-tubes

• Humidified air expelled and surface is
contaminated by droplets

Protection of Staff in a setting where
mask on the patient does not address
the source of contamination.
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Personal Isolation during
Procedures – CDC guidance
Perform aerosol-generating procedures in an airborne isolation environment
•If the patient is in an airborne isolation room, perform the procedure in that
environment.
•If an airborne isolation room is not available, the procedure should be performed
in a private room, away from other patients. If possible, steps should be taken to
increase air exchanges, create a negative pressure relative to the adjacent room or
hallway, and avoid recirculation of the room air.
•If recirculation of air from such rooms is unavoidable, the air should be passed
through a HEPA filter before recirculation as recommended for Mycobacterium
tuberculosis.
•Air cleaning devices such as portable HEPA filtration units may be used to
further reduce the concentration of contaminants in the air. Doors should be kept
closed except when entering or leaving the room, and entry and exit should be
minimized during the procedure.
Source:http://www.cdc.gov/ncidod/sars/aerosolinfectioncontrol.htm
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SARS – Prevention vs
Treatment
This device removes SARS and all
other viruses from the air
 It is not a treatment strategy (although
it cannot be bad to reduce the
airborne inoculum)
 This is a device to lessen spread of
SARS to other patients or to Medical
Staff. A containment system
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Air/Surface Purification
•Pre-Filter [Dust &
Vapor]
•HEPA [99.97%
>0.1micron]
•700 to 2000 CFM
•UV irradiation
•OZONE oxidation
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Problem: Decontamination
in SARS environments
Units and rooms (including isolation
areas) are surface contaminated with
viral particles, some of which appear to
remain infectious after 24-48 hrs
 Need coverage for inevitable breaks in
infection control or failures of masks
 Example: contaminated waiting room..
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Integrated Technology
PF
F
UVGI
Dust
Vapor *
Fungus
Bacteria
Virus
Odor*
OZONE
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Problem: Dealing with large
numbers of Infected Patients..
Not every patient needs personal
isolation if there are many patients with
the disease confined to an area.
 It is necessary to protect HCWs and the
other patients in settings of large
numbers of SARS cases
 Solution is an isolation wing or facility..
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Fast setup of an isolation
area for patients..
•Pre-Filter [Dust &
Vapor]
•HEPA [99.97%
>0.1micron]
•700 to 2000 CFM
•UV irradiation
•OZONE oxidation
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‘HOT’ Shelter
60 x 80 x 10 Tent
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Hospital Wing
Negative
Pressure
Room
HOT
Positive
Pressure
Room
Stk Rm
COLD
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Travel - related SARS

Medical need – Bioterrorism,TB,
Airborne Disease, SARS, and
spreading during flu season
First Line of defense is a mask on the
suspect patient.
Top-of-the-line defense is currently a
negative pressure room.
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A detained American Airlines jet sits on
the tarmac in a cargo area of San Jose
International Airport. (AP)
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Problem: Airplane landing
with several febrile patients..
Remove infected patients (07 transport
Units) and admit them under continuous
isolation (model 77 Units)
 Manage these patients in ICU or ward
under personal isolation units
 FASS units to decontaminate the
airplane with ozone
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Summary
 Cost
effective, proactive solution for hospitals
and other healthcare facilities to prevent the
spread of airborne infectious diseases
 Dual Use Technology (infection control and bioterrorism); Airborne pathogens in general
 Proven technologies – HEPA, UV and Ozone
 Several Patents; FDA approval in USA
 Equipment available in US, Canada, and (before
end of 2003) in China
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