Where To Use

Table of Content

• Airborne Hospital Infections
• Construction and renovations in hospitals
• Isolation Rooms
• ICU - Oncology - Neonatology - Transplants
• Operating Department - day surgery
• Tuberculosis, SARS, Avian Flu and Air Purification
• MRSA Patients in hospitals
• Emergency Departments - General safety for healthcare workers.
• Intensive Care Burn Units
• Laboratories - Cytostatica - Pharmacy
• Pathology - Forensic Laboratories
• Tuberculosis in prisons
• MOD - Ministry of Defence: Army Hospitals

Airborne Hospital Infections

Information

Increasing air pollution combined with the rising number of patients with immune system deficiencies has become a serious problem within the Hospital Environment.

There is a huge price to pay for airborne infections, both in terms of human life and financial costs.

Consequently there is a general need to ensure that the air in the hospital environment - in all parts of the facility - is of the highest possible quality.

Medically controlled air is the only reliable solution and this should be based on the most important requirement - it has to be thorough - all pollution must be eliminated.

 

There is no point in cleaning just a little.

 

This drawing illustrates the importance of eliminating all contamination.

This shows the size of pollution, the way in which it is measured, and the method to eliminate pollution.

 

Air is a major 'transporter' of infections and airborne infections are neither limited to certain sources nor boundaries.

There are a huge number of potential sources of infection ranging from outside air to defective ventilating systems, construction material and people be they staff, visitors or patients.

 

Important fact

An important fact is that the majority of airborne infections develop inside the hospital.

 

Installation:

The unit is to be put on a shelf at minimum 2/3rd of the height of the wall. Electricity to be supplied (220V), the unit to be turned on and not to be touched again during 12 months after which the distributor will change the filter cartridge and perform the maintenance. All MedicCleanAir^® Mobile Hepa Units are equipped with an alarm that informs the client when the filter cartridge has to be changed.

MedicCleanAir^® Mobile Hepa Units are also installed outside the patient's rooms to clean sources of airborne infections in the surrounding area's like the entrance of the department and the corridor.

(See also FAQ - Installation of MedicCleanAir^® Mobile Hepa Units)

 

Construction and renovations in hospitals

Information

A practical guide - "how to handle building activities in hospitals"?

Official guidelines from CDC - MOH of various countries, and practical solutions to decrease the high risk of Aspergillus outbreaks.

By © MedicCleanAir^® International.

 

Demolition - Construction - Renovation - Repair

a. General Information

Environmental disturbances due to demolition, construction and/or renovation activities adjacent to or inside healthcare facilities markedly raise the counts of thermophilic fungal spores in such hospitals in the patients' environment. The increased Aspergillus.spp. concentrations cause an undisputed risk for patients in general (pneumonia) and are the major extrinsic risk factor for the occurrence of invasive Aspergillosis in immune-compromised patients.

These demolition, construction, renovation and repair activities adjacent or inside healthcare facilities require substantial planning and co-ordination to minimize the risk for airborne infections both during projects and after their completion.

Therefore education of maintenance and construction workers, health-care staff caring for high-risk patients and people responsible for controlling indoor air quality, improves the awareness that minimizing dust and moisture intrusion from construction sites decreases the level of airborne contamination, prevents infiltration of thermophilic fungal spores in the patients' environment, decreases the risk of infections through Asp.spp. and consequently improves patient care.

b. Preliminary Considerations

The three major topics to consider before initiating any construction or repair activity are:

• Design and function of the new structure or area (what exactly is to be done)
• Assessment of environmental risks for airborne infections and opportunities for prevention
• Measures to contain dust and moisture during construction - infection control actions to be taken

Note:

The objective of all measures is:
"To break the chain between the source of contamination and vulnerable recipients".
"Air" is the 'transport vehicle' for airborne infections and air, also indoor air, knows no limits or boundaries.

c. Infection-Control Risk Assessment (ICRA)

This is the basis of infection control during these building activities. Hospitals should make an ICRA (infection-control risk assessment) before initiating demolition, construction, renovation or repair activities to identify potential exposure of airborne contamination such as Asp.spp. to the patients' environment and determine the need for dust and moisture containment measures.

 

Knowledge of the air flow patterns and pressure differentials helps to minimize or eliminate the inadvertent dispersion of dust that could contaminate air space, patients, patient-care items, and surfaces. Therefore it is also recommended that during long-term projects, temporary essential services (e.g. toilet facilities) and conveniences (e.g. vending machines) for construction workers within the construction-site should be available to minimize traffic in and out of the construction area.

 

CDC - MOH specifically stress that neither the location (adjacent or inside the hospital) nor the size of the activity (large or small, long or short term) determines the risk for Asp. spp. outbreaks and that consequently an ICRA to determine preventive measures, is always of utmost importance.

 

Some examples.

Construction activity in an adjacent building to the hospital at risk - large project.

An Aspergillosis outbreak among oncology patients. This outbreak was attributed to depressurisation of the building with the HSCT unit while construction was underway in an adjacent building. Due to the depressurisation, unfiltered outdoor air flowed into the building, exposing patients in the HSCT unit to fungal spores. Source: CDC - USA

 

Small project - Repair activities inside the hospital

Source: The Scientific Institute for Hygiene and Epidemiology Brussels - Europe:
An invasive Aspergillus outbreak in a department Haematology resulted in 15 I.A. casualties. This outbreak was attributed to the change/replacement of fire-resistant isolation plates.

d. Air Sampling

Air sampling in health-care facilities may be conducted both during periods of construction and on a periodic basis to determine indoor air quality, efficacy of dust-control measures, or air-handling system performance via parametric monitoring.

Parametric monitoring consists of measuring the physical performance of the HVAC system in accordance with the system manufacturer's specifications.

Parametric monitoring only gives results regarding the efficiency of the HVAC systems themselves and does not determine the indoor air quality of the hospital room/ward itself.

 

Therefore, CDC recommends air sampling to be performed at different places within the area's at risk.
Following this, several health-care institutions have opted to use microbiologic sampling when construction projects are anticipated and/or executed to assess the safety of the patients' environment, especially for departments with immune-compromised patients.

 

Philpott-Howard J Prevention of fungal infections in haematology patients. Infect Control Hosp Epidemiol 1996;17:545-551 states:

Although "It is not known whether there is a 'safe' level of exposure"; to prevent exogenous Aspergillus infections in neutropenic patients, their environment should be as free as possible from Aspergillus spores, i.e. considerably below 1,0 cfu/m3.

 

Some other studies with recommendations on this subject are:

• Hay RJ, Clayton YM, Goodley JM.
  Fungal aerobiology : how, when and where?
  J Hosp Infect 1995;30(Suppl): 352-357
• CDC, Guidelines for prevention of nosocomial pneumonia. MMWR 1997; 46:1-79
  Research recommends limits of 15 CFU/m3 for gross colony counts of fungal organisms and < 0,1 CFU/m3 for Aspergillus fumigatus and other potentially opportunistic fungi in heavily filtered, high risk, areas.
• Arnow PM, Sadigh M, Costas C, Weil D, Chudy R
  Endemic and epidemic Aspergillosis associated with in-hospital replication of Aspergillus organism.
  J Infect Dis 1991;164:998-1002
• Mahieu LM, De Dooy JJ, Van Laer FA, Jansens H, Ieven MM.
  A prospective study on factors influencing Aspergillus spore load in the air during renovation works in a neonatal intensive care unit.
  Journal of Hospital Infection 2000;45:191-197

e. Internal Demolition and Construction

The focus of a properly implemented infection-control program during demolition, construction, renovation and repair inside the facility, is containment of dust and moisture.

 

1. Short term projects

a. limited projects (e.g., installation of new cables or wiring above ceiling tiles...)

CDC guidelines:

Required are portable plastic enclosures with negative pressure and HEPA filtration of the exhaust air from the enclosed work area. The placement of a portable industrial-grade HEPA filter device adjacent to the work area will help to remove fungal spores, but its efficacy is dependent on the supplied ACH and size of the area.

For limited projects in the general hospital environment, an alternative option is:

• Activity in a corridor; to install portable Hepa filter units

1. to limit airborne pollution to develop within/from the project
2. to prevent airborne pollution to spread within the department
3. to prevent airborne pollution to spread to adjacent departments

• Activity in a room; to install portable Hepa filter units

1. to limit airborne pollution to develop within/from the project
2. to prevent airborne pollution to spread to adjacent areas.

 

b. extensive projects

CDC guidelines:

Use short-term, dust-abatement, fire-resistant plastic curtains. These should be completely airtight and sealed from ceiling to floor with overlapping curtains. Possible holes, tears, or other perforations should be repaired promptly with tape. A portable, industrial-grade HEPA filter unit on continuous operation is needed within the contained area, with the filtered air exhausted to the outside of the work zone.

 

An alternative option is to install portable Hepa filter units within the sealed area as well as in the surrounding locations to protect the environment from exposure to airborne pollution.

2. Long term projects:

CDC guidelines:

Required are more elaborate barriers that are indicated for long-term projects that generate moderate to large amounts of dust.

 

a. Activities in adjacent construction sites.
As mentioned in the ICRA, air flow patterns and pressure differentials have to be established after which preventive measures can be taken such as seal windows, limit air-intake and use of Hepa filter units to clean the air with a focus on high-risk departments.

 

b. Activities inside the hospital.
CDC recommends creating negative pressure in the construction area through Hepa filtration with the remark to ensure that the Hepa filters will not be overloaded with (large) dust. The goal of the negative pressure at the construction site (positive pressure in the surrounding areas) is to create an airflow towards the construction area thus preventing airborne contamination to spread.

Portable Hepa filter units, equipped with an extra accessory with an extra pré-filtration, are able to create a negative pressure in a construction area. Individual conditions decide the number of units to be installed.

 

Remark:

During our visits to various hospital construction sites, we noticed happenings that influence the strict implementation of CDC guidelines, e.g.:

• A construction site is often large and very difficult to keep well sealed as any leaks will influence the negative pressure that is required to keep airborne pollution inside the construction area.
• In a construction site with outside windows, these will either be open (working conditions for construction workers) or used to transport rubble from the site,
• In an enclosed construction site, there will be frequent transport of material, rubble etc. from and into the site.

From everyday experiences it can be noted that to maintain a permanent negative pressure in a construction site is rather difficult unless rigid control on behaviour and discipline is implemented.

 

"Based on the facts from Infection-Control Risk Assessment it should be considered if and how alternative options as protective measure are required to meet the objective which is limit airborne contamination to spread from the construction site to other areas."

 

Extra protective measures

1. Install portable Hepa filter units in the construction site to decrease the level of airborne contamination as much as possible, where area's as entrances to other hospital areas require special attention.
   Note: extra pré-filtration for large dust should be considered. These units will continuously affect (clean) airborne contamination that develops inside the construction site.
2. Install portable Hepa filter units outside the construction site, close to the exit(s) of the construction site. These units will decrease the level of airborne contamination escaping the construction site.
3. Install portable Hepa filter units at the connections to other areas. (to be placed at the entrance / corridor of the connecting hospital departments.) These units will clean the indoor air and create a final blockade to prevent airborne infections to spread to other areas.

f. Summary of Recommendations

CDC guidelines:

• Establish a multidisciplinary team - Infection Control Committee
• Educate both the construction workers and the hospital staff - importance of infection control.
• Establish and maintain surveillance for airborne environmental diseases (Aspergillosis) - continuous periodically air sampling method.
• Implement infection-control measures :

• Perform an ICRA before the projects
• Implement infection-control measures for internal and external construction activities.
• Perform those engineering and work-site related infection-control measures as needed for internal construction, repairs, and renovations.
• Make barriers
• Create and maintain negative air pressure in work zones adjacent to patient-care areas by using portable HEPA filters
• Monitor negative air flow inside barriers
• Monitor barriers and repair them as soon as possible
• Seal windows in work zones if practical, if not ensure anyway that negative pressure is maintained
• Create an anteroom where construction crew can change clothing and storing equipment

• Consider portable Hepa filter units in connecting departments.

The main objective of the guidelines is to limit fungal exposure to vulnerable patients. The point of view is "to break the chain between the source of contamination and for infections vulnerable patients". This leads to block contamination to spread by cleaning the fungal 'transport-vehicle' which is the hospital indoor air. The use of portable, industrial-grade, Hepa filters in the construction area as well as at surrounding spots can facilitate to reach the target to limit the spread of thermophilic fungal spores in hospital facilities and consequently decrease the risk of infections.

 

		Absolute conditions for portable Hepa filter units are:
		Published medical and clinical proof for results also under extreme conditions
		Technique	Safety Class I Easy to install Easy to maintain Different volumes
		note - capable to create negative / positive pressure when required
		Filter-cartridge	Leak tested Préfilter F9 Activated Carbon Hepa H 14
		note - extra préfiltration when installed in the construction zone
		Airflow	Air extraction over 360° Air inlet over 360°
		Casing	Stainless steel Mobile
		note - when required - accessory to create negative / positive pressure
		Production	ISO 9001 ISO 14001

 

© September 2004 MedicCleanAir^® International.

 

Isolation Rooms: The MedicCleanAir® - ISO Concept

Through our international contacts, we noted an increasing need for isolation rooms in hospitals.

The MedicCleanAir^® - ISO Concept creates isolation rooms with pressure difference (positive or negative) in less than ½day and for less than 9.000.

 

What kind of isolation rooms:

1. Isolation rooms to protect immune compromised patients from infections (E.g. neonatology, BMT, Burn Units, oncology, etc.- CDC : P E Protective Environment
2. 2. Isolation rooms to protect the environment from infectious patients (E.g. Tuberculosis, SARS, Avian Flu, Pox, ..) CDC : A I I Airborne Infection Isolation

Information

1. Protect the patient - PE - positive pressure rooms

Some patients are extremely vulnerable to infections for ex. Invasive Aspergillosis. The incidence of I.A. in various patient populations is considerable as proven by several medical studies.

Lung transplant, Allogenic Bone Marrow transplant, Acute Leukaemia etc. are major risk populations.

This risk of infections can be severely reduced when a patient has an environment with clean air and a protection, through positive pressure, against contamination entering from adjacent, connecting areas.

 

2. Protect the environment - AII - negative pressure rooms

There are an increasing number of patients that are a threat to their environment because of the infection they carry. Patients infected with for instance SARS or -Multi Resistant- Tuberculosis have to be accommodated in isolation with all necessary precautions.

 

A considerable number of hospitals have either not sufficient allocations and/or these allocations do not offer the necessary conditions.
Plans to improve the present situation to become in line with todays and future requirements are often blocked by either the required budget and/or the implications of major reconstructions like closing down complete departments.

 

The MedicCleanAir^® - ISO Concept offers an alternative that allows every hospital to fulfil its needs for professional isolation rooms. Negative or positive pressure can be created in each and every room within ½ day work.

 

Please contact MedicCleanAir^® for a tailor made proposal.

 

ICU - Oncology - Neonatology - Transplants

Information

 

MedicCleanAir^® protects those most at risk.

 

All professionals in Hygiene do their utmost to decrease the number of infections.

Measures are taken, guidelines issued for hygiene control and surveillance.
International studies and publications proof the need to give a high priority to prevention of infections.

These infections cause tremendous social and human losses and at the same time these infections are a large drain on all healthcare resources.

 

Not only financially, one (1) Invasive Aspergillus Infection costs about 30.000 , but also mentally.

A department that has done every possible effort for the welfare of a patient, results in the situation of the death of the patient due to E.g. an I.A. infection.

 

Traditional methods for avoiding the spread of airborne infections in hospitals are of limited utility and/or difficult to enforce.

The major reason for this is that the majority of airborne infections develop inside the hospital and there are no boundaries that stop their spread.

 

Particularly susceptible to airborne infections are patients that are immune-compromised such as in I.C.U., Neonatology, Transplant-depts., Burn Units, Haematology/Oncology etc...

 

A recent development is the increased risk for hospital staff because of the development of (MR) Tuberculosis.

 

MedicCleanAir^® has developed the first mobile air cleaner that reduces the risk of airborne infections in hospitals and medical centres. The revolutionary MedicCleanAir^® Pro Mobile Hepa Unit has been proven to reduce the airborne infections:

• under normal, day by day, working conditions
  Ref - "European Congress of Bone Marrow Transplant"
• under severe, high risk, conditions such as during renovations
  Ref - "Hospital Infection Society"

Especially when high-risk activities like renovations are planned, known and used preventive measures are either unpractical, like sealing doors, or economically unfeasible, like closing down departments.

With MedicCleanAir^® Pro, a barrier is made to prevent airborne contamination (like I.A.) to spread to other area's.

 

Optional:

The MedicCleanAir^® - ISO Concept that makes it possible to immediately create an isolation room with "positive pressure".

 

Operating Department - day surgery

Immediately a Perfect Air Quality in the O.T. for a minimal budget and no (construction) efforts.

This MedicCleanAir^® concept has already been installed in various German Hospitals and Surgery Centres.

Regular Operating Theatre

MedicCleanAir^® protects those most at risk and particularly susceptible to airborne infections are patients that undergo surgery.
In regular O.T.'s, the laminar flow installation supplies clean air over the operating table, however this clean air does not reach and influences the surrounding area's like the jumper area with operating material and staff.

 

With the MedicCleanAir^® concept you are able to create a perfect air quality (no CFU's) in the whole of the O.T. not only over the operating table but also in the jumper area (high risk) and the adjacent area's such as preparation and recovery.

 

This concept has proven results - see Medical-Scientific study HS Horsens.

Operating Theatre in Day-Surgery

Through changes in healthcare systems, budget cuts and newly developed techniques there is an increase in so called 'day-surgery'.
Standard O.T.'s often have a limited capacity and/or are too costly to use for day-surgery.
Therefore there is a focus on other locations.
These locations often do not meet hygiene demands on the air-quality that is required to protect the patients against airborne infections.

With the MedicCleanAir^® concept you are able to create a perfect air quality (no CFU's) in the whole of the O.T. not only over the operating table but also in the jumper area (high risk) and the adjacent area's such as preparation and recovery.

The concept is based on air-cleaning at the source.
In general:

• 2 MCA Units are installed in the O.T. of which
  
  • 1 unit cleans the indoor air
  • 1 unit cleans the indoor air and the incoming fresh air.
• 1 MCA Unit is installed in the scrub-room
• 1 MCA Unit is installed in preparation
• 1 MCA Unit is installed in recovery

and depending on the circumstances, MCA Units clean the air in the corridor and build a barrier against polluted air enterring from the general hospital area.

 

Please contact MedicCleanAir for a tailor-made proposal for your hospital.

 

An example from Germany

 

MedicCleanAir^® has developed the first mobile air cleaner that has proven to reduce the risk of airborne infections in Operating Theatres.

 

Tuberculosis, SARS, Avian Flu and Air Purification

Information

Air is the means of transport to pass (airborne) infections like e.g. tuberculosis. It would be a logical step to consider 'treatment of the air' as very important in all preventive measures being taken to diminish the risk of 'airborne' infections.

You have certainly remarked that the words "would be" are written and not the word "is".

From experiences of the last 10 years, we noted that there are a couple of reasons for this and these are the most important ones:

1. the unawareness of the topic air purification
2. the combination of 'infections' and 'air' is the combination of 2 different worlds; the world of the technique/engineering and the medical world.

Publications of studies that combine both worlds of engineers and medical people are very valuable because these define the problem of transmission of infections.

These publications give sustained scientific and medical reasons to look at other than the normal preventive measures taken in hospitals; to be open and look further for techniques and ways to reduce airborne and other infections.

 

Two examples:

1. MRSA - Journal of Hospital Infection (2002) 50; 30-35
   "Evaluation of bed-making related airborne and surface MRSA contamination"
   In this study, it was confirmed that MRSA-concentrations are permanently present in the ambient air, where high concentrations are noted during bed making. This leads to the conclusion that MRSA is also spread by air having severe consequences for all other preventive measures being taken.
2. "Hospital Ventilation and Risk for Tuberculosis Infection in Canadian Health Care Workers"
   Reference (8) in the Magazine VRGT, jaargang 14, nr. 3 of December 2004;9-14 Dr. A. Aerts.
   The risk that hospital staff gets infected with Tuberculosis is higher in the general departments (non-isolation) than in special equipped departments (isolation rooms).
   Examples of these general departments at high risk are i.e. emergency departments, intensive care and autopsy/forensic labs.
   Other non-medical examples are personnel in prisons, asile centres and police buildings.

What is in the air ? What is pollution ?

There are only 2 sorts of pollution in the air:

1. gases, chemical compounds
2. particles

Examples of type a: in the medical world are glutaraldehyde and gases that origin from cytostatic products at room temperature.

Examples of type b. in the medical world are all particles (solid and fluid), including fungi, bacteria and viruses. The difference between all particles is their size which in turn is important in relation to the efficiency of the air purification as a preventive measure.

Airborne particles have neither limits nor barriers and when not stopped, they will spread over large distances; from room to room, from department to department. How far and whom it will reach depends on the size of the particle. On the whole, one can say that particle smaller than 4 microns (0.004 millimetres) enter the human body and that Tubercel-bacil is smaller than 4 micron.

Air scheme

From this air scheme, one can conclude that air purification can only be efficient when there is a successful adsorption of all contaminants. To achieve this, there are some essential conditions which have to be fulfilled.

Essential conditions for effective air purification in relation to health

The most important condition for a purification concept implemented in the medical sector is that the concept is proven through medical-clinical tests and that these tests were published by recognized medical organisations (1.2)

Filter cartridge:

The only and correct composition - construction of the filter cartridge:

1. A pré-filter, that complies with the quality of filters type F8 or F9. Pré-filtration sees to it that larger particle > 1 micron are captured and at the same time it protects the second type of filter: activated carbon
2. Activated carbon, to adsorb gases and chemical compounds. It is the quality of the activated carbon that defines the capacity of adsorption. There have to be sufficient micro-, meso- and macro pores in order to have efficient gas adsorption.
3. The Hepa-filter, to adsorb particles < 1 micron. Important to know is that about 99% of all particles is smaller than 1 micron. For general air purification a quality filter Hepa 13 will be sufficient, but for medical applications Hepa 14 is a must, together with an individual leak test - excluding any technical manufacturing errors.

An optimal combination of these 3 types of filters is a must to achieve successful results in air purification, and this is only possible when they are combined in one filter cartridge (3).

The air-flow:

Air-flow is the subject with the most confusion and this applies to fixed installations as well as to mobile air purification units.

Fixed installation see to it that the ambient air is suppressed by filtered air. Mostly one forgets that this is only possible when there is a perfect current of the air available, where contaminated ambient air is being pushed out by purified air. Not taking other technical factors into account, the most elementary condition is that air-inlet is positioned opposite air-outlet in the patient's room. (and not next or very close to one another)

Mobile air purifiers have to create an airflow where the contaminated air is being sucked into the device, and where the purified air is blown back into the room in such a way that both mix as quickly as possible.

The greatest risk of inhaling contaminated air is at the height of 1 meter (bed height).

A mobile air purification system must be able to create a horizontal intake over 360° and at the same time create a vertical outlet of purified air over 360°. When a purification system does not have a 360° in and outlet (e.g. when a device takes in the air as from the floor/ground), results will be insignificant and the system will be useless for medical applications. (4).

Other aspects of efficient air cleaning

The casing:

A smooth and shiny casing reduces the risk of fungi being able to stick, as well as contamination is immediately visible.

The technique:

Airborne infections develop all the time - 24/24 hours and 365 days per year. An efficient air purification device must be able to function 24/24 hours, 365 days per year and deliver successful results at all times.

The electronics:

Devices for the medical sector have to comply with the highest security rules. The requirements for and installation itself. Installation has to be easy - no complicated renovation works - closing down departments to install the devices - etc. The installation, connection to electricity and results must be easy and immediate.

The maintenance:

Maintenance is important as additional work and costs are involved. An efficient air purification unit does not require additional and frequent intervention. The filter cartridge must be efficient for a longer period of time during which it is unnecessary to replace or clean parts of the filter cartridge. Swiss norms clearly state that each filter cartridge has to be changed every 12 months.

 

An efficient air purification unit functions 24/24 hours per day and eliminates all airborne contamination during 12 months after which the filter cartridge is changed.

Financial aspects of air purification:

Air purification as well must be topic of financial analysis. We are all aware of the fact that safety for staff has a social impact as well. The question: what is socially acceptable is not a topic of this article. Certain is that the reduction of aerogene infections has an impact on the 'human' as well as 'financial' aspect and results in considerable advantages.

Remark: A lot of medical publications relate the medical cost of infections to the direct implication of a certain infection, e.g. prolonged stay, drugs, etc. In reality, the cost of infections is much higher (macro-economical)

 

It speaks for itself that not all risks can be excluded, but fact is that we can reduce the risks by implementing preventive measures. To take preventive measures to protect staff and reduce the incidence of tuberculosis, is a decision which is taken by the organisation itself by taking into account the following items:

• There are certain categories in staff that may be subject to higher risk to tuberculosis
• Tuberculosis is spread by air
• Air purification - that has proven itself through medical studies - reduces the risk of spreading of tuberculosis.

We have come to the point that we have to look further than what we are doing presently. This applies to the complete medical organisation and thus also to the department of hygiene and prevention. New scientific and medical proven ways of prevention have to be looked at with an open mind. Air purification is a hot topic, especially with the (Avian) influenza-pandemic which is expected and will come, if not soon than later.

 

Air purification means that the link between the source and the vulnerable recipient is broken. The chain between the person who is infected with tuberculosis and the persons in other rooms/departments is broken.

Basic air quality without infections is known to be of prior importance for medical facilities.

 

References:

1. L. Mahieu et all. Journal of Hospital Infection (2000) 45; 191-197
2. N. Mordini et all. EBMT 29, (2) 2002 - p.5245 P852
3. VITO 2000/MIM/R/7
4. S. Engelhart et all. Journal of Hospital Infection (2003) 54; 300-309
5. GDEPIH-GOSPIZ. MRSA 2003 vs 030723
6. D. Mattei et all. EBMT 29, (2) 2002 - p. 5245 P853
7. MedicCleanAir^®
8. A.Aerts VRGT-Berichten 14, 3, december 2004; 9-14

MRSA Patients in Hospitals

Airborne and surface MRSA contamination.

The question of how infections are transmitted has been and often is a major subject of discussions.

The focus is on the transmission through 'contact' as 'contact' is the most obvious way for transmission and consequently the measures are aimed to prevent transmission through 'contact'.

Frequently this results in negligence of the 'airborne' transmission, sometimes even in a denial that there is a link between 'contact' and 'airborne' transmission. Through the increasing occurrence of MRSA, it has been noted that this attitude is (slightly) changing.

The reason is that, despite severe hygiene and control measures to prevent transmission through contact, MRSA is an increasing problem for hospitals so another option - airborne transmission - has to be considered.

It is likely that also the fact that MRSA has become a subject in the media has contributed to a changing attitude towards 'airborne transmission'.

 

Since 2002, when the clinical facts on MedicCleanAir^® Mobile Hepa Units were published on Aspergillus concentrations "in the air" - "on surfaces" - "on the floor", following questions are valid:

1. what is the reason that material, furniture, medical equipment etc. is contaminated with CFU's when people have not touched it?
2. what is the reason that material, furniture, medical equipment etc. is not contaminated with CFU's when MedicCleanAir has been implemented? [1]

 

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other common antibiotics such as oxallin, penicillin and amoxillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centres) who have weakened immune systems. [2]

The principle mode of transmission of MRSA is mainly from patient to patient via the transiently colonized hands of healthcare staff.

Healthcare staff acquires the organism:

• from patient contact or
• by handling contaminated surfaces / materials. [3][4]

Since MRSA has been recovered from many sites, including floors, linen, medical equipment and hospital furniture, consequently transmission via inanimate environments may also be important.

Airborne transmission is generally considered to occur at lower frequency than transmission through direct contact, but MRSA in the form of a bio aerosol can contaminate air and cause airborne infection. [5]

Cost of an MRSA infection is estimated between 10.000 and 36.000 Euros. [6]

 

Journal of Hospital Infection (2002) 50; 30-35

Evaluation of bed-making related airborne and surface methicillin-resistant Staphylococcus Aureus contamination.

Facts from this publication:

• This study was from August 2000 to July 2001.
• The MRSA patients were in closed, single-patient rooms connected to a central air-conditioning system.
• There were no other activities by personnel and no visitors for an hour before and during bed making.
• Air sampling was done before, during, 15, 30 and 60 min after bed making.
• MRSA containing particles were measured in 6 stages linked to particle sizes

stage1	>7 µm		stage2	4.7 - 7.0 µm		stage3	3.3 - 4.7 µm
stage4	2.1 - 3.3 µm		stage5	1.1 - 2.1 µm		stage6	0.65 - 1.1 µm

 

MedicCleanAir^® -remark

• All sizes meet "airborne infection" qualifications and are transmittable by air to other locations. The transmission can be to the direct environment for instance the adjacent department but also to other area's of the hospital through the ventilation system.
• Sizes from stage 3 - 4 - 5 - 6 / from 0.65 to 4.7 µm are respirable, able to reach the lung.
• MCA Pro efficiency on MRSA-containing particles is 100%. [7]

MRSA-containing particles were liberated into the air during bed making.

a.- no activity (before bed making)		6
b.- 30 and 60 minutes after bed making		6
c.- 15 minutes after bed making		30
d.- during bed making		116

 

MedicCleanAir^® -remark

• Even without any activity, 6 CFU/m³ (MRSA-containing particles) are airborne.

The study - Discussion

"These findings suggest that increase of airborne MRSA during bed making can contaminate the hospital environment and may play a role in MRSA colonization in the nasal cavity, or sequentially, in respiratory MRSA infections. Thus, it is crucial to design an efficient control system to limit the accumulation of MRSA in environments where air is recirculated. Laminar unidirectional airflow, air ventilation and air filtration could also be beneficial in hospital environments, and should be considered for isolation rooms."

"Although measures for prevention and control of hospital-acquired infection with MRSA include hand disinfection, wearing a gown, gloves, a mask, and removing MRSA from the nasal vestibule, few measures are aimed at control of airborne bacteria".

 

MedicCleanAir^®

From various publications, including Journal of Hospital Infection (2002) 50; 30-35 and its references, it is obvious that MRSA infections require 3 measures to prevent transmission:

1. existing hygiene-measures to prevent transmission through contact should be severely controlled
2. MRSA infected patients should be in kept in isolation and
3. the isolation room itself should be equipped with an efficient Hepa air-cleaning system to control MRSA-containing particles: CFU numbers Journal of Hospital Infection (2002) 50; 30-35.

Remark:

MedicCleanAir^® offers a workable, economical concept to create A.I.I. (Airborne Infection Isolation) rooms that is very quickly implemented - see MedicCleanAir^® - ISO Concept for Tuberculosis and Sars.

Infectious diseases such as Tuberculosis are treated in a specific specialised "Infection" department that is to be equipped with permanent A.I.I. rooms.

MRSA is present in different patient populations, thus in various departments and this makes the discussion on permanent A.I.I. rooms very difficult.

 

MRSA Facts

• MRSA infected patients are to be separated from the environment and kept in isolation.
• MRSA-containing particles (CFU) are always present, also when there is no activity. [5]
• The number of CFU per M³ increase (explode) during activities. [5]

MedicCleanAir^® recommendation

Installation of 1 MedicCleanAir^® Pro in the room where an MRSA-patient is treated.

This will prevent transmission of airborne MRSA contamination.

 

MCA Guidelines

MedicCleanAir^® Pro will realise an optimum air quality when following guidelines are met.

1. A MedicCleanAir^® Pro Mobile Hepa Unit to be installed near the patients' bed on the other bed-side as the door.
2. The Unit to function at level 1 or 2 during the non-activity period (6 CFU/m³)
3. The Unit to function at level 4 during the bed making procedure and 15 minutes afterwards. (the 30 and 116 CFU/m³)
4. Door to stay closed during bed making and "some" minutes afterwards. "Some" depends on the size of the room (see following note 2).

 

Note 1

MedicCleanAir^® has a 100 % efficiency on all sizes of MRSA-containing particles from 0.65 - 7 µm [7]

 

Note 2

The efficiency of the MedicCleanAir^® filter cartridge and the airflow that is made by the device itself will create and maintain air integrity in the isolation room. Tests by the University Hospital St. Pierre in Brussels - Belgium - established that MedicCleanAir^® required 7 minutes to achieve a 'clean room air-quality' in their isolation-rooms 28 M³

 

Note 3

MedicCleanAir^® will not only eliminate the airborne MRSA, but the consequence is that also the risk of contaminated surfaces like medical instruments, furniture etc. will decrease.

What is not in the air cannot sink.

This was proven during a longitudinal study on Invasive Aspergillosis, published by the E.B.M.T. [6]

The size of Invasive Aspergillosis equals the sizes of airborne MRSA.

 

References

1. Bone Marrow Transplant 29, (2) 2002 - p. 5245 Nº 852
2. Centre of Disease Control (CDC)
3. Infect Control Hosp Epidemiol 1989; 10: 106-110
4. Infect Control Hosp Epidemiol 1997; 18: 622-627
5. Journal of Hospital Infection (2002) 50; 30-35
6. Am. J Infect COntrol 2002; 30()3): 145 - 152
7. VITO 2000/MIM/R/006

Emergency Departments - General safety for healthcare workers.

The risk that hospital staff gets infected with i.e. Tuberculosis is higher in the general departments (non-isolation) than in special equipped departments (isolation rooms).

Examples of these general departments at high risk are i.e. emergency departments.

Information

Air is the means of transport to pass (airborne) infections like e.g. tuberculosis. It would be a logical step to consider 'treatment of the air' as very important in all preventive measures being taken to diminish the risk of 'airborne' infections.

You have certainly remarked that the words "would be" are written and not the word "is".

From experiences of the last 10 years, we noted that there are a couple of reasons for this and these are the most important ones:

1. the unawareness of the topic air purification
2. the combination of 'infections' and 'air' is the combination of 2 different worlds; the world of the technique/engineering and the medical world.

Publications of studies that combine both worlds of engineers and medical people are very valuable because these define the problem of transmission of infections.

These publications give sustained scientific and medical reasons to look at other than the normal preventive measures taken in hospitals; to be open and look further for techniques and ways to reduce airborne and other infections.

 

Two examples:

1. MRSA - Journal of Hospital Infection (2002) 50; 30-35
   "Evaluation of bed-making related airborne and surface MRSA contamination"
   In this study, it was confirmed that MRSA-concentrations are permanently present in the ambient air, where high concentrations are noted during bed making. This leads to the conclusion that MRSA is also spread by air having severe consequences for all other preventive measures being taken.
2. "Hospital Ventilation and Risk for Tuberculosis Infection in Canadian Health Care Workers"
   Reference (8) in the Magazine VRGT, jaargang 14, nr. 3 of December 2004;9-14 Dr. A. Aerts.
   The risk that hospital staff gets infected with Tuberculosis is higher in the general departments (non-isolation) than in special equipped departments (isolation rooms).
   Examples of these general departments at high risk are i.e. emergency departments, intensive care and autopsy/forensic labs.
   Other non-medical examples are personnel in prisons, asile centres and police buildings.

What is in the air ? What is pollution ?

There are only 2 sorts of pollution in the air:

1. gases, chemical compounds
2. particles

Examples of type a: in the medical world are glutaraldehyde and gases that origin from cytostatic products at room temperature.

Examples of type b. in the medical world are all particles (solid and fluid), including fungi, bacteria and viruses. The difference between all particles is their size which in turn is important in relation to the efficiency of the air purification as a preventive measure.

Airborne particles have neither limits nor barriers and when not stopped, they will spread over large distances; from room to room, from department to department. How far and whom it will reach depends on the size of the particle. On the whole, one can say that particle smaller than 4 microns (0.004 millimetres) enter the human body and that Tubercel-bacil is smaller than 4 micron.

Air scheme

From this air scheme, one can conclude that air purification can only be efficient when there is a successful adsorption of all contaminants. To achieve this, there are some essential conditions which have to be fulfilled.

Essential conditions for effective air purification in relation to health

The most important condition for a purification concept implemented in the medical sector is that the concept is proven through medical-clinical tests and that these tests were published by recognized medical organisations (1.2)

Filter cartridge:

The only and correct composition - construction of the filter cartridge:

1. A pré-filter, that complies with the quality of filters type F8 or F9. Pré-filtration sees to it that larger particle > 1 micron are captured and at the same time it protects the second type of filter: activated carbon
2. Activated carbon, to adsorb gases and chemical compounds. It is the quality of the activated carbon that defines the capacity of adsorption. There have to be sufficient micro-, meso- and macro pores in order to have efficient gas adsorption.
3. The Hepa-filter, to adsorb particles < 1 micron. Important to know is that about 99% of all particles is smaller than 1 micron. For general air purification a quality filter Hepa 13 will be sufficient, but for medical applications Hepa 14 is a must, together with an individual leak test - excluding any technical manufacturing errors.

An optimal combination of these 3 types of filters is a must to achieve successful results in air purification, and this is only possible when they are combined in one filter cartridge (3).

The air-flow:

Air-flow is the subject with the most confusion and this applies to fixed installations as well as to mobile air purification units.

Fixed installation see to it that the ambient air is suppressed by filtered air. Mostly one forgets that this is only possible when there is a perfect current of the air available, where contaminated ambient air is being pushed out by purified air. Not taking other technical factors into account, the most elementary condition is that air-inlet is positioned opposite air-outlet in the patient's room. (and not next or very close to one another)

Mobile air purifiers have to create an airflow where the contaminated air is being sucked into the device, and where the purified air is blown back into the room in such a way that both mix as quickly as possible.

The greatest risk of inhaling contaminated air is at the height of 1 meter (bed height).

A mobile air purification system must be able to create a horizontal intake over 360° and at the same time create a vertical outlet of purified air over 360°. When a purification system does not have a 360° in and outlet (e.g. when a device takes in the air as from the floor/ground), results will be insignificant and the system will be useless for medical applications. (4).

Other aspects of efficient air cleaning

The casing:

A smooth and shiny casing reduces the risk of fungi being able to stick, as well as contamination is immediately visible.

The technique:

Airborne infections develop all the time - 24/24 hours and 365 days per year. An efficient air purification device must be able to function 24/24 hours, 365 days per year and deliver successful results at all times.

The electronics:

Devices for the medical sector have to comply with the highest security rules. The requirements for and installation itself. Installation has to be easy - no complicated renovation works - closing down departments to install the devices - etc. The installation, connection to electricity and results must be easy and immediate.

The maintenance:

Maintenance is important as additional work and costs are involved. An efficient air purification unit does not require additional and frequent intervention. The filter cartridge must be efficient for a longer period of time during which it is unnecessary to replace or clean parts of the filter cartridge. Swiss norms clearly state that each filter cartridge has to be changed every 12 months.

 

An efficient air purification unit functions 24/24 hours per day and eliminates all airborne contamination during 12 months after which the filter cartridge is changed.

Financial aspects of air purification:

Air purification as well must be topic of financial analysis. We are all aware of the fact that safety for staff has a social impact as well. The question: what is socially acceptable is not a topic of this article. Certain is that the reduction of aerogene infections has an impact on the 'human' as well as 'financial' aspect and results in considerable advantages.

Remark: A lot of medical publications relate the medical cost of infections to the direct implication of a certain infection, e.g. prolonged stay, drugs, etc. In reality, the cost of infections is much higher (macro-economical)

 

It speaks for itself that not all risks can be excluded, but fact is that we can reduce the risks by implementing preventive measures. To take preventive measures to protect staff and reduce the incidence of tuberculosis, is a decision which is taken by the organisation itself by taking into account the following items:

• There are certain categories in staff that may be subject to higher risk to tuberculosis
• Tuberculosis is spread by air
• Air purification - that has proven itself through medical studies - reduces the risk of spreading of tuberculosis.

We have come to the point that we have to look further than what we are doing presently. This applies to the complete medical organisation and thus also to the department of hygiene and prevention. New scientific and medical proven ways of prevention have to be looked at with an open mind. Air purification is a hot topic, especially with the (Avian) influenza-pandemic which is expected and will come, if not soon than later.

 

Air purification means that the link between the source and the vulnerable recipient is broken. The chain between the person who is infected with tuberculosis and the persons in other rooms/departments is broken.

Basic air quality without infections is known to be of prior importance for medical facilities.

 

References:

1. L. Mahieu et all. Journal of Hospital Infection (2000) 45; 191-197
2. N. Mordini et all. EBMT 29, (2) 2002 - p.5245 P852
3. VITO 2000/MIM/R/7
4. S. Engelhart et all. Journal of Hospital Infection (2003) 54; 300-309
5. GDEPIH-GOSPIZ. MRSA 2003 vs 030723
6. D. Mattei et all. EBMT 29, (2) 2002 - p. 5245 P853
7. MedicCleanAir^®
8. A.Aerts VRGT-Berichten 14, 3, december 2004; 9-14

Intensive Care Burn Units

Information

Air quality in I.C. Burn Units is of the utmost importance since those patients are one of the most immune-compromised of all.

It is therefore necessary to create a 'clean room' environment in all stations where those patients are being treated: not only in the operating rooms, but also in revalidation, bath stations, etc.

The creation of positive pressure in the patient's room is to be considered as well.

Since hospital staff in I.C. Burn Units are continuously confronted with certain dangerous drugs regularly used for those patients, the protection of hospital staff is not something to be taken lightly.

Note:

The MedicCleanAir^® Heavy Duty Filter Cartridge is developed as a preventive measure for hospital staff.

1. Cytostatic drugs (fixed or fluid) vaporize and Safety Cabinets are not equipped with filtration for gases and chemical compounds. Hospital staff during preparation and distribution is being affected by vaporized cytostatics.
2. I.C.B.U. patients are, during bath therapy, treated with sprayed anesthetics. These anesthetics are also inhaled by hospital staff with all consequences. The MedicCleanAir^® Heavy Duty Filter Cartridge is the answer to air quality problems in IC Burn Units.

Example of an I.C. Burn Unit and MedicCleanAir^® Heavy Duty Mobile Hepa Units:

Laboratories - Cytostatica - Pharmacy

Information

Especially drugs require intensive manipulation by the employees of health care centres during admixture, administration, transport, handling and working with patient's exhalation etc...

Formation, spread and inhalation of particles is a well known problem and preparation systems have been equipped with high-efficiency particle filters therefore.

However, laboratory experiments as well as investigations under real working conditions have proven that evaporation of pharmaceuticals takes place and certain amounts of carcinogenic drugs can be detected in the outgoing air behind the filter which in most cases is vented back into the working room.

Esp. the possibility of evaporation of hazardous drugs during normal handling, their subsequent spreading as gas phase has been discovered very recently.

The filter material at present used in devices for preparation of hazardous pharmaceuticals is designed to hold back particles and fails to keep gaseous compounds which in most cases are vented back into the working room together with the recirculated air.

Uptake of airborne (aerosol-bound and gaseous) chemotherapeutic agents by inhalation may explain findings of unexpected high contamination on surfaces and in body fluids of exposed persons.

This special route of exposure and uptake needs appropriate control and protective measures; by implementing additional filter systems to decrease all airborne pollutants whether being particles or gaseous.

Optimum adsorption of gaseous chemotherapeutic agents can only take place through activated carbon protected and guarded by optimum (particle) filter-media.

Possible production failures should, at all times, be excluded by individual leak-tests on each and every filter-medium.

Sources of contamination

Several sources have been expressed regarding the contamination:

• Vapours are formed because pressure differential in the transfer of the antineoplastic liquids via syringe. The vapours cannot be captured by HEPA filters.
• The transfer of materials into and out of the open face of biological safety cabinets combined with operator movement into and out of the cabinet disturbs air flows thereby 'dragging' contamination out of the cabinet.
• In the preparation of cytostatic agents made from powders and solutions, portions are released in gaseous form at regular room temperature. Gaseous contaminants are not captured by HEPA filters.

Exposure to cytostatic agents:

• During 'Preparation'.
  Even when 100 % of the air is extracted from the 'safety cabinet' (to outside air) the risk exists as the prepared drugs are stored in the area before giving to distribution.With all other installations, the risk of contamination is even higher.
• During 'Distribution'.
  In this area all prepared drugs are assigned to departments and patients.
• During 'Transport'.
  From 'Administration' to departments and patients.
• During 'Handling and Administration' to patients.
  Within the patient's room and surrounding area's.

Whatever precautions are taken, they do not prevent from contamination through vaporised drugs.

These gaseous contaminants can only be efficiently adsorbed by the filter-cartridge in the MedicCleanAir^® Heavy Duty Filter Cartridge

Pathology - Forensic Laboratories

Information

Laboratories are especially vulnerable in regard to pollution due to the state of work which is being carried out. Forensic Labs are no exception to this. On the contrary, the people that work in Forensic Labs are mostly more confronted with potential infections than any other doctor, also due to the exceptional exposure to chemicals.

Many international medical studies[*] stress the importance of taking preventive measures to be implemented to protect doctors, clinical staff, technicians, students and visitors. As infections due to contact are very well known and can be easily prescribed, the exposure to airborne pathogens was - up to now - not so easy avoided.

As you are informed, not only exposure to aerosolized pathogens such as human immunodeficiency virus, hepatitis B and C viruses (or non-A, non-B), meningitis, various fevers and pulmonary mycobacterium tuberculosis is a risk, the toxic chemicals (e.g. chloroform, ether, formaldehyde, formalin, cyanide and organophosphates as even radiation) are a substantial risk factor of infections as well and often lead to cancer. Most of these pathogens retain their infectivity after death and continue to be a risk to healthcare workers during and even after bodies are removed from the lab due to the aerosol formation.

Infectious aerosols can be divided into two groups:

• particle based (including droplets)
• toxic agents (chemical compounds)

In order to eliminate or reduce the incidence of airborne infections, one must apply a device which is capable of eliminating both particles as chemical based compounds from the air.

The MedicCleanAir^® Heavy Duty Unit was designed to be able to eliminate both. The unit is mostly used in pharmacies, hospital laboratories and research labs.

The "HEAVY DUTY" filtercartridge is mostly used with an accessory, added to the filtration device: préfiltration by fine dust filters and additional activated carbon layers. The combination of both is top of the bill in relation to top airquality in severe labconditions.

Sources:

[*]
- American Journal of Forensic Medicine and Pathology. 23(2):107-122, June 2002
- Journal of Clinical Pathology 2003;56:254-260

Standards issued by:
- Royal College of Pathologists of Australasia & Australasia MOH
- Occupational Safety & Health Services of New Zealand
- CDC-guidelines

Tuberculosis in prisons

Source: CDC - Center of Disease Control: Extract of Guidelines 2005 - page 49 regarding medical facilities and prisons.

Medical Settings in Correctional Facilities

TB is a substantial health concern in correctional facilities; employees and inmates are at high risk (105,196--205). TB outbreaks in correctional facilities can lead to transmission in surrounding communities (201,206,207). ACET recommends that all correctional facilities have a written TB infectioncontrol plan (196), and multiple studies indicate that screening correctional employees and inmates is a vital TB control measure (204,208,209).

The higher risk for M. tuberculosis transmission in health-care settings in correctional facilities (including jails and prisons) is a result of the disproportionate number of inmates with risk factors for TB infection and TB disease (203,210). Compared with the general population, TB prevalence is higher among inmates and is associated with a higher prevalence of HIV infection (197), increased illicit substance use, lower socioeconomic status (201), and their presence in settings that are at high risk for transmission of M. tuberculosis.

A TB infectioncontrol plan should be developed specifically for that setting, even if the institution is part of a multifacility system (196,211). Medical settings in correctional facilities should be classified as at least medium risk; therefore, all correctional facility health-care personnel and other staff, including correctional officers should be screened for TB at least annually (201,203,208).

Correctional facilities should collaborate with the local or state health department to decide on TB contact investigations and discharge planning (105,212) and to provide TB training and education to inmates and employees (196). Corrections staff should be educated regarding symptoms and signs of TB disease and encouraged to facilitate prompt evaluation of inmates with suspected infectious TB disease (206).

At least one AII room should be available in the correctional facility. Any inmate with suspected or confirmed infectious TB disease should be placed in an AII room immediately or transferred to a setting with an AII room; base the number of additional AII rooms needed on the risk assessment for the setting.Sputum samples should be collected in sputum induction booths or AII rooms, not in inmates' cells. Sputum collection can also be performed safely outside, away from other persons, windows, and ventilation intakes.

MOD - Ministry of Defence: Army Hospitals

Information

1. casualties in case of a war
   It is clear that in case of war, more casualties are to be treated than when there is no war and that the number of casualties can be higher than what the army hospital can handle is clear as well. The consequences in such a situation in relation to infection control are obvious. The difference with 'fixed' hospitals on the home front is that most MOD - Hospitals involved in war are mobile and have to be flexible. These "field" hospitals exist either on land (containers/tents), sea (complete hospital ships) or air (emergency hospital planes). The tools and equipment used in those "field" hospitals are often of the highest quality and little can be improved in relation to these items as top of the bill is usually implemented. However, it has always been a public secret that air quality is a major problem for these "field" hospitals. Only the 'mobile operating theatre' is often equipped with a laminar flow system, the other rooms fail to have such luxery with all consequences in relation to airborne infections. As is proven already now, even the laminar flow systems have little effect on the reduction of hospital acquired infections.
2. biological and chemical agents
   Hospitals belonging to the Ministry of Defense are in fact not different from any other hospital apart from the fact that its healthcare workers are more intensively trained dealing with casualties of war and in biological & chemical agents. Both exist either in the form of particles (e.g. SARS) or gases/chemical compounds.

Solutions

MedicCleanAir Mobile Hepa Units are equipped with filter cartridges that eliminate both particles and gases. Depending on the type of gas or chemical compound that has to be adsorbed, MedicCleanAir^® is able to manufacture the right filter cartridge.

For each and every purpose within the (mobile) Army Hospitals of the MOD, the MedicCleanAir^® Mobile Hepa Units are the perfect tool to reduce the risk of spreading contamination among casualties and staff.