medizone dr zoutman 3-14-2013

7/29/2019 Medizone Dr Zoutman 3-14-2013

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Updateon"notouch"room

disinfec3onsystems-uvlights,

hydrogenperoxideandozone

DickZoutman,MD,FRCPCEmeritusProfessor

MedicalMicrobiology&Infec3ousDiseases

QueensUniversity

HostedbyMar3nKiernan

[email protected]

www.webbertraining.com March14,201


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ConflictOfInterestDisclosure

AninventorofAsep3cSure ChiefMedicalOfficerofMedizoneInterna3onalInc.

ShareholderofMedizoneInterna3onalInc

RapidlyevolvingfieldDatacanbehardtocomebyNotpossibletoincludeALLtechnologiesoutthere

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Objec3ves

Attheendofthispresenta3onIhopeyou: WillbeabletodescribethetwotypesofUVlamp

technologies,theircharacteris3csandefficacy

Willbeabletodescribethebasisforthehydrogenperoxidevaporandmisttechnologiesandtheirefficacy

Willbeabletodescribehoweffec3veozonebasedmethodsareasaspacedisinfec3ontechnology

Understandthesynergyofcombiningozoneandhydrogenperoxideasanovelhighleveldisinfec3ontechnologyforhealthcarespacesandotherapplica3ons

Willknowwhattolookforininvitro,invivoandclinicalstudiesofthenewtechnologiesforroomdecontamina3on

anddisinfec3on


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TheProblem

Toomanyhealthcareinfec3ons Needlesssufferingandmortality Despiteinnova3onsandbestefforts Environmentamajorsourceandreservoir Weneedtofindatransforma3onaltechnology!

Justcleaningwherethedotsareisnotgoodenough!

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Characteris3csoftheIdealRoom

Disinfec3onSystemHighestpossiblekillofallrelevantorganismsespeciallyC.difficilespores

FastSimpletoperformCosteffec3veCanbesafelydeployedNoenvironmentalresiduesReducesincidenceofhealthcareinfec3onsHighqualitysuppor3vescien3ficevidence

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QualityofEvidenceConcerning

H2O2,UV,O Canbeverymixedsoreaditcri3cally Peerreviewedliteraturebest invitrostudies

Usingtestchambersetc Bacteriaorotherorganismsonvariousmaterials

Steeldiscs/coupons Fabric,carpet,plas3cs,variousbuildingfinishes

Goodcontrolswithmanyreplicates Quan3ta3veCarrierTests(QCT)ProtocolbySpringthorpeandSaaretal Useofasoilload Eachorganismbringsuniquechallenges

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invivoTes3ng

Inhospitalrooms,laboratories,variousfieldloca3onsRandomassignmentofrooms/spacesNooverlapofmethods,washout3mesDetailedsurfacecultureprotocolwithlargenumberof

samples Highlystandardized,withdifferentmethods

Supplementedwithmicrobeloadedcouponsinstandardloca3onsintheroom

Alwaysusesporesofsporeformingpathogens egC.difficile,Bacillusspp,Geobacillusspp.etc.

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Interpre3ngResults

Wanttoseeexpressionofdataaslog10kill(orlog10survivor) Kill=star3nginoculum-survivors

Expressedaslog10kill

Usegeometricmeansforlargenumberofsamples Needdozensofreplicatesunderanyonesetofcondi3ons

especiallyforinvitrotes3ng

Surfaceswabs Typicallyexpressedascfu/cm2 Typicallysee10sto100scfu/cm2

Countspecificpathogens Orcountallheterotrophicbacteriaonthesurface

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ClinicalStudies

Beforeandaerstudiesci3ngreduc3onsininfec3ons

RatesofHAIvarysignificantlyover3meBecau3ousintheinterpreta3onoftheseresults

Preferrandomizedandmul3centerdesignideallyDifficulttodoandcostlyCombinedwithsurfaceculturesandloadedcouponsandclinicaloutcomestomakeacomprehensive

evalua3on

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ABitofPhysicsAboutUVLight

Ultravioletgermicidalirradia3on(UVGI) Wavelengthshorterthanthatofvisiblelight

UVA400nmto15nmUVB15nmto280nmUVC280nmto200nm

Theen3reUVspectrumcankillorinac3vatemanydifferentmicroorganisms

UVCenergyprovidesthemostgermicidal 265nmop3mumwavelength

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Suscep3bilityofOrganismstoUVC

FromMar3nSBetal.ASHREJournal.August2008 11


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MercuryVaporLamps

Inmercuryvaporlamps,themercuryvaporisexcitedtocreateUV-C

CreateUVat25.7nm. ThisisclosetotheaveragepeakDNAabsorbedat260-265nm.

Mercurylampsproducecon3nuousUVlight

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XenonVaporLamps

PulsingaxenonUVlampPX-UV Resultsinaflashoflightwithabroadspectrumfrom200nmto20nm

Millisecondpulses MoreUV-CwavelengthsareproducedHighintensityofthefastpulsesmaygivePX-UVbeerdisinfec3onefficacy?

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Tru-DUnitbyLumalier

FromECRIHealthDevicesMay2011 14


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MercuryUVSystemTru-D

AnautomatedmobileUV-Cunit Tru-D;byLumalier Showntoproducealog10killofvegeta3vebacteria

MRSA,VRE,andA.baumannii 2.4-log10killofC.difficileseededontoFormicasurfacesinexperimentally

contaminatedpa3entroom

RutalaWA,GergenMF,WeberDJ.Roomdecontamina3onwith

UVradia3on.InfectControlHospEpidemiol2010;1:10251029. 15


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Tru-D

Tru-D,Lumalierstudiedinreducingenvironmentalcontamina3onwithvegeta3ve

bacteria MeasuredusingaerobiccolonycountsandC.difficileinoculatedontostainlesssteelcarrier

disks

BoyceJMetal.InfectControlHospEpidemiol2011;2:77742

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Tru-D

Roomdecontamina3onwiththeTru-DUVsystem Reduc3onsinaerobicbacteriaon5high-touch

surfaces.

MeanC.difficilelog10reduc3onsrangedfrom1.8to2.9whencycle3mesof4.2100.1minuteswereused.

Surfacesindirectlineofsightweresignificantlymorelikelytoyieldnega3vecultureresultsaerUV

decontamina3onthanbeforedecontamina3on BoyceJMetal.InfectControlHospEpidemiol

2011;2:77742

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Tru-D Oninoculatedsurfaces Reflecteddoseof22,000Ws/cm2for45minutes KillofC.difficilesporesandMRSAby>2-log10colony

formingunits(CFU)/cm2

KillofVREby>-4log10CFU/cm2 SamelevelofkillofMRSAandVREwasachievedin20

minutesatareflecteddoseof12,000Ws/cm2,

ButkillingofC.difficilesporeswasreducedsignificantly.

NerandzicMM.BMCInfectDis2010;10:197.18


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Tru-DLog10BacterialKill

FromNerandzicMMetal.BMCInfectDis2010;10:19719


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Tru-DSurfaceSwabs

Hightouchsurfacesofabathroom 60,000cm2

C.difficilespores Before:600spores

Aer:24spores MRSAbacteria

Before:1,200 Aer:240

VREbacteria Before:180 Aer:0

FromNerandzicMMetal.BMCInfectDis2010;10:197 20


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Xenex

From:www.xenex.com

PulsedxenonUVlight

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XENEXinvitroLabStudy

C.difficilewas1meterfromlamp,MRSAandVRE2metersfromlamp. C.difficile9samples,MRSA&VRE4samples. TheexperimentwasconductedatanindependentmicrobialtesDnglaboratory Modifiedfrom:SDbichM.AbstractpresentedatSHEA/Fi7hDecennialMee;ng2010

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XenexStudyatMDAnderson

JanuarytoMarch2010atMDAndersonCancerCenter,HoustonTx

12roomsextensivelysurfaceculturedatdischargeforVREisola3on Isola3oncleanwithgermicidex0mins. x4minexposurestoXenexlamp Culturestakenbeforecleaning,aercleaningandusingtheXenexlampS@bichetal.InfectControlHospEpidemiol2011;2()

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XENEX

[email protected];2()24


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XenexCooleyDickinsonHospitalStudy

140bedacutehospital,NorthamptonMA

January-September2011Xenexused

Uncontrolledobserva3onalstudy 2x7mininroom 1x7mininbathroom

Pre-cleanedwithchlorinebleach(SOPthroughout)

CDIRates 2009:notstated 2010:0.95/1000PtDay 2008-2010Q1-:0.98/1000PtDay 2011(Q1-):0.2/1000PtDay

LevinJetal.IDSA2011Abstract25


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UVLightSummary

Property UV-CLight XenonPulseLight

Source Mercurybulb Xenonbulb

Exposure3me 20-100min 8-12minsover2-doses

Vegeta3vebacterialkill -4log 4-5log

C.difficilesporekill 2-log 4-5log(limiteddata)

Risks UVexposure UVexposure

Toxici3es/ByProducts Mercuryvapor None

ControlledClinicalTrials Yes Noneyet

Costs $124,500capital$1,600forlamps(9000h)

??Lampsx-4months

Other Lineofsighteffect Scantdata,

lineofsighteffect

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H2O2Technologies

Bioquell 0%H2O2solu3on H2O2vapor

Glosair(ASP) 5-6%H2O2solu3on ASP(J&J)acquiredSterinis

in2009

H2O2mist/aerosol VHP(Steris)

5%H2O2solu3on H2O2vapor

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SterisVHP1000EDSystem

From:www.steris.com 28


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BioGienie

Hyproxil 6%H2O2withsilverions Hyproxilasaliquidas

4-6log10killofMRSA,Ecoli,P.aeruginosa

NopublisheddataonefficacyasHPvapour

system

hourcycle3me

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BioQuellQ-10

www.bioquell.com 0


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Glosair(ASP)

Glosair600 Glosair400

www.aspjj.com 1


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VHP(Steris)AgainstAerobicSpores

PoageT.Appl.Environ.Microbiol.2012,78(12):4169.

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SealingDuctsinaRoom

JimDoyleinwww.stltoday.com/business/ar3clepublishedAugust15,2010


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BioquellEfficacyforCDI

HPVdecontamina3onof5high-incidenceCDIwardsfollowedbyhospital-wide

decontamina3onofroomsvacatedbypa3ents

withC.difficileinfec3on(CDI)

25.6%ofculturesfromsurfacesbeforeHPVdecontamina3onyieldedC.difficile

comparedwith0culturesofsamplesobtainedaerHPVdecontamina3on(P


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BioquellandCDIContd

During9monthinterven3onperiod Onthe5highincidencewardsratesofCDIdroppedfrom2.28vs1.28casesper1,000pa3ent-days(P


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BioquellandMRSA

74%of59swabstakenbeforecleaningyieldedMRSA Aercleaning,allareasremainedcontaminated,with

66%of124swabsyieldingMRSA.

Aertreatmentof6roomswithHPV(Bioquell)only1of85(1.2%)swabsshowedMRSA

notesmallersamplesizeaerexposurehowever 5hourcycle3me 500ppmH2O2(high)

FrenchGLetal.JournalofHospitalInfec3on(2004)57,17

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BioquellClinicalStudy

PassareCLetal.ClinInfectDis201;56:27-5

Acquiredanyone

ofMRSA,VRE,

MDRGNBor

Cdiff

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HPVprocesstook1.5-.0hours Theonlyreduc3oninMDROwasthereducedincidenceseenforVREacquisi3ons

53meslesslikelyintheHPVtreatedroomsadjustedIRR,0.2095%CI,.08.52

Nosta3s3callysignificantreduc3oninacquisi3onsofMRSA,C.difficileorMDRgramnega3vebacilli

PassareCLetal.ClinInfectDis201;56:27-5 8


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218(21.0%)ofthe109pa3entroomssampledwerecontaminatedwith1MDRO

HPVdemonstratedreducedbacterialcontamina3onin: roomscontaminatedwithmul3pleMDROs(RR,0.16;P


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SterinisTrial(becomesGlosair)

TeachinghospitalinZonguldak,Turkey

Steeldiscsinoculatedandplacedinmanyloca3onsinpa3entrooms5m

MRSAandA.baumannii AppliedSterinisHPMist 2.5hrcycles

PiskinNetal.AmJInfectControl.2011Nov;9(9):757-62

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Tru-DvsBioquellHeadtoHead

500bedhospital 15pa3entroomsat

randomfrom8wards

5hightouchsurfacesculturedforACC

Steeldiscsloadedwith106C.difficilesporesplacedin5areascloseto

hightouchsurfaces BIswith104and106G.stearothermophilus

Results HPV(Bioquell)

9%ACCnega3ve 6log10C.difficilekill 99-100%BIskilled 2.5-hrcycles

UV-C(TRU-D) 52%ACCnega3ve


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HardyKetal.JHospInfect2007;66:60-68

RapidMRSA

regrowthaer

HPV.

Didntgetthemall?

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ComparisonofH2O2Systems

Parameter Glosair(ASP) VHP(Steris) BioGienie BioQuell

H2O2% 5-6% 5% 6% 5%

Dispersion DryMist/

Aerosol

Vapor DryMist/

Aerosol

Vapor

FinalConc

H2O2

50-80ppm ~500ppm ~500ppm

CycleTime ~2-hr 2-8hrs hr 2hr,upto5

hr

C.difficile

log10kill

2-log NodataforC.

difficile.

5-6logfor

Bacillus

NodataforC.

difficile.

5-6logfor

Bacillus

6logforC.

difficile.

6logfor

BacillusControlled

ClinicalTrials

Somesmall ? ? Yes

Cost $65,000?

$50perroom

? ? $44,000capital

Costperroom?

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PureOasAn3bacterial

Sharma&Hudson.AmJInfectControl2008;6:559-6. 44


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Ozone&HydrogenPeroxidein

BiologicalSystems An3bodieshavebeenshowntohavecataly3cac3vitythatproducesBOTHH2O2ANO3BUTtheamountproducedofeachissolowthat

neithercouldkillanymicroorganism

Trioxidane(H2O)hasbeendetectedastheextremelyreac3veintermediarymoleculeofthisreac3on

Trioxidaneislethaltoorganismsinminuteamounts!

Nyffeler,Wentworth&Lerneretal.AngewandteChemie

2004,fromScrippsResearchIns3tuteandOxford

University

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TheScienceofAsep3cSuresSynergy

O3

H2O2

H2O3

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Asep3cSureMicrobiologyTechniques

Thequan3ta3vecarriertest(QCT-2)

standardusedormodified

1cmstainlesssteeldisksasthebacteria

&sporecarriers

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InvitroTes3ngSystemforAsep3cSure

Polycarbonatechamber Fullyinstrumentedto

measurecondi3ons

Computercontrolledandrecordedresults

UsedMRSAastestorganismini3allyto

defineop3mal

condi3ons

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InvivoTes3ngSystemAsep3cSure

Fans

OGenerator

H2O2Vapourizer

GasMeasurement

Channelsx5

Scrubbers

80PPMOzonePLUS

1%HydrogenPeroxide

21Cand80%Humidity

TestiscsTestiscs

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Asep3cSureResults

Organism Ozone

(PPM)

H2O2

(%)

Exposure

(min)

MicrobialKill

(Log10)

MRSA 80 1 15 6.3

VRE 80 1 15 6.2

E.coli 80 1 15 6.5

S.typhimurium 80 1 15 6.1

P.aeruginosa 80 1 15 6.0

L.monocytogenes 80 1 15 6.3

C.difficilespores 80 1 15-30 6.1

B.sub;lisspores 80 1 30 6.1

Mycobacterium

terrae

80 1 30 6.250


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Tes3ngMaterials

Asep3cSuresystemalsoeffec3veon:StainlesssteelPlas3cfromtoiletseatsLaminateCarpe3ngCoonorsynthe3cclothWithandwithoutorganicsoilload

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SummaryofAsep3cSure

Firsteveruseofozoneandhydrogenperoxideforhighleveldisinfec3onofclinicalspacesandsurfaces

CapitalizesuponHUGEsynergybetweenozoneandhydrogenperoxideproducingtrioxidane

Veryfast Broadspectrum Consistenthighleveldisinfec3on(6log10=steriliza3on) PenetraDnggasgoeseverywhere Lowdosesofozoneandhydrogenperoxidereducescosts,

risksanddamagetoinfrastructure

Technologyproventobeveryrobustandreliable CapitalCost~$95,000+~$10-20perroom

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AmJInfControl2011;9:87-9

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Asep3cSure

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Characteris3csoftheIdealRoom

Disinfec3onSystemHighestpossiblekillofallrelevantorganismsespeciallyC.difficilespores

FastSimpletoperformCosteffec3veCanbesafelydeployedNoenvironmentalresiduesReducesincidenceofhealthcareinfec3onsHighqualitysuppor3vescien3ficevidence

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TheFinalResult

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21 March TB INFECTION CONTROL IN HIGH HIV BURDENED COUNTRIES

Speaker: Virinia Lipke, Centers for Disease Control, Atlanta

09 April (WHO Teleclass)INNOVATION AND NEW INDICATORS IN HAND HYGIENESpeaker: Prof. John Boyce, Yale University

11 April UTILIZING HOSPITAL-TO-HOSPITAL PARTNERSHIPS TO STRENGTHENINFECTION PREVENTION AND CONTROLSpeaker: Dr. Shams B. Syed, World Health Organisation, Geneva

16 April (WHO Teleclass)REVIEW OF THE EUROPEAN UNION SHARPS LEGISLATION

Speaker: Jane Aston, NHS

17 April (WHO Teleclass) CLOSTRIDIUM DIFFICILE IN THE COMMUNITY: FOOD FORTHOUGHTSpeaker: Prof. Tomas Riley, University of Western Australia

18 April LEADERSHIP IN INFECTION PREVENTION AND CONTROL57


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medizone dr zoutman 3-14-2013

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