the day before tomorrow - national air filtration association€¦ · the day before tomorrow...

The Day Before Tomorrow

Preparing for Avian Influenza and other Emerging Infectious Diseases

Bill Palmer NAFA Tech Session

AeroMed, Inc. Phoenix 2007

Blissful Ignorance

The Fateful Forecast

Arrogant Intimidation & Manipulation

Denial of the Problems Extent

Overwhelmed

Acceptance

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

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

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.

Threats to Social Equilibrium from the Human Health Sub-System

Antibiotic Resistance

¢ Predicted from the beginning

¢ Resistance is transmissible

¢ Bacteria transfer resistance to each other

¢ Resistance is transmissible ¢ Bacteria transfer resistance

to each other ¢ Incidence of resistance is

increasing

¢ Bacteria transfer resistance to each other

¢ Incidence of resistance is increasing

¢ The geographic reach of resistance is increasing

¢ 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.”

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

XDR-TB Case in Phoenix

¢ If you see this man: l Good candidate

for imprisonment for not wearing a mask in public!

Bio-Terrorism

¢ Man induced ID outbreak

¢ Hospitals first line of defense

¢ Could start new epidemic (smallpox)

¢ Bio agents engineered to be resistant

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

Global Infectious Disease Rates

15.4 Chihuahua

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)

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

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

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

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.

Avian Influenza

Threats to Social Equilibrium from the Human Health Sub-System

We Can Shield Our Equilibrium With 5 Steps to a Solution

5 Stages of a Solution

¢ Due Diligence Regarding the Threats ¢ Acceptance ¢ Due Diligence of Potential Solutions ¢ Proceed with measured response ¢ Always Exhibit Due Vigilance

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

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

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

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

Seal Return

Set up HEPA unit and flex duct

Discharge air to the outside

Environmental Controls Responsive Measures – TNPI Discharge air to return air system

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

Portable Anteroom

Safe Area to Isolate Infectious Disease Zone (IDZ)

Temporary Surge Capacity Using HEPA Filter Exhaust

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

the day before tomorrow - national air filtration association€¦ · the day before tomorrow...

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