The Day Before Tomorrow - National Air Filtration Association€¦ · The Day Before Tomorrow...
Transcript of The Day Before Tomorrow - National Air Filtration Association€¦ · The Day Before Tomorrow...
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The Day Before Tomorrow
Preparing for Avian Influenza and other Emerging Infectious Diseases
Bill Palmer NAFA Tech Session
AeroMed, Inc. Phoenix 2007
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Blissful Ignorance
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The Fateful Forecast
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Arrogant Intimidation & Manipulation
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Denial of the Problems Extent
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Overwhelmed
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Acceptance
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Six Stages of a Disaster Movie = Art Imitating Life
¢ Blissful Ignorance ¢ Fateful Forecast ¢ Arrogant Intimidation &
Manipulation ¢ Denial of Problems Extent ¢ Overwhelmed ¢ Acceptance
These steps are a natural progression
as we process dramatic changes to our status quo
otherwise know as our social
equilibrium
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Social Equilibrium
¢ There is a dynamic balance among interdependent parts of society
¢ Subsystems adjust to changes until equilibrium is retained
¢ Equilibrium is maintained if changes happen slowly
¢ Rapid changes throw society into chaos
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Movies vs. Real Life
¢ Movies condense the disaster stages into a two hour rollercoaster of emotions with little time for other considerations
¢ In real life, these events usually occur over long periods of time with ample time for strategic planning and corrective measures.
¢ We still don’t like threats to our equilibrium.
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Threats to Social Equilibrium from the Human Health Sub-System
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Antibiotic Resistance
¢ Predicted from the beginning
¢ Resistance is transmissible
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Antibiotic Resistance
¢ Predicted from the beginning
¢ Resistance is transmissible
¢ Bacteria transfer resistance to each other
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Antibiotic Resistance
¢ Predicted from the beginning
¢ Resistance is transmissible ¢ Bacteria transfer resistance
to each other ¢ Incidence of resistance is
increasing
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Antibiotic Resistance
¢ Predicted from the beginning
¢ Resistance is transmissible
¢ Bacteria transfer resistance to each other
¢ Incidence of resistance is increasing
¢ The geographic reach of resistance is increasing
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Antibiotic Resistance
¢ Predicted from the beginning ¢ Resistance is transmissible ¢ Bacteria transfer resistance
to each other ¢ Incidence of resistance is
increasing ¢ The geographic reach of
resistance is increasing ¢ The severity of resistance is
increasing
“Experts fear that we may soon see an untreatable
form of TB, a return to the time before streptomycin was discovered in 1946.”
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XDR-TB Case in Phoenix
¢ Man detained indefinitely in Phoenix jail
¢ Not charged with any crime ¢ Would not wear mask in
public ¢ Not 1st XDR case in US ¢ Not 1st in US quarantined
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XDR-TB Case in Phoenix
¢ If you see this man: l Good candidate
for imprisonment for not wearing a mask in public!
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Bio-Terrorism
¢ Man induced ID outbreak
¢ Hospitals first line of defense
¢ Could start new epidemic (smallpox)
¢ Bio agents engineered to be resistant
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Changing Face of Healthcare
¢ Cost cutting l Primary providers l Out patient services l Short staffing l Insufficient
engineering controls ¢ In patient population
more sick ¢ Antibiotics over
prescribed
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Global Infectious Disease Rates
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Global Infectious Disease Rates
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Global Infectious Disease Rates
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15.4 Chihuahua
35.8
28.8
7.3 Texas
17.3 Coahuila
Nuevo León Tamaulipas
El Paso 9.9
Webb 20.8
Cameron 17.6 Hidalgo 11.9
TB rates on the Mexico border are increasing.
Mexico 14.4
U.S. 5.1
Rate: Cases per 100,000 in 2003 Sources: Centers for Disease Control and Prevention, and Sistema Único de Información para la Vigilancia Epidemiológica (SUIVE)
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Global Infectious Disease Rates
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Avian Influenza
¢ Flu Facts (not specific to avian)
l Viral infection l Mutates easily and quickly l 5 – 20% of US population is infected each
year l 200,000 infections and 36,000 deaths
annually in US l Sub-micron in size l New research argues for airborne spread
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Avian Influenza ¢ Three Classifications
l Type B – Circulates widely in human population
l Type C – Found in humans, pigs & dogs
• Causes mild respiratory infections • Does not cause epidemics
l Type A - found in many kinds of animals, including ducks, chickens, pigs, whales, and also in humans. (Birds only get type A)
• Most frightening of the three • Believed to cause 1918, 1957 and
1968 pandemics • H5N1 Avian influenza is a type A flu
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1918 Influenza
¢ 28% of US population falls ill with flu ¢ 40% of Navy and 36% of Army ¢ Global death toll was estimated
between 20 – 100 million ¢ Life expectancy in US fell 12 years ¢ Same pandemic today would result
in nearly 2 million deaths in USA
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Avian Influenza
Avian influenza – situation in China - update 29 March 2007
The Ministry of Health in China has reported a new fatal case of human infection
with the H5N1 avian influenza virus. The case has been confirmed by the national laboratory.
The 16-year-male from Anhui province developed fever and pneumonia-like
symptoms on 17 March and was hospitalized on 20 March. He died on 27 March.
There is no initial indication to suggest he had contact with sick birds
prior to becoming unwell and investigations to identify the source of his exposure are ongoing. Close contacts have been placed under medical observation and all remain well.
Of the 24 cases confirmed to date in China, 15 have been fatal.
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Avian Influenza
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Avian Influenza
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Avian Influenza
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Avian Influenza
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Avian Influenza
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Avian Influenza
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Threats to Social Equilibrium from the Human Health Sub-System
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We Can Shield Our Equilibrium With 5 Steps to a Solution
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5 Stages of a Solution
¢ Due Diligence Regarding the Threats ¢ Acceptance ¢ Due Diligence of Potential Solutions ¢ Proceed with measured response ¢ Always Exhibit Due Vigilance
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The Other Obstacle – Technical ¢ Education l Code – AIA, CDC, OSHA, State,
JCAHO, ASHRAE l Infectious Disease Characteristics l Applicable air filter types, required
efficiency levels and hardware requirements for removal of airborne pathogens
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Environmental Controls Traditional / Permanent
¢ Contain l High risk areas l Negative pressure l HEPA Exhaust
¢ Direct l Directional air flow l From clean to contaminated
¢ Dilute l Make certain that facilities meet minimum efficiency
levels for HVAC filtration l Adequate dilution with removal by exhaust l Equivalent ACH with HEPA recirculation
¢ Inactivate
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Environmental Controls Responsive Measures
¢ Temporary Negative Pressure Isolation (TNPI) l Two main concepts:
• Individual rooms for the isolation of a single patient
• Isolation wards for the isolation of multiple patients in a space
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Environmental Controls Responsive Measures – TNPI
¢ TNPI – Individual Rooms l Type 1: Discharge air to the outside l Type 2: Discharge air to return air system l Type 3: Curtain method l Type 4: Portable Anteroom
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Environmental Controls Responsive Measures – TNPI
Seal Return
Set up HEPA unit and flex duct
Discharge air to the outside
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Environmental Controls Responsive Measures – TNPI Discharge air to return air system
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Environmental Controls Responsive Measures – TNPI
The intake must be within the plastic enclosure and the output must be outside the plastic enclosure.
The area around the bed can be “sealed off” by attaching fire-rated plastic sheeting.
Curtain method
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Environmental Controls Responsive Measures – TNPI
Portable Anteroom
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Environmental Controls Responsive Measures – TNPI
Safe Area to Isolate Infectious Disease Zone (IDZ)
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Environmental Controls Responsive Measures – TNPI
Temporary Surge Capacity Using HEPA Filter Exhaust
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Conclusions
¢ What are we? ¢ What can we do? ¢ We can help with recommendations to
a customers accessed risks ¢ Our professional approach elevates
our status and lays the groundwork to avert disaster