The Disarming of America (and the world)

1. The Disarming of America(and the world) Bill Palmer AeroMed, Inc. NAFA Tech Session Louisville, KY April 2013

5. Gun Control controversy

8. CRE

9. Nightmare Bacteria • "These are nightmare bacteria that present a triple threat," CDC director Thomas Frieden told USA Today. "They're resistant to nearly all antibiotics. They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria." 

13. Human Biome • Body – made up from 10 trillion human cells • Total cells in human body = 100 trillion • Bacteria • Viruses • Other micro organisms • Natural Flora • 10,00 species of microbes • Representing 8 million genes

14. Hospital Infections • Klebsiella pneumoniae • Methicillin-resistant Staphylococcus aureus (MRSA) • Norovirus • Clostridium difficile • Influenza • Mycobacterium tuberculosis

15. Klebsiella bacteria • Does not normally affect healthy people • Causes healthcare-associated infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. • Spread through contact (person to person), not spread through the air • Infection common in those using ventilators, IV catheters and those on long course of antibiotics • Growing resistance to antibiotics (CRE)

16. Methicillin-resistant Staphylococcus aureus (MRSA) • Staphylococcus aureus or staph infection, is a bacteria that is part of our normal flora • Normally presents as an easily controlled skin infection such as boils or pustules • Has become resistant to antibiotics • Can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart

17. Methicillin-resistant Staphylococcus aureus (MRSA) • How transmitted • Contact with infected skin • Contact with fomites • Airborne • Droplet nuclei from sneezes • Infected dust from cleaning • Skin squames • Co infection with a virus (such as rhinovirus) increases airborne transmission of MRSA as does allergy related sneezing.

18. Norovirus • group of viruses that cause gastroenteritis • inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea. • not affected by treatment with antibiotics • most people get better within 1 or 2 days

19. Norovirus • Where? • 30-50% in Hospitals, retirement centers and nursing homes • 28% in restaurants • 16% on cruise ships • 8% in day care centers • Infection Control • Very difficult to kill by cleaning • Very expensive to control • Transmission • Food • Water • Contact with surfaces • Person to person • Airborne • Vomit aerosols • Toilet plume • Can persist in the environment for 3-4 weeks

20. Clostridium Difficile • Spore forming bacteria that causes inflammation of the colon, known as colitis • More common in elderly and in patients on prolonged antibiotic use • Found in 3% of healthy individuals and 30% of hospitalized patients • Shed / transmitted by fecal matter • Contact with contaminated surfaces • Contact with contaminated hands • Airborne – fecal cloud • 336,000 infections in US hospitals in 2009 (<100,000 in 1993), 9% fatal!

21. Influenza • Viral respiratory infection • Seasonal • Constantly changing • Resistance to Tamiflu is developing • Transmission • Droplet transmission • Airborne transmission* • New avian flu in China • H7N9 • Symptoms • Fever* or feeling feverish/chills • Cough • Sore throat • Runny or stuffy nose • Muscle or body aches • Headaches • Fatigue (very tired)

23. Avian Influenza • Infectious disease has an impact across borders

24. Mycobacterium tuberculosis • Bacteria • Transmission • Obligate – airborne • Growing anti-microbial resistance • MDR-TB • XDR-TB • TDR-TB • Diminishing # of cases in US, huge problem globally • Majority of US cases are foreign born

27. TB in China

28. TB in China

29. MRSA CRE C Diff TB Influenza Norovirus

31. Klebsiella pneumoniae • Filtration response • NONE • Not airborne

32. Methicillin-resistant Staphylococcus aureus (MRSA) • Most likely contribution of filtration is to prevent environmental contamination from airborne skin squames • Source capture with MERV 15 – HEPA with about 20 ACH to reduce likelihood of transmission • MERV 15 filters on return air to prevent spread to other areas of the facility • Secondary contribution is to provide source capture filtration in rooms housing MRSA patients with viral co infection or active allergy symptoms

33. Norovirus • Most likely contribution from air filtration is the reduction of droplets and droplet nuclei from patient vomit aerosols and toilet plume • Use of portable air filtration with MERV 15 – HEPA and 20 ACH • Possible use of source capture filtration of toilet seats • MERV 15 filters on return air to prevent spread to other areas of the facility

34. Clostridium Difficile • Most likely contribution from air filtration is the reduction of patient fecal cloud and possibly toilet plume • Use of portable air filtration with MERV 15 – HEPA and 20 ACH • Possible use of source capture filtration of toilet seats • MERV 15 filters on return air to prevent spread to other areas of the facility

35. Mycobacterium tuberculosis • Many filtration applications • Use of HEPA recirculation in waiting areas serving at risk population • Use of HEPA on exhaust from isolation rooms and special treatment rooms • MERV 15 filters on return air to prevent spread to other areas of the facility • Use of portable HEPA recirculation in rooms where negative pressure containment is not available • Use of HEPA filters in sputum induction booths

36. Defenseless?