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Designers Light Forum
Treat Your Building As A Patient
Clifford J. Yahnke, Ph.D.28-Mar-17
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Credit(s)earnedoncompletionofthiscoursewillbereportedtoAIACESforAIAmembers.CertificatesofCompletionforbothAIAmembersandnon-AIAmembersareavailableuponrequest.
ThiscourseisregisteredwithAIACESforcontinuingprofessionaleducation.Assuch,itdoesnotincludecontentthatmaybedeemedorconstruedtobeanapprovalorendorsementbytheAIAofany
materialofconstructionoranymethodormannerofhandling,using,distributing,ordealinginanymaterialorproduct.___________________________________________Questionsrelatedtospecificmaterials,methods,andserviceswillbeaddressedattheconclusionofthispresentation.
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ThispresentationisprotectedbyUSandInternationalCopyrightlaws.Reproduction,distribution,displayanduseofthepresentationwithoutwritten
permissionofthespeakerisprohibited.
©Kenall ManufacturingandIndigo-Clean
CopyrightMaterials
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LearningObjectives
1. IdentifythetypesofHealthcareAcquiredInfections(HAIs)andtheircollectiveimpactupontheUShealthcaresystem
2. Explainhowinfectionscanbeacquiredthroughthebuiltenvironment3. Describetherangeofsolutionstoimproveenvironmentalhygienewhichareavailableto
healthcareproviders4. Listthecharacteristicsofspecification-gradelightfixturesthatcanreducethespreadof
pathogenswithintheenvironment5. Recognizethebenefitsofcontinuousenvironmentaldisinfectionandtheareaswithina
healthcaresettingwhereitisbestused
Attheendofthethiscourse,participantswillbeableto:
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HEALTHCARE:THENEWWORLDWELIVEIN...
5
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USHealthcareIsBeingDrivenByChangesInReimbursement
Objectiv
eAssessmen
t
ValueBasedPurchasing
ReadmissionReductionProgram
HealthcareAcquiredConditionProgram
PolicyPenalties
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USStatisticsonHealthcareAcquiredInfections(HAI)
• 1in20patientsacquiresaninfectionwhileinaUShospital
• 1.7MHAI’s/year(US)• 99,000deaths/year(US)• Consumingmorehealthcaredollarseach
year• Estimatesvarywidelydependingupon
whatisconsideredcost• Typicallyacceptedcostis~$23Kper
infection• 2,225Hospitals=$227Minwithheld
compensation• Excludes26,000USfacilitiessuchas:
– AmbulatorySurgeryCenters– SkilledNursingFacilities– Long-TermAcuteCare– Hospice– DialysisCenters
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WhatisanHAI?SurgicalSiteInfection(SSI) CatheterAssociatedUrinaryTract
Infection(CAUTI)
CentralLineAssociatedBloodstreamInfection(CLABSI)
VentilatorAssociatedPneumonia(VAP)
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HAICostbyModality
19%
33%
32%
15%
1%
CLABSI(+MRSA)
SSI(+MRSA)
VAP
CDI
CAUTI
91Zimlichman,E.etal.“HealthCare-AssociatedInfections:AMeta-analysisofCostsandFinancialImpactontheUSHealthCareSystem”,JAMAInternMed2013;173:2039-46
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EndoftheGoldenAge?
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InfectionPreventionModalities
PatientImproved
HandwashingCompliance
AntimicrobialStewardship
IsolationPrecautionGuidelines
Patient&Staff
Education
TargetedBundles
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What’sMissing?
Host
PathogenEnvironment
• Whatabouttheenvironment?
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ROLEOFTHEENVIRONMENTINHAI
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Clostridiumdifficile>5monthstoyears
MethicillinresistantStaph.Aureus (MRSA)
>12months
MDR– Gramnegative(e.g Acinetobacter)
>30months
Vancomycin ResistantEnterococci (VRE)
>46months
Norovirus>2weeks
OrganismsPersistintheEnvironment
AdaptedfromKrameret.al.BMCInfectDis2006;6:130
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HaveYouEverWonderedHowDiseasesSpread?
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ContractTransmissionfromPatienttoEnvironment
• AcquisitionofMRSAaftercontactwithcolonizedpatientandterminallycleanedsurface
1.Stiefel U,etal.InfectControlHosp Epidemiol 2011;32:185-72.Donskey CJ,EcksteinBC.NEngl JMed2009;360:e33.BoyceJMetal.InfectControlHosp Epidemiol 1997;18:622-74.Bhalla A,etal.InfectControlHosp Epidemiol 2004;25:164-75.HaydenMK,etal.InfectControlHosp Epidemiol 2008;29:149-154
Patient Surface
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RoleoftheEnvironmentinHAI
0
2
4
6
8
10
12
HadC.diff DidNOTHaveC.diff
Percen
tageofP
atientsW
hoAcquired
C.diff
PriorRoomOccupant
PriorRoomOccupancyRisk
Shaughnessyet.al.Infect.ControlHosp.Epidemiology2011;32:201-206
~265%IncreasedRiskbasedonPriorOccupant
Status
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ADifferentApproach…• Whatifthebuildingweretreatedasapatient?
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YourBuildingAsAPatientPatientImprovedhandwashingcompliance
Antimicrobialstewardship
Isolationprecautionguidelines
Patient&StaffEducation
TargetedBundles
BuildingImprovedsurfacedisinfectioncompliance
Propersurfacedisinfectant
Roomsdesignedforinfectionprevention
Engineering&FacilitiesEducation
Location-specificBundles
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IMPROVINGENVIRONMENTALHYGIENE
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ImprovingEnvironmentalHygiene
Additionalstaffing
Policies &Procedures
ComplianceMonitoring
Technology
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TechnologySolutionsforEnvironmentalHygiene
Sterilization- Theactiveremovalofallformsoflife andotherbiologicalagents
Disinfection–Theactiveapplication ofantimicrobialagentstodestroymicroorganisms
Inhibition– Thepassivereductionofmicro-organsim accumulationand/ormigration
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TechnologyClassificationsSterilizatio
n • ChemicalsFoggers
• UV…
Disin
fection • Continuous• HEPA Filters• UV/PlasmaAirHandlers
• VisibleLight• ...
• Episodic• Chemicals(e.g.Bleach)
• FoggersUVDevices
• ...
Accumulation/
Migratio
n • Antimicrobialsurfaces(e.gcopper)
• Antimicrobialpaint
• Sealedlightfixtures
• Environmentalsprays
• ...
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HowCanLightFixturesHelp?• Specification-gradelight
fixtureswhicharesealedanddesignedforinfectionpreventioncan:– Reducethetransmission of
pathogensthroughtheair– Reducetheaccumulation of
pathogensuponitthroughcleanabledesignandantimicrobialcoatings
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WhatisSpecification-GradeLighting?
• Specificationgradelightingforhealthcareapplications:
– Withstandthechallengingenvironment
– Dependablyprovidethenecessarylevelofvisualacuity
• 4keyElements:– SealedEnclosuretoprevent
ingress/egressofpathogens– Sealedmountingtoceilingorwallto
preventingress/egressofpathogens– Designedtobecleanablewithharsh
chemicals– Preventinterferencecriticalmedical
equipment
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Listings
ListingsInsurePerformanceinYourChallengingEnvironment
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SealedEnclosureLuminaire• Preventintrusionofcontaminantsintoluminaire– Dust-tight– Waterproof
• Dynamic,notjustastaticenclosure!
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IngressProtectionStandards• Usedtovalidateperformanceofsealedenclosureluminaires
Ensures that particles of 1 micron orlarge do not enter the fixture
Protected against splashing water andwater jets
IP65 IP65
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MaintainSealedRoomEnvelope
• Preventpassageofcontaminantsbetweenluminaireandceiling.– Ceilingconstruction– Mounting– Caulkinginplace– Gasketing (vulcanized)– Seamwelding
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RoomEnvelopeStandard• Maintaintwoinchesofpressure+/- 10%for30minutes– K230baseduponNSF-49
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FixtureCleanability• Ensuresthatafixturecanbe
cleanedtoremovepathogenbuildup
• IntheUS,theNationalSanitationFoundation(NSF)hascreatedcleanabilitystandards:• NSF/ANSI- 2FoodEquipment–Section5
• Surfacecleanability• Resistancetocausticchemicals• UseofNon-toxicmaterials
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WhereElseAreSealedEnclosuresBestUsed?
• Thedecisiontousespecification-gradelightingforinfectionpreventionshouldbaseduponthreefactors:– Thesusceptibilityofthepatientintheroomtoacquireaninfection
– Theneedtorestricttheflowofpathogensinto/outoftheroom
– Theneedtoreducethefixtureasanenvironmentalsourceofpathogens
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PotentialHealthcareApplications
WaitingAreas
PatientRooms
SterileProcessing Oncology
OR
BoneMarrowTransplant
WoundCareClinics
Triage/Trauma
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TechnologyClassificationsSterilizatio
n • ChemicalsFoggers
• UV…
Disin
fection • Continuous• HEPA Filters• UV/PlasmaAirHandlers
• VisibleLight• ...
• Episodic• Chemicals(e.g.Bleach)
• Foggers• UVDevices• ...
Accumulation/
Migratio
n • Antimicrobialsurfaces(e.gcopper)
• Antimicrobialpaint
• Sealedlightfixtures
• Environmentalsprays
• ...
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NoTouchDisinfectionTechnology
Continuous• AirFilters• UV/Plasmaairhandlers• Coppersurfaces• Environmentalsprays• VisibleLight
Episodic• UVDevices• ChemicalVapor
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EPISODICVS.CONTINUOUSDISINFECTION
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Episodicvs.Continuous- Definition
37
Continuous
=TotalBacteriaKilled(High-LevelContinuous-Ideal,butnotpractical)
=TotalBacteriaKilled(Episodic- Practicalimplementationofidealsolution)
=TotalBacteriaKilled (Low-LevelContinuous-ComplimenttoEpisodic)
“ContinuousDisinfectionFillstheGaps”
(Bacteria
Killed
/Tim
e)
=
ShadedArea=TotalBacteriaKilled
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EffectsofEpisodicDisinfectionUponBacteriaLevels
38
High
Low
BacteriaLevels
Time
EpisodicDisinfectionApplied
Regrowth
“LogXKill”
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ContinuousDisinfection
39
High
Low
BacteriaLevels
Continuous(NoRegrowth)Time
Continuous(WithRegrowth)
DynamicEquilibriumLimit
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Continuous+EpisodicDisinfection
40
High
Low
BacteriaLevels
Time
ContinuousDisinfectionApplied
EpisodicDisinfectionAppliedDecreasingBacteriaLevels
EpisodicDisinfectionAppliedEpisodicDisinfectionApplied
BacteriaRegrowth
BacteriaRegrowth
BacteriaRegrowth
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BenefitsofContinuous+Episodic
41
High
Low
BacteriaLevels
Time
=Continuous+Episodic
=ContinuousOnly
=EpisodicOnly
BenefitfromContinuous+Episodicvs.Episodic-OnlyDisinfection
AdditionalBacteriaRemoved
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Episodicvs.Continuous
Episodic(UV)• Usefulinoutbreakorterminal
cleaningapplications• Oftentakestheroomoutof
service• Potentialsafetyissues• Potentialcomplianceissues
Continuous(Visible)• Usefulinareaswhichmust
remainoperational24/7– CapacityLimitations– QuickTurnover
• Cleansevenwhenpeoplearen’tintheroom
• Designedtobesafeforpatientsandstaff
• Eliminatescomplianceissues
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WhichisBetter?
EpisodicVS. Continuous Episodic+ Continuous
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CONTINUOUSENVIRONMENTALDISINFECTIONUSINGVISIBLELIGHT
44
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WhatisVisibleLightDisinfection?
TypicalUV-CGermicidalWavelength
VisibleLightDisinfectionGermicidalWavelength(405nm)
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WhatisVisibleLightDisinfection?• Acontinuousenvironmentaldisinfectionsystemwhich:
– Usessafe,visible light– Canbeintegratedintonormal,overheadlighting
46
Indigo-OnlyMixed-White
WhiteDisinfectionMode=AmbientWhiteLight+Disinfection
IndigoDisinfectionMode=IncreasedDisinfectionOnly
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TypesofVisibleLightDisinfection
• Disinfectiononly
47
• Indigo-Only • MixedWhite
• Useofcomplimentarycolorsallowsforambientlightingapplications
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HowDoesVisibleLightDisinfectionWork?
48
3.Pathogeninactivationbreakstheenvironmentalchainofinfection
2.EnvironmentcreatesReactiveOxygenSpecieswithinbacteriacausinginactivation
=
1.Continuous,automatic,safesystemcreateshostileenvironmentforbacteria
4.Measuredbacterialreduction**MacleanM.,et.al.Environmentaldecontaminationofahospitalisolationroomusinghigh-intensitynarrow-spectrumlight,J.Hosp.InfectionVol.76,pp.247-251(2010)
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VisibleLightDisinfectionSafety
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HistoryofAcademicResearch&InvestmentinVisibleLightDisinfection
ResearchTimelineMorethan30
refereedpublications
andproceedingssince2008
VisibleLightDisinfectionCommerciallyAvailable
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VisibleLightDisinfection InAnOperatingRoom
51
AirbornePathogens
VarietyofSurfaces HardtoReach
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WhyVisibleLightDisinfectionintheOR?
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VisibleLightDisinfectionApplication:OperatingRooms
• AmbientlightinglevelsinoperatingroomsaregovernedbyIESguidelines
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DeployingVisibleLightDisinfectionintheOR
~625sq.ft. ~625sq.ft.
1:1Replacement
~625sq.ft.
• Contactmanufacturertoensureproperdosingofroombasedon1:1replacement
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VisibleLightDisinfectionOperatingRoomSolutions
55
2’x4’ 2’x2’ 1’x4’
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ClinicalImplementationofVisibleLightDisinfection
• Wallswitchcanbeusedtoselectdesiredmode OR• Occupancy/vacancysensorcanautomaticallyswitchbetweenmodes
56
Indigo-OnlyMixedWhite
WhiteDisinfectionMode=AmbientWhiteLight+Disinfection
IndigoDisinfectionMode=IncreasedDisinfectionOnly
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ControlSolution(s)• “MaximizeDoseWithoutImpactingVisualAcuity”
57
PassiveInfraredSensordetectslargermotionsoveralargerarea
UltrasonicSensordetectssmallmotionsinafocusedarea(overthetable)
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CURRENTEVALUATIONDATAFORVISIBLELIGHTDISINFECTION
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ESKAPE Pathogens• Enterococcus faecalis• Staphylococcal Aureus*
(including MRSA)1
• Klebsiella pneumoniae• Acinetobacter baumannii• Pseudomonas aeruginosa• Enterobacter species
DemonstratedLaboratorySusceptibilitytoVisibleLightDisinfection
Gram-Positive Bacteria• Clostridium perfringens• Staphylococcus epidermidis (CONS)• Staphylococcus hyicus (CONS)• Streptococcus pyogenes• Listeria monocytogenes• Mycobacterium terrae• Corynebacterium striatumGram-Negative Bacteria• Proteus vulgaris• Escherichia coli (E. coli)• Campylobacter jejuni• Salmonella enteritidis• Shigella sonnei• Serratia sppYeast & Filamentous Fungi• Aspergillus niger• Candida albicans• Saccharomyces cerevisiaeBacterial Endospores• Clostridium difficile• Bacillus cereus
*=DemonstratedclinicalsusceptibilitytopresumptiveS.Aureus &MRSA
1MacleanM.,et.al.Environmentaldecontaminationofahospitalisolationroomusinghigh-intensitynarrow-spectrumlight,J.Hosp.InfectionVol.76,pp.247-251(2010)
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Significant reduction of total bacterial contamination on surfaces around the room (2-day use)
76%reduction
86%reduction
All reductions in bacterial contamination were achieved over and above standard cleaning and infection control practices
Whole Room Results Surface-Specific Results
Bacterial reduction on a range of surfaces before and after use of the Visible Light Disinfection
GlasgowRoyalInfirmary:IntensiveCareUnit(InitialStudies)2
2MacleanM.,et.al.Continuousdecontaminationofanintensivecareisolationroomduringpatientoccupancyusing405nmlighttechnology.JournalofInfectionPrevention,14(5);176- 181(2013)
LightsOff
LightsOn
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AdditionalPublicationData
61
Forafulllistofavailablepublications,pleasevisit:
http://www.indigo-clean.com/resources-white-papers
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Froedtert &TheMedicalCollegeofWisconsinFroedtert Hospital
• GIDiagnosticWaitingArea– Easiertoshowareductiondueto
highamountofbacteria– Proximitytoprocedurerooms– Approximately450ft.2 (Equivalent
tosmallOR)– Resultsconsistentwithpreviously
publishedpatientroomresults– Additionalstudiesunderway
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ClinicalResultsforVisibleLightDisinfection
• InactivationofS.aureusinWaitingRoom
63
70%+Decrease
“InPhase2ofthetrial,wherethelightingdeploymentwasoptimizedacrosstheroom,wewereabletoimprovethebacterialreductiontomorethan70%.”
- Dr.NathanLedeboer,AssociateProfessorofPathology,MedicalCollegeofWisconsin
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Clinicaland CommercialDeployment• State-of-the-artfacilitiesinLas
Vegas• HendersonHospitalandSpring
ValleyHospital- UniversalHealthServicesInc.
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ClinicalResultsfromIDWeek2016
• 4 posterscovering:– VisibleLightDisinfection– ImprovedEnvironmental
Hygiene=ReducedHAI
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Summary• VisibleLightDisinfectionprovidesawaytoimproveenvironmentalhygienethatcomplimentscurrentefforts
• Itissafe,containsnoUV,andcanbeoperatedwhilepeopleareintheroom
• Itcanbeintegratedwithoverheadlightingandoperatedautomaticallywithouttheneedforadditionalpeople
• ItusesreliableLEDtechnologytoincreaselifetimeandlowerongoingcosts
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ThisconcludesTheAmericanInstituteofArchitectsContinuingEducationSystemsCourse
Dr.CliffordJ.Yahnke
Director,ClinicalAffairs
Indigo-Clean
(262)891-9738