Dr chandrashekhar airborne infection

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Presentation on Controlling Airborne Infection in Hospitals by Dr.Chandrashekhar

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  • Sponsored by C.C. Dickson Co. A patented process using quad metallic catalyst (Rhodium, Titanium Dioxide, Silver, Copper) and 300 nm UV light.
  • Dr chandrashekhar airborne infection

    1. 1. AIR BORNE INFECTION Current Situation , Opportunities for Improvement & Possible Mechanism for Implementation Dr R Chandrashekhar Chief Architect DteGHS Ministry of Health & F W Govt. of India
    2. 2. Ventilation - Design <ul><li>Considerations </li></ul><ul><ul><li>Site design – building location, layout, orientation, landscaping… </li></ul></ul><ul><ul><li>Building design – type, function, form, envelope, ventilation strategy… </li></ul></ul><ul><ul><li>Vent opening design – position, types, size… </li></ul></ul><ul><li>Principles </li></ul><ul><ul><li>Select desired airflow pattern </li></ul></ul><ul><ul><li>Identify the driving forces </li></ul></ul><ul><ul><li>Size and locate the openings </li></ul></ul>
    3. 3. Ventilation - Methods <ul><li>Natural </li></ul><ul><li>Mechanical (with fans) </li></ul><ul><li>Hybrid </li></ul>
    4. 4. <ul><li>ZONING / LOCATION </li></ul><ul><li>Separation of Curative & Preventive Area </li></ul><ul><li>Appropriate traffic flow (e.g., no “dirty” movement through “clean” areas) </li></ul><ul><li>Location of sinks and dispensers for hand washing </li></ul><ul><li>Convenient location of soiled utility areas </li></ul><ul><li>Isolation rooms with anterooms as appropriate </li></ul><ul><li>Location of adequate storage and supply areas </li></ul><ul><li>Properly engineered areas for linen services and solid waste management </li></ul><ul><li>Air-handling systems engineered for optimal performance, easy maintenance, and repair </li></ul>
    5. 5. <ul><li>Use of E nvironmental controls to prevent the spread and reduce the concentration of infectious droplet nuclei in ambient air. </li></ul><ul><li>Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation </li></ul><ul><li>Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source (AII rooms) and cleaning the air by using high efficiency particulate air (HEPA), filtration, or UVGI . </li></ul>
    6. 6. <ul><li>Improperly maintained HVAC systems may cause symptoms associated with Sick Building Syndrome (SBS). </li></ul><ul><li>SBS symptoms that may be attributed to moisture with the HVAC systems </li></ul><ul><li>&quot; Humidification systems with poor condition/maintenance were associated with significantly increased upper respiratory symptoms, eye symptoms, fatigue/difficulty concentrating, and skin symptoms </li></ul><ul><li>Less frequent cleaning of cooling coils and drain pans was associated with significantly increased eye symptoms and headache </li></ul><ul><li>Symptoms may be due to microbial exposures from poorly maintained ventilation systems and to greater levels of vehicular pollutants at air intakes nearer the ground level </li></ul>
    7. 7. 1 - Supply duct 2 - Fan compartment 3 - Vibration isolators 4 - Heating and/or cooling coil 5 - Filter compartment 6 - Return and fresh air duct Air Handling Unit
    8. 8. <ul><li>Moisture-related HVAC components such as cooling coils and humidification systems , when poorly maintained, may be sources of contaminants that cause adverse health effects in occupants, even if we cannot yet identify or measure the causal exposures </li></ul><ul><li>If you have dirty or inefficient cooling coils , your HVAC is likely a reservoir for microorganisms. These microorganisms can cause symptoms associated with SBS, in hospitals these pathogens can promote Hospital Acquired Infections (HAI). </li></ul>
    9. 9. SOLUTION <ul><li>The need for Ultraviolet Germicidal Irradiation (UVGI) in all air conditioned buildings </li></ul><ul><li>UVGI deactivates bacteria, fungi and viruses on surfaces as well as in the air. Importantly, this protection is constant. Unlike one time cleanings the germicidal irradiation of cooling coils continues 24 hours a day </li></ul>
    10. 10. <ul><li>A supplemental Portable anteroom High-Efficiency Particulate Air (PAS- HEPA) filter unit placed outside operating room suites may prevent secondary transmission of airborne microorganisms like Mycobacterium tuberculosis (M. tuberculosis). </li></ul><ul><li>study reinforces use of portable anteroom HEPA filtration </li></ul><ul><li>Filters are great for trapping microorganisms, but they do not 'kill '. Eventually filters can become colonized and act as a breeding ground for pathogens. Thinking that you have 100% protection because you have HEPA filtration is a false sense of security. </li></ul><ul><li>It is suggested to have a balance between UV and filtration to provide a better strategy for reducing environmental pathogens in critical care areas of your hospital. </li></ul><ul><li>Ionic air purifiers have undeniable appeal, but there's a problem: They don't really improve air quality </li></ul>
    11. 11. IAQ Particulates Microbial Gases
    12. 12. Particulates <ul><li>Dust, dander, pollen, organic clumps </li></ul><ul><li>Usually handled by air filtration. </li></ul><ul><li>Filters must be maintained to be affective. </li></ul>
    13. 13. Microbial <ul><li>Single Cell Organism </li></ul><ul><li>Self contained and can reproduce without a host </li></ul><ul><li>E.g., MRSA, E. Coli, Staph, Strep….. </li></ul>Bacteria Viruses Mold Spores <ul><li>Minimal structure of genetic material and protein </li></ul><ul><li>Can only be seen with an electron microscope </li></ul><ul><li>E.g., Norwalk, SARS, Avian Flu…. </li></ul><ul><li>Airborne Single Cell Organism </li></ul><ul><li>Grows into mold as soon as conditions permit </li></ul><ul><li>Causes allergic reactions, asthma episodes, irritations, infections, sinus congestion problems…. </li></ul>
    14. 14. Gases <ul><li>VOC’s (Volatile Organic Compound) are found in smoke, adhesives, carpets, cleaning agents, nail polish, paint, new construction, pressed wood products… </li></ul><ul><li>Can cause eye, nose, and throat irritation, headaches, loss of coordination, nausea… </li></ul>VOC’s Odors <ul><li>Caused by odorant molecules dissolved in the air. </li></ul><ul><li>E.g., pet odors, perfumes, food odors… </li></ul>
    15. 15. Current IAQ Technologies U LTRA V IOLET LIGHT For Microbial Inverse Square Law 100% POWER 25% POWER 6.25% POWER 1.56% POWER 1” 2” 4” 8” UV
    16. 16. UV Treated Heat Exchanger On Surface Inside Heat Exchanger
    17. 17. PHOTO HYDRO IONIZATION (PHI ) <ul><li>Hydrogen based oxidizers are created by exposing activated oxygen molecules to a hydrated catalyst containing four unique metals and 300 nm UV light (Photon Energy). </li></ul><ul><li>These Friendly Oxidizers are…. </li></ul><ul><ul><li>Hydro-peroxides </li></ul></ul><ul><ul><li>Hydroxides </li></ul></ul><ul><ul><li>Super Oxide Ions </li></ul></ul><ul><ul><li>Ozonide Ions </li></ul></ul>
    18. 18. HVAC PHI HVAC PHI
    19. 19. <ul><li>The System is designed to provide enough UVC exposure (dose) to destroy aspergillus. UV technology disinfects HVAC surfaces and then keeps those areas clean by continuously radiating the reservoirs where microorganisms can thrive. </li></ul><ul><li>This Systems combine filtration and the germicidal effect of UVC . Rather than just trapping aspergillus spores </li></ul>
    20. 20. What is PHI Cell <ul><li>Friendly Oxidizers are blown into the conditioned space </li></ul><ul><li>Microbes and gases are destroyed on contact. </li></ul><ul><li>Oxidizers break down into oxygen and water vapor </li></ul>Kills airborne and surface pollutants
    21. 21. <ul><li>This is an integrated system of components engineered for Indoor Air Quality (IAQ), air purification, energy savings and bio-defense. The major components of this System are ultra violet germicidal irradiation , filtration , reflective materials and monitoring hardware. </li></ul><ul><li>This is flexible and can be installed in any new or existing HVAC system. </li></ul>
    22. 27. HEPA - MD TM High Efficiency Particulate Arrestance - Microbial Destruction
    23. 28. HEPA - MD TM REACTOR Exposition to a non thermal plasma Capture by a electrical media Reactor with 4 modules Molecular filtration 3 2 2 1 2 3 4 Molecular Trapping 4 1
    24. 29. HEPA - MD Technology Destruction of airborne microorganisms by exposure to strong electric fields and to oxidative species in unique non-thermal plasma chambers Charged materials exiting stage 1 are captured by an electrically active media where organic materials are continuously exposed to the plasma ions Oxidant chemical species are removed by a catalytic monolith (notably ozone and NOx) 2. Biological decontamination and High Efficiency Particulate Arrestance 1. Microbial Destruction 3. Catalytic Conversion 4. Molecular Trapping Organic and mineral volatile molecular pollutants are adsorbed onto an activated carbon medium
    25. 30. Compounds and Odors Effectively Removed VOC removed ODORS removed
    26. 31. Product Range Mobile Air-decontamination unit Mobile Protective Environment Ceiling Diffuser Systems for air decontamination in high infectious risk zones Ceiling Air-decontamination unit
    27. 32. <ul><ul><li>Creating comfort conditions in “General Areas” in place of normal air-conditioning by low-energy techniques </li></ul></ul><ul><ul><li>Earth Tunnel cooling systems for non air-conditioned spaces </li></ul></ul><ul><ul><li>Use of flash-misting and other evaporative techniques including indirect systems </li></ul></ul>HVAC and Climate Control <ul><li>Improve Indoor air quality with well designed ventilation system and air filters to prevent nosocomial infection. </li></ul>
    28. 33. <ul><ul><li>VAV (Variable Air Volume) systems for efficiency in unbalanced occupancy conditions coupled with VFDs in Air Handling Units </li></ul></ul><ul><ul><li>Enthalpy ( Total Heat) Control in non-medical areas </li></ul></ul>HVAC and Climate Control (Contd.)
    29. 34. VAV System
    30. 35. <ul><li>Enthalpy control is a control which checks to see if both the temperature (sensible heat) and the humidity (latent heat) are low enough to be used for cooling. This combination provides for the greatest comfort at the least cost. </li></ul><ul><li>If the indoor thermostat calls for cooling and the outside air enthalpy (total heat) is low enough then the economizer brings in this cooler and less humid air and uses it for cooling instead of operating the compressor. Using the outside air for cooling is less expensive than operating the compressor to provide cooling. </li></ul><ul><li>Enthalpy control is located in the outdoor air air-stream and is a relatively sensitive control, it is not uncommon to have to replace it every few years depending upon the location of the equipment and the weather extremes in the area. </li></ul>
    31. 36. STUDIES & FINDINGS <ul><li>For the effectiveness of UVGI, the best ventilation rates seem to fall in the range of 10-12 ACH for winter (no baseboard heating) and at 6ACH for summer with the UVGI location </li></ul><ul><li>UVGI does result in the killing of a significant percentage of the viable particles in the room. </li></ul><ul><li>Changing the location of the UV lamp and increasing its intensity result in a higher percentage of particles being killed. However, further increases in UV intensity show diminishing returns. </li></ul><ul><li>The addition of baseboard heating results in better kill UVGI rates irrespective of ACH. </li></ul><ul><li>Baseboard heating should therefore be used in winter cases, especially at low ACH. </li></ul>
    32. 37. Assessing the Efficacy of Ultraviolet Germicidal Irradiation and Ventilation in Removing Mycobacterium Tuberculosis <ul><li>High level exhausts are generally better than low level exhausts in terms of vented percentage for the particle release points considered in the study, particularly at low to medium ACH. This trend is not present at the higher values of ACH. However, note that patient rooms display better air conditions for low exhausts at low to medium ACH, </li></ul>
    33. 38. <ul><li>Opening windows and doors provides maximum natural ventilation and this lowers the risk of airborne contagion </li></ul><ul><li>opening windows and doors provides ventilation more than double that of mechanically ventilated negative-pressure rooms and 18 times that of rooms with windows and doors closed. </li></ul>
    34. 39. <ul><li>Even at the lowest of wind speeds, natural ventilation exceeded mechanical ventilation. Facilities built more than 50 years ago, characterized by large windows and high ceilings, had greater ventilation than modern naturally ventilated rooms. </li></ul><ul><li>Opening windows and doors maximizes natural ventilation and that the risk of airborne contagion is lower than with mechanical ventilation systems. Old-fashioned clinical areas with high ceilings and large windows provided the greatest protection. </li></ul>
    35. 40. A R T CENTRE At Dr R M L HOSPITAL DELHI
    36. 41. A R T CENTRE AT Dr R M L HOSPITAL DELHI
    37. 42. WAITING AREA
    38. 43. CONSULTANT ROOM
    39. 44. CUT OUT IN DOOR FOR AIR OUTLET
    40. 45. WAITING AREA
    41. 46. WAITING AREA ( EXHAUST AIR )
    42. 47. DIVIDER BETWEEN WAITING AREAS
    43. 49. +VE +VE - VE - VE
    44. 50. WAITING AREA WITH NATURAL LIGHT & VENTILATION
    45. 51. Natural Light
    46. 52. TYPICAL WARD LAYOUT
    47. 53. TYPICAL WARD LAYOUT
    48. 54. TYPICAL WARD LAYOUT
    49. 55. TYPICAL DETAIL OF ONE CUBICLE IN WARD
    50. 56. WARD DESIGN WITH EVIDENCE BASED
    51. 57. Antibiotics are not the cure for superbugs, cleanliness is - and the hospitals simply aren't clean enough in India . Accountability is needed, not money, Run a hospital like a fast food joint. &quot;Clean as you go&quot; and it is all staff's responsibility to clean up, not delegated to the lowest bidder
    52. 58. FOR ANY QUERY E - Mail [email_address]
    53. 59. Many thanks for your attention!

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