CISATimesAutumn 2007 feel the innovation

Medica 2007BREAK THR OUGH IN STERILIZ ATION TECHNOLOGY L AUNCHED AT

The technology for low water consumption for steam sterilization

Cisa Times 2

CISA GROUP SPA

Water World

With CISA all traditional so-lutions for sterilization and disinfection are changing daily to meet the growing challenge for sterilization as well as the different re-quests of making steriliza-tion solutions easier, more efficient and less expen-sive.The sterilizer is a machine that comes in contact with the environment more than any other medical device; it also defines both the performance and safe-ty of operations of many medical devices to a high degree.The worst threat today on human life and its environ-ment is water shortage. Water will become the most valuable resource on earth and saving water will not only save humanity but also our environment : Our Big Home.In addition to this in many places world wide where sterilizers are being used, there is a great need for good quality water, and this will not only raise costs but also increase water consumption.

For good sterilization re-sults we have to apply pre vacuum and post vacuum, and this requires a water supply to feed circulation around the vacuum pump. Considering that each cy-cle consumes around 600 Litres for cooling the vac-uum pump we can make a simple calculation: 600Lt X10 cycles /day = 6 Cubic meters by 300 days for one year operation. That is 1800 cubic meters per machine!How many steam sterilizers do we have all around the world? Multiply this with the water consumption!Can you guarantee water quality to supply sterilizers in those countries where it is difficult to supply even low quality water for hu-mans!The big question in all CSSDs worldwide and the big challenge is Water; Aqua in Latin.CISA invites you to feel our innovation! Welcome to our Aqua Zero solution.It is true with Aqua Zero: the steam sterilizer with zero water consumption for generating vacuum pre and post! And not only this: with vacuum quality reach-

ing 99% of air removal it is higher in quality than any obtainable value that any water ring vacuum pump has ever reached before!! This will lead to shorter cy-cle times and surely a great drop on the running costs thanks to vacuum quality.The new innovative solu-tion by CISA is in line with the all the innovative ideas that CISA is constantly in-troducing on the market like the innovative solu-tion for endoscope repro-cessing which is the only system world wide that guarantees absolute steril-ity to patients, or the very successful Plasma sterilizer solution.Which is why we are invit-ing you to feel our inno-vative solutions, feel our complete infection control solutions. In two words:feel CISA

Silvano Pieroni

Silvano PieroniChairman CISA GROUP SPA

Cisa Times 3

3 Waterworld, by S. Pieroni

4 Aquazero: the new technology

6 CSSD: network hospital

7 SPS: plasma, new generation

8 CISA official web site

9 Itineris: the software

10 ERS machine

11 Interview with Dr. Costamagna

12 Cycle meeting

14 Focus on new products

15 Organization first... by I. Alamleh

Contents

AqUAZeRO IS the SOlUtIOnthAt All enGIneeRS And OPeRAtORS

ARe wAItInG fOR SOlvInG SteAm SteRIlIZeRS wAteR PROblemS.

Pre vacuum

Any steam sterilization cycle must be pre treated by air removal to guarantee the good diffusion of steam inside the chamber without air residual resistance. The air removal is done by pulsating steam (positive pressure) and vac-uum (negative pressure) in sequential pulses that have shape and quantity in function to load material and selected cycle.The pre vacuum is used to remove as much air as possible inside the chamber and load air pockets. It is also used for the pre heating of the load.The quality of the next phases of the steriliza-tion cycle is fully dependent on the quality of the Pre Vacuum.The quality of the Pre Vacuum is not measured by the number of pulses but with vacuum qual-ity, therefore a good quality of vacuum means more air removal and so less air resistance and thus good sterilization results.

Post vacuum

Post vacuum combined with steam in the Steam Jacket are used for the drying func-tion. Drying quality is dependent on three factors: Temperature in Steam Jacket, Time and Vacuum quality. While the temperature in the Steam Jacket is limited for safety reasons, and time is needed to be as less as possible then the factor that can make a big difference in drying quality and drying time is the post vacuum.

Production cost/quality

As per all standards worldwide the quality of vacuum pre and post must be guaranteed to be within accepted limits.If we look at the function of sterilization and CSSD then we must study the sterilization as it was a manufacture of sterile products from contaminated material in a process that must be controlled perfectly for the safety of pa-tients who will be in contact with end prod-ucts (medical devices), achieving at the same time safety for operators and environment and safety for the product to be reused.Let us call this process as a production pro-cess.Production quality is measured by having maximum products with minimum cost; and the cost is a function of production time; so with less time we have lower production cost and the better the process is achieved.

vacuum techniques

The vacuum can be created in differ-ent ways and the most cost effective technique is the water ring vacuum pump; this technique require the use of water for cooling the vacuum pump and the lower the temperature of the feed water the better is the perfor-mance of the vacuum pump.The other system used is the venturi system which consumes more water and needs low water temperature for generating the vacuum.

So in steam sterilizers the vacuum is needed to be fed with cold water and high volume of water.

water recovery system

Some customers and manufacturers exploit the solution of re using the water in closed circuit as water recov-ery system to reduce water consump-tion; the system is used after mixing circulating water with some fresh water to reduce the temperature and using discharge cooling device. But

The name Acqua means water, and AquaZero is the technology of using a waterlessvacuum pump in steam sterilizers.

AquaZero is the name given to the patented innovative system produced this year after long and intensive research, and a development process which led to the manufacture of a vacuum pump with high performance without the use of cooling water; the pump can reach better results for pre and post vacuum, which reduce cycle time up to 75% of its original value. It reaches the needed vacuum and more with fully independent function on the surrounding environment and with minimum cost for maintenance. The vacuum pump has a cost effective value which is much less than the water consumption cost when using a water ring vacuum pump, and much less that any other vacuum system.

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AqUAZeRO IS the SOlUtIOnthAt All enGIneeRS And OPeRAtORS

ARe wAItInG fOR SOlvInG SteAm SteRIlIZeRS wAteR PROblemS.

this also can not reduce completely wa-ter consumption, and it increases cycle time and requires cold water supply; so in those areas where the water tem-perature is high the functionality of the water recovery system is too limited and wrong use of water recovery system can affect pre and post vacuum quality and so end with non guaranteed sterilization results.

Production cost (Sterilization)

Aside from the cost of pre wash, decontamination and packing, let us discuss the main production phase cost which is sterilization.The sterilization cost is calculated by the following factors: equipment value; operator cost; material consumption (water, energy) and control material. All in function of total production volume, which can be more when the time for each batch is less!And the biggest consumable that increases the cost is the water consumption and the water treatment cost!

water for steam sterilizers

Water is the important factor for the gen-erating of vacuum; and the water con-sumption is high, up to reach 600 Lt per cycle which means that for 10 cycles per day the consumption per machine can reach 6000 Lt; in 500 Beds hospital with 5 machines the consumption can reach 30,000 Lt per day!The water must be soft (not hard) for the components’ quality and must be cold for good performance!

water Problem

In many areas in the world the tempera-ture of supplied water can exceed 30 degrees and the water is hard and the cost of water is high which makes a big headache for CSSD because production costs get higher, production time is in-creased and more maintenance is need-ed, whereas the quality of sterilization is not guaranteed and neither is quality of drying! CISA SOlUtIOn

AquaZero is a Cisa patented system and all rights of this technology belong to Cisa. It will be available on the market starting from December 2007. AquaZero has been announced for the first time in November 2007. The system was tested and approved in big institutes worldwide with perfect results.

ImAgINe...

Imagine that your steam sterilizer is re-ducing water consumption by more than 90%; that it is reducing cycle time, cycle cost, high temperature, water problems, working hours and staff cost; as well as reducing water quality problems and maintenance costs. And at the same time imagine increased quality of sterilization, increased machine resistance to installa-tion problems, less water loss... imagine all that... imagine Aqua Zero... why imag-ine? It is not a dream... it is real!! And now available for your satisfaction.

NeW mAChINe...UpgrADe kITs

The Cisa Aqua system can be used with all steam sterilizers that carry the name Aqua Zero ; it is also available as an up-grade system for old machines and other sterilization systems

Please contact CISA or CISA agents for more information; they are available to answer all your questions about Aqua Zero.

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INTERNAL DESIGN

The internal design of the CSSD for out hospital ser-vice are not different than CSSD inside hospital ser-vice, only the size and the extra out sourcing con-nection and cars disinfec-tion facility; the standards for both solutions are the same, and design factors that must respect smooth and hygienic material flow, safe air flow and safe staff flow must all be respected with clear fully separated different zones includ-ing dirty, clean and sterile zones and special facilities for the function and for the staff.

when it is needed?

The CSSD for a hospital network can be a good solution for guaranteeing good quality recir-culation of medical devices when there is lack of experienced staff in CSSD which cannot cov-er the different hospitals’ needs for high quality CSSD staff; also the solution of one outsourc-ing disinfection and sterilization service can be used to reduce the cost of the service as the cost reduces with a bigger CSSD.For cost and quality networking the service of disinfection and sterilization in a central pro-cessing area could be the solution.

what are the difficulties?

The difficulties of using the central service are summarized with the time delay that will occur because of using an out hospital service , as well as the difficulties to guarantee well sealed and safe transportation. This can be solved since the tools for safe transportation are available like special cars for collecting and distribution as well as the sealed trolleys and double pack-ing system, disinfection of cars and trolleys. One more difficulty is the need to have spare instruments and devices kits to overcome the delay in the recirculation process.

Running cost

Running cost with outsourcing solution will show dramatic reduction on the running cost concerning electrical and water and function-ing material as well as maintenance cost and labour cost.

Outsourcing Calculation

In the outsourcing service the sterilization containers are the basic element; it is used for safe transportation as well as for reference; in case the service is chargeable to the hospital then the calculation of cost can be referred to the container; the same for endoscopes using store case as reference .For other material the cost can be calculated based on the size of sterilization pouches; mainly when the material are long and cannot fit sterilization container.

traceability and management System

The same Management system used for CSSD can be used with the modification of hospitals as destination and collection points with via in-ternet based network and system for account-ing connecting to the system when this service is chargeable.

CSSDNetwork Hospital

CISA, with its complete range of products for CSSD can be the only manufacturer that can complete the whole equipment and management system from one source.With the experience and quality of its equipment, the availability of both equipment and management system, Cisa can be at your disposal for helping in the design, supply and management of your Big CSSD for network of hospitals.

CISA AnD CSSD ServICe for netWork of hoSPItAlS

SPSNew generation plasma sterilizers

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References world wide

CISA made in one year big success world wide with its state of the art low temperature Plasma Sterilizers; the success that CISA touched with this product has many reasons that started with the customers’ need to have safe, low cost, guaranteed results for low temperature sterilization in addition to their need to have strong and reliable ma-chines, and not just a delicate machine that is manufactured to be installed outside the CSSD.The only right place for the plasma sterilizer is inside the CSSD.CISA has made references in more than 40 Hospitals in one year in 19 countries world wide!It is a fact that no other Plasma sterilization company could reach such a big success world wide in its first year; but with our CISA SPS system the rule was broken and the success was created.

Plasma for CSSd

In many hospitals there was a contradiction in terms: the CSSD is de-signed as a double-door sterilizer plant where the sterilizer is loaded in the clean area and unloaded in the sterile area, except the plasma sterilizer which was single door supplied with a Pass box window used to transfer the material to the sterile area after making direct contact between the clean and sterile area, unloading sterile mate-rial in non sterile area and breaking all standards for CSSD!All this besides other mistakes where the Plasma is installed in oper-ating rooms or in corridors.The big question: why have the steam sterilizer as double-door and the plasma as single door?

why buy the Plasma and external drying cabinet?

In some hospitals it is compulsory when buying the Plasma to buy a drying cabinet with it for pre drying of material; this solution is only available with old generation plasma systems when the little residual humidity can stop the cycle and make the customer lose the cartridge and call the maintenance!But with the new generation of Plasma the problem is overcome and the need to have a drying cabinet beside the plasma sterilizer is elimi-nated.Another important point is the drying time: it is known that the plas-ma sterilizer has a big advantage which is short cycle time but if you add drying time - that is a must with old generation systems - to the cycle then this advantage disappears!

boosters!!

Not approved... not guaranteed... extra cost!Why does the old generation system need boosters for long narrow lumens?It is simply for two major reasons: the first one is the vacuum needed for plasma generation which was not enough for making the environ-ment for the sterilization inside long narrow lumens and the second reason is the homogenous distribution of plasma inside the chamber which is related to the way plasma is generated.With the new generation SPS system no need for Boosters or adaptors and the cost will automatically go down and the results go up.

Stainless Steel Construction

All operators working in CSSD understand the harsh environment in-side CSSD with the heavy loads and different shapes of material and so on. For this reason all standards are asking for strong machines and furniture to meet this environment. Stainless steel is one of the best materials to be used for CSSD machines and furniture; for this reason there are no safe places for machine with delicate plastic cover inside the CSSD. Unless, of coursed, you put up a big sign with “Attention : Delicate machine!”

CISA SPS

These are the reasons why the SPS system (CISA Sterilization Plasma System) has found its way to the mind and heart of many customers who are looking for strong, reliable, low cost, short time sterilizer.

Production volume

CISA decided to increase its production volume to meet the high ex-pected demands on the Plasma system; delivery time will be short and Plasma cartridges and material will be available at the agent’s end.

SteRIlIZAtIOn PlASmA SyStem

This new project aims to make the Cisa web-site a benchmark to be always up to date on what is going on in the sterilization world.

More information in the clearest possible way!

for this reason the website has been focus-ing not only on a change of look but also on better accessibility and readability.

The space in the website has increased, big-ger spaces have been added to make it clear-er and more transparent both in the contents and in the colors.

The logic behind this choice is to have a clean and clear communication, therefore a white background and a very soft writing which translates in video images which are as little intrusive as possible. This new way translates also into the Cisa Website the communication strategy which is common to all the Perini Group companies.

In order to highlight the environment where Cisa works (Health and Safety assistance) more space has been given to light and clear images.

What we wanted to communicate with this new web site is: “to be a placid lake where floating is safe!”

CISA official web siteChanges look www.cisagroup.it

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In the last few years Cisa has been highly involved in promoting soft-ware products able to trace and monitor all the phases of the ster-ilization cycle in order to support and increase the safety and control of the productive process.

The products that we offer are al-ways up to date with a market that is in continuous development and which require always more and more sophisticated products.

the Cisa answer to this market are those products:

Itineris/Itineris light the traceability system that is becoming more and more efficient and an essential tool in managing data:

1. New techniques for instruments marking (micro-impact print) for a permanent mark-ing (datamatrix code).

2. New procedure to manage coded instru-ments (procedures to manage maintenance jobs, new procedures for instruments pack-ing , new inventory procedures).

3. New interfacing video to make the touch screen monitor more dynamic.

4. New functions that enable the system to trace also the Washing phase.

ItinerisThe software Our products:

Traceability system that trace all the activities the surgical instruments are submitted to.

Traceability system that trace the washing and disinfection of endoscopes

The system that checks and supervises all the Cisa machines

Machines remote maintenance system

nCS 2.007 completely renewed:

- Compatibility with the new operative system- New graphic interfaces- Full Web access- Possibility of supervising and check activities not only of the Cisa machines but of any machines that the central of sterilization is using (trough connection protocol)

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eRS In british Standards

After the big success that CISA ERS/ESS so-lution made in Great Britain and with the adaptation of the system to meet British standards, CISA has started to receive many enquiries from end customers who want to collect information on ERS and ESS system.During one of the most important events for the gastroenterology and endoscopy confer-ences held in Great Britain, which took place in Glasgow during this year, it was a common question from CISA stand visitors asking for more information about CISA ERS/ESS. The majority of them made the same comments “ERS/ESS is an alternative and innovative concept for Endoscopes reprocessing and it is a perfect solution for the reprocessing and storing of endoscopes”. An interest which ac-companies the strong start of our business activity on the British market, with the study carried out by the CISA team & CISA agent Team in cooperation with big hospitals and institutes for research and development.The system had been adapted to the British standards.

Also In netherlands

ERS/ESS also started its activity in Nether-lands after the big story of infected patients in Netherlands because of lack of reprocess-ing quality of endoscopes there; the solution of ERS/ESS are used now by a big outsourcing service company that provides the service for a network of hospitals that have grouped together to get the service of high quality endoscopes reprocessing, storing and sterile transportation which becomes possible with the unique features of CISA ERS/ESS.

ERS

Registered in China & Australia

ERS/ESS trip to the far end of the world started with the registration process in TGA which is in its final stages, Also ERS is registered in China and many other Asian countries.

eRS In middle east and Central Asia

ERS/ESS activity in Middle East and Central Asia have obtained a big success in Kuwait, Egypt, Syria, UAE, Kazakhstan and Russia; ERS/ESS success thanks to the understanding of customer needs: the request for reliable sterilization results, sterile storage and sterile fully sealed transportation avoiding the traditional non guaranteed methods of transpor-tation in open environment, storage in external drying cabinets and non efficient repro-cessing systems.

eRS In latin America

ERS/ESS keep growing in Mexico, Venezuela and Brazil.

eRS In europe

ERS/ESS is strongly active in most European countries , beside Italy, Serbia, Czech republic and others.

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Dr. Costamagna, the medical applications of Endoscopes are changing, and they are now used more and more for applications that go beyond simple diagnostics. Can you update the Cisa Times readers with the news in this field?

I have operated in the field of Digestive Endoscopy for over 25 years, and I have seen it grow into an instrument not only for diagnosis, but also for therapy: during the same Endoscopy, both in the digestive tube and in the bile ducts and pancreas that can be reached through their opening in the duodenum, it is possible to make or confirm a diagnosis, and, in many cases, to proceed to an immediate solution of the problem. Some examples of the most frequent cases are the removal of polyps from the stomach or the colon, the extraction of duct stones, the positioning of prosthesis to re-route tracts of the di-gestive tube or the bile and pancreas ducts, which may be obstructed by an inflammatory process or a neoplasia. In other words, modern Digestive Endoscopy is becoming more and more therapeutic, or, if we wish, surgical in a very non-invasive manner.

A simple question: do you agree with the Disinfection level of endoscopes and when do you recommend the sterilization level?

Endoscopes need to be submitted after every use to a high disinfec-tion process to avoid any possible contamination between patients. Sterilization is yet another step forward, which guarantees even more the patient’s integrity. It is obvious that the more Endoscopy tends to become surgical and therapeutic, then the more sterilization will be-come the so-called Gold Standard. More specifically, there are many research programmes under way (and in some cases there have al-ready been clinical applications, though limited) on the possibil-ity of operating inside the abdominal cavity through natural orifices (stomach, vagina, bladder, colon) to avoid even the smallest trauma and scarring. Science Fiction? No, the near future. It is clear that if this trend is confirmed, sterilization will become compulsory.

CISA ERS: How do you judge this new technology introduced by Cisa?

ERS represents an innovation in this very same direction: not only the possibility of sterilizing, but also of an opportunity to preserve the sterile instrument in its case fort many hours, and to be able to carry it to its place of use in sterile condition. This gives the patient the ut-most guarantee of safety. This is a real absolute novelty.

Can you tell us about your global activity?

My activity is that of a University Professor in a Faculty of Medicine: this means trying to combine the education of students and doctors in training with clinical research and, most of all, with the care of pa-tients who need our support.

Our activities in the teaching of Endoscopy techniques to doctors in training have generated a wide demand not only from Italy and Eu-rope, but also from countries in every Continent. We have constantly two or three trainees from abroad who stop over in our centre for a long period, on average a year. We are proud to say that we have trained many Endoscopists from countries with an advanced medical tradition like the United States, Japan, Germany or the UK. In the cen-tre which I have the honour of managing at the Università Cattolica di Roma we also host the European Endoscopy Training Centre where we hold brief advanced training courses nearly every week.

In the field of clinical research we are involved in various protocols for the study and development of new diagnostic and therapeutic procedures in Digestive Endoscopy. More specifically we have often been called upon to evaluate technologies and their clinical appli-cations at a very early stage, even participating in the creation of a knowledge base required for approval by very strict authorities, such as the FDA.

As for our clinical activities, besides its hospital ward with 27 beds, the Unit which I manage runs an Endoscopy service with 6 examina-tion rooms and various departments for all the requirements of our Policlinico Universitario A. Gemelli and for specialist treatment of pa-tients coming from many hospitals in Rome and in Lazio.

One advice to Cisa for ERS?

To spread its innovative concept even more, and, on a more technical note, to make its cases even lighter.

Can you tell us of your experience with Cisa ERS/ESS?

I took part in the final stages of development of the machine and it was an extremely interesting and rewarding experience. It has also allowed me to come to know a prime company with a potential in the medical field which is still largely unexpressed. As an Italian, I would love to be part of an expansion process, which would bring Cisa to become a worldwide reference for Endoscopy.

Interview with professor Costamagna

prof. guido Costamagna is professor of surgery at the Uni-versità Cattolica del s. Cuore in rome, and Director of the Department of surgical Digestive endoscopy, policlinico gemelli, rome. he is also scientific Director of the european endoscopy Training Centre (eeTC) at the Università Cat-tolica del s. Cuore. prof. Costamagna has also been Chair-man of the Italian society of Digestive endoscopy (sIeD) and holds the position of Vice president, société Internationale d’endoscopie et radiologie.

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C I S A t e a m C e l e b r a t e s s u c c e s s

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C I S A t e a m C e l e b r a t e s s u c c e s s

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medical waste treatment Range

CISA offers different solutions for Medical waste treatment using wet thermal methods; starting from single special sterilizers for high pathogen and moving to complete treatment units composed of sterilizer, conveyer, shred-der and compactor all housed in stainless steel housing with semi automatic system that guarantees sterilization, shredding and compacting of waste by completely remov-ing any biological threat, removing sharp ends and edges, and making waste unrecog-nizable and lower in volume, the technology that CISA produces is patented and guaran-tees full and safe waste treatment without af-fecting the environment with any infectious air or dangerous gases deriving from the treatment of drainage.

Also available as special request system with double sterilizers and shredding for more sterilization efficiency.Available models are : MWT3290 ( 10-15 Kg/Hr), MWT4212( 30-40 Kg/Hr), MWT6412 ( 60-80 Kg/Hr) & MWT1115 ( 120-150 Kg/Hr) and other models are available for customized volume

table top Sterilizer new Capacity

CISA is introducing a new Table Top sterilizer of the 200 Series family called CISA 290 with 75 Lt Capacity; the system follows the up-dated technology of the 200 series with high performance built-in vacuum pump, Printer and Large LCD Display and microprocessor based control. For perfect sterilization as per the European standards.CISA 290 joins CISA 260 ( 35 lit) and CISA 250 ( 25 lit) in the 200 series family.

bedpan /Urinal washer disinfector

CISA Bedpan/urinal washer Disinfector is available with Model BP01 in the CISA prod-uct range with state of the art technology for circulation by washing and disinfection of bedpans, urinals, kidney dishes...and different materials in short cycle and perfect results.

Ultrasonic Cleaners – Automatic, bench type and bench top

Ultrasonic Cleaner solution in CISA is assorted by having the bench top tanks or bench type washing counter with built-in ultrasonic tank and automatic water feeding and tank emp-tying , also the innovative automatic move-ment of the ultrasonic system is achieved by two automatic movements between different sinks of ultrasonic cleaning and rinsing and drying and vertical movement inside the sink with pre programmed and programmable cycles.The ultrasonic cleaning technology is depen-dent on high efficiency high frequency ultra-sonic wave generation that can be optionally combined with built-in heating system.

FocusOn new products

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Organization first... Success follows!Iyad Alamleh

It is a great pleasure to meet all Cisa Regional Managers coming from all CISA offices to the cycle meeting!

Different cultures! Different languages! Different… But one CISA and one success will join them all together in very nice group: CISA.

This is the same feeling that our Regional Managers share with their partners, our agents and our distributors.

All the time a feeling which links CISA & Success.

One Day I was asked the following Question: why is CISA the fastest growing company in our field and how does CISA attain a growth rate in its exports that reached 50% in 2006 and is expected to exceed 60% in 2007 (regis-tered figures)?

I answered why not? We have all the elements for suc-cess: human quality and product quality.

The organization in the company is built to meet this huge success and the teams inside the company were well prepared for such success levels. Also investments made in our staff improvement are creating this result!

In Cisa we believe that people are the first step in our in-vestment program.

We invested in the R&D staff and before investing in the R&D facilities!We invested in the regional mangers before investing in regional offices!We invested in our service engineers world wide and be-fore investing in maintenance tools.We invested and invested in the first level, in the work force that shares with us the responsibility to provide the best products that are innovative both quality wise and service wise to all our customers.

The organization first… success follows!This is our strong belief in the head office, the same belief we find in all the regional Cisa teams and that we are in-troducing to all our partners world wide

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CISA America Office1840 Coral Way - Suite 101Miami - FloridaZip Code 33145Phone + 1 305 858 3406Fax + 1 305 858 3451e-mail: latinamerica.sales@cisagroup.it

CISA Brasile LTDA.Rua Dona Francisca, 8300Distrito Industrial - Bloco C - Mòdulo 6CEP 89239 - 270 - Joinville - SC BrasilTelefone + 55 47 3437 9090 Fax + 55 47 3435 7592e-mail: cisa@cisabrasile.com.brwww.cisabrasile.com.br

CISA S.p.A Via Pontina Km 2800040 - Pomezia - Roma - ItaliaTelefono + 39 06 9114371E-mail: d.vendite@cisagroup.itservice@cisagroup.itiyad.alamleh@cisagroup.itwww.cisagroup.itCoordinamento Assistenza Tecnica + 39 06 9122288

CISA Middle East OfficeAlsafa Wa Almarwa Building,Almadina Almonawara Street Telaa Al Ali - Amman - JordanPhone + 962 6 5516592Fax + 962 6 5511596e-mail: middleeast.sales@cisagoup.itP.O. box 3692 Amman 11821 - Jordan

CISA CIS OfficeShimkent - KazakhstanPhone + 7 495 953 8577e-mail: cis.sales@cisagroup.it

CISA India OfficeNew Delhi - IndiaPhone + 91 9811 1838 39Fax + 91 124 4370 397e-mail: india.sales@cisagroup.it

CISA Asia Office190 Middle Road # 19 - 05 Fortune CenterSingapore 188979Phone + 65 6826 1065Fax + 65 6826 3373e-mail: asia.sales@cisagroup.it

CISA Sub-Sahara Office Lotissement El HamadLot 26 - Sidi MoumenCasablanca - MaroccoPhone + 212 22 74 11 45Fax + 212 22 74 10 42e-mail: subsahara.sales@cisagroup.it

Cisa is part of the Perini Group of Companies www.perininavi.itCisa is part of the Perini Group of Companies www.perininavi.it