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healthcare

Environmental solutionsnews Covering infection prevention, medical waste management & sustainable practices

VOL. XIV NO.41 XII NO.

www.HealthcareEnvironmentalSolutions.com

spring 2018 WINTER 2016

Study: Far-UVC Light Zaps Airborne Viruses Without Harming Human Tissue

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he benefits of using ultraviolet light in healthcare applications – killing microbes and bacteria and sterilizing surgical instruments and operating rooms -- has long been known. But the risks posed to people associated with using so-called germicidal UVC light, particularly skin cancer and cataracts, have prevented its widespread use in public spaces. Now, however, researchers have reported that low doses of far ultraviolet light (far-UVC) can not only kill airborne viruses – including the influenza virus that this season has already claimed more than 80 children’s lives nationwide – but do so without harming human tissue. The study, by the Center for Radiological Research at Columbia University Irving Medical Center (CUIMC), could have a far ranging impact in battling airborne viruses, including influenza, measles, tuberculosis, chickenpox, smallpox and possibly even anthrax. “I think it does [have huge potential],” said David J. Brenner, the study leader and director of the Center for Radiological Research at CUIMC. “If it only took a bite out of influenza it would be just terrific.”

By P.J. Heller

Installing far-UVC lights in places such as airports, airplanes, schools and medical facilities, could slow seasonal flu epidemics or even a flu pandemic that could spread rapidly from country to country. “Our results indicate that far-UVC light is a powerful and inexpensive approach for prevention and reduction of airborne viral infections without the human health hazards inherent with conventional germicidal UVC lamps,” Brenner

said. “If these results are confirmed in other scenarios, it follows that the use of overhead very low level far-UVC light in public locations may represent a safe and efficient methodology for limiting the transmission and spread of airborne-mediated microbial diseases. “Public locations such as hospitals, doctors’ offices, schools, airports and airplanes might be considered here. This approach may help limit seasonal influenza epidemics, transmission of tuberculosis, as well as major pandemics,” he said. Some published reports hailed the study, which has been conducted over the last five years, as a “breakthrough.” Others, including Brenner, himself, were not willing to go that far since the use of UVC at certain wavelengths has long been proven effective for germicidal irradiation. Germicidal UVC peaks around 254 nm, Brenner noted. The far-UVC lamps used in the study had a single wavelength of 222 nm. “I think we were expecting those results. I don’t think we were too surprised,” said Brenner, the Higgins Professor of Radiation

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Study: Far-UVC Light Zaps Airborne Viruses Without Harming Human Tissue Continued from page 1

Biophysics and professor of Environmental flu virus has been limited to basically three Health Sciences. “What we saw in bacteriastrategies: vaccine, hand washing and wearing killing experiments with far-UVC light was masks. Because people often skip some of those roughly the same efficiency of killing bacteria steps, “we need something that’s better,” she said. with germicidal UVC.” “What’s also exciting about this is that this The major difference, he noted, was that really could be used against other viruses,” Perl tests on human skin models and on mice, using said. “Everyone is thinking about influenza side-by-side tests of far-UVC and right now, but there are other viruses germicidal UVC, showed no out there that are equally harmful effects with the farproblematic . . .” UVC light with the single While flu vaccines “While flu 222 nm wavelength. have to be formulated vaccines have to be “Due to its each year to deal with strong absorbance a particular strain, formulated each year to in biological f a r - U VC l a m p s deal with a particular strain, materials, far-UVC would remain the light does not have same. far-UVC lamps would remain sufficient range to “Unlike flu the same. If you have these penetrate through vaccines, far-UVC eve n t h e o u t e r i s l i ke ly t o b e lamps in the ceiling, they’re layer on the surface effective against all not going to distinguish of human skin, nor airborne microbes, the outer tear layer even newly emerging between which bugs are on the outer surface strains,” Brenner said. floating around.” of the eye, neither of “It’s going to kill all which contain living cells; the different strains pretty however, because bacteria and much the same.” viruses are typically of micron or He also agreed with Perl that smaller dimensions, far-UVC light can far-UVC lights would also be effective still efficiently traverse and inactivate them,” against other airborne-mediated microbial the study said. diseases. The study used the H1N1 virus carried by “If you have these lamps in the ceiling, aerosols in a bench-top aerosol UV irradiation they’re not going to distinguish between which chamber. The generated aerosol droplets were bugs are floating around,” he said. similar in size to those generated by human Temperature, humidity and airflow were coughing and breathing, according to the study not expected to have any impact on the efficacy results published in Scientific Reports. of far-UVC. UVC light is divided into three wavelengths, “As long as the far-UVC light hits the bug, UVA, UVB and UVC. UVA has the longest I think it would be independent of all those wavelength, from 400 nanometers to 320 nm things,” Brenner said. and accounts for approximately 95 per cent of He admitted that researchers had initially the UV radiation reaching the Earth’s surface. been focused on using far-UVC to kill bacteria UVB ranges from 320 nm to 290 nm; most solar rather than viruses. That focus was sparked by UVB is filtered by the atmosphere. UVC has the concern over multi-drug resistant bacteria and shortest wavelength, from 290 nm to 100 nm and superbugs. is absorbed by the atmosphere and doesn’t reach “One of the really good things about the Earth’s surface. UV light is that it kills bacteria by a different “With 222 nanometer light we have never mechanism than drugs,” he explained. “A big seen any biological damage whereas with the issue in the bacteria world is its multi-drug conventional germicidal lamps we always see resistance. UV doesn’t suffer from that. It kills biological damage,” Brenner reported. bugs irrespective of their drug resistance. We Dr. Trish Perl, chief of the Division of were very concerned about superbugs in the Infectious Diseases and a professor at the future. That’s really where we started from.” University of Texas Southwestern Medical The first target of the research was MRSA Center, called Brenner’s study “very exciting and (methicillin-resistant Staphylococcus aureus), a very interesting.” bacteria that is resistant to many of the antibiotics Perl, who was not involved in the study, said used to treat ordinary staph infections. the results could be a paradigm shift. The initial research was focused on surgical “I think it could be unbelievably important,” site infections, which Brenner estimated occurred she said, noting that trying to prevent the in about 5 percent of all surgeries. The idea was spring 2018

to use the far-UVC lamps directly above the surgical area, essentially creating a clean zone above a wound to prevent bacteria from floating down in the air and infecting the wound. Brenner noted that a conventional UVC system had been utilized like that since World War II, but the health risks to those in the operating room and their unwillingness to put on bulky protective clothing, prevented the system from catching on. “That’s where we started from. But as we were going along, we started to think about viruses because the same logic applies to viruses,” he said. The study attempted to simulate in a test chamber what happens when a person with influenza would sneeze. When that happens, viruses are shot out into the air, then quickly attach themselves to aerosols such as dust particles or water vapor. They then float around in the air attached to the aerosols, eventually being breathed in by someone else.

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healthcare

Environmental solutionsnews Covering Infection prevention, medical waste management & sustainable practices

PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers P.J. Heller • Chris Wall Sandy Woodthorpe Production & Layout Barb Fontanelle • Christine Mantush Advertising Sales Rick Downing Subscription / Circulation Donna Downing Editorial, Circulation & Advertising Office 6075 Hopkins Road, Mentor, OH 44060 Ph: 440-257-6453 • Fax: 440-257-6459 Email: downassoc2@oh.rr.com Subscription information, call 440-257-6453. Healthcare Environmental Solutions news (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission in whole or in part, without written permission of the publisher, is prohibited. Annual subscription rate U.S. is $19.95. Outside of the U.S. add $10.00 ($29.95). Contact our main office, or mail-in the subscription form with payment. ©

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Healthcare Environmental Solutions news

EPA Effluent Limitations Guidelines and Standards for the Dental Category (Amalgam Separator Rule) By Chris Wall, Medentex HWI member

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h e E nv i ro n m e n t a l P ro t e c t i o n Agency (EPA) released its final rule for technology-based pre-treatment standards under the Clean Water Act. This new rule, coined the “EPA Amalgam Separator Rule”, will reduce mercury discharges from dental offices discharging into the municipal sewage system where the wastewater is treated at the Publicly Owned Treatment Works (POTW). Although mercury has been well documented as a persistent and bio-accumulative pollutant, until now mercury from U.S. dental offices have not been regulated. Mercury and its ecological effects are a global concern, the American dental industry is responsible for 40% of mercury found in American public waterways. This was documented after a voluntary mercury reduction program lasting 6 years failed. As a result the EPA, the American Dental Association (ADA) and other authorities decided to regulate dental amalgam. The EPA Amalgam Separator Rule became effective on July 14, 2017 with a three year transition period for compliance (July 14, 2020). From July 14, 2017, most dental offices that discharge wastewater to POTWs across the United States must install an amalgam separator as well as follow best management practices (BMP) recommended by the ADA. That is the essence of the new EPA Amalgam Separator Rule, also known as Effluent Limitations Guidelines and Standards for the Dental Category. Dental offices located in a previously regulated areas are also subject to the EPA rule and should ensure they are still compliant.

1. Use evacuation cleaners with pH between 6 and 8.

Background

Pretreatment Amalgam Solids

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ccording to the EPA, dental clinics are the main source of mercury discharges to POTWs. The EPA estimates that about 103,000 dental offices use or remove amalgam in the United States. Almost all of them send their wastewater to POTWs. The EPA has estimated that dentists discharge approximately 5.1 tons of mercury each year to POTWs.

Overview

www.creweb.com/secure 4

he Amalgam Separator Rule requires dental T offices to use amalgam separators and follow two BMPs recommended by the ADA:

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

spring 2018

2. No amalgam waste discharged to POTWs.

Applicability

he Amalgam Separator Rule is applicable to all Dental Dischargers. A Dental T Discharger is defined as a facility where the practice of dentistry is performed, including, but not limited to, institutions, permanent or temporary offices, clinics, home offices, and facilities owned and operated by Federal, state or local governments, that discharges wastewater to a POTW. The Amalgam Separator Rule does not apply to the following Dental Dischargers: 1. To Dental Dischargers that exclusively practice one or more of the following dental specialties: oral pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, periodontics, or prosthodontics. 2. To wastewater discharges from a mobile unit operated by a Dental Discharger. 3. To Dental Dischargers that do not discharge any amalgam process wastewater to a POTW, such as dental facilities that discharge amalgam process wastewater into a septic system. All new dental offices must comply with the EPA rule on amalgam waste effective as of July 14, 2017.

he Amalgam Separator Rule requires all T applicable Dental Dischargers to remove dental amalgam solids from ALL amalgam process wastewater by installation, operation, and maintenance of one or more amalgam separators, or amalgam removal device(s) that meet the following requirements. •

Achieve at least a 95% removal efficiency.

Sized to accommodate the maximum discharge rate of amalgam process wastewater. Continued on next page


Healthcare Environmental Solutions news Continued from previous page •

Inspected in accordance with the manufacturer’s operating manual to ensure proper operation and maintenance.

Retaining units (containers) replaced in accordance with the manufacturer’s schedule and operating manual.

Pretreatment BMPs

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he Amalgam Separator Rule requires all applicable Dental Dischargers to implement the following two Best Management Practices (BMPs).

1. Waste amalgam including, but not limited to, dental amalgam from chair-side traps, screens, vacuum pump filters, dental tools, cuspidors, or collection devices, must not be discharged to a POTW. 2. Dental unit water lines, chair-side traps, and vacuum lines that discharge amalgam process wastewater to a POTW must not be cleaned with oxidizing or acidic cleaners, including but not limited to bleach, chlorine, iodine and peroxide that have a pH lower than 6 or greater than 8.

Reporting and recordkeeping The Amalgam Separator Rule requires:

3. Existing Dental Dischargers to provide a one-time Compliance Report to their Control Authority no later than 3 years and 90 days from the rule Effective Date, or 90 days from transfer of ownership. 4. New sources to provide a one-time Compliance Report to their Control Authority no later than 90 days following the introduction of wastewater into a POTW. 5. To maintain for inspection, in either physical or electronic form, for a minimum of 3 years, the following documentation. •

Date, person(s) conducting the amalgam separator inspection.

Amalgam retaining container (or equivalent) replacement, including the date.

Dates that collected dental amalgam is sent for proper disposal in accordance with 40 CFR 261.5(g)(3), and the name of the permitted or licensed treatment, storage or disposal facility receiving the amalgam retaining containers.

Repair or replacement of an amalgam separator or equivalent device, including the date, person(s) making the repair or replacement, and a description of the repair or replacement (including make and model).

What is Dental Amalgam?

ental amalgam consists of Copper, Silver, Zinc and Tin as contains D up to 50% mercury. Mercury is the only common metal that is liquid at room temperature and is one of most toxic elements on Earth. Mercury vapor is odorless, tasteless and colorless and in its liquid form there is limited absorption through skin.

Health Impacts of Long Term Exposure to Mercury

ccording to scientists, mercury is a neurotoxin in humans. The health A effects by exposure to mercury depend on a number of factors including, the type of mercury (methylmercury or elemental mercury), mercury exposure, the age of the person exposed (the fetus is the most vulnerable), length of exposure, exposure method (breathing, eating, skin contact, etc.) and finally the health of the person exposed. The effects of mercury exposure can be very severe, subtle, or may not even occur at all. The effects depend on the above factors but care should be taken to reduce levels of exposure. In addition, mercury can cause damage to the human central nervous system. The liver, lung and brain are most effected. Potential symptoms of long term exposure to mercury vapor are tiredness or fatigue, memory loss and severe joint pain. It has also been linked to birth defects, Alzheimer’s and Schizophrenia. Ultimately and perhaps the most well know effects of long term exposure are insanity and even death. By far the most popular depiction of mercury poisoning we know today is the character known as “The Mad Hatter” from Lewis Carroll’s Alice’s Adventures in Wonderland. In Victorian England, mercury was used in the manufacturing of top hats causing a high rate of mercury poisoning. At that time, many people died early as a result of mercury poisoning for those working in the hat industry. Continued on page 6

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Require standards for the type of Amalgam Separator

operation, and maintenance of one or more amalgam Installation, separators that meet the following requirements:

6. Compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) with Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95% removal efficiency. Compliance must be assessed by an accredited testing laboratory under ANSI’s accreditation program for product certification or a testing laboratory that is a signatory to the International Laboratory Accreditation Cooperation’s Mutual Recognition Arrangement. The testing laboratory’s scope of accreditation must include ANSI/ADA 108-2009 or ISO 11143. 7. The amalgam separator(s) must be sized to accommodate the maximum discharge rate of amalgam process wastewater. spring 2018

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

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Healthcare Environmental Solutions news

EPA Effluent Limitations Guidelines and Standards for the Dental Category (Amalgam Separator Rule) Continued from page 5

Ecological Effects of Mercury Exposure

cientists have found alarming levels of mercury accumulation in a wide variety S of wildlife species, causing reproductive and neurological problems. Birds and mammals that eat fish have more exposures to methylmercury than other animals in water ecosystems. Predators, including humans,that eat the fish, birds and mammals are also at risk.

Is the amalgam Collected in the separator considered a hazardous waste?

he amalgam collected in a separator is likely T to be a hazardous waste under the Resource Conservation and Recovery Act (RCRA) due to the mercury and silver content of the amalgam. Dental offices producing less than 100 kg of hazardous waste per month and less than 1 kg of acute hazardous waste per month are considered Very Small Quantity Generators (VSQGs) and are exempt from most RCRA requirements for the disposal of their hazardous waste (note that VSQGs were formerly called conditionally exempt small quantity generators (CESQGs), but were renamed in November 2016). The EPA generally does not expect dental offices collecting amalgam waste to be above the VSQG threshold.

State and Local Requirements

he EPA rule is a floor (i.e. a minimum T requirement), not a ceiling, for regulating discharges of dental office wastewater to POTWs. There may be additional requirements under state or local laws that exceed those in the EPA’s new rule.

Estimated costs for Dental Offices

he EPA has researched the estimated costs for dental offices ranging from small 1-2 T chair to very large 15 chairs dental offices with the new rule. Their estimate is based on values in 2016 and with government applied discounts, therefore the actual costs will be higher than those stated in the graph below. Realistically, year one cost will range from $80m to $100m and subsequent years from $50m to $60m allowing for non-discounted separators, replacement parts, etc. and 2017 prices. The graph below shows these costs as market potential due to the services and products required for compliance with the new rule. The EPA estimates there will be 1% growth in dental offices year-on-year in the US.

1. EPA Final Amalgam Separator Rule: Effluent Limitations Guidelines and Standards for the Dental Category 2. EPA Web site: Dental Effluent Limitations 3. Proposed rule: Effluent Limitations Guidelines and Standards for the Dental Category 4. Docket No. EPA-HQ-OW-2014-0693: Government Printing Office’s FDsys website 5. Office of Management and Budget: Rule - Reginfo.gov HEALTHCARE ENVIRONMENTAL SOLUTIONS news

ental amalgam discharged to POTWs has contributed to a significant portion D of mercury in our waterways. By regulating dental amalgam management, this new rule is anticipated to reduce that quantity more effectively than previous volunteer efforts. Dental Dischargers have until June 14, 2020 to come fully into compliance. Chris Wall is General Manager (North America) for medentex LLC and has nearly 30 years of experience in the dental and medical waste industry and was originally from London England but now lives in New Jersey. Questions regarding this article should be directed to Chris at 888-640-2527.

About the Healthcare Waste Institute

Useful Links:

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Conclusion

spring 2018

he Healthcare Waste Institute is made T of members representing transporters, suppliers, processors, and disposal facilities. Our mission is to facilitate responsible healthcare waste management among those handling infectious and hazardous waste arising from the healthcare industry. For more information contact Anne Germain at 202-364-3724.


Healthcare Environmental Solutions news

Study: Far-UVC Light Zaps Airborne Viruses Without Harming Human Tissue Continued on page 3

“What we tried to do was simulate that system,” Brenner explained. “We started with the influenza virus, attached them to aerosols and then flowed them across a window and exposed the window to far-UVC light. We then looked to see if the viruses were alive or dead . . . how well could the far-UVC light kill viruses in the air in real life situation attached to aerosols. The answer was very well, indeed.” While the results are promising, both Brenner and Perl say more research needs to be done. “This is what I would call a preliminary report,” Perl said. “Now the hard work has to continue.” That work would include determining whether the far-UVC light was effective at various distances as well as further ensuring that it was safe to be used around people, she suggested. In a typically envisioned situation, the lights, which are about 2 inches by 2 inches by one-quarter inch thick, would be placed or grouped in a ceiling and the intensity of the lights could be adjusted to best meet that environment, Brenner said. 2018 “You have to consider, in a hospital room or an airport, what is the Environmental Solutions - MWMA typical Healthcare concentration of bugs you would expect in those rooms and you would set thePage intensity appropriately,” he explained. Half Horizontal The far-UVC lights emit a purple light when on and might in the future incorporate conventional white visible light.

The study has prompted interest from school districts and other wanting to use the lights. Brenner says such use is probably at least two years away with success hinging on three areas: showing it works, proving it’s safe and bringing down the cost of the lamps. “I feel reasonably comfortable about the efficacy of far-UVC. I think it definitely works. It does kill microbes. If any of these applications come to pass, you need to be 350 percent certain that it’s safe . . . We’ve never done studies where we’ve specifically looked at skin cancer. We’ve always looked at DNA damage. I think we need to do some experiments [looking explicitly at skin cancer],” he said, adding that he plans to conduct about a year-long study into that safety issue. He said there was little concern about far-UVC affecting skin microbiome, which consists of thousands of species of bacteria. Widespread use of the lights could also be hampered by their cost, now about $1,000 each. Mass production of the lights could cut that cost by more than 90 percent, Brenner predicted. Approvals from federal government agencies would also likely be required before the lights could be used in public. Brenner and Perl are optimistic about the future of the lights. “These technologies are really going to be another arm of what we need for protection against infection,” Perl said.

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News Briefs

New “Smart” Door Handles Have Built-In Sanitizers

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and hygiene compliance continues to challenge in healthcare settings, but one company has come up with a solution – a door handle that dispenses hand sanitizer, according to a UK news service (CetusNews.com). The PullClean smart doorhandles made by Altitude Medical employ a push button, which makes them natural and easy to use. The handles first were trialed in the US and saw the percentage of people sanitizing their hands more than triple, from 24 per cent to 77 per cent. Now the PullClean handles have been introduced in the UK, which has been hit hard by Aussie flu this season. At least 23 people have died from flu in the UK this winter season. Flu cases will continue to rise, Public Health England has warned. Aussie flu is particularly dangerous to elderly, children, pregnant women, and people with weakened immune systems.

Survey: 54 Percent of Healthcare Facilities Allow Clinicians to Wear Scrubs Home

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any healthcare facilities allow employees to wear their scrubs to and from work, even though infection preventionists from these same facilities identify the practice as an infection risk, according to a TRSA survey emailed to Becker’s Hospital Review. For the survey, TRSA polled more than 1,400 infection prevention experts at healthcare facilities nationwide. Here are four survey findings. 1. More than half (54 percent) of facilities allowed employees to leave work while wearing their scrubs and clean them at home. 2. Sixty percent of facilities allowed employees to wear their scrubs into the hospital before work. 3. A majority (79 percent) of infection preventionists said putting scrubs on at home and wearing them into a facility presents an infection or contamination risk to patients. 4. Eighty-six percent of respondents said wearing scrubs home from the hospital poses an infection or contamination risk to the public.

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spring 2018

Chinese Scientists Experiment with Light to Kill Bacteria

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new study shows that antibacterial film combined with light is effective for disinfection and infection prevention, according to a paper published in the Wiley online journal, Small. The concept of using light in combination with a photosensitizer to induce a phototoxic reaction is similar to photodynamic therapy that is used for skin cancer. In this case, Chinese researchers used black phosphorus nanosheets as the initial photosensitizers and a reactive oxygen species, endoperoxide, that was stored on the nanosheet, or antibacterial film. The mechanism, they learned, can achieve long-term disinfection. Once the endoperoxide is stabilized, it is capable of timedependent release in the absence of light. The research team tested the antibacterial film against gram-negative Escherichia coli and grampositive Staphylococcus aureus. They conducted in-vitro experiments and live/dead staining after which they used scanning electron microscopy to see results. The imagery showed that the application of endoperoxide combined with light and photosensitization destroyed both bacteria. Tissue samples showed reduced inflammation and no abnormalities or lesions, demonstrating the in-vivo biocompatibility of antibacterial film.


News Briefs

Stericycle Inc. Fourth-quarter Profit of $89.2 Million Below Projected Earnings

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ccording to the Centers for Disease Control and Prevention (CDC), record setting cases of all four major flu strains have been circulating throughout the U.S. during the 2017-2018 season. During week 7 (February 11-17, 2018), the most frequently identified influenza virus subtype reported by public health laboratories was influenza A (H3). The percentage of respiratory specimens testing positive for influenza in clinical laboratories remained elevated. The proportion of deaths attributed to pneumonia and influenza (P&I) was above the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System and largely attributed to the influenza A (H3N2). A total of 97 children have died of influenza-associated illness since October 2017. Although adult deaths from flu are not tabulated, the CDC estimates that 8.2 percent of those for the week ending February 17 were due to pneumonia and influenza – a statistic more than one percent higher than usual. The CDC reported a cumulative rate of 74.5 laboratory-confirmed influenza-associated hospitalizations per 100,000 population, and a spike in the number of outpatient visits for influenza-like illness (ILI) to 6.4 percent, which is above the national baseline of 2.2 percent. All 10 regions reported ILI at or above region-specific baseline levels. New York City, the District of Columbia, Puerto Rico and 39 states experienced high ILI activity; five states experienced moderate ILI activity; three states experienced low ILI activity; and three states experienced minimal ILI activity. H3N2 also was the predominant strain during the 2014/2015 flu season, which resulted in 56,000 deaths, 710,000 hospitalizations and 36.5 million symptomatic cases, said Dr. Dan Jernigan, director of the influenza division at the federal Centers for Disease Control and Prevention. The H3N2 strain did circulate during the 2016/2017 season, but rates of infection were fewer, resulting in a lower immune response in the population this season. Three factors determine the severity of season — the nature of the virus, the population’s previous exposure and the vaccine match. In a statement last January, Dr. Alicia Fry, a medical officer and team leader for the Influenza Prevention and Control Team at the CDC, said that during the 2016/17 season, vaccine coverage helped prevent 84,600 hospitalizations; 2.6 million outpatient visits and 5.3 million illnesses.

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

spring 2018

Epidemiologist Emphasizes Need for Pandemic Preparedness

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hoenix, AZ – Posting in a ContagionLive.com article, a U.S. epidemiologist notes that the challenges of the 2017-2018 flu season, urging healthcare professionals to make significant improvements in infection control and public health awareness. Saskia V. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children’s Hospital, believes that misunderstandings about the spread of flu germs, as well as lapses in hospital isolation and inconsistent adherence to hand hygiene have hampered control of the flu outbreaks. Shortages of flu test kits and intravenous (IV) bags, among other preparedness and treatment methods have been strained, she adds, noting that the current level of management would be inadequate should an influenza pandemic occur at proportions seen during the Spanish flu pandemic of 1918-1919. In addition, new study findings are disrupting long-held conclusions about influenza transmission. Surgical masks, for example, do not capture smaller influenza droplets. Sneezing and coughing are not required for influenza aerosolization, Popescu relates. One important finding is that fine aerosols are shed when a patient is just breathing. Popescu urges healthcare professionals to take cues from this year’s influenza season to update and strengthen their infection control programs.

The Best Defense Against Hospital-Acquired Infections

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indings of a study published in the February 2018 issue of the International Journal of Infectious Diseases show that manual cleaning is the best way to prevent hospital-acquired infections (HAIs) such as Clostridium difficile infection (CDI). Researchers from the Virginia Commonwealth University Health Infection Prevention Program conducted a survey of 7000 published research articles to review qualitative and quantitative data on the impact of manual cleaning techniques on reducing HAIs. Also revealed was that continuous assessment and feedback provides the most practical approach to environmental cleaning for healthcare facilities, particularly those with limited resources. Lead by investigator, Michelle Doll, MD, MPH, the team pointed out that limited healthcare settings face different challenges when it comes to environmental health. Most of the research on environmental cleaning to avoid infection in healthcare settings has focused on countries and healthcare systems with abundant resources to deal with environmental cleaning, the study authors noted. The findings also showed that “the extent to which the hospital environment contributes to hospital-acquired infections (HAIs) continues to be controversial,” because “the extent to which environmental contamination contributes to healthcare-associated infections is unclear,” the authors said. Effective ways to prevent HAI include: •

Manual cleaning of “frequently touched hospital services”

Careful maintenance and cleaning of water sources (sinks, ice machines and bath areas)

Trained, monitored cleaning teams for high-risk areas, such as patient rooms of CDI-positive patients and enhanced cleaning through the use of methods specific to those organisms and problem areas

Proper hand hygiene and meaningful monitoring/assessment of cleaning performance

Existing research has not shown significant impact on specific acquisition rates for MRSA and CDI among patients where antimicrobial surfaces (such as copper-containing surfaces), “touchless” technologies (UV-light emitting robots and hydrogen peroxide aerosols) are used.


News Briefs

CDC Program Supports State Efforts to Identify, Combat Resistant Bacteria

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tlanta, GA – Since 2016, CDC has provided $144 million to 56 state and local health departments and Puerto Rico to address antibiotic resistance. CDC has also invested more than $76 million in some 60 universities and healthcare partners to find and implement innovative ways to prevent resistant infections and contain their spread. Thirty-eight states and two cities now use whole genome sequencing to monitor for outbreaks and identify antibiotic resistance for Listeria, Salmonella, Campylobacter, and coli that are commonly transmitted through food and animal contact. When these outbreaks are detected, local CDC-supported epidemiologists investigate the cases to stop the outbreaks and spread of resistance. Since the end of fiscal year 2017, six more health departments successfully implemented whole genome sequencing. The CDC plots 170 success stories from fiscal year 2017 that the CDC on its Antibiotic Resistance Investment Map, an online tool that tracks investments the agency has made in state efforts to combat the emergence and spread of drug-resistant bacteria. The funds, which are provided through the CDC’s Antibiotic Resistance Solutions Initiative (ARSI), include money for state and local public health laboratories to help identify and track drug-resistant pathogens and for healthcare-associated infection prevention programs to curb the spread of these microbes in hospitals. The approach appears to be working. So far, •

Oklahoma and Connecticut each have successfully identified and contained a single case of Candida auris, a multidrug-resistant fungus that can cause deadly infections.

In Tennessee, when a person got a rare and concerning infection, the state health department and facility immediately began CDC’s containment protocol and isolated the patient. Within 48 hours, the teams fully executed the containment protocol (Antibiotic Resistance Lab Network testing, infection control assessments, colonization screening). Since then, the facility has not identified additional cases.

Michigan reduced Carbapenem-resistant enterococci (CRE) by 30 percent in 40 facilities and prevented more than 300 infections through its surveillance and prevention initiative.

In Kentucky, an aggressive and coordinated response to a rare and concerning resistance gene successfully contained the outbreak and stopped its spread.

California increased its local response capacity to combat resistant gonorrhea and increased its rapid susceptibility testing by eightfold. Susceptibility testing shows how well a gonorrhea strain will respond to specific antibiotics. These results are used to inform local outbreak response action, national treatment guidelines, and antibiotic resistance trends.

In Iowa, CDC funds helped state public health officials identify and rapidly contain an enzyme that can make bacteria resistant to lastresort antibiotics.

Texas used CDC funds to place antibiotic resistance epidemiologists across the state. Learn more about CDC’s AR Solutions Initiative and ongoing work to combat AR at www.cdc.gov/DrugResistance. •

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News Briefs

The Latest Guidance on Contact Precautions for Drug-Resistant Infections

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ew York, NY – The Society for Healthcare Epidemiology of America (SHEA) has released new guidance advising hospitals on when they can safely discontinue contact precautions for patients with multi-drug resistant bacteria, PTCommunity. com reports. The guidance, published in Infection Control and Hospital Epidemiology, advises from one to three negative cultures prior to discontinuing safety protocols to reduce spread of the bacteria, along with the use of molecular testing. The guidance also spells out contact precautions for gowns, gloves, and masks, which are specific to key multi-drug resistant organisms, such as MRSA, Vancomycin-resistant enterococci (VRE), and Carbapenem-resistant Enterobacteriaceae (CRE), as well as Clostridium difficile. Hospital personnel should weigh how much time has elapsed since the last positive culture to determine if contact transmission is likely. The guidance also advises on patient characteristics that could determine the duration of care. For Clostridium difficile infections (CDIs) specifically, the recommendation is to continue contact precautions for at least 48 hours after the resolution of diarrhea and consider extending if CDI rates are elevated despite infection prevention and control measures. At this time, insufficient evidence exists to make a formal recommendation on whether patients with CDI be placed on contact precautions if readmitted to the hospital. The recommendations state that any guidance should be overseen and revisited by infection prevention and control leadership, especially in outbreak situations. The authors note that hospitals should carefully assess their institutional risks, priorities, and resources prior to adopting a new policy on the duration of contact precautions, as well as weigh the cost and feasibility of implementation.

The 2018 Medical Waste Conference and Expo: Something for Everyone

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hose involved in medical waste management in any capacity will not want to miss the upcoming Medical Waste Conference to be held at the Gaylord Opryland Resort & Convention Center in Nashville, TN this April 13-15. Though only the second event for the Medical Waste Management Association™ (MWMA™), it already boasts a more robust curriculum than the first.

More Sessions with Broader Scope he 2018 Medical Waste Conference planners are well aware that medical waste management professionals come to an event such as this with a varying degree of experience and educational expectations. As a result, they have both increased the number of sessions and offered considerable diversity. Broadly speaking, the session content breaks down into sales, operations, and regulations with plenty to offer seasoned veterans and new entrants.

Hospital-Acquired Pneumonia Infecting Younger Patients

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rlington, VA – Gaps in prevention may be leading to greater risk of nonventilator hospital-acquired pneumonia (NV-HAP) in patients age 65 and younger, according to study findings published in the January issue of the American Journal of Infection Control (AJIC). Typically associated with the elderly and intensive care units (ICU), more than half of the NV-HAP cases reviewed for the nationwide study were patients 65-years and younger. In addition, the retroactive study (using cases from the year 2014) showed that pneumonia is occurring outside intensive care units. Up to 35.4 million US patients are at risk for NV-HAP annually—as compared to 3.9 million patients at risk for ventilator-associated pneumonia (VAP). And while both healthcare-associated infections (HAI) have a roughly 19 percent mortality rate, NVHAP costs health systems some $156 million, in contrast to the $86 million attributed to VAP costs. What’s more, patients with NV-HAP are 8.4 times more likely to require intensive care and/or die during hospitalization; 8.0 times more likely to require mechanical ventilation and, on average, have a readmission rate of 19.3 percent. The 1,300 patient cases collected from 21 US hospitals revealed: •

Roughly seven in 10 (70.8 percent) NV-HAP cases were acquired outside of the ICU. Of these cases, 43.1 percent were acquired in medical-surgical departments; 8.5 percent in telemetry; 7.2 percent in progress care units; 4.9 percent in oncology; and 2.8 percent in orthopedic.

Almost six in 10 patients (57.7 percent) recorded hospital stays that ranged upwards of 15 days. Of the patients transferred to the ICU, four in 10 (40.8 percent) stayed in the hospital more than 20 days. Of the 1300 cases, 19.3 percent were readmitted to the hospital within 30 days. Patients in the ICU typically stay in the hospital for more extended periods of time and are at greater risk for mortality.

27.3 percent of patients acquired NV-HAP in the ICU, indicating that patients in the ICU continue to acquire HAP despite preventive efforts in place.

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World Class Presenters and Panelists f course, the planning committee understands that the quality of a session is dependent not only on its content but that it must also be supported by quality presenters as well. As a result, the 2018 Medical Waste Conference features those in high regard within the industry as presenters and panelists.

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Innovation in the Exhibit Hall he 2018 Medical Waste Conference promises more than robust educational sessions. The exhibit hall will also deliver excellent industry innovations, including live demos of the latest software, many launching at the event, and a closer look at multi-purpose shredders. Pay attention to the MWMA on Twitter @MedWasteOnline as additional information on these conference opportunities are released leading up to the event. 

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One look at the agenda for the 2018 Medical Waste Conference and it is obvious that this year’s planning committee took their job seriously. Register today at www.medwasteonline.org/events.

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

spring 2018

Patient records showed that certain critical preventative measures were being skipped. For example, 58.6 percent of patients diagnosed with NV-HAP did not receive oral care; 81.8 percent did not receive incentive spirometry; 67.4 percent did not undergo cough and deep breathing exercises; and only 28.7 percent of patients stepped out of bed two or more times in the 24-hours prior to their pneumonia diagnosis. Dian Baker, PhD, RN, the study’s lead author and a school nurse program coordinator at the California State University School of Nursing noted the importance of standardization – from oral care protocols to tracking hospital-wide NV-HAP rates. “We predict that with the right interventions to cut NV-HAP rates in half, hospitals could save roughly 10 thousand lives, 490,000 hospital days and $2.43 billion in costs per year,” she said.


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April 13-15, 2018

The Power of Performance With the medical waste management industry constantly changing, industry professionals need new skills, new information, new tactics and new strategies to grow and succeed. Invest in yourself and your company by attending the 2018 Medical Waste Conference.

Quality Industry Sessions* • • • • • • • • • • • • • • • •

Keynote Speaker Presentation – No Excuses: Taffer’s Simple Science of Success Setting Standards: MWMA Best Practices and Their Inevitable Impact Zoning Challenges: To Fight, Flee, or Fly Under the Radar How Medical Waste Diversion Programs Succeed or Die RMW Container Regulations What’s New in State Regulations? What’s New in RMW Technology and Processing? Changing the Conversation: A Disruptive Approach to Selling Beyond the Pickup: In-Demand Value-Add Services for Health Facilities The Benefits & Challenges of Opening a Commercial Autoclave Treatment Facility Plasma Gasification: A Turnkey Solution for the Destruction of Hazardous Wastes Medical Waste Services Insurance: What Your Broker Might Not Know The Customers’ Perspective: What Keeps Them Awake at Night? The Regulators’ Perspective: What Keeps Them Awake at Night? How Breach Notification Impacts Medical Waste Processors And more…

Register Now +1 602-621-4007 | www.medwasteonline.org/events |

#MWMA2018

*Sessions subject to change. See our current list of sessions at www.medwasteonline.org/events

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News Briefs

Copper-Coated Uniforms Could Help Reduce HAIs

Antibacterial Wipes Do Little to Kill Microbes

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anchester, England – Material scientists at The University of Manchester, working in collaboration with universities in China, have created a composite material made from antibacterial copper nanoparticles, according to a Manchester.ac.Uk article. Using a process called ‘Polymer Surface Grafting’, the researchers have succeeded in binding the composite to materials such as cotton and polyester, fabrics most commonly used for uniforms and scrubs worn by healthcare providers. Prior to this breakthrough, techniques for binding copper to materials such as cotton for medical and antimicrobial textile production had limitations. In essence, the research team has tethered copper nanoparticles to cotton and polyester using a polymer brush, thus creating a strong chemical bond. They describe the composite as “durable, washable and concrete-like.” Precious metals, such as gold and silver, have excellent antibacterial and antimicrobial properties, but their commercial use in textiles is prohibitive due to extremely high costs. That means copper is the material of choice for researchers as it has very similar antibacterial properties to gold and silver but is much cheaper. Bacterial infection is a major issue in hospitals across the UK and has been rising due to its spread on surfaces and clothing. E. coli infections alone killed more than 5,500 NHS patients in 2015 and Government estimates put the cost of such infections to the NHS at £2.3 billion this year alone.

ewcastle, England – Research by a Northumbria University biomedical scientist shows that microbes on kitchen surfaces proliferate so rapidly that antibacterial wipes are practically useless, according to a MedicalDaily.com report. Appearing on a BBC Television show, Dr. Clare Lanyon explained the experiments she conducted at Northumbria. It takes about 6.6 hours for one cell to become one million cells, she said. The scientist also emphasized that removing all bacteria is not desirable anyway since exposure to pathogens helps to keep the human immune system healthy and strong. Wiping down an already-clean surface with antibacterial sprays is redundant because we carry bacteria and fungi on our bodies, depositing them on various surfaces where they recolonize, she explained. Studies conducted by Professor Peter Collignon from the Australasian College of Infection Prevention and Control have shown that vigorously scrubbing with soap and water and using vinegar and bleach work as well as antibacterial sprays and wipes, which have chemicals that persist in the environment. Collignon advises drying cleaning cloths and sponges properly after use and soaking them in bleach once a week.

Product/Equipment Profiles The Ultimate Room Mobile 60 Watt Disinfection System Chemical-Free UV Sterilization, By CureUV.com

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ur 60W GermAwayUV Mobile UVC Surface Sterilizer is designed with a 0-180 degree adjustable arm for complete room disinfection. The GermAwayUV mobile unit is ideal for virtually any room that needs total air and surface disinfection where permanent fixtures are not practical. This powerful UV mobile sterilizer is capable of safely sanitizing a room using UV-C energy in as little as 15 minutes. Ultraviolet Germicidal Irradiation (UVGI) is proven to disinfect 99.9% of harmful bacteria, viruses, mold spores, yeasts, C. diff, and odors in the air and on surfaces. Features & Benefits: • Two 35” high purity quartz UV bulbs provide 60 • User-Friendly Operation - 15 minute, 30 minute, and watts of combined power to effectively clean the 1 hour control modes air and surfaces • 60 second delayed start up with voice prompt to • 0-180° Adjustable Arm, Foldable Lamp Bracket and guarantee the safety of others 360° Universal Wheels • FREE Amber UV Safety Glasses WITH EACH UNIT www.cureuv.com For more information visit cureuv.com or call 800-977-7292.

Proximity Systems Announces New UV-Clean Self-Disinfecting Technology

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liminates 99.9% of infectious disease on high-touch surfaces around the clock, independent of human intervention Proximity Systems, Inc., recently announced its own Proximity UV-Clean selfdisinfecting technology, which helps reduce the transmission of infection pathogens in healthcare environments. Proximity has incorporated UV-Clean into the Classic SD and Embrace SD self-disinfecting (SD) cabinets, which reduce bioburden on hospital surfaces around the clock, independent of human intervention. The Proximity UV-Clean self-disinfecting technology delivers low levels of UVC light that damages the DNA of pathogens, effectively eliminating their ability to reproduce. Proven to kill up to 99.9% of infectious diseases when combined with important hand-washing protocols, UV-Clean gives hospital employees the peace of mind that all high-touch surfaces are being treated all the time. The UV-Clean technology is designed to attach to a monitor screen, insert into any wall mounted workstation or as a free-standing keyboard application. For more information contact us at sales@proximitysystems.com or call 800-437-8111.

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spring 2018


April 25–26, 2018

Las Vegas Convention Center (Central Halls) Las Vegas, NV USA

Find the right solutions to your healthcare waste needs. Stay up to date on the key legislative, regulatory and technical issues affecting the industry.

You need to be here!

Save time, money and practice responsible waste-management. If you’re in the business of collecting, generating or processing healthcare waste, then you need to be at the Waste360 Healthcare Waste Conference—it’s THE event of the year! You’ll get the latest insights on legislative, regulatory and technical issues that affect your industry and your job.

Register Today!

www.healthcarewasteconf.com

Join us in Las Vegas for productive sessions on timely topics such as: • Accreditation issues • Safety for workers, handlers, patients, and the community at large • Infectious disease updates and risks • Autoclave advancements and best practices • The growing importance of data in the industry

BONUS: Your registration includes access to the WasteExpo Exhibit Hall & a rockin’ 50th Anniversary Party on Monday evening. In Collaboration with:

Marketing Sponsor:

Co-located with:

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

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Visit us at the 2018 Medical Waste Conference April 13-15 Gaylord Opryland Resort & Convention Center Nashville, TN

www.cleanwastesystems.com

or, visit us at the 2018 Healthcare Waste Conference April 24-26 Las Vegas Convention Center Las Vegas, NV

Hes spring '18 final  
Hes spring '18 final