Ma2si mobile air applied science inc “Break the Chain Of Infection” © CLEAN AIR.

ma2simobile air applied science inc

“Break the Chain Of Infection”©

CLEAN AIR

• The air looks clear so it must be clean

• The air entering the room from the facility HVAC system is clean because your told so

• Increasing the room air exchange rates will solve all air quality issues by itself

• Where the filters are placed in the system flow is not critical to the air quality as it enters the room

• The facility has installed HVAC filtration at a central location, so it ought be delivering ultra clean air to the connected rooms downstream

• They always change out the dirty filters in a timely manner

ma2simobile air applied science

Misconceptions About Quality Air Filtration

A particle is defined as a small object that behaves as a whole unit in terms of its transport and properties.

• Fine particles cover a range between .1 and 10,000 micrometers (µm)

• Ultrafine particles are sized between .0001 and .1 µm

• Airborne Particles range from .0001 to 10,000 µm

• Particles >50 µm or larger are visible to the eye


What Is a Particle

Particles are easily inhaled thru the mouthor nose into the lungs

• Particles <100 µm can be inhaled into the lungs (clay, silt, fine sand, smog, spores, pollen, viruses, bacteria, tobacco smoke, nebulized drops, metal fumes)

• Ultrafine Particles <10 µm are capable of entering the deep part of the lungs (clay, silt, smog, viruses, bacteria, tobacco smoke, metal fumes)

• Ultrafine Particles then have the ability to enter the bloodstream

• Ultrafine Particles also have the unexplained ability to penetrate cells and impair cellular function


Why Are Particles A Concern

Particle Settling Velocities in Still Air

Mean Particle Diameter (µm) Settling Velocity

Skydiver . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,920 feet per minute

100.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59.2 feet per minute

50.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.8 feet per minute

10.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 ft per minute

1.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 inches per hour

0.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 inches per hour

0.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.13 inches pre day

<0.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . negligible

Smaller airborne particles in an occupied room will resist gravitational settling and will remain in suspension indefinitely


Misconceptions About Air Quality

On Sterile Core DiffuserCalcite, skin flakes, clothing fiber, natural minerals, paint spheres, starch, fern spores, pollen, hyphae, cosmetics, insect parts, fungal spores, plant parts, charred wood, bird feather barbules, rust, and ink

Operating RoomWear metals, dog and cat dander, shoe wear, floor wear, cleaning residues

On Anesthesia DiffuserSoot, clothing fiber, skin flakes, pollen, hyphae, fern spores, insect parts, paint spheres, plant parts, cosmetics, rust, ink, bird feather barbules


Samplings Found In One Hospital HVAC System


• Persons entering the room (patient, staff, or visitor) - On their clothing and shoes - On their body - Dislodged from objects by air currents as they pass

• Naturedly suspended in the room airflow currents

• From the room HVAC air inlet registers

• Displaced from equipment, food trays, equipment, etc., brought into room

• From bedding, curtains, gowns, etc.

• Shedding from wall/ceiling surfaces

• Stirred from the floor while walking

Where Do Room Contaminated Particulates Originate?

Theater Air

Ventilation

Patient’s Skin

Body Incisions &Wound Drapes

Wound Site

Personnel

Gloves

Masks

Clothing

Instruments

MouthHands Body

Adjacent Areas

Floor


Sources of Wound Contamination & Routes of Transmission in the OR


• Wall friction pulls along the sides of the duct against airflow for the entire duct

• This causes contaminates from the room to stick to the inside duct walls

• Build-up occurs and eventually re-enters

the room more contaminated

• Duct cleaning is in ineffective since it cannot reach every nook and seam

• Bacteria & virus pathogens are found in ducts at heath centers

Duct Wall Friction And Why It Impacts Air Quality Negatively


• Air blower & filter system on the area roof

• Duct maze system with many twists, turns and jagged assembly joints

• Simple air outlet registers

• Room return air exhauststhrough ceiling

• Room doors left open that upsets airflow

A Facility HVAC Normal Airflow Diagram


• Takes the duct contaminates out of the equation

• Places room air exhaust as far from air intake as possible

• Utilizes “Cleanroom” air movement principals - Enter

from the ceiling and exit near the floor

• Each room is a island unto itself and needs to be individually addressed

Improved Facility Air Quality Using HEPA Filtration Located at Room Interface

Particles Released Human Activity Per Minute (>0.3µ)

Sitting at Rest +++++++++++++++++++++++++++++ 450,000Standing Still ++++++++++++++++++++++++++++ 550,000Neck Rotation +++++++++++++++++++++++++++1,100,000Body Twisting +++++++++++++++++++++++++++ 2,000,000Body Bending +++++++++++++++++++++++++++ 4,000,000Stepping +++++++++++++++++++++++++++++++++++ 4.200,000Standing & Sitting +++++++++++++++++++ 4,400,000Knee Bending +++++++++++++++++++++++++++ 4,200,000Arm Motion ++++++++++++++++++++++++++++++ 4,700,000


Particles Released from People

• Sepsis after elective surgery imposes both significant clinical and resource utilization burdens

• Studies demonstrate sepsis increased significantly over last decade

• As payers move to performance-based reimbursement, sepsis prevention becomes financially prudent

• A 3.3-fold increase in hospital cost in cases with postoperative sepsis went from $17,229 (median) to $57,032


Postoperative Sepsis in the United States

• 5% of hospital patients will develop an HAI; that number increases to 30% for patients in ICUs

• The added risk of infection to the antimicrobial resistance of pneumonia in the ICU was 20%

• Healthcare-associated pneumonia doubles the risk for death and increases the length of stay

• "Prevention of health-care-related infections needs to be reasserted and emphasized as an absolute priority."


Healthcare Acquired Infections (HAIs) Linked to Increased ICU Mortality

Airborne Contamination

From facility’s HVAC system

Suspended in air currents

Blown off dirty surfaces

Created by people movement

From personnel in room

Surface Contamination

From furniture & equip. surfaces

Off dirty objects carried in

Brought in by patients, staff,or visitors

Hands touching dirty surfaces

Off people’s clothing


Breaking The Chain Of Infection© Follow the path

Abstracts Highlight the Reduction of Infectious Disease Using HEPA Filter Technology

• MRSA, now becoming a deadly visitor to healthcare facilities, can begreatly diminished by portable HEPA filtration (Department of

Microbiology, Nottingham City Hospital, UK.)

• Establish effective management over spread of aspergillosis for severely immunocompromised patients using flexible (HEPA based) aerial control measures (Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263)

• A clear, demonstrable, statistically significant reduction in microbial organisms followed the activation of an air filtration system in a hospital ward (Glasgow Caledonian University, Glasgow, UK) * The full abstracts for these and other studies are available


The Incidence and Control of Airborne Healthcare Infection is Relevant

• Influenza & Respiratory Syncytial Virus Spread by Infectious Airborne Particles (NIH/IDSA Vol 50 ISSN 1537-6591 2010 Mar)

• Airborne Spread of Clostridium Difficile (Clin Infec Dis, Lindsey, et al, 2010 Feb)

• Airborne Transmission of DS/DR TB Fueled by Risk of HIV (NIH/IDSA Vol 50

Sup 3 ISSN: 1537-6591 2010 May)

• Growing Evidence of Linking Air Pollution with Cardiovascular Disease (American Heart Assoc, Circulation 2010 May)

• Potential for Airborne Dispersal of C. Difficile from Symptomatic Patients (Best et al, IDSA Vol 50 ISSN: 1537-6591 2010 Jun)

• Significance of Airborne Transmission of MRSA in an Otolaryngology-Head & Neck Surgery Unit by Teeruo Shiomori, et al, Head Neck Surg. 2010; 127:644-648


Recent Reports of Airborne Spread of Disease and Infection

•A new “Superbug” (NDM-1) that is resistant to even the most powerful antibiotics has entered hospitals worldwide

•NDM-1 enzyme has travelled back with patients visiting who went abroad to countries like India and Pakistan

•NDM-1 can exist inside different bacteria (E. coli)

•NDM-1 Infections have already been passed from patient to patient in UK hospitals. Recommendation: “Patient Isolation”

•International researchers say that NDM-1 could “produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat”


Alert! Another New “Superbug”

• In US hospitals overall, HAI’s account for an estimated 2 million infections and 99,000 deaths each year at a total cost of over $30+ Billion dollars.

• 22% or 440,000 are surgical site infections (SSI)

• 15% or 300,000 are lung infections (Pneumonia)

In the US there were 14,561 AIDs deaths in 2007However …


The Numbers Are Alarming

• Influenza virus particles are about 0.12 micron in size*• Airborne Influenza viruses are usually transmitted by droplet

transmission• The average droplet nucleus is 5-10 microns• The average size sneeze/cough droplet is over 10 microns• Research has shown that one virus particle is theoretically enough

to cause infection * Viruses tend to clump together forming larger contaminants


Viruses Facts

• Pulmonary Tuberculosis (TB)

• Chicken Pox and Measles

• Disseminated Zoster

• Small Pox

• Severe Acute Respiratory Syndrome (SARS)

• Swine Flues & Avian Flues

• Viral Hepatitis (kills >1 million annually)ma2si

mobile air applied science

A Few of Today’s Airborne Virus Droplets

Pseudomonas Aeruginosa

• Free-living bacterium, commonly found in soil and water

• Occurs as a nosocomial pathogen

• Antibiotic resistance is increasing in clinical isolates

• An opportunistic & virulent pathogen

• Studies show Bacterial growth thru the filtration media in six months even in low humidly


A Bacteria To Be Very Concerned AboutIn Clean Air Filtration Media

• Biofilm-forming bacteria, different from planktonic bacteria, needs 1,000 times more antimicrobial agent to destroy

• The best practice is to reduce migration of bacteria to the open wound before the protective biofilm completes

• The best solution in controlling open wound infection requires both best Practice and best product combination

• Protect open wounds until the biofilm completely forms by substantially reducing the number of airborne bacteria


Connecting Airborne & Blood Borne Infection Prevention

Defining the risk of Surgical site Infection (all surgeries)

Level of Contamination Risk

Clean < 2 %

Clean Contaminated < 10 %

Contaminated ≈ 20 %

Dirty ≈ 40 %


The Risk of Surgical Site Infection

• Duct contaminants increase over time due to standard building HVAC design verses cleanroom design filter placement

• More surgery procedures are moving to clinics and outpatient surgery centers designed with restrictive building HVAC systems

• The near-open wound site air is often contaminated with over 600,000 particles per ft3 by HVAC, staff and equipment

• Laser & cautery fumes carry toxic and infectious contaminants


Today’s Surgery Suites Are Contaminated In Many Ways

• Remove the invisible airborne pathogens/contaminants that contribute to the high infection rates

• Create cleaner patient and staff environments transparently and targeted when and where needed

• Reduce the infection incidence and resulting cost of hospital acquired infections from air contribution

• Decrease patient suffering and high cost of treatment

• Introduce “Focused Clean Air Zone” applications


How Do We Change This Picture and What Are the Results?

• HEPA filtration can trap viral and bacterial pathogens

• The use of a Focused Clean Air Zone© has been shown to reduce infections in surgery

• Over 475 operations completed in a surgical suite over three years with < .01% infection rate*

• Superior reduction of micro-organisms can be achieved

• Upgrade existing facilities; converting most any space to a cleaner and safer environment

* Both complex and routine plastic and reconstructive surgeries


The Science of Air Contamination Control Can Effectly Reduce Infections

The four processes of the HEPA filter media to capture particulates:

• Sieving - 98.7% @ 2 micron - 30% @ .5 micron Sieving, the most common mechanism in filtration

• Inertial Impaction - 99.9% @ 1 micron – 20% @ .02 micron Inertia works on large, heavy particles suspended in the air stream

• Interception - 99.99% @ .7 micron – 20% @ .02 micron The mid-range size that are not quite large enough to have inertia and not small enough to diffuse within the flow stream

• Diffusion - 40% @ .3 micron – 99.999% @ .01 micron Diffusion works on the smallest particles that disperse within the flow stream


How HEPA Filters Function

• Placing of final filtration at room air discharge

• Utilizing certified HEPA filter with 100% gasket seal technology

• Regulating airflow velocity rates creating smooth, near-laminar airflow

• Creating proven room airflow directional dynamics with incoming and exhaust strategic placement

• Controlling air volume to minimize external interferences


Cleanroom Proven Design Principals That Transfer To Healthcare Applications

• Reduce new construction expenses for facility HVAC systems both new and remodel

• Provide cost effective airborne environmental upgrades within existing facilities

• Create immediate surge capacity for onsite and offsite surgery, patient isolation and staff safety

• Upgrade hospital and private pharmacies to meet

USP797 requirementsma2si


What Can This Technology Do?

• FDA accepted 1st mobile air filtration system

• Mobile isolation systems for quick placement in any potential setting; “Clean Air Anywhere”

• Enhance site-specific HVAC conditions with strategic installation of exclusive high-efficiency filtered environments

• Suites of follow-on devices to address specific applications in the operating theater, patient isolation, staff safety and more


Welcome To Clean Air World From Mobile Air Applied Science


Mobile Air Applied Science’sEvidence Based Solutions

A self-contained mobile air filtration solution that provides immediate infection and airborne contamination control wherever it’s needed


The Mobile M100 Device Solution

M100 Adjustable PositionsAirflow Directional Operation

90 FPM Velocity

120 FPM Velocity


“Focused Clean Air Zone”

M100 Flexibility And Airflow Output

• Recirculates filtered room air at rates from 100 to 480 CFM

• Totally adjustable hood projects “Focused Clean Air Zone”© onto the desired target

• Pulls & collects pathogens, odors & VOCs from lower worksite level

• Provides non-shadowing and variable intensity lighting

• Plug it in, turn it on and in minutes you have a “Focused Clean Air Zone©”


M100 – What Does It Achieve?

Negative Pressure Configuration

Positive Pressure Configuration

Both patient isolation configurations from a single unit


Single Patient Isolation Versatility

The mobile M100 adapts to the patient isolation system to provide either a positive pressure (PP) or a negative pressure (NP) Isolation chamber unit


How Does A Single Patient Isolation System Work?

• (Red) Primary surgical site HEPA filtration creating the “Focused Clean Air Zone©”

• (Blue) Secondary HEPA filtration operated 24/7 to maintain maximum room air quality at all times (< 4,000 particles per ft3)

Note: Outside of room over (1m PCF)


PCF322 - Ceiling Room Incoming Air Filtration Devices In A Clinic Surgery Room

A. “Focused Clean Air Zone” envelope gently projected downward

B. Extension of airflow downward until surface is encountered

C. Airflow outward after surface is encountered thereby gently moving room air outward


PCF322 – Room Airflow Dynamics

A. Use clean filtered air to push contaminated air out

B. Airflow moves from the inlet filtered air register toward the exhaust register creating a cleaner environment

C. The exhaust outlet is placed at the opposite side of the room to achieve best possible impact

Optimizing the placement of the PCF series, in relation to exhaust, creates better room airflow dynamics and increased effective room contaminate reduction

ma2si


Purging Room With Clean Filtered Air

• PCF series placement is critical for very best airflow dynamics while keeping the contaminates near floor level

• Maintain the airflow in this manner provides maximum room clean air movement, once

contaminated, below patient and staff level

• Balance the room positive pressurization by restricting the exhaust air while maintaining sufficient air changes

• Install a pressure air pressure meter outside near the entrance to assure room pressurization


Maximizing Airflow Dynamics & Creating Positive Pressure in Room

• The airflow dynamics in this example is most undesirable

• Clean air coming into the room is pulled directly toward the exhaust register thereby creating

unprotected zones in room

• Little prospect exists for purging many contaminates from the room

• Creating a positively pressurized room is nearly impossible with clean air throughout


Ineffective Airflow Dynamics Within Room

• Replaces incoming HVAC air register with HEPA filtered air system

• Produces a “Focused Clean Air Zone©” projection onto the worksite gently pushing contaminants down to the floor

• Produces regulated amount HEPA clean air entering the room assuring control of the number of air exchanges per hour

• Positively pressurizes a site by limiting the exhaust rate will keep out contaminants entering the room during access

All at a Very Reasonable Price


PCF322/422 – What Do They Provide?

Surgery Emergency Intensive Care

Surge Capacity

BurnUnits

PatientIsolation Pharmacy Immune

Suppressed

Clean Air Clean Air Clean Air Clean Air

Healthcare Applications Needing Clean Air

Secure Environments

Research Laboratories

Surge Isolation/

Quarantine

Capture Airborne

Pathogens

Pharmaceutical Admixing

SurgicalProcedures


Disaster Preparedness, Bio/Pharma, Research and Staff Safety

Surgery Rooms• Clean the airborne environment surrounding the wound site

• Push contaminated air away from and below the OR table

• Reduce room environmental contamination

• Pressurize the OR to keep contaminates out & fix exchange rate

Emergency Rooms• Precautionary isolation for undiagnosed Infection or disease

• Open wound and staff protection


Impacting Healthcare Critical Areas

• Intensive Care

Reduce infections and length of stay and provide greater patient and staff protection

• Surge Capacity

Add patient isolation (negative/positive) and portable surgical zones in-house or elsewhere in the community quickly and at low cost


Additional Healthcare Applications

• Open burn wounds from infections with minimal drying

• Patients suffering from respiratory distress

• Neonates once they’ve left the incubator

• ERs by isolating those suspected of being contagious

• Pharmacies during admixture of drugs & nutritional fluids

• Laboratory specimens and those who handle them

• Professional staff during performance of their duties

• Facility HVAC systems from airborne pathogens


MA2SI Technology Positively Defends …

• Simple and affordable implementation

• Easily transported to wherever needed

• Counteracts the high costs associated with infections

• Proven reliability you can count on

• Fewer infections and less patient trauma


Universal Benefits

• Simplify design & construction with effective clean air systems

• Upgrade facilities to create increased capability for patient care

• Install clean air environments anywhere they are needed

• Increase surge capacity quickly and at low cost

• Add safety and airborne infection control to new and existing facilities


Facility Construction Solutions

• Nationally recognized plasticand reconstructive surgeon

• Over 475 nearly infection free (<1%)surgeries using a combination of two ma2si clean air systems

• Captures cauterizing smoke particulates and odors with post-wound site system


The Real World of Dr. Partington

A low velocity ultra clean air zone that does not produce dry-eye conditions during surgery


Cataract Surgery


• Providing supply room with ultra-clean air reduces contaminant buildup on surgical supplies

• Greatly reduces the transfer of collected contaminates into surgical suite

Surgical Supplies Storage Room

Creates secure laboratory and pharmacy environments easily and at low cost (USP-797)


Pharmaceutical Research Lab

• Dramatically reduces patient and provider chemical sensitivity reactions

• Provides a clean environment for office surgeries

• Removes toxic and potentially infectious plumes during electrocautery or laser surgery


Physicians, Examination & Clinic Rooms

• World recognized authority in particulate identification

• Verifiable contamination free work environment

• MA2SI E100 has worked flawlessly for eight years


Premier US Particulate Analytical Lab

• Airborne related infection reduction in your facility?• Staff and patient protection from spread of infections?• Overflow during local and national emergencies?

• Protecting staff and facility’s air handling systems?• Quickly adding low cost isolation capacity during local

and national disasters• Moving operations offsite successfully when needed?


What Is Your Strategy For…

Clean Air Devices That Can “Break The Chain Of Infection”©


Mobile Air Applied Science, Inc.

Ma2si mobile air applied science inc “Break the Chain Of Infection” © CLEAN AIR.

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air currents

quality air filtration

air quality issues

lungs particles particles

room air exchange rates

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ultrafine particles