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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



September 2012

Operating Room

Outpatient Connection

High blood sugar, obesity increase SSI

Two recent studies in the July issues of the Journal of Bone and Joint Surgery (JBJS) looked at surgical site infections and hyperglycemia, the technical term for high blood glucose, or high blood sugar. According to the first study "Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery," high blood sugar is a concern during the post-traumatic and post-operative period and it may help to preoperatively identify a population of patients with musculoskeletal injuries who are at significant risk for infectious complications.

Nearly, one-third of patients who are admitted to the hospital without a history of diabetes have hyperglycemia, which is associated with a longer hospital stay, higher rates of admission to the intensive care unit (ICU), and increased mortality.

Study authors reviewed data on patients 18 years or older who had isolated orthopaedic injuries requiring acute operative intervention. Patients diagnosed with diabetes or who were in the ICU were not included in the study.

Of 790 patients, there were 268 open fractures (if the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone), and 21 surgical-site infections (SSIs) at 30-day follow-up. Age, race, comorbidities, injury severity, and blood transfusion were not associated with SSI at 30 days.

The authors concluded hyperglycemia was an independent risk factor for thirty-day SSI in orthopaedic trauma patients without a history of diabetes.

This study suggests that recognition of the relationship between hyperglycemia and infections complications may substantially influence post-operative care of orthopaedic patients. Large, prospective, randomized studies are necessary to further delineate this relationship.

A second study found that diabetes and morbid obesity increased the risk of infection following hip and knee replacement. Authors of "Obesity, Diabetes, and Preoperative Hyperglycemia as Predictors of Periprosthetic Joint Infection" analyzed 7,181 hip and knee replacements and found that 52 post-operative joint infections occurred within the first year, and that the infection rate increased from a .37 percent in patients with a normal body index to 4.66 percent in the morbidly obese group. Normal BMI was defined as a body mass index (BMI) of less than 25, while morbid obesity was defined as more than 40.

Diabetes more than doubled the risk of a post-operative joint infection independent of obesity. The infection rate was the highest in morbidly obese, diabetic patients.

For patients without a diagnosis of diabetes at the time of surgery, there was a trend toward a higher infection rate in association with a pre-operative glucose level of more than 124 mg/dL.


TSK UV surface
disinfection system

Hands-free environmental cleaning strives for high-five

by Jeannie Akridge

No one likes to hear that their best isn’t good enough, but when dealing with human behavior there is always the potential for error, interpretation and missteps. Despite all best intentions, manual cleaning methods often fall short of perfection. Even when procedures are followed exactly, it’s likely that deadly pathogens will remain on many surfaces.

As the focus on eliminating healthcare associated infections (HAIs) begins to hone in on ways to augment current practices, automated technologies are becoming increasingly attractive.

Nancy E. Fellows, MPA, MSN, RN, CNOR, senior clinical education consultant for Advanced Sterilization Products (ASP), described the connection between surface contamination and HAIs. "There is growing concern and scientific consensus that transmission of pathogens is responsible for HAIs. The Centers for Disease Control and Prevention (CDC) states that the transfer of microorganisms from environmental surfaces to patients is largely by hand contact with the surface. Although hand hygiene is important to minimize the impact of this transfer, cleaning, disinfecting, and decontamination of environmental surfaces is fundamental in reducing their potential contribution to the incidence of HAIs."

"Best practice is evolving, but today, most facilities rely on elbow grease to move a microfiber cloth across surfaces hoping to collect and remove harmful germs as microscopic biomass. Literature suggests that even after three passes, a surface could still be contaminated," said Eric Klein, MBA, MS, environmental engineering, TSK Products.

Marc Lessem, vice president of Medline’s Ready Care Division, illustrated, "Studies show that only 40 percent of near-patient surfaces are being cleaned in accordance with existing hospital policies1. In addition, the CDC reports that pathogenic microorganisms cause one in every 20 patients to develop HAIs. Independent research shows contamination is difficult to eliminate and nearly impossible to certify. Multi-drug resistant pathogens are passed from surfaces to hands to patients easily. Significant evidence has been published in recent years that enhanced environmental disinfection and documentation is an extremely important risk management tool. This issue, along with the need to increase patient satisfaction and safety, is why no-touch surface disinfection solutions are being considered to complement current cleaning protocols."

Describing the inherent limitations of manual cleaning practices, Jim Gabalski, vice president marketing, North America, Getinge USA Inc., explained, "There are multiple studies that say that usually with the typical manual cleaning you’re leaving anywhere from 40 to 60 percent of the high touch surfaces uncleaned. Even if they did a really good job, there are still 40 percent of surfaces that are not disinfected. They might have been wiped, but they’re not disinfected."

Chuck Dunn, president & CEO, Lumalier Corporation/Tru-D LLC, expounded, "Clinical studies show that even after terminal manual cleaning efforts, up to 50 percent of all environmental surfaces culture positive for pathogens. This may be due to human fatigue and error, chemical ‘sit-and-soak’ times that are largely ignored, and cleaning protocols that are often a compromise between ideal patient safety and hospital room demands."

"As healthcare reform continues to unfold and Medicare and Medicaid reimbursements are truly going to be linked to hospital performance — and one of the big protagonists of true positive performance is the infection rate — hospitals are going to absolutely have to do something different with their protocol to make sure they reduce the number of HAIs that occur," Gabalski reasoned.

Automation fills the gaps

HPV systems

One type of automated area decontamination system uses hydrogen peroxide vapor (HPV) to clean surfaces.

Bioquell Q-10 Suite

For example, Bioquell provides an automated "no-touch" HPV process for room bio-decontamination that utilizes an EPA-registered sporicidal sterilant for hard non-porous surfaces and soft porous materials, explained Mark Hodgson, head of sales, healthcare, Bioquell Inc. "Presently, there are a number of infection prevention protocols indicating that the use of a sporicidal sterilant would be effective in reducing infection rates. The CDC recommends that for C. difficile control, terminal cleans should use either bleach or an EPA registered sterilant," he noted. "The APIC Elimination guide for Acinetobacter identifies the Bioquell automated ‘no-touch’ HPV process as one of the appropriate methods for use in terminal cleaning to reduce infection rates. Also, the CDC recommends that for Norovirus outbreaks, an EPA registered product be used to decontaminate rooms and equipment and provides a statement on the value of using HPV."

In addition to the cost savings associated with reducing HAI rates, Hodgson pointed out some practical ways Bioquell can positively impact a hospital’s bottom line. "Bioquell HPV is EPA registered as a sterilant for soft fabrics. This means patient curtains can be treated in place when treating a patient room with Bioquell’s HPV process. This eliminates the need to take down patient curtains for laundering when a contact precaution patient vacates a room. The cost in additional labor, laundry service, and wear and tear on the curtains is reduced."

Also, "Most hospitals dispose of unopened consumable items when a contact precautions patient vacates a room. Though the value of the supplies in the room may only total a few hundred dollars, when this is multiplied across the total number of contact precautions discharges every year the value of the items discarded rapidly escalates. Bioquell has demonstrated the ability to safely and efficiently eliminate pathogens from the outside packaging of these supplies, reducing waste and saving the hospital money often running to hundreds of thousands of dollars every year. This program can only be operated safely utilizing a system providing a full three dimensional, 6-log kill of pathogen, achievable with the Bioquell HPV process," he said.


ASP offers its HPV-based GLOSAIR Area Decontamination System, which disinfects all hard non-porous surfaces and hard-to-reach areas by dispensing a mist of 5 percent hydrogen peroxide to all exposed and unexposed areas, Fellows explained. "The three-phase Sure Cycle technology automates hydrogen peroxide-based decontamination and safely delivers powerful disinfection. First, there is Phase 1: Delivery, where the system automatically calculates the quantity of disinfectant to be dispensed, as well as the spraying time, based on the size of the room. Next, in Phase 2: Contact, the action of the hydrogen peroxide results in major reductions in a broad spectrum of pathogens within 10 minutes. The third and final phase is Active Aeration. The patented process combines dehumidification with dispersion of sterile water to optimize extraction of remaining hydrogen peroxide leaving the room dry with no wipe-down required. The system automatically notifies staff when the room is ready for re-entry."

Fellows described unique advantages of the GLOSAIR system. "Firstly, the 5 percent hydrogen peroxide used in GLOSAIR Systems has been proven to be efficacious against a wide range of pathogens. In addition, this area decontamination solution is noncorrosive and biodegradable, safe for patients, staff and equipment. Furthermore, the low concentration of 5 percent hydrogen peroxide solution of the GLOSAIR System reduces microbial load without leaving toxic residues. Because GLOSAIR System leaves no toxic residue, environmental decontamination may be repeated as often as desired within rooms."

Sanosil Halo Fogger

The Sanosil Halo Fogging System from Med Effect kills 99.99% of bacteria, viruses, and fungi on pre-cleaned surfaces, without harming sensitive equipment, electronics, surfaces or substrates. The system is lightweight, portable, quiet, odorless, colorless, easy to use and effective. The Halo Fogging System assures a homogeneous mist of ionized particles that gets to areas that regular cleaning can’t or doesn’t reach, to include high touch areas around doors, behind window treatments, and under desks and beds. A 2,000 cubic foot room can be decontaminated in under 20 minutes, for less than $5.00 with the Halo system, and up to 10,000 cu. ft. can be treated with one machine in one session, explained John Barton, president, Med Effect Inc.

To help ease preparation for using HPV room decontamination and other aerosol-generating systems, or otherwise isolating an area, the Mintie Environmental Shield System (ESS) features an easy rolling applicator that allows anyone to seal HVAC vents without the need for a ladder. This greatly reduces the cost of labor and risk of irregular application of makeshift solutions, offered David Lutz, vice president, products, Mintie Inc. "Using the vent covers and extra wide tape an entire room can be isolated in 7 minutes. These components are made of a proprietary material which is inherently sticky, unlike traditional materials that must be sprayed with chemical adhesive. As a result they have very strong adhesive properties, but have no residue to leave behind and do not damage surfaces. The material is also recyclable."

STERIS Corporation is introducing an HPV based system, the VaproQuip Decontamination Room designed to disinfect moveable equipment and furniture. Explained Ted Mielnik, vice president global VHP application development, "High-touch environmental surfaces such as hospital equipment and furniture can harbor infectious agents. These items are included in the definition of noncritical items in CDC’s ‘Guideline for Disinfection and Sterilization in Healthcare Facilities’ (2008) as ‘noncritical items … that come in contact with intact skin but not mucous membranes.’ In response to this patient safety concern, STERIS Corporation will be offering the VaproQuip Decontamination Room (patents pending) for use with 35% Vaprox Hydrogen Peroxide Sterilant (EPA Registration No. 58779-4) for application to noncritical items including equipment, furniture and other movable environmental surfaces."

STERIS VaproQuip Decontamination Room

"The VaproQuip Decontamination Room is completely self-contained and engineered for safe operation away from patient care areas," Mielnik continued. "Its modular panel construction enables installation in existing hospital spaces, turning existing equipment storage rooms, for example, into functional, high-turn reprocessing centers for difficult-to-clean items. The VaproQuip Decontamination Room has many standard integrated safety features such as onboard aeration, hydrogen peroxide sensors and monitors, door interlocks, a safety storage cabinet for the sterilant, and cycle status lights, alarms and abort features."

"It is sometimes difficult to reach all the surfaces of complex electronic and other high-touch equipment [via manual cleaning and disinfection methods2]," he said. "The hydrogen peroxide vapor generated in the VaproQuip Decontamination Room during a cycle optimizes surface coverage, making it an excellent complement to manual cleaning. Equipment and furniture surfaces need only be visibly clean and dry prior to undergoing the Vaprox application process. When Vaprox Hydrogen Peroxide Sterilant3 is applied in the room as a low-temperature dry vapor, it is effective against a broad spectrum of biological organisms (spores, bacteria, viruses, and fungi). The VaproQuip process leaves no residue and no lingering odor, and has excellent compatibility with a wide variety of materials."

UV systems

Ultraviolet (UV) light is another type of technology that can be used to decontaminate a specified area.

"Ultraviolet germicidal disinfection is a tool that works in consort with wiping down a room with chemical disinfectant," said Klein. "Although UV will kill every single-cell organism it reaches, it can’t kill what it can’t see. Therefore, UV disinfection fits into the terminal cleaning process as an additional tool (after wiping away any microbial shelter) to disrupt the transfer of germs, thus eliminating HAI."

Klein described the science behind UV-based decontamination systems such as those offered by TSK Products. "Utilizing ultraviolet as a germicidal disinfectant, a light wave is propagated from the source (a bulb resembling a fluorescent light) and sent out in all directions in equal strength. The light will not stop until it crashes into a solid object. At the crash site, the wavelength of the light sees the same wavelength of double bonds in the germ’s DNA, and disturbs nature, causing the double bond to break momentarily. Since these particular atoms prefer a double bond status, the bonds are reformed, however, typically not with the original carbon atom. Because this is DNA that’s disturbed, when it comes time for cell division, the code is no longer valid and mitosis fails."

While the premise is simple and the germicidal effects of UV are well-documented, there are some key points to keep in mind, noted Klein. "The physics of light travel, and therefore UV’s effectiveness, controls the disinfecting results. The further the light travels, the weaker the intensity of the light becomes. Also, light travels in a straight line, making for some dark, or shadow, areas. As best practice grows to include automated room disinfection technology, UV light best practices will include 1) minimizing the distance from light source to contaminated surface that are ‘high touch’, 2) minimizing dark or shadow areas, 3) minimizing the cost of acquiring and maintaining the equipment."

"Light generated from each of TSK Products’ Sanuvox Technologies’ bulbs is completely directed at the contaminated surfaces because of the parabolic surfaces behind each bulb, unlike other designs which allow bulbs to shadow each other," Klein added.

Getinge offers the Steriliz R-D Rapid Disinfector, a portable device which uses UVC light to permeate a room and kill harmful bacteria on commonly touched surfaces. "UVC light is a known germicidal; it’s just what intensity and what dose and for how long you deliver it that will effectively result in a kill," said Gabalski. What makes the Steriliz R-D unit unique, he said, are "the electronic challenge devices that can be placed in multiple areas of the room that measure whether or not a definitive killing dose has been delivered. The more important thing is not what’s being put out of the lamps themselves, it’s what’s being received in the areas of the room."

The Steriliz R-D is designed to keep running until a killing dose has been received at all of the challenge devices positioned within the room. Through a handheld control unit, operators are apprised of progress of each of the challenge devices so that the system can be paused and the unit moved to better target the intended areas. "With that type of proactive management you a), shorten the time required to disinfect the room, and b), you can definitely state that all targeted areas of the room have received a killing dose," said Gabalski.

The Steriliz R-D system can also be used between surgical cases to augment manual cleaning and decrease the risk of an HAI, adding just 10 minutes or less to the time spent on the turnover of each room.

Xenex UV device at MountainView • Photo courtesy Las Vegas Sun

According to Dr. Mark Stibich, chief scientific officer, Xenex Healthcare Services, Xenex’s portable device is the only system that uses pulsed xenon ultraviolet light (PX-UV) to quickly destroy viruses, bacteria and bacterial spores in the patient environment without contact or chemicals. "Uniquely designed for ease of use and portability, the Xenex device can be operated by a hospital’s environmental services staff without disruption in hospital operations. Requiring only 5-10 minutes to disinfect a room, the Xenex device can disinfect dozens of rooms per day, so hospitals use the system continuously to reduce contamination levels throughout their facilities. The Xenex device has been proven effective even with a minimum of visual cleaning in the room prior to use. Best of all, we have supporting data and case studies for our protocols."

"What makes our device so different is that we use pulsed xenon ultraviolet light, which is 25,000 times more intense than other UV technologies (which take hours to clean a single room)," said Stibich. "Hospitals don’t have hours — they have minutes — to clean rooms in between patients. We hear repeatedly from our customers that automated room disinfection needs to be quick, it needs to be performed by the hospital’s environmental services (EVS) team (housekeeping) and it needs to be affordable. Hospitals need to turn over rooms quickly — and being able to disinfect a room in only 5-10 minutes is something that fits into their routine. We’re also affordable, which is a big consideration for hospitals. It costs about $3/room to use our device — which is considerably less than other room disinfection systems."

Stibich shared customer success stories in reducing infection rates using the Xenex system. "Cooley Dickinson Hospital reported 67% lower C. diff rates and 100% lower C. diff deaths and colectomy rates since adopting the Xenex system. This brought savings of over $1 million to the hospital’s bottom line. In 2011, Cone Health reduced MRSA infections in its ICUs more than 50% after using the Xenex device (its 6-month savings was $2.3 million in infection-associated hospital costs). Meanwhile, another customer did a study that showed using the Xenex device would actually speed up room cleaning time by 23%, thereby saving in labor costs."

Medline’s IRiS UVC decontamination system

Lessem described Medline’s UVC system. "IRiS is a mobile no-touch disinfection device that utilizes ultraviolet C (UVC) wavelength light to complement current cleaning and disinfecting protocols in an effort to help prevent the spread of germs and reduce HAIs thereby improving patient safety and reducing overall treatment costs. IRiS is fast, powerful, safe and easy to use as housekeeping staff typically operate it during their normal routine. The most prevalent use for IRiS is to disinfect patient rooms after discharging isolation patients (approx. 15 minutes for patient rooms and 30 minutes for O.R. suites depending on room size and other environmental variables) during the day and deploying IRiS to the OR for use during the night."

The IRiS system uses "Dose Assurance/UVC Field Balancing" — which Lessem explained is a proprietary algorithm that adjusts UVC output to deliver the optimal complete UVC dose needed for each targeted area regardless of room size, surface coatings, and other environmental variables. "IRiS reduces the likelihood of human error associated with other similar technologies because it requires nothing of its user other than to activate the device. IRiS does all the calculating."

Lumalier’s TRU-D is an automated, mobile room disinfection device engineered to deliver a measured, lethal dose of ultraviolet germicidal energy to quickly and effectively destroy environmental microbial contamination, without the use of corrosive chemicals or harmful ozone, Dunn explained. "Pathogens that were once susceptible to chemical disinfection have evolved into drug and chemical-resistant organisms, in part because drug and chemical treatment may only damage, but not destroy, the organism. The resulting mutation exhibits greater resistance. There is no DNA/RNA based pathogen that is resistant to a lethal dose of UV germicidal energy. [Because of this] TRU-D has been proven to be highly effective in neutralizing MRSA, Acinetobacter, C. diff and other multiple-drug-resistant, infectious microbes."

Dunn described how the TRU-D system is able to "proactively manage" the dose of UV light to ensure optimal results. "The TRU-D generates the precise wavelength of UV-C energy required to prevent growth, reproduction and colonization of targeted pathogens. A 360° array of sensors measures the UV germicidal energy reflected from walls, ceilings, floors and equipment. Exposed surfaces, including those within secondary shadows, quickly achieve desired disinfection levels. Tru-D SmartUVC is the only portable UV disinfection system that precisely measures reflected UV-C emissions with Sensor360 to automatically calculate and generate a precise, pathogen-lethal UV dose required for each unique room, dynamically compensating for room size, shape and other dose altering variables such as the position of contents, windows, blinds and doors."

Lumalier TRU-D

The Tru-D device has been featured in multiple, peer-reviewed studies and trials presented at leading medical conferences, Dunn offered as evidence of effectiveness. "There is a misperception that there is little or no difference between portable UV disinfection equipment. While it is exceptionally clear in the literature that a proper dose of UV-C directed to contaminated high-touch surfaces results in significant pathogen reduction, it is less widely known that room size, shape, content, and geometric features variability require a UV-C instrument capable of compensating for variables to thoroughly disinfect within shadows. Readers should understand the importance of a device-specific evidence base. The UV technology category is of serious consideration to infection preventionists. Rutala and Weber (ICHE)4 noted after a thorough literature search, that there are only four proven instruments; three Hydrogen Peroxide Vapor variations and one UVC instrument, Tru-D SmartUVC: ‘There is now ample evidence that no-touch systems such as UVC light or HP can reduce environmental contamination with healthcare-associated pathogens. However, each specific system should be studied and its efficacy demonstrated before being introduced into healthcare facilities.’"

UVGI HVAC applications

While surface contamination can play a large role in disease transmission, so can the air that circulates throughout the hospital.

Dr. Robert Scheir, president and microbiologist, Steril-Aire, explained how HVAC systems can potentially be a contributing factor in the development of HAIs: "Heating ventilation and air conditioning systems have been proven to be an amplification source and a transport system contributing to the hospital bioload. Multiple studies have documented pathogenic and opportunistic bacteria, viruses and mold distributed by these systems. The biofilms themselves give off VOCs and MVOCs, which have been found to play a major role in Sick Building Syndrome."

Steril-Aire UVGI

Fortunately, noted Scheir, "there is sufficient scientific and anecdotal evidence that demonstrates how ultraviolet-C germicidal irradiation (UVGI) in HVAC systems can decrease the microbial load contributing to HAIs. To prevent the growth of microorganisms on the cooling coil, Steril-Aire recommends a minimum UVC intensity of 200 µW/cm2 should be maintained on all portions of the evaporator coil at all times, running 24/7. By eliminating the source of contamination at the coils and in the drain pan, Steril-Aire’s UVGI can help reduce surface biofilm and the spread of airborne contaminants."

Steril-Zone, an advanced room air purifier from Steril-Aire, combines three scientifically proven technologies — germicidal UVC, activated carbon and a HEPA-style filter — to provide a safe and energy-efficient way to clean the air in rooms up to 1,000 square feet. Independent testing has shown a significant log reduction in microbiological and chemical contaminants. Steril-Aire is also putting the final touches on a UVGI ceiling troffer for operating and procedure rooms. Intended for use in unoccupied surgical suites, the troffer will provide surface disinfection with immediate reuse of the room, added Scheir.

He described the cost-saving and energy-saving opportunities available with Steril-Aire products: "By continuously cleaning the HVAC coils and drain pan, Steril-Aire’s UVGI reduces the biofilm growth which serves to reduce heat exchange and impede airflow. The results are improved cooling efficiency; airflow and net cooling capacity; chiller efficiency and thermal comfort."

"Hospitals can save considerable sums of money by the use of ultraviolet irradiation on cooling coils of air handlers," noted Lee Hadin, president and CEO, Medical Air Solutions Inc. (MAS). "The key to a short ROI is by correct dosage specification of the UVGI units for the size and type of air handler. By irradiating either new coils or freshly cleaned coils the initial efficiency of air handlers can be maintained. Additionally, yearly cleaning with caustic chemicals, and disposing of them as well as the labor to clean the coils is avoided. The end result is less labor, less chemical expense and more efficient air delivery. Most importantly is elimination of one more source of pathogen contamination of the air delivered."

Wall-mounted intake grill (for pathogen capture and creation of negative room pressure) above a patient bed, from MAS.

Airborne isolation

MAS designs and manufactures various models of air purification systems (APS) for healthcare application in the U.S. These systems are quality controlled to be "medical-grade", the highest grade of air purification systems available, said Hadin. "This quality control assures what the exact CFM delivery is for each unit manufactured as well as checking for the precise total system efficiency which must exceed 99.9% efficient for the unit to be released for sale. They incorporate certified 99.99% HEPA filters, antimicrobial prefilters. Ultraviolet germicidal irradiation (UVGI) can be added as an option to this product line called AirShield. These systems are controlled by all digital electronic wall mounted control panels."

Hadin added, "The AirShield product line meets the RoHS-95 federal directives so as to be classified as ‘Green’ systems and therefore may qualify for reimbursement based on being free of hazardous materials and being energy efficient by employing DC motor-blowers units versus AC in each of their models."

MAS has designed many special purpose environments for airflow containment and safety; sputum booths, mail handling rooms, emergency preparedness facilities, as well as compacted isolation rooms designed for the military which can be air dropped and assembled and functional in a few hours. The EPIC or Emergency Preparedness Isolation Center concept can accommodate up to several hundred infected patients in the event of bioterrorism events, but when not used for such purposes it can be used as a staging center for an over crowded emergency room and less serious patients.

Hadin noted that "the CDC, by the year 2015, wants to have a least 20 percent of hospital patient rooms prepared to be certifiable airborne infectious isolation rooms (AIIR). By the year 2018 their goal is 30 percent of patient rooms converted to AIIR. We’re nowhere near even 10 percent at present, maybe 4 or 5 percent at best."

Mintie products provide easy, convenient and high efficacy temporary barriers with optional HEPA filtration, Lutz described. "And we have developed both reusable and disposable solutions to better meet customer needs. All our systems are built around our patented collapsible frame design, which makes them portable and intuitive to use as well as easy to store."

"For pandemic preparedness applications," he continued, we recommend our ECU2 modular containment system, as it is the most durable and allows for individual room and mass patient isolation."

"For construction containment, however, readers may want to review our new line of Disposable Envelopes (DE) which work with our existing frames. Not only are they significantly less expensive than traditional systems, but also easier to work with because they are lighter and act as their own trash bags. Work is more efficient. They also provide the added safety of a new clean envelope with every use, eliminating the risks associated with improperly disinfected reusable units. It is important to consider how easy products will actually be to maintain. A lot of reusable solutions become ‘mobile reservoirs of contamination’ and unusable after a poor or negligent cleaning. When appropriate, Mintie DEs can negate this issue," Lutz offered.

Abatement ISOQUAD 200 Bed Isolation Module

David M. Shagott, president, Abatement, described the company’s patient isolation and construction solutions. "Our products mainly fall into one of three categories: Fixed and portable containment products for physically isolating construction areas or infectious patients from unaffected areas of the facility; HEPA filtration systems for continuously filtering pollutants out of the air and creating and maintaining negative (lower) air pressure within the ‘dirty’ area compared to surrounding areas; and instrumentation such as differential pressure monitors and particle counters to monitor the effectiveness of these measures."

Abatement’s ISOQUAD 200 Bed Isolation Module "enables facilities to enclose any bed or gurney and convert it into a negative pressure isolation module for an individual patient, a low cost option to placing a patient room or larger area under negative pressure, and to very expensive structures such as large specialized isolation tents," said Shagott.

Abatement’s latest generation AIRE GUARDIAN 3000 Mobile Containment Cube is used to isolate particles released into the air during activities that require access into wall and ceiling cavities, such as pulling wire and cable containment enclosures and barriers in accordance with CDC guidelines and NFPA and other relevant fire/life safety standards, he noted.

Hadin emphasized the importance of establishing correct airflow dynamics in critical care areas. "You can have the proper number of air changes per hour in an isolation room, you can have the proper negative pressure in the room, but the room can still be ineffective or even dangerous for the healthcare worker. Airflow must enter the room at, or near, the room entrance door and flow directly toward the patient, then exit up and out of the room above the patient’s head." Proper sealing of windows and other openings such as wall sockets, light switches are also critical to maintaining the correct and constant negative pressure of 0.3 inches of water column pressure, he added. Pressurized AIIRs require annual inspections and certifications per OSHA and Joint Commission regulations, services also offered by MAS.

Shagott commented, "Maintaining proper pressure relationships is the main requirement for a negative pressure patient isolation room. While interval monitoring is allowable under current guidelines, continuous electronic monitoring is the only way to document room pressure conditions 24/7. Abatement offers two wall-mounted room pressure monitor models designed to be surface or flush mounted to a corridor wall. The RPM-DX deluxe model in particular offers exceptional user features. It has a graphical, full color touch screen display and is capable of simultaneously monitoring the pressure differential between two rooms and a reference point. It is both BACNET and 3N2 compatible, and data can be downloaded to a PC in Excel format via a jump drive. In the event of a pressure loss incident available options include a portable wireless remote annunciator that’s about the size of a cell phone and an auto dialer that can contact a pre-programmed cell phone number."


1. Carling PC, Bartley JM. Evaluating hygienic cleaning in healthcare settings: What you do not know can harm your patients. Journal of Infection Control. 2010;38(5) S41-S50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20569855. Accessed July 2, 2012.

2. Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. Brittany C Eckstein, Daniel A Adams, Elizabeth C Eckstein, Agam Rao, Ajay K Sethi, Gopala K Yadavalli and Curtis J Donskey. BMC Infectious Diseases 2007, 7:61 doi:10.1186/1471-2334-7-61. The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2334/7/61.

3. Not for use as a terminal sterilant or high-level disinfectant for critical or semi-critical medical devices

4. "Are Room Decontamination Units Needed to Prevent Transmission of Environmental Pathogens?", William A. Rutala, PhD, MPH; David J. Weber, MD, MPH, infection control and hospital epidemiology august 2011, vol. 32, no. 8.