1. Contact Information:
Sodexo John LaRochelle Head of Innovation, North America Lighthouse Healthcare Partners – Supports all Innovations reviewed Christian Manchester Vice President
Welcome to Sodexo’s Environmental Infection Prevention presentation.
Each of you participates in providing Sodexo’s Environmental Infection Prevention solutions to our clients. As a result, you play a critical role in the ultimate prevention of infectious diseases in our society. You are on the front line of infection prevention.
This presentation is designed to make you aware of how dangerous healthcare acquired infections are; how easily these infections are being spread; and how we at Sodexo are doing our part to make our world a stronger and safer place in which to live.

2. Before Cleaning After Cleaning REALITY CHECK VISUAL vs. ACTUAL CLEAN
For years, hospital housekeepers have been taught that “visually clean” is acceptable.
So, what’s the difference between “visually clean” and “actually clean”?
This first image depicts a hospital room surface before manual cleaning.
And the second image depicts a surface after cleaning, see the difference we can very easily make the problem worse instead of better by spreading harmful pathogens
so perhaps it time for a reality check about infections and about how we clan hospitals
Before Cleaning
After Cleaning

3. People = Time, competency, accountability
Challenges With Disinfection – HITS Conference 2017
People, process and technologies used for surface disinfection are broken:
People = Time, competency, accountability
Process = Procedures, clean vs disinfection
Technology = Outdated & different standards

4. Odds of a plane crash 1 in 11 million
STATISTICS
Odds of a plane crash 1 in 11 million
Odds of hospital infection 1 in 25
Today’s airline traveler has a 1 in 11 million chance of getting in a plane crash. By contrast, today’s hospital patient has a 1 in 25 chance of getting an infection during their hospital stay.
Think about that for a second. When a plane crashes it’s a big deal.
NOTE:
Re-record. John says “…1 in 11 million chances…” and it should be “…1 in 11 million chance…”
: “People freak out” is still in there.
KEY TAKEAWAYS
1 You have a great chance of getting an HAI than being in a plane crash
2 1 in 25 patients compared to 1 in 1 million airplane
3 there is 0 tolerance for plane crashes, but HAI are tolerated
4 MRSA lives on surfaces up to 9 month
5 C. dif lives on surfaces up to 5 moths
6 Norovirus lives on a surface up to 3 weeks

5. during their hospital stay.
STATISTICS
Ever Year 75,000 people DIE from infections and 750,000 people are INFECTED
during their hospital stay.
When we think of infections, we also think of hospitals: the one place that’s supposed to make us better when we have an infection – right?
The truth is that every year, 75,000 patients die from infections they acquire at a hospital. And 750,000 people every year are infected during their hospital stay.
Why aren’t these numbers alarming to us? Perhaps if we thought of them differently. To put them in perspective let me give you an analogy.
NOTE:
Slide 4: Re-record. The various “pieces” aren’t pieced together well, and John sort of mangles the first sentence. (Also, I would change “give you an analogy” to “give you a comparison” – because the airplane thing isn’t an analogy; it’s a comparison.
Key Take Away
During annual hospital stays
75K Die of infections
750K are infected

6. Real PEOPLE  Real LIVES  Real IMPACT
THE WAR ON PATHOGENS
Real PEOPLE  Real LIVES  Real IMPACT
Pathogens world wide threaten everyone . Infections such as MRSA and C.diff are causing death and suffering every day. It is estimated that up to 200,000 people die world wide each year of infections.

7. And, of course, none of these pathogens can be seen
And, of course, none of these pathogens can be seen. So we can be lulled into a false sense of security. If a surface looks clean, the industry has been taught that it is acceptable.
But as we now know, looks can be deceiving. These surfaces can not only contain dangerous pathogens; they can contain pathogens that can be lethal to humans.
That is why we need to deliver precise solutions.

8. STUDY OF SURFACES CLEANED Why is Hand Hygiene So Important?
49%
Cleaned
51% Missed 8

9. PATHOGEN LIFESPAN ON SURFACES9
months 7
months
> 5
months 4
months 3
weeks
days -
weeks
“And, as we’ve seen, infectious pathogens are even more challenging because of how long they live on surfaces: from days or weeks – to four, five – even nine months or more.”
MRSA
Norovirus
Staphy-lococci
C. Diff
VRE
SARS, HIV H1N1

10. BioFilm on Dry Surfaces

11. BACTERIA RESIDE ON THE 6 OBJECTS IN ROOM (CFU/100 cm2)
BIOBURDEN
<500
>8000
Percentage of Population with HAIs
A CDC study showed us as the number of bacteria increased on a surface, so does the likelihood of an infection.
KEY TAKEAWAYS
1 The number of bacteria that increases on a surface so the increase in the likelihood of an infection
HAI ACQUISITION DURING
PATIENT STAY
21%
13% 9% 7%
BACTERIA RESIDE ON THE 6 OBJECTS IN ROOM (CFU/100 cm2)

12. #1 PATIENT FEAR

13. HAI Rates Are Becoming a Social Media Issue
Hospital Compare
Consumer Reports
Hospital Safety Score
Yelp 13

14. COST OF INFECTIONS AND IMPACT ON US HEALTHCARE FACILITIES
It costs healthcare facilitates in the us along around 40 billion dollars a year

15. Disinfectant Regulatory Challenge
By law, all applicable label instructions on an EPA-registered disinfectant must be followed.
If the user selects contact times that differ from those on the EPA-registered product label, the user assumes liability from any injuries resulting from off-label use and is subject to enforcement action under FIFRA.

16. DISINFECTANTS DO NOT MEET EPA REGULATIONS
98% Failed Contact Time
Further testing of disinfectants shows a 98% failure rate to EPA required contact time, as seen on the chart on the right.
The Chart on the left demonstrates a 33% failure rate of the amount of disinfectant present in solution. As highlighted on the Boyce study
Some of the failure points are
Dispenser broken in-operatable Water Pressure/Quality
10 Minute contact time required

17. DISINFECTANT EFFICACY
This Study by Dr Boyce from Yale Medical shows how many disinfectants can become ineffective.
As you can see when Microfiber or cotton mops and cloths are put into a disinfectant solution, that solution quickly becomes ineffective. And in some cases the amount of disinfectant goes to zero.
John M. Boyce, Linda Sullivan, Arica Booker and James Baker (2016). Quaternary Ammonium Disinfectant Issues Encountered in an
Environmental Services Department. Infection Control & Hospital Epidemiology, 37, pp doi: /ice

18. PROBLEM POTENTIAL CROSS CONTAMINATION
Another surface issue is cross contamination This second study by the university of Arizona shows that mops and cloths can contain pathogens even after laundering.

19. PROBLEM
In validation of the Arizona study, we conducted our own testing and here are the actual examples of pathogens that were left on laundered mops and cloths.

20. MICROFIBER MOP COMPARISON
CHALLENGE
MICROFIBER MOP COMPARISON
The challenge with microfiber is that it’s a very effective tool at removing pathogens, however it does not like letting go of the pathogens during the laundering process. In addition, microfibers damage easily as shown in this picture.
KEY TAKEAWAYS
1 Microfibers do no let go of pathogens during the laundering process
Microfibers are easily damaged during laundering process
Figure 1 Shows a new unlaundered microfiber flat mop photographed at 1000x.
Figure 2 Also at 1000x, shows a re-laundered microfiber flat mop. In comparison, the fibers appear melted, have lost their elasticity and absorbency and lack the capacity to grab particulate matter.

21. Floors Contamination is leading to HAIs
Key Findings
Pathogens on the floor quickly patient areas
Pathogens spread outside the patient room
Most facilities do not clean their floors with a disinfecting solution
C.Diff rooms are not being clean with a sporicidal
BruTab and Defender are solutions
Pathogens are escaping the patient room.
Tracing where traffic exists thoughout the unit

22. ✗ ✗ SPORICIDAL PROBLEM Bleach Hydrogen Proxide/Peroxyacetic Acid
Employee Injuries
Negative Patient Satisfaction
Damage to medical equipment
No floor care option (OR/ED/Isolation)
EPA Changes
Not effective on Biofilm
Employee Injuries (Union Activity)
Negative Patient Satisfaction
Not compatible with metal surfaces
No floor care option (OR/ED/Isolation)
30% fail rate in-use solution
Not shown to be effective on Biofilm
Currently, most facilities use either bleach or a combination of hydrogen peroxide and peroxyacetic acid, which you may know as Oxycide. Both these products are extremely caustic and damaging to people, equipment, and surfaces.

23. Surface Damage from Bleach
Before
After
Is creating the equivalency of wood
Its becoming uncleanbale, and aiding to Pathogen growth.
Drill down on Damage from repetitive cleaning with chlorine which causes damage to surfaces
Bleach use Damages Surfaces
Creates an Unclean-able Surface
Accelerates Pathogen Growth
Failure to Disinfectant Surface

24. Competency of HCW Hand Washing
35%
65%
45%
55%
80%
20% 2%
98%

25. CMS – Federal Regulatory Compliance
Poor hand hygiene procedures are leading to infections and lawsuits against noncompliance:
“One physician told investigators she did not wash her hands between treating patients.”
CMS stipulates that hospitals must be able to:
The SureWash® Advantage
Yes
The only technology to prove documented training and competency
Clinically proven to improve and increase competency and compliance
“…provide evidence [of] documented training and competency to perform proper hand hygiene”
“…provide evidence [of] routine audits of adherence to hand hygiene policies”

26. REGULATORS ARE BEGINNING TO CRACK DOWN
Source: CMS data on HospitalInspections.org.
Note: At this time, this data is based on a small sampling of CMS violations but CMS and the Association of Health Care Journalists are working to publish all violations in the future.

27. GLOBAL PARTNERS & RESOURCES
UV-C – Canada & Russia
SureWash - Ireland
Fortunately that’s where Sodexo’s resources and our global partnerships can help alleviate those concerns.
We have partnered with “best in class” thought leaders throughout the world like:
Xenex, OxivirTB, SureWash, Medentech, American Green as well as the Naval Research Lab
to deliver a bundled approach to fight infections
Oxivir - Canada
Medentech - Ireland
Naval Research Lab - USA
Microfiber - China

28. PROTECTA BUNDLED SOLUTION
PATIENT SATISFACTION
Sodexo’s unique bundled approach to environmental infection prevention is strategically designed to combat infections in the hospital setting by providing our people with the tools – processes and technologies – they need to succeed.
Our solutions begin with the awareness and understanding of how pathogens travel through and impact the environment. Then, education and communication to change behaviors about using the proper processes and technologies to remove pathogens from surfaces, hands, water and air.
Understanding how each of these four areas impacts environmental cleanliness is critical. Surface and hand are the areas most affected by human interaction, and education to change behaviors focuses on people, process and technology.
And, Sodexo’s water and air can be controlled by technology obtained from our global partnerships.
So – what are the results achieved by Sodexo’s bundled approach?
NOTE:
Slide 31: Re-record – at least the fourth and fifth sentences – particularly the fifth.
KEY TAKEAWAYS
1 Sodexo’s bundled approach to IP to combat infection in hospitals -provided sodexo employees people tools, processes and technology
2 you have to understand how pathogens travel through and impact environment
3 Education and communication is needed to change the culture and behaviors
SURFACE
HAND
AIR
WATER
WASTE

29.    SODEXO DELIVERS SOLUTIONS… PROCESSES TECHNOLOGY PEOPLE
The Sodexo solution brings the capabilities of our global technology to support our people and processes – to help you succeed with Environmental Infection Prevention
Here’s how it all comes together, and how our bundled solution – people, processes and technology – has achieved tangible results.
PROCESSES 
TECHNOLOGY
PEOPLE  

30. Cleaners are the Heroes of Environmental Infection Prevention
PEOPLE…
Cleaners are the Heroes of Environmental Infection Prevention
Sodexo’s environmental services staff are the unsung heroes of environmental infection prevention. Their work to ensure the elimination of infections from hands, surfaces, air and water is every bit as important as the work of surgeons, doctors and nurses. And the ongoing education and training of environmental services staff is critically important to their continued high performance.
KEY TAKEAWAYS
1 The proper cleaning and processes of the environmental services staff is as important to saving a patients life as a surgeon, doctor or nurse

31. NC health System 70% Reduction
6 Hospital System
1,283 beds
Infection rates for C.diff historically at national average
We started at Cone Health a little early – in May A year down the line we have seen some real benefits.
Our client tells us that in 2017 so far, they have seen cost reduction & avoidance of over $850,000 from reduced length of stay, treatment costs, and penalties.

32. FL health System 71% Reduction
8 hospitals in Florida, including acute, Women’s and Children’s
2000+ total beds
100,000+ annual discharges
Over 3 million square feet of facility space
We started at Cone Health a little early – in May A year down the line we have seen some real benefits.
Our client tells us that in 2017 so far, they have seen cost reduction & avoidance of over $850,000 from reduced length of stay, treatment costs, and penalties.

33. Trust Single Use Microfiber
Foundational Platform
Trust Single Use Microfiber
Oxivir
Defender
SureWash
Black Light Audit
As you can see, we face many challenges preventing infections on surfaces in the hospital space. Let’s review the solutions

34. Oxivir DISINFECTANT WIPES
1 minute contact time
Safe on people and surfaces no VOC’s
No PPE required
Helps to Remove Biofilm
Reduce HAIs
Low, pleasant odor
Environmentally responsible
Effective against norovirus
First - OxivirTB
1 minute contact time (assures regulatory compliance)
Safe on people and surfaces no VOC’s (No required PPE)
Only EPA approved soft Surface disinfectant (cubical curtains, carpet…)
Reduced the HAI rate for C. diff, MRSA and VRE, by 23%
Helps to Remove Biofilm

35. RESULTS AHP Outperformed Quats in 3 key areas:
Oxivir – A Proven Solution to Reduce HAIs
John M. Boyce, MD Presented at APIC 2016
Quat disinfectant (+bleach for C. diff isolation rooms) compared to 0.5% AHP disinfectant (for standard and C. diff isolation rooms)
AJIC 2016;44(6)Suppl:S16
In a year-long study at Yale Medical Center by Dr. Boyce, this product produced a 23% reduction in HAIs related to C Diff, MRSA and VRE.
AHP Outperformed Quats in 3 key areas:
Reduced the HAI rate for C. diff, MRSA and VRE, by 23%
Increased reduction of pathogens by over 58%
Increased the amount of surfaces yielding no growth by 36%
HAI rates reduced by
> 23%

36. ✓ Defender SPORICIDAL DISINFECTANT NaDCC
Safe for Employees and Patients
Far Less damaging Medical Equipment/Surfaces
Safe on floors (OR/ED/Isolation)
Effective on Biofilm
WHO used during Ebola outbreak ✓
Sodexo’s sporicidal alternative is called Brutab. This product is safe on employees and patients. And far less damaging on medical equipment and surfaces. It also is effective at removing biofilm.

37. 100% of UK and Irish hospitals use NaDCC
RESULTS
NaDCC is EFFECTIVE
2008 UK hospitals began switching from bleach to NaDCC due to health/ safety requirements
2010 transition complete
100% of UK and Irish hospitals use NaDCC
In 2008, all UK hospitals switched from using bleach to the Brutab chemical for health and safety reasons. As you can see from the chart, prior to the implementation, their C diff rate was twice of the US. After full implementation, their C diff rate went to half of that in the US.

38. Stainless Steel Corroded by Repeated Bleach Use
Stainless Steel exposed to 1:10 dilution of bleach
Stainless Steel exposed to NaDDC 1,000ppm
W. Hollands , J. Postlewaite,
Pennsylvania State University, University of Illinois

39. Trust™ SINGLE USE MOPS & CLOTHS
Reduction of Cross Contamination
Eliminates Inventory & Quality Issues
Dramatic Reduction in Water Usage
Eliminates Laundry Challenges
HCAHPS- Fresh Clean Appearance
3X more effective than reusable mops
Because the important thing to realize is that disposable microfiber mops and cloths are
effective, efficient and durable than traditional laundered mops and cloths

40. RESULTS PathogenLock™ Technology Maximize Pathogen Removal
CLEANING EFFICACY
This independent study shows the results of the re-laundered mops compared to disposable microfiber
Disposables are 3x more effective than reusable Mops & Cloths
Trust™ S1 Microfiber Mops are proven to reduce the amount of microorganisms present on the floor by 91%
*ATP Testing is a process of rapidly measuring actively growing microorganisms through detection of adenosine triphosphate (ATP).

41. Sodexo’s Black Light Training
RESULTS
Effective Cleaning of High Touch Surfaces
Before an after effectiveness of cleaning
Training for effective cleaning and proper technique
Increases the efficacy of manual cleaning from 49% to 91%.
Surpasses CDC and Prevention guidelines for environmental monitoring.
Sodexo’s Black Light Program
100%
In a study conducted at UNC Medical Center by Epidemiologist Dr. Bill Rutala, Sodexo’s black light inspection program increased compliance from 49% to 91%. This surpasses the CDC guidelines.
50%
Industry Average
Sodexo’s Black Light Training
In a study conducted at UNC Health Care by Epidemiologist Dr. Bill Rutala, using medical, surgical and pediatric wards (both ICU and non-ICU) it was proven that fluorescent marker is 169% better than ATP at mimicking the microbiological data to determine how thoroughly a surface has been cleaned.
In a study conducted at UNC Health Care by Epidemiologist Dr. Bill Rutala, using medical, surgical and pediatric wards (both ICU and non-ICU) it was proven that fluorescent marker is 169% better than ATP at mimicking the microbiological data to determine how thoroughly a surface has been cleaned.

42. Surewash Saves Time Saves Money Saves Lives Operates 24/7 - training
Mobile
All Training records available to infection control staff.
Saves Money
Reduces time for hand hygiene training
Increases frequency of training, which reduces infection rates.
Reduces the costs of HCAIs.
Saves Lives
Healthier patients and hospital visitors.
Sure wash is a competency based hand hygiene training tool. It’s a computerized system that uses gaming technology to demonstrate and measure the effectiveness of hand hygiene. Let’s take a look at how this works. (VIDEO Clip )

43. SureWash Proven Results*
SureWash Improved Hand Washing Effectiveness…
And, Improved Hand Hygiene Compliance
SureWash Implementation
SureWash Implementation 43

44. So, here are some additional innovations related to environmental prevention protection that we are evaluating.
Other
Innovations

45. Automated Disinfection Systems
HPV
30-35% H2O2 vapour
AHP
5-6% H2O2 + Ag aerosol
UVC Mercury
UVC (280 nm)
PX-UV
Pulsed-xenon UV
Efficacy 1
>6-log reduction 2
~4-log reduction
2-4
~2-4 log reduction
2-3
~1-4 log reduction
Distribution
Homogeneous
Non-homogenous 3
Line of sight issues
Ease of use 4
Multiple units; sealing / monitoring
Sealing & monitoring
Multiple positions; no sealing / monitoring
Cycle time
~1.5 hrs single room
>2 hrs single room
1-3
10-45 mins
2--5 mins
Purchase cost
Running cost
HCAHPS
Studies
3-4

46. PULSE XENON UV-C DISINFECTION
Best In Class Pulse UV-C
Mercury Free
User Friendly Touch Screen
Cycle times of 3-10 minutes
No toxic (burnt hair) smell
Best outcomes when used with Protecta program
Solaris (Lytbot) & Xenex
Essentially, this is what the Xenex Robot looks like…
It’s very user Friendly
Built in Safety Features
And a durable design

47. Surface Cleaning Required Prior to UV-C Disinfection
Cleaning is the most critical step to achieve disinfection
All visible soil must be removed prior to disinfection.
The protected layer of biofilm needs to be removed to enable disinfection of surfaces
Sporicidal cleaning and UV-C disinfection are more effective if biofilm protective coating is removed

49. Lighthouse Healthcare Partners
Expert advisors related to Environmental Infection Prevention
Support portfolio of Best-In-Class solutions
Assure Operational Effectiveness
Focus on Clinical Evidence
After Sale Training & Support

50. Questions?