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mobile air applied science inc “Break the Chain Of Infection”©

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1 mobile air applied science inc “Break the Chain Of Infection”©
ma2si mobile air applied science inc “Break the Chain Of Infection”© CLEAN AIR

2 Misconceptions About Quality Air Filtration
The air looks clear so it must be clean The air entering the room from the facility HVAC system is clean because your told so Increasing the room air exchange rates will solve all air quality issues by itself Where the filters are placed in the system flow is not critical to the air quality as it enters the room The facility has installed HVAC filtration at a central location, so it ought be delivering ultra clean air to the connected rooms downstream They always change out the dirty filters in a timely manner . ma2si mobile air applied science

3 mobile air applied science
What Is a Particle A particle is defined as a small object that behaves as a whole unit in terms of its transport and properties. Fine particles cover a range between .1 and 10,000 micrometers (µm) Ultrafine particles are sized between and .1 µm Airborne Particles range from to 10,000 µm Particles >50 µm or larger are visible to the eye ma2si mobile air applied science

4 Why Are Particles A Concern
Particles are easily inhaled thru the mouth or nose into the lungs Particles <100 µm can be inhaled into the lungs (clay, silt, fine sand, smog, spores, pollen, viruses, bacteria, tobacco smoke, nebulized drops, metal fumes) Ultrafine Particles <10 µm are capable of entering the deep part of the lungs (clay, silt, smog, viruses, bacteria, tobacco smoke, metal fumes) Ultrafine Particles then have the ability to enter the bloodstream Ultrafine Particles also have the unexplained ability to penetrate cells and impair cellular function National Institute of Environmental Health Sciences report ma2si mobile air applied science

5 Misconceptions About Air Quality
Particle Settling Velocities in Still Air Mean Particle Diameter (µm) Settling Velocity Skydiver ,920 feet per minute feet per minute feet per minute ft per minute inches per hour inches per hour inches pre day < negligible Smaller airborne particles in an occupied room will resist gravitational settling and will remain in suspension indefinitely ma2si mobile air applied science

6 Samplings Found In One Hospital HVAC System
On Anesthesia Diffuser Soot, clothing fiber, skin flakes, pollen, hyphae, fern spores, insect parts, paint spheres, plant parts, cosmetics, rust, ink, bird feather barbules Operating Room Wear metals, dog and cat dander, shoe wear, floor wear, cleaning residues On Sterile Core Diffuser Calcite, skin flakes, clothing fiber, natural minerals, paint spheres, starch, fern spores, pollen, hyphae, cosmetics, insect parts, fungal spores, plant parts, charred wood, bird feather barbules, rust, and ink  ma2si mobile air applied science

7 Where Do Room Contaminated Particulates Originate?
Persons entering the room (patient, staff, or visitor) - On their clothing and shoes - On their body - Dislodged from objects by air currents as they pass Naturedly suspended in the room airflow currents From the room HVAC air inlet registers Displaced from equipment, food trays, equipment, etc., brought into room From bedding, curtains, gowns, etc. Shedding from wall/ceiling surfaces Stirred from the floor while walking ma2si mobile air applied science

8 Sources of Wound Contamination & Routes of Transmission in the OR
Adjacent Areas Floor Personnel Ventilation Theater Air Clothing Mouth Hands Body Patient’s Skin Masks Gloves Body Incisions & Wound Drapes Instruments Wound Site ma2si mobile air applied science

9 Duct Wall Friction And Why It Impacts Air Quality Negatively
Wall friction pulls along the sides of the duct against airflow for the entire duct This causes contaminates from the room to stick to the inside duct walls Build-up occurs and eventually re-enters the room more contaminated Duct cleaning is in ineffective since it cannot reach every nook and seam Bacteria & virus pathogens are found in ducts at heath centers ma2si mobile air applied science

10 A Facility HVAC Normal Airflow Diagram
Air blower & filter system on the area roof Duct maze system with many twists, turns and jagged assembly joints Simple air outlet registers Room return air exhausts through ceiling Room doors left open that upsets airflow ma2si mobile air applied science

11 mobile air applied science
Improved Facility Air Quality Using HEPA Filtration Located at Room Interface Takes the duct contaminates out of the equation Places room air exhaust as far from air intake as possible Utilizes “Cleanroom” air movement principals - Enter from the ceiling and exit near the floor Each room is a island unto itself and needs to be individually addressed ma2si mobile air applied science

12 Particles Released from People
Particles Released Human Activity Per Minute (>0.3µ) Sitting at Rest ,000 Standing Still ,000 Neck Rotation ,100,000 Body Twisting ,000,000 Body Bending ,000,000 Stepping ,000 Standing & Sitting ,400,000 Knee Bending ,200,000 Arm Motion ,700,000 Camfil Farr Literature ma2si mobile air applied science

13 Postoperative Sepsis in the United States
Sepsis after elective surgery imposes both significant clinical and resource utilization burdens Studies demonstrate sepsis increased significantly over last decade As payers move to performance-based reimbursement, sepsis prevention becomes financially prudent A 3.3-fold increase in hospital cost in cases with postoperative sepsis went from $17,229 (median) to $57,032 Postoperative Sepsis in the United States Todd R. Vogel, MD, MPH; Viktor Y. Dombrovskiy, MD, PhD, MPH; Jeffrey L. Carson, MD; Alan M. Graham, MD; Stephen F. Lowry, MD Authors and Disclosures Posted: 12/13/2010; Annals of Surgery. 2010;252(6):  © 2010 Lippincott Williams & Wilkins ma2si mobile air applied science

14 mobile air applied science
Healthcare Acquired Infections (HAIs) Linked to Increased ICU Mortality 5% of hospital patients will develop an HAI; that number increases to 30% for patients in ICUs The added risk of infection to the antimicrobial resistance of pneumonia in the ICU was 20% Healthcare-associated pneumonia doubles the risk for death and increases the length of stay "Prevention of health-care-related infections needs to be reasserted and emphasized as an absolute priority." Healthcare Acquired Infections Linked to Increased ICU Mortality News Author: Laurie Barclay, MD CME Author: Penny Murata, MD In intensive care units in Europe, bloodstream infections occur in 3% and pneumonia occurs in 6.2% of patients with more than a 2-day stay, according to the European Centre for Disease Prevention and Control. In the January 2009 issue of Intensive Care Medicine, Hanberger and colleagues reported that patients in the intensive care unit have a high risk for infection with pathogens resistant to antibiotics. This prospective cohort study evaluates the association between bloodstream infection and pneumonia and the risks for mortality and extended length of stay in intensive care units. ma2si mobile air applied science

15 Breaking The Chain Of Infection© Follow the path
Surface Contamination From furniture & equip. surfaces Off dirty objects carried in Brought in by patients, staff, or visitors Hands touching dirty surfaces Off people’s clothing Airborne Contamination From facility’s HVAC system Suspended in air currents Blown off dirty surfaces Created by people movement From personnel in room ma2si mobile air applied science

16 The Incidence and Control of Airborne Healthcare Infection is Relevant
Abstracts Highlight the Reduction of Infectious Disease Using HEPA Filter Technology MRSA, now becoming a deadly visitor to healthcare facilities, can be greatly diminished by portable HEPA filtration (Department of Microbiology, Nottingham City Hospital, UK.) Establish effective management over spread of aspergillosis for severely immunocompromised patients using flexible (HEPA based) aerial control measures (Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263) A clear, demonstrable, statistically significant reduction in microbial organisms followed the activation of an air filtration system in a hospital ward (Glasgow Caledonian University, Glasgow, UK) One Virus Particle Is Enough To Cause Infectious Disease ScienceDaily (Mar. 14, 2009) — Can exposure to a single virus particle lead to infection or disease? Until now, solid proof has been lacking. Experimental research with insect larvae at Wageningen University and Simon Fraser University in Canada has shown that one virus particle is theoretically enough to cause infection and subsequent disease. ma2si mobile air applied science * The full abstracts for these and other studies are available

17 Recent Reports of Airborne Spread of Disease and Infection
Influenza & Respiratory Syncytial Virus Spread by Infectious Airborne Particles (NIH/IDSA Vol 50 ISSN Mar) Airborne Spread of Clostridium Difficile (Clin Infec Dis, Lindsey, et al, 2010 Feb) Airborne Transmission of DS/DR TB Fueled by Risk of HIV (NIH/IDSA Vol 50 Sup 3 ISSN: May) Growing Evidence of Linking Air Pollution with Cardiovascular Disease (American Heart Assoc, Circulation 2010 May) Potential for Airborne Dispersal of C. Difficile from Symptomatic Patients (Best et al, IDSA Vol 50 ISSN: Jun) Significance of Airborne Transmission of MRSA in an Otolaryngology- Head & Neck Surgery Unit by Teeruo Shiomori, et al, Head Neck Surg. 2010; 127: ma2si mobile air applied science

18 Alert! Another New “Superbug”
A new “Superbug” (NDM-1) that is resistant to even the most powerful antibiotics has entered hospitals worldwide NDM-1 enzyme has travelled back with patients visiting who went abroad to countries like India and Pakistan NDM-1 can exist inside different bacteria (E. coli) NDM-1 Infections have already been passed from patient to patient in UK hospitals. Recommendation: “Patient Isolation” International researchers say that NDM-1 could “produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat” Environmental Protection – Contending with Waterborne and Airborne Pathogens, Kris Ellis, Infection Control Technology, April 2006 ma2si mobile air applied science

19 The Numbers Are Alarming
In the US there were 14,561 AIDs deaths in 2007 However … In US hospitals overall, HAI’s account for an estimated 2 million infections and 99,000 deaths each year at a total cost of over $30+ Billion dollars. 22% or 440,000 are surgical site infections (SSI) 15% or 300,000 are lung infections (Pneumonia) CDC Stats ma2si mobile air applied science

20 * Viruses tend to clump together forming larger contaminants
Viruses Facts Influenza virus particles are about 0.12 micron in size* Airborne Influenza viruses are usually transmitted by droplet transmission The average droplet nucleus is 5-10 microns The average size sneeze/cough droplet is over 10 microns Research has shown that one virus particle is theoretically enough to cause infection * Viruses tend to clump together forming larger contaminants ma2si mobile air applied science

21 A Few of Today’s Airborne Virus Droplets
Pulmonary Tuberculosis (TB) Chicken Pox and Measles Disseminated Zoster Small Pox Severe Acute Respiratory Syndrome (SARS) Swine Flues & Avian Flues Viral Hepatitis (kills >1 million annually) Environmental Protection – Contending with Waterborne and Airborne Pathogens, Kris Ellis, Infection Control Technology, April 2006 ma2si mobile air applied science

22 A Bacteria To Be Very Concerned About In Clean Air Filtration Media
Pseudomonas Aeruginosa Free-living bacterium, commonly found in soil and water Occurs as a nosocomial pathogen Antibiotic resistance is increasing in clinical isolates An opportunistic & virulent pathogen Studies show Bacterial growth thru the filtration media in six months even in low humidly Environmental Protection – Contending with Waterborne and Airborne Pathogens, Kris Ellis, Infection Control Technology, April 2006 ma2si mobile air applied science

23 Connecting Airborne & Blood Borne Infection Prevention
Biofilm-forming bacteria, different from planktonic bacteria, needs 1,000 times more antimicrobial agent to destroy The best practice is to reduce migration of bacteria to the open wound before the protective biofilm completes The best solution in controlling open wound infection requires both best Practice and best product combination Protect open wounds until the biofilm completely forms by substantially reducing the number of airborne bacteria ma2si mobile air applied science

24 The Risk of Surgical Site Infection
Defining the risk of Surgical site Infection (all surgeries) Level of Contamination Risk Clean < 2 % Clean Contaminated < 10 % Contaminated ≈ 20 % Dirty ≈ 40 % Cruse, PJ and Foord, R. The epidemiology of wound infection. A ten year prospective study of 62,939 wounds. Surg. Clin. Am (1980) 60:27-40 ma2si mobile air applied science

25 Today’s Surgery Suites Are Contaminated In Many Ways
Duct contaminants increase over time due to standard building HVAC design verses cleanroom design filter placement More surgery procedures are moving to clinics and outpatient surgery centers designed with restrictive building HVAC systems The near-open wound site air is often contaminated with over 600,000 particles per ft3 by HVAC, staff and equipment Laser & cautery fumes carry toxic and infectious contaminants ma2si mobile air applied science

26 How Do We Change This Picture and What Are the Results?
Remove the invisible airborne pathogens/contaminants that contribute to the high infection rates Create cleaner patient and staff environments transparently and targeted when and where needed Reduce the infection incidence and resulting cost of hospital acquired infections from air contribution Decrease patient suffering and high cost of treatment Introduce “Focused Clean Air Zone” applications ma2si mobile air applied science

27 The Science of Air Contamination Control Can Effectly Reduce Infections
HEPA filtration can trap viral and bacterial pathogens The use of a Focused Clean Air Zone© has been shown to reduce infections in surgery Over 475 operations completed in a surgical suite over three years with < .01% infection rate* Superior reduction of micro-organisms can be achieved Upgrade existing facilities; converting most any space to a cleaner and safer environment * Both complex and routine plastic and reconstructive surgeries From the white paper authored by Russ Crutcher, “MA2SI Focused Clean Air In Surgical, Laboratory and Industrial Environments” 2/10/2009 ma2si mobile air applied science

28 How HEPA Filters Function
The four processes of the HEPA filter media to capture particulates: Sieving - 2 micron micron Sieving, the most common mechanism in filtration Inertial Impaction - 1 micron – .02 micron Inertia works on large, heavy particles suspended in the air stream Interception micron – .02 micron The mid-range size that are not quite large enough to have inertia and not small enough to diffuse within the flow stream Diffusion - .3 micron – .01 micron Diffusion works on the smallest particles that disperse within the flow stream This information is from Donaldson Filter paper on “How HEPA filter works” ma2si mobile air applied science

29 mobile air applied science
Cleanroom Proven Design Principals That Transfer To Healthcare Applications Placing of final filtration at room air discharge Utilizing certified HEPA filter with 100% gasket seal technology Regulating airflow velocity rates creating smooth, near- laminar airflow Creating proven room airflow directional dynamics with incoming and exhaust strategic placement Controlling air volume to minimize external interferences Per Federal Cleanroom Design and Operation 209E ma2si mobile air applied science

30 What Can This Technology Do?
Reduce new construction expenses for facility HVAC systems both new and remodel Provide cost effective airborne environmental upgrades within existing facilities Create immediate surge capacity for onsite and offsite surgery, patient isolation and staff safety Upgrade hospital and private pharmacies to meet USP797 requirements ma2si mobile air applied science

31 Welcome To Clean Air World From Mobile Air Applied Science
FDA accepted 1st mobile air filtration system Mobile isolation systems for quick placement in any potential setting; “Clean Air Anywhere” Enhance site-specific HVAC conditions with strategic installation of exclusive high-efficiency filtered environments Suites of follow-on devices to address specific applications in the operating theater, patient isolation, staff safety and more ma2si mobile air applied science

32 Mobile Air Applied Science’s Evidence Based Solutions
ma2si mobile air applied science

33 The Mobile M100 Device Solution
A self-contained mobile air filtration solution that provides immediate infection and airborne contamination control wherever it’s needed ma2si mobile air applied science

34 M100 Flexibility And Airflow Output
90 FPM Velocity 120 FPM Velocity M100 Adjustable Positions Airflow Directional Operation “Focused Clean Air Zone” ma2si mobile air applied science

35 mobile air applied science
M100 – What Does It Achieve? Recirculates filtered room air at rates from 100 to 480 CFM Totally adjustable hood projects “Focused Clean Air Zone”© onto the desired target Pulls & collects pathogens, odors & VOCs from lower worksite level Provides non-shadowing and variable intensity lighting Plug it in, turn it on and in minutes you have a “Focused Clean Air Zone©” ma2si mobile air applied science

36 Single Patient Isolation Versatility
Positive Pressure Configuration Negative Pressure Configuration Both patient isolation configurations from a single unit ma2si mobile air applied science

37 How Does A Single Patient
Isolation System Work? The mobile M100 adapts to the patient isolation system to provide either a positive pressure (PP) or a negative pressure (NP) Isolation chamber unit ma2si mobile air applied science

38 PCF322 - Ceiling Room Incoming
Air Filtration Devices In A Clinic Surgery Room (Red) Primary surgical site HEPA filtration creating the “Focused Clean Air Zone©” (Blue) Secondary HEPA filtration operated 24/7 to maintain maximum room air quality at all times (< 4,000 particles per ft3) Note: Outside of room over (1m PCF) ma2si mobile air applied science

39 PCF322 – Room Airflow Dynamics
“Focused Clean Air Zone” envelope gently projected downward B. Extension of airflow downward until surface is encountered C. Airflow outward after surface is encountered thereby gently moving room air outward ma2si mobile air applied science

40 Purging Room With Clean Filtered Air
A. Use clean filtered air to push contaminated air out B. Airflow moves from the inlet filtered air register toward the exhaust register creating a cleaner environment C. The exhaust outlet is placed at the opposite side of the room to achieve best possible impact Optimizing the placement of the PCF series, in relation to exhaust, creates better room airflow dynamics and increased effective room contaminate reduction ma2si mobile air applied science Bill, I don’t like either of these two drawing showing the exhaust in the ceiling especially with the next slide. I realize retrofit often runs into this situation.

41 Maximizing Airflow Dynamics & Creating Positive Pressure in Room
PCF series placement is critical for very best airflow dynamics while keeping the contaminates near floor level Maintain the airflow in this manner provides maximum room clean air movement, once contaminated, below patient and staff level Balance the room positive pressurization by restricting the exhaust air while maintaining sufficient air changes Install a pressure air pressure meter outside near the entrance to assure room pressurization ma2si mobile air applied science Placement of the PCF-322 is critical to assure the best possible airflow throughout the room to keep the contaminated air near the floor level. The air outlet register when positioned across the room and near the doorway keeps the airflow going in the best possible direction so as to purge the room and keep the room clean where normally a patient would be placed. Convert this room to a positive pressurized room by restricting the amount of air that passes out of the room but not closing it off. A manometer to monitor the pressure differential should be installed near the room entrance so the staff can be confident the room air supply is sufficient.

42 Ineffective Airflow Dynamics Within Room
The airflow dynamics in this example is most undesirable Clean air coming into the room is pulled directly toward the exhaust register thereby creating unprotected zones in room Little prospect exists for purging many contaminates from the room Creating a positively pressurized room is nearly impossible with clean air throughout ma2si mobile air applied science

43 PCF322/422 – What Do They Provide? All at a Very Reasonable Price
Replaces incoming HVAC air register with HEPA filtered air system Produces a “Focused Clean Air Zone©” projection onto the worksite gently pushing contaminants down to the floor Produces regulated amount HEPA clean air entering the room assuring control of the number of air exchanges per hour Positively pressurizes a site by limiting the exhaust rate will keep out contaminants entering the room during access All at a Very Reasonable Price ma2si mobile air applied science

44 Healthcare Applications Needing Clean Air
Clean Air Clean Air Clean Air Clean Air Surgery Emergency Intensive Care Surge Capacity Burn Units Patient Isolation Pharmacy Immune Suppressed

45 Disaster Preparedness, Bio/Pharma, Research and Staff Safety
Surge Isolation/ Quarantine Research Laboratories Secure Environments Surgical Procedures Pharmaceutical Admixing Capture Airborne Pathogens ma2si mobile air applied science

46 Impacting Healthcare Critical Areas
Surgery Rooms Clean the airborne environment surrounding the wound site Push contaminated air away from and below the OR table Reduce room environmental contamination Pressurize the OR to keep contaminates out & fix exchange rate Emergency Rooms Precautionary isolation for undiagnosed Infection or disease Open wound and staff protection ma2si mobile air applied science

47 Additional Healthcare Applications
Intensive Care Reduce infections and length of stay and provide greater patient and staff protection Surge Capacity Add patient isolation (negative/positive) and portable surgical zones in-house or elsewhere in the community quickly and at low cost ma2si mobile air applied science

48 MA2SI Technology Positively Defends …
Open burn wounds from infections with minimal drying Patients suffering from respiratory distress Neonates once they’ve left the incubator ERs by isolating those suspected of being contagious Pharmacies during admixture of drugs & nutritional fluids Laboratory specimens and those who handle them Professional staff during performance of their duties Facility HVAC systems from airborne pathogens ma2si mobile air applied science

49 mobile air applied science
Universal Benefits Simple and affordable implementation Easily transported to wherever needed Counteracts the high costs associated with infections Proven reliability you can count on Fewer infections and less patient trauma ma2si mobile air applied science

50 Facility Construction Solutions
Simplify design & construction with effective clean air systems Upgrade facilities to create increased capability for patient care Install clean air environments anywhere they are needed Increase surge capacity quickly and at low cost Add safety and airborne infection control to new and existing facilities ma2si mobile air applied science

51 The Real World of Dr. Partington
Nationally recognized plastic and reconstructive surgeon Over 475 nearly infection free (<1%) surgeries using a combination of two ma2si clean air systems Captures cauterizing smoke particulates and odors with post- wound site system ma2si mobile air applied science

52 mobile air applied science
Cataract Surgery A low velocity ultra clean air zone that does not produce dry-eye conditions during surgery ma2si mobile air applied science

53 Surgical Supplies Storage Room
Providing supply room with ultra-clean air reduces contaminant buildup on surgical supplies Greatly reduces the transfer of collected contaminates into surgical suite ma2si mobile air applied science

54 Pharmaceutical Research Lab
Creates secure laboratory and pharmacy environments easily and at low cost (USP-797) ma2si mobile air applied science

55 Physicians, Examination & Clinic Rooms
Dramatically reduces patient and provider chemical sensitivity reactions Provides a clean environment for office surgeries Removes toxic and potentially infectious plumes during electrocautery or laser surgery ma2si mobile air applied science

56 Premier US Particulate Analytical Lab
World recognized authority in particulate identification Verifiable contamination free work environment MA2SI E100 has worked flawlessly for eight years ma2si mobile air applied science

57 What Is Your Strategy For…
Airborne related infection reduction in your facility? Staff and patient protection from spread of infections? Overflow during local and national emergencies? Protecting staff and facility’s air handling systems? Quickly adding low cost isolation capacity during local and national disasters Moving operations offsite successfully when needed? ma2si mobile air applied science

58 Clean Air Devices That Can “Break The Chain Of Infection”©
Mobile Air Applied Science, Inc. Clean Air Devices That Can “Break The Chain Of Infection”© ma2si mobile air applied science

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