Designers Light Forum

Treat Your Building As A Patient

Clifford J. Yahnke, Ph.D.28-Mar-17

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materialofconstructionoranymethodormannerofhandling,using,distributing,ordealinginanymaterialorproduct.___________________________________________Questionsrelatedtospecificmaterials,methods,andserviceswillbeaddressedattheconclusionofthispresentation.

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CopyrightMaterials

LearningObjectives

1. IdentifythetypesofHealthcareAcquiredInfections(HAIs)andtheircollectiveimpactupontheUShealthcaresystem

2. Explainhowinfectionscanbeacquiredthroughthebuiltenvironment3. Describetherangeofsolutionstoimproveenvironmentalhygienewhichareavailableto

healthcareproviders4. Listthecharacteristicsofspecification-gradelightfixturesthatcanreducethespreadof

pathogenswithintheenvironment5. Recognizethebenefitsofcontinuousenvironmentaldisinfectionandtheareaswithina

healthcaresettingwhereitisbestused

Attheendofthethiscourse,participantswillbeableto:

HEALTHCARE:THENEWWORLDWELIVEIN...

5

USHealthcareIsBeingDrivenByChangesInReimbursement

Objectiv

eAssessmen

t

ValueBasedPurchasing

ReadmissionReductionProgram

HealthcareAcquiredConditionProgram

PolicyPenalties

USStatisticsonHealthcareAcquiredInfections(HAI)

• 1in20patientsacquiresaninfectionwhileinaUShospital

• 1.7MHAI’s/year(US)• 99,000deaths/year(US)• Consumingmorehealthcaredollarseach

year• Estimatesvarywidelydependingupon

whatisconsideredcost• Typicallyacceptedcostis~$23Kper

infection• 2,225Hospitals=$227Minwithheld

compensation• Excludes26,000USfacilitiessuchas:

– AmbulatorySurgeryCenters– SkilledNursingFacilities– Long-TermAcuteCare– Hospice– DialysisCenters

WhatisanHAI?SurgicalSiteInfection(SSI) CatheterAssociatedUrinaryTract

Infection(CAUTI)

CentralLineAssociatedBloodstreamInfection(CLABSI)

VentilatorAssociatedPneumonia(VAP)

HAICostbyModality

19%

33%

32%

15%

1%

CLABSI(+MRSA)

SSI(+MRSA)

VAP

CDI

CAUTI

91Zimlichman,E.etal.“HealthCare-AssociatedInfections:AMeta-analysisofCostsandFinancialImpactontheUSHealthCareSystem”,JAMAInternMed2013;173:2039-46

EndoftheGoldenAge?

InfectionPreventionModalities

PatientImproved

HandwashingCompliance

AntimicrobialStewardship

IsolationPrecautionGuidelines

Patient&Staff

Education

TargetedBundles

What’sMissing?

Host

PathogenEnvironment

• Whatabouttheenvironment?

ROLEOFTHEENVIRONMENTINHAI

13

Clostridiumdifficile>5monthstoyears

MethicillinresistantStaph.Aureus (MRSA)

>12months

MDR– Gramnegative(e.g Acinetobacter)

>30months

Vancomycin ResistantEnterococci (VRE)

>46months

Norovirus>2weeks

OrganismsPersistintheEnvironment

AdaptedfromKrameret.al.BMCInfectDis2006;6:130

HaveYouEverWonderedHowDiseasesSpread?

ContractTransmissionfromPatienttoEnvironment

• AcquisitionofMRSAaftercontactwithcolonizedpatientandterminallycleanedsurface

1.Stiefel U,etal.InfectControlHosp Epidemiol 2011;32:185-72.Donskey CJ,EcksteinBC.NEngl JMed2009;360:e33.BoyceJMetal.InfectControlHosp Epidemiol 1997;18:622-74.Bhalla A,etal.InfectControlHosp Epidemiol 2004;25:164-75.HaydenMK,etal.InfectControlHosp Epidemiol 2008;29:149-154

Patient Surface

RoleoftheEnvironmentinHAI

0

2

4

6

8

10

12

HadC.diff DidNOTHaveC.diff

Percen

tageofP

atientsW

hoAcquired

C.diff

PriorRoomOccupant

PriorRoomOccupancyRisk

Shaughnessyet.al.Infect.ControlHosp.Epidemiology2011;32:201-206

~265%IncreasedRiskbasedonPriorOccupant

Status

ADifferentApproach…• Whatifthebuildingweretreatedasapatient?

YourBuildingAsAPatientPatientImprovedhandwashingcompliance

Antimicrobialstewardship

Isolationprecautionguidelines

Patient&StaffEducation

TargetedBundles

BuildingImprovedsurfacedisinfectioncompliance

Propersurfacedisinfectant

Roomsdesignedforinfectionprevention

Engineering&FacilitiesEducation

Location-specificBundles

IMPROVINGENVIRONMENTALHYGIENE

20

ImprovingEnvironmentalHygiene

Additionalstaffing

Policies &Procedures

ComplianceMonitoring

Technology

21

TechnologySolutionsforEnvironmentalHygiene

Sterilization- Theactiveremovalofallformsoflife andotherbiologicalagents

Disinfection–Theactiveapplication ofantimicrobialagentstodestroymicroorganisms

Inhibition– Thepassivereductionofmicro-organsim accumulationand/ormigration

TechnologyClassificationsSterilizatio

n • ChemicalsFoggers

• UV…

Disin

fection • Continuous• HEPA Filters• UV/PlasmaAirHandlers

• VisibleLight• ...

• Episodic• Chemicals(e.g.Bleach)

• FoggersUVDevices

• ...

Accumulation/

Migratio

n • Antimicrobialsurfaces(e.gcopper)

• Antimicrobialpaint

• Sealedlightfixtures

• Environmentalsprays

• ...

HowCanLightFixturesHelp?• Specification-gradelight

fixtureswhicharesealedanddesignedforinfectionpreventioncan:– Reducethetransmission of

pathogensthroughtheair– Reducetheaccumulation of

pathogensuponitthroughcleanabledesignandantimicrobialcoatings

WhatisSpecification-GradeLighting?

• Specificationgradelightingforhealthcareapplications:

– Withstandthechallengingenvironment

– Dependablyprovidethenecessarylevelofvisualacuity

• 4keyElements:– SealedEnclosuretoprevent

ingress/egressofpathogens– Sealedmountingtoceilingorwallto

preventingress/egressofpathogens– Designedtobecleanablewithharsh

chemicals– Preventinterferencecriticalmedical

equipment

Listings

ListingsInsurePerformanceinYourChallengingEnvironment

SealedEnclosureLuminaire• Preventintrusionofcontaminantsintoluminaire– Dust-tight– Waterproof

• Dynamic,notjustastaticenclosure!

IngressProtectionStandards• Usedtovalidateperformanceofsealedenclosureluminaires

Ensures that particles of 1 micron orlarge do not enter the fixture

Protected against splashing water andwater jets

IP65 IP65

MaintainSealedRoomEnvelope

• Preventpassageofcontaminantsbetweenluminaireandceiling.– Ceilingconstruction– Mounting– Caulkinginplace– Gasketing (vulcanized)– Seamwelding

RoomEnvelopeStandard• Maintaintwoinchesofpressure+/- 10%for30minutes– K230baseduponNSF-49

FixtureCleanability• Ensuresthatafixturecanbe

cleanedtoremovepathogenbuildup

• IntheUS,theNationalSanitationFoundation(NSF)hascreatedcleanabilitystandards:• NSF/ANSI- 2FoodEquipment–Section5

• Surfacecleanability• Resistancetocausticchemicals• UseofNon-toxicmaterials

WhereElseAreSealedEnclosuresBestUsed?

• Thedecisiontousespecification-gradelightingforinfectionpreventionshouldbaseduponthreefactors:– Thesusceptibilityofthepatientintheroomtoacquireaninfection

– Theneedtorestricttheflowofpathogensinto/outoftheroom

– Theneedtoreducethefixtureasanenvironmentalsourceofpathogens

PotentialHealthcareApplications

WaitingAreas

PatientRooms

SterileProcessing Oncology

OR

BoneMarrowTransplant

WoundCareClinics

Triage/Trauma

33

TechnologyClassificationsSterilizatio

n • ChemicalsFoggers

• UV…

Disin

fection • Continuous• HEPA Filters• UV/PlasmaAirHandlers

• VisibleLight• ...

• Episodic• Chemicals(e.g.Bleach)

• Foggers• UVDevices• ...

Accumulation/

Migratio

n • Antimicrobialsurfaces(e.gcopper)

• Antimicrobialpaint

• Sealedlightfixtures

• Environmentalsprays

• ...

NoTouchDisinfectionTechnology

Continuous• AirFilters• UV/Plasmaairhandlers• Coppersurfaces• Environmentalsprays• VisibleLight

Episodic• UVDevices• ChemicalVapor

35

EPISODICVS.CONTINUOUSDISINFECTION

36

Episodicvs.Continuous- Definition

37

Continuous

=TotalBacteriaKilled(High-LevelContinuous-Ideal,butnotpractical)

=TotalBacteriaKilled(Episodic- Practicalimplementationofidealsolution)

=TotalBacteriaKilled (Low-LevelContinuous-ComplimenttoEpisodic)

“ContinuousDisinfectionFillstheGaps”

(Bacteria

Killed

/Tim

e)

=

ShadedArea=TotalBacteriaKilled

EffectsofEpisodicDisinfectionUponBacteriaLevels

38

High

Low

BacteriaLevels

Time

EpisodicDisinfectionApplied

Regrowth

“LogXKill”

ContinuousDisinfection

39

High

Low

BacteriaLevels

Continuous(NoRegrowth)Time

Continuous(WithRegrowth)

DynamicEquilibriumLimit

Continuous+EpisodicDisinfection

40

High

Low

BacteriaLevels

Time

ContinuousDisinfectionApplied

EpisodicDisinfectionAppliedDecreasingBacteriaLevels

EpisodicDisinfectionAppliedEpisodicDisinfectionApplied

BacteriaRegrowth

BacteriaRegrowth

BacteriaRegrowth

BenefitsofContinuous+Episodic

41

High

Low

BacteriaLevels

Time

=Continuous+Episodic

=ContinuousOnly

=EpisodicOnly

BenefitfromContinuous+Episodicvs.Episodic-OnlyDisinfection

AdditionalBacteriaRemoved

Episodicvs.Continuous

Episodic(UV)• Usefulinoutbreakorterminal

cleaningapplications• Oftentakestheroomoutof

service• Potentialsafetyissues• Potentialcomplianceissues

Continuous(Visible)• Usefulinareaswhichmust

remainoperational24/7– CapacityLimitations– QuickTurnover

• Cleansevenwhenpeoplearen’tintheroom

• Designedtobesafeforpatientsandstaff

• Eliminatescomplianceissues

WhichisBetter?

EpisodicVS. Continuous Episodic+ Continuous

CONTINUOUSENVIRONMENTALDISINFECTIONUSINGVISIBLELIGHT

44

WhatisVisibleLightDisinfection?

TypicalUV-CGermicidalWavelength

VisibleLightDisinfectionGermicidalWavelength(405nm)

WhatisVisibleLightDisinfection?• Acontinuousenvironmentaldisinfectionsystemwhich:

– Usessafe,visible light– Canbeintegratedintonormal,overheadlighting

46

Indigo-OnlyMixed-White

WhiteDisinfectionMode=AmbientWhiteLight+Disinfection

IndigoDisinfectionMode=IncreasedDisinfectionOnly

TypesofVisibleLightDisinfection

• Disinfectiononly

47

• Indigo-Only • MixedWhite

• Useofcomplimentarycolorsallowsforambientlightingapplications

HowDoesVisibleLightDisinfectionWork?

48

3.Pathogeninactivationbreakstheenvironmentalchainofinfection

2.EnvironmentcreatesReactiveOxygenSpecieswithinbacteriacausinginactivation

=

1.Continuous,automatic,safesystemcreateshostileenvironmentforbacteria

4.Measuredbacterialreduction**MacleanM.,et.al.Environmentaldecontaminationofahospitalisolationroomusinghigh-intensitynarrow-spectrumlight,J.Hosp.InfectionVol.76,pp.247-251(2010)

VisibleLightDisinfectionSafety

HistoryofAcademicResearch&InvestmentinVisibleLightDisinfection

ResearchTimelineMorethan30

refereedpublications

andproceedingssince2008

VisibleLightDisinfectionCommerciallyAvailable

VisibleLightDisinfection InAnOperatingRoom

51

AirbornePathogens

VarietyofSurfaces HardtoReach

WhyVisibleLightDisinfectionintheOR?

VisibleLightDisinfectionApplication:OperatingRooms

• AmbientlightinglevelsinoperatingroomsaregovernedbyIESguidelines

53

DeployingVisibleLightDisinfectionintheOR

~625sq.ft. ~625sq.ft.

1:1Replacement

~625sq.ft.

• Contactmanufacturertoensureproperdosingofroombasedon1:1replacement

VisibleLightDisinfectionOperatingRoomSolutions

55

2’x4’ 2’x2’ 1’x4’

ClinicalImplementationofVisibleLightDisinfection

• Wallswitchcanbeusedtoselectdesiredmode OR• Occupancy/vacancysensorcanautomaticallyswitchbetweenmodes

56

Indigo-OnlyMixedWhite

WhiteDisinfectionMode=AmbientWhiteLight+Disinfection

IndigoDisinfectionMode=IncreasedDisinfectionOnly

ControlSolution(s)• “MaximizeDoseWithoutImpactingVisualAcuity”

57

PassiveInfraredSensordetectslargermotionsoveralargerarea

UltrasonicSensordetectssmallmotionsinafocusedarea(overthetable)

CURRENTEVALUATIONDATAFORVISIBLELIGHTDISINFECTION

58

ESKAPE Pathogens• Enterococcus faecalis• Staphylococcal Aureus*

(including MRSA)1

• Klebsiella pneumoniae• Acinetobacter baumannii• Pseudomonas aeruginosa• Enterobacter species

DemonstratedLaboratorySusceptibilitytoVisibleLightDisinfection

Gram-Positive Bacteria• Clostridium perfringens• Staphylococcus epidermidis (CONS)• Staphylococcus hyicus (CONS)• Streptococcus pyogenes• Listeria monocytogenes• Mycobacterium terrae• Corynebacterium striatumGram-Negative Bacteria• Proteus vulgaris• Escherichia coli (E. coli)• Campylobacter jejuni• Salmonella enteritidis• Shigella sonnei• Serratia sppYeast & Filamentous Fungi• Aspergillus niger• Candida albicans• Saccharomyces cerevisiaeBacterial Endospores• Clostridium difficile• Bacillus cereus

*=DemonstratedclinicalsusceptibilitytopresumptiveS.Aureus &MRSA

1MacleanM.,et.al.Environmentaldecontaminationofahospitalisolationroomusinghigh-intensitynarrow-spectrumlight,J.Hosp.InfectionVol.76,pp.247-251(2010)

Significant reduction of total bacterial contamination on surfaces around the room (2-day use)

76%reduction

86%reduction

All reductions in bacterial contamination were achieved over and above standard cleaning and infection control practices

Whole Room Results Surface-Specific Results

Bacterial reduction on a range of surfaces before and after use of the Visible Light Disinfection

GlasgowRoyalInfirmary:IntensiveCareUnit(InitialStudies)2

2MacleanM.,et.al.Continuousdecontaminationofanintensivecareisolationroomduringpatientoccupancyusing405nmlighttechnology.JournalofInfectionPrevention,14(5);176- 181(2013)

LightsOff

LightsOn

AdditionalPublicationData

61

Forafulllistofavailablepublications,pleasevisit:

http://www.indigo-clean.com/resources-white-papers

Froedtert &TheMedicalCollegeofWisconsinFroedtert Hospital

• GIDiagnosticWaitingArea– Easiertoshowareductiondueto

highamountofbacteria– Proximitytoprocedurerooms– Approximately450ft.2 (Equivalent

tosmallOR)– Resultsconsistentwithpreviously

publishedpatientroomresults– Additionalstudiesunderway

ClinicalResultsforVisibleLightDisinfection

• InactivationofS.aureusinWaitingRoom

63

70%+Decrease

“InPhase2ofthetrial,wherethelightingdeploymentwasoptimizedacrosstheroom,wewereabletoimprovethebacterialreductiontomorethan70%.”

- Dr.NathanLedeboer,AssociateProfessorofPathology,MedicalCollegeofWisconsin

Clinicaland CommercialDeployment• State-of-the-artfacilitiesinLas

Vegas• HendersonHospitalandSpring

ValleyHospital- UniversalHealthServicesInc.

64

ClinicalResultsfromIDWeek2016

• 4 posterscovering:– VisibleLightDisinfection– ImprovedEnvironmental

Hygiene=ReducedHAI

65

Summary• VisibleLightDisinfectionprovidesawaytoimproveenvironmentalhygienethatcomplimentscurrentefforts

• Itissafe,containsnoUV,andcanbeoperatedwhilepeopleareintheroom

• Itcanbeintegratedwithoverheadlightingandoperatedautomaticallywithouttheneedforadditionalpeople

• ItusesreliableLEDtechnologytoincreaselifetimeandlowerongoingcosts

ThisconcludesTheAmericanInstituteofArchitectsContinuingEducationSystemsCourse

Dr.CliffordJ.Yahnke

Director,ClinicalAffairs

Indigo-Clean

cyahnke@kenall.com

(262)891-9738