An Innovative Approach to Fighting Healthcare-associated Infections (HAIs)

1. Threads Antimicrobial Textiles Life An Innovative Approach to Fighting Healthcare-associated Infections (HAIs) PROVIDING LONG-LASTING PROTECTION TO HEALTHCARE TEXTILES Antifungal Antimicrobial Fluid Barrier Technology Odor Control Tel: +1(646)762-4533 | Fax: +1(212)869-1735 | info@life-threads.com | www.life-threads.com 45 West 45th Street Suite 702 New York, NY 10036

2. ABOUT LIFETHREADS LifeThreads® LLC is a life sciences company focused on infection control and management in clinical healthcare settings. It is dedicated to having an impact on healthcare-associated infections (HAIs). The company manufactures and distributes a “first of its kind” product line of professional medical apparel, patient garments and related items treated with an EPA-registered antimicrobial active ingredient and binding agents that protects the fabric from harmful pathogens found within institutional medical environments. The company has rolled-out its product line to doctors, nurses, dentists, veterinarians, lab technicians, chiropractors, pharmacists, medical and dental assistants, therapists, EMT works and scientists through a diverse and comprehensive distribution strategy. LifeThreads products include lab coats, scrubs, scrub warm-up jackets, patient gowns and linens. RE-THINK YOUR INFECTION CONTROL Healthcare-associated infections (HAIs) in hospitals impose significant economic consequences on the nation’s healthcare system. One in twenty-five hospital patients have at least one healthcare-associated infection – approximately 722,000 people – in the U.S. each year*. About 75,000 hospital patients with HAIs die during their hospitalization. More than half of all HAIs occurred outside of the intensive care unit. Due to efforts by the CDC and other world health organizations, the dangers of HAIs are getting exposed. The stakes have never been higher for health systems to prevent HAIs, not only for patient safety, but to avoid Affordable Care Act (ACA) provisions that penalize hospitals with high infection rates. Most recently, Centers for Medicare & Medicaid Services (CMS) named 721 hospitals with the highest HAI rates, all of which will have Medicare payments cut by 1 percent this year**. One out of every seven hospitals in the nation will have their Medicare payments lowered over the fiscal year that began on Oct. 1 and continues through September 2015. The health law mandates the reductions for the quarter of hospitals that Medicare assessed as having the highest rates of hospital-acquired conditions. These conditions include infections from catheters, blood clots, bed sores and other complications that are considered avoidable. The penalties, which are estimated to total $373 million, are falling particularly hard on academic medical centers: Roughly half of them will be punished, according to a Kaiser Health News analysis. In order to significantly reduce HAIs, healthcare organizations have to adopt a broad, vigilant infection-control strategy that includes implementing antimicrobial-treated medical soft surfaces. 90% of a patient contact environment is made up of soft surfaces and they have virtually been ignored in today’s infection-prevention practices. In order to significantly reduce HAIs, healthcare organizations have to adopt a broad, vigilant infection- control strategy that includes implementing antimicrobial-treated medical soft surfaces. *Centers for Disease Control and Prevention (CDC), Healthcare-Associated Infections Data and Statistics: http://www.cdc.gov/HAI/surveillance/ **Kaiser Health News: http://kaiserhealthnews.org/news/medicare-cuts-payments-to-721-hospitals-with-highest-rates-of-infections-injuries/ 1

3. CAN SOFT SURFACES LIKE MEDICAL GARMENTS & LINENS BE GERM CARRIERS? The rate of nosocomial infections, especially those caused by antibiotic resistant bacteria are increasing around the globe. We all know that one way germs can spread is through unwashed hands. In a healthcare setting filled with sick patients, these dangers are obviously increased. So, besides unwashed hands, where else can bacteria and viruses be commonly lurking? Equipment, furniture – they can be on almost any surface within reach of human hands in a hospital, clinic, or doctor’s office. But one important area deserves more attention and study. What about the clothes worn by healthcare workers themselves? Textiles are an excellent substrate for bacterial growth under appropriate moisture and temperature conditions. Patients shed bacteria and contaminate their pajamas and sheets. Several studies have found that the healthcare worker in contact with contaminated textiles were the source of transmission of the microorganisms to susceptible patients. Furthermore, it has been reported that bed making in hospitals release large quantities of microorganisms into the air, which contaminate the immediate and non-immediate surroundings. Contaminated soft surfaces or textiles in hospitals can thus be an important source of microbes contributing to endogenous, indirect-contact and aerosol transmission of nosocomial related pathogens. The use of antimicrobial textile, especially those that are in close contact with the patient like bed linens, patient gowns and scrubs can significantly reduce bio burden in healthcare settings and consequently reduce the risk of healthcare-associated infections (HAIs). A NEW APPROACH CAUSE: When bacteria comes into contact with a health care workers uniform it will accumulate and grow in the absence of antimicrobial technology. EFFECT: The microbes need to continually convert nutrients into energy to grow and proliferate. The LifeThreads zinc pyrithione antimicrobial ingredient penetrates the cell wall and attacks the cellular functions of the microbes so they can’t take food and reproduce. The antimicrobial action inhibits the conversion of nutrients into energy and kills the microbe. Our technology has various modes of action against bacteria. Studies have shown that zinc pyrithione: • Starves cells for iron, calcium, and other vital nutrients due to its chelating properties (Dinning, AL-Adham, Austin, Charlton & Collier, 1998; Yamanaka, Hara & Kudo, 2005). • Depolarizes the cellular membrane (Ermolayeva & Sanders, 1995). • Causes damage to iron-sulfur proteins (Reeder et al., 2011). • Blocks the proton pump that powers membrane transport by hydrogen bonding to free cysteine residues on ATPase (Chandler & Segel, 1978). • Disrupts the lipid bilayer of the cell membrane through its interaction with the phospholipid head groups (Dinning, AL-Adham, Austin, Charlton & Collier, 1998). 2

4. ALL-IN-ONE PERFORMANCE ANTIMICROBIAL TECHNOLOGY Antimicrobial pesticides are substances or mixtures of substances used to destroy or limit the growth of microorganisms, whether bacteria, viruses, or fungi -- many of which are harmful on inanimate objects and surfaces. LifeThreads incorporates zinc pyrithione into its textiles during the manufacturing process. The antimicrobial additive is homogenously distributed throughout the polymer matrix and is impregnated into the fibers of the textile with an efficacy that lasts for the life of the product. Upon contact, the LifeThreads® active ingredient penetrates the cell wall of the bacteria. It attacks the bacteria’s ability to reproduce and absorb nutrients, which eventually leads to the elimination of the bacteria. Our products have been tested and comply with American Association of Textile Chemist and Colorists guidelines and have been proven effective by independent third-party research facilities. The active ingredient in LifeThreads® product is registered for use as an antimicrobial with EPA and under EU’s Biocidal Products Directive (BPD). About Zinc Pyrithione Figure 1 Zinc Pyrithione is the antimicrobial agent in all of LifeThreads’ products. This biocide was developed in the 1930s and possesses a wide range of antibacterial activity (Kastelein, 2015). Since its development, zinc pyrithione has been commonly used as the main ingredient for anti- dandruff shampoo as well as over-the-counter creams, lotions, and soaps (Kastelein, 2015). Zinc Pyrithione is a coordination complex of zinc, where the pyrithione ligands are chelated to the zinc ion (Figure 1). In solution, zinc pyrithione disassociates into zinc ion and pyrithione molecules. In crystalline form, zinc pyrithione acts as a centrosymmetric dimer where zinc is bonded to two sulfur molecules and three oxygen molecules (Barnett, Kretschmar & Hartman, 1977, Figure 2). This structure allows pyrithione to facilitate membrane transport of zinc and other metals (Reeder et al., 2011). Figure 2 Zinc Pyrithione 3

5. FLUID BARRIER TECHNOLOGY To protect clothing from contamination and staining, our fabric is also engineered to repel fluids. Our fabric protector forms an invisible shield against stains and bodily fluids. Liquids easily bead up and roll off the garment avoiding the need for instant cleaning or laundering and more importantly, avoiding contact with dangerous bodily fluids. Liquid spills can easily be wiped away when blotted with a clean cloth, making your fabric look clean and fresh each time. In addition, our fabric protector works without impacting the fabric’s weight, look, feel, color or breathability. All of LifeThreads® products are equipped with a fluorocarbon based fluid barrier technology without impacting the look, touch, feel, color or breathability of the fabric. Items treated with our fabric protector: • Helps prevent the need to wash or spot clean because liquids bead up and roll off. • Eliminates ring around the collar, reducing detergent use and repetitive washing. • Removes stains at lower wash temperatures versus untreated fabrics. • Allows fabrics to dry 25 percent faster than untreated fabrics using either tumble dry or air dry. Fluid Barrier Technology Our fluid barrier technology is a polytetrafluoroethylene (PTFE) based compound. This compound made of only carbon and fluorine is hydrophobic due to the high electronegativity of the fluorine molecules. PTFE if often used as a non-stick coating for many different products and is very non-reactive due to the strength of the carbon fluorine bonds. 4

6. ODOR CONTROL TECHNOLOGY Body odor is the result of bacteria breaking down protein into certain acids. When microbes grow to high numbers in clothing and textiles, they can cause unwanted odor and trigger allergic reactions. LifeThreads technology has been engineered to eliminate unwanted odor. The technology physically absorb odor-source molecules, and its incorporation into polymer structures can result in entrapping and rendering inoffensive odor and taste compounds that may have been generated from polymer oxidation, migration of external contaminants, or dissolution of additives. It works 24/7 to minimize unpleasant odors. ANTIFUNGAL TECHNOLOGY Fungus as an organism feeds on organic matter. The most common kinds of fungus that use humans as hosts are those that cause athlete’s foot, ringworm and dandruff. Fungal diseases are called mycoses. Mycoses can affect human skin, nails, body hair, internal organs such as lungs, and body systems such as the nervous system. Aspergillus fumigatus, for instance, can cause aspergillosis, a fungal infection in the respiratory system. Fungi obtain nutrients, eliminate waste, and reproduce is a much more complex way than bacteria. The best protection against fungus is to prevent it from breeding. 5

7. LIFETHREADS QUICK FACTS Inhibits Growth of Bacteria Antifungal Fluid-barrier Technology Odor Control Can Withstand Over 125 Launderings No Allergic Reaction Safe, EPA-registered Ingredient Used in OTC Products Use of Less Detergent 6

8. LIFETHREADS TEST RESULTS LifeThreads® products have been tested by nationally recognized scientific research laboratories. Dr. Matthew Hardwick at ResInnova Labs performed the Splatter Fabric Challenge and AATCC TM 100, AATCC TM 147 were performed at independent third-party research facilities. All of the tests performed strongly indicate that LifeThreads® antimicrobial textiles are highly effective against important pathogens such as Staphylococcus aureus (S aureus), including Methicillin-resistant S aureus (MRSA), and Escherichia coli (E coli). In every test performed, LifeThreads® antimicrobial textiles reduce bacterial concentrations by > 99.9%. SPECIFIC TESTS Splatter Fabric Challenge is a test designed to recapitulate transmission of pathogens via splatter and test the efficacy of antimicrobial textiles in a more “real world” simulation. A splatter is a bulk transfer of fluids commonly seen in the healthcare environment (i.e. – blood, urine, vomit). AATCC Test Method 100 is a quantitative procedure for the comparison and evaluation of the degree of antibacterial activity after a 24 h exposure to the test bacteria on the test fabric. Relative to untreated control textiles (UTCs; textiles without antimicrobial or fluid barrier chemistries), LifeThreads antimicrobial textiles reduced S aureus by 99.96% and E coli by 99.98%. LifeThreads® antimicrobial textiles performed exceedingly well in the Splatter Fabric Challenge reducing MRSA levels with a range between 4.09 and 4.48 log colony- forming units (CFUs). A 4 log reduction is the equivalent of a 99.99% reduction. For perspective, UTCs reduced MRSA with a range between 1.90 and 2.37 log CFUs. See Table 1 and Figure 1 on next page for more details. AATCC Test Method 147 is a qualitative estimate of antimicrobial activity. This test further allows for detection of a zone of inhibition surrounding the specimen that determines if the antimicrobial chemistry leaches away from the textile. LifeThreads® antimicrobial textiles completely abrogate growth of both S aureus and E coli. Further, no zone of inhibition was seen with LifeThreads antimicrobial textiles indicating that its antimicrobial chemistry does not leach out of the textile. 7

9. COMPILED TEST RESULTS Table 1: Complied Results of Splatter Fabric Challenge Figure 1: Splatter Fabric Challenge Results 8

10. OTHER PATHOGENS TEST RESULTS The results below show the effectiveness of other pathogens on LifeThreads® antimicrobial textiles. In each case the fabric was tested against conventional control fabric that does not have antimicrobial characteristics. Clinical results may vary depending on conditions in the clinical environment. Findings % Reduction at 24 hours vs. control fabric Enterococcus faecailis Staphylococcus aureus Klebsiella pneumoniae Acinetobacter baumannii Enterobacter cloacae Escherichia coli Candida albicans Proteus vulgaris MRSA >99 >99 >99 >99 >99 >99 >99 >99 >99 9

11. CLINICAL TESTING http://www.ncbi.nlm.nih.gov/pubmed/18834751 Bacterial contamination of health care workers’ white coats Treakle AM1. Thom KA, Furuno JP, Satauss SM, Harris AD, Perencevich EN. Abstract BACKGROUND: Patient-to-patient transmission of nosocomial pathogens has been linked to transient colonization of health care workers, and studies have suggested that contamination of health care worker’s clothing, including white coats, may be a vector for this transmission. METHODS: We performed a cross-sectional study involving attendees of medical and surgical grand rounds at a large teaching hospital to investigate the prevalence of contamination of white coats with important nosocomial pathogens, such as methicillin-sensitive Staphylococcus aureus, methicillin-resistant S aura (MRSA), and vancomycin-resistant enterococci (VRE). Each participant completed a brief survey and cultured his or her white coat using a moistened culture swab on lapels, pockets, and cuffs. RESULTS: Among the 149 grand rounds attendees’ white coats, 34 (23%) were contaminated with S aureus, of which 6 (18%) were MRSA. None of the coats was contaminated with VRE. S aureus contamination was more prevalent in residents, those working in inpatient settings, and those who saw an inpatient that day. CONCLUSION: This study suggests that a large proportion of health care workers’ white coats may be contaminated with S aureus, including MRSA. White coats may be in important vector for patient-to-patient transmission of S aureus. http://www.ncbi.nlm.nih.gov/pubmed/18549314 Detection of methicillin-resistant Staphylococcus aureus and vancomycin- resistant enterococci on the gowns and gloves of healthcare workers Snyder GM1, Thom KA, Furuon JP, Perencevich EN, Roghmann MC, Strauss SM, Netzer G, Harris AD. Abstract OBJECTIVE: To assess the rate of and the risk backers for the detection of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs). METHODS: We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs’ hands prior to their entering a patient’s room, from HCWs’ disposable gowns and gloves after they completed patient care activities, and from HCWs’ hands immediately after they removed their protective gowns and gloves. RESULTS: Of the 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%-24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P < .05). HCW contact with the head and/or neck of a patient (P < .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and /or jejunostomy tube (P < .05) were associated with an increased risk of acquiring these organisms. CONCLUSIONS: The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient’s respiratory tract and any associated indwelling devices. As part of a larger infections control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting. 10

12. HOW WE COMPARE TO OTHER ANTIMICROBIAL TECHNOLOGIES MODE OF ACTION LEACHING COST ADAPTIVE ORGANISMS COLOR SHIFT DETERGENT LAUNDRY Physically ruptures the cell membrane and prevents the import of vital nutrients Zinc Pyrithione Non-Leaching Economical Does not create adaptive organisms Does not change product color Does not require a specific detergent 200 Industrial Physically ruptures the cell membrane SiQUAT Non-Leaching Moderate Adaptive organisms Does not create product color Does not change detergent only Non-bleach 50 Industrial Leaches out of fabric and metabolized by bacteria Silver-Based Leaches out of fabric Expensive Can create adaptive organisms Product color shifts to brown, grey, and yellow can occur Does not require a specific detergent 50 Industrial Leaches out of fabric and metabolized by bacteria Tricosan Leaches out of fabric Moderate Can create adaptive organisms Does not change product color Does not require a specific detergent N/A Source: http://www.gelest.com/goods/PDF/brochures/Biosafe.pdf 11

13. Classic Our contemporary style medical apparel not only looks great, but also offers built-in antimicrobial and fluid resistant properties. The soft, ultra-lightweight uniform takes into account a variety of factors, including functionality, durability, comfort and convenience. Collection Available in WHITE Unisex Lab Coat Women’s Classic Top Women’s Classic Pant Style No. 3140 Style No. 1110 Style No. 1120 Unisex Classic Top Unisex Classic Pant Unisex Scrub Warm-Up Jacket Style No. 3130 Style No. 3120 Style No. 3110 Available in March 2016 CEIL CARIBBEAN CEIL CARIBBEAN NAVY BLACK BLUE BLUE BLUE BLUE BLUE 12

14. LifeThreads has recently launched its Contego collection of premium scrubs. The word ‘Contego’ means to cover, shield, and protect in Latin. Our antimicrobial scrubs inhibit the growth of bacteria and provide protection from contaminated fluids prevalent in a healthcare environment. Contego by LifeThreads has been designed keeping in mind stylish designs and stretch fabric that offers exceptional elasticity and comfort. Collection Collection Women’s Stretch Top Women’s Stretch Cargo Pant Men’s Stretch Cargo Pant Style No. 1210 Style No. 1220 Style No. 2220 Available in BLACK PEWTER WHITE NAVY ROYAL WINE BLUE BLUE March 2016 March 2016 March 2016 HUNTER CEIL EGGPLANT GREEN BLUE Unisex Stretch Top Unisex Stretch Pant Style No. 3210 Style No. 3220 Visit www.life-threads.com to learn more about our products or write to us at info@life-threads.com 13

15. REFERENCES Barnett, B., Kretschmar, H., & Hartman, F. (1977). Structural characterization of bis(N-oxopyridine-2- thionato)zinc(II). Inorganic Chemistry, 16(8), 1834-1838. doi:10.1021/ic50174a002 Chandler, C., & Segel, I. (1978). Mechanism of the Antimicrobial Action of Pyrithione: Effects on Membrane Transport, ATP Levels, and Protein Synthesis. Antimicrobial Agents And Chemotherapy, 14(1), 60-68. doi:10.1128/aac.14.1.60 Dinning, A., AL-Adham, I., Austin, P., Charlton, M., & Collier, P. (1998). Pyrithione biocide interactions with bacterial phospholipid head groups. Journal Of Applied Microbiology, 85(1), 132-140. doi:10.1046/j.1365-2672.1998.00477.x Ermolayeva, E., & Sanders, D. (1995). Mechanism of pyrithione-induced membrane depolarization in Neurospora crassa. Appl Environ Microbiol, 61, 3385–90. Google Patent. (2015). Retrieved 16 June 2015, from http://patentimages.storage.googleapis.com/US20120220516A1/US20120220516A1-20120830-C00002.png Kastelein, K. (2015). Ingredients - Pyrithione Zinc. Dermaharmony.com. Retrieved 17 June 2015, from http://www.dermaharmony.com/ingredients/pyrithionezinc.aspx Reeder, N., Xu, J., Youngquist, R., Schwartz, J., Rust, R., & Saunders, C. (2011). The antifungal mechanism of action of zinc pyrithione. British Journal Of Dermatology, 165, 9-12. doi:10.1111/j.1365- 2133.2011.10571.x Wikipedia. (2015). Polytetrafluoroethylene. Retrieved 23 July 2015, from https://en.wikipedia.org/wiki/Polytetrafluoroethylene Wikipedia. (2015). Zinc pyrithione. Retrieved 22 June 2015, from https://en.wikipedia.org/wiki/Zinc_pyrithione#/media/File:Zink-Pyrithion.svg Yamanaka, M., Hara, K., & Kudo, J. (2005). Bactericidal Actions of a Silver Ion Solution on Escherichia coli, Studied by Energy-Filtering Transmission Electron Microscopy and Proteomic Analysis. Applied And Environmental Microbiology, 71(11), 7589-7593. doi:10.1128/aem.71.11.7589-7593.2005 14

16. For more information: +1(646)762-4533 Threads Antimicrobial Textiles Life info@life-threads.com | www.life-threads.com