TB Infection Control

I was wondering who has had experience installing these lights in sub-Saharan Africa, where can they be obtained for the lowest price? Who has expertise in doing the installation and maintenance of the UVGI?

Thank you so much

Philip Lederer M.D.

Clinical Director UCSD Department of Medicine/ Maputo Central Hospital Educational Collaboration
Maputo, Mozambique

Hello Philip,
Ultraviolet light for upper room UVGI has been installed in the Butaro District Hospital in Rwanda. It is used in conjunction with large very slow moving fans which enable 12 changes of room air every hour. Unfortunately I cannot answer your other questions but I have emailed a couple of other people in the organisation who may have that information. I will add the information here if I am able to obtain it.

Sorry I forgot to add my identification. I am
Dianne Longson RN, MN
Nurse Education
PIH / Butaro Hospital
Rwanda

Dear Dianne,

I am involved in UVGI design in the RSA and will soon be appointed for
some UVGI design in the central Africa region.

I fully support the combination of upper volume UVGI units and ceiling
fans to improve the efficacy. It is also cost effective.

It will be interesting to exchange information on the sub-Saharan TB
situation with you. I am attending the Building Design and Engineering
Approaches to Airborne Infection Control at the Harvard School of Public
Health in August. I am sure that I will obtain valuable information
which can be applied to the Africa situation and I would gladly share
the info with you.

Dries Meyer. Independent Consultant.
()

Hi Dianne.
I am a researcher at the CSIR in Pretoria, where we have look at infection prevention and control measures throughout South Africa and in some of our neighbouring countries. It may interest you to know that after careful consideration the South African National Department of Health has decided to impose a moratorium on the procurement of these fittings in our public health facilities. Studies have shown upper room UVGI has enormous potential to provide effective, safe and cost-effective protection from airborne pathogens - particularly TB. So why this "drastic" step.

There are several reasons. In South Africa (throughout sub-Saharan Africa, I believe) there is no legislation regarding fixture specification or performance. There is some very useful guidance and resource material from CDC,WHO,MRC and others.

However persons procuring these devices are generally not trained or equipped to specify appropriate fittings - nor can they verify whether they work correctly.

In several cases (though certainly not all cases) unethical suppliers have installed fittings which have no germicidal effect (blue lights) and in many cases installations are not properly designed rendering them ineffective or harmful. Basing investment decisions for UVGI on lowest price may not be wise particularly in the absence ...

Hi Dianne.
I am a researcher at the CSIR in Pretoria, where we have look at infection prevention and control measures throughout South Africa and in some of our neighbouring countries. It may interest you to know that after careful consideration the South African National Department of Health has decided to impose a moratorium on the procurement of these fittings in our public health facilities. Studies have shown upper room UVGI has enormous potential to provide effective, safe and cost-effective protection from airborne pathogens - particularly TB. So why this "drastic" step.

There are several reasons. In South Africa (throughout sub-Saharan Africa, I believe) there is no legislation regarding fixture specification or performance. There is some very useful guidance and resource material from CDC,WHO,MRC and others.

However persons procuring these devices are generally not trained or equipped to specify appropriate fittings - nor can they verify whether they work correctly.

In several cases (though certainly not all cases) unethical suppliers have installed fittings which have no germicidal effect (blue lights) and in many cases installations are not properly designed rendering them ineffective or harmful. Basing investment decisions for UVGI on lowest price may not be wise particularly in the absence of regulation and independent validation.

It is critical to note that UVGI is not a maintenance-free solution. It is our experience that the installation is often done without provision being made (in budgets) for replacement of lamps. As lamps continue to glow even after they have lost effectiveness there is a false sense of security. Our estimates put maintenance costs at equaling investment costs in the South African context within about 5 years of installation. Also electricity consumption at the facility will increase.

In the end when deciding whether to use these fixtures at all please consider in addition to initial cost whether they can be maintained and to ensure that the installations are properly designed for safety and effectiveness and that this is independently validated.

Hope this helps.

Hello Peta
Your comments will be of particular interest to Dries Mayer (South Africa) and Peter Lederer (Mozambique)- see earlier posts.

However the UVGI is already installed in conjunction with fans during the building of the hospital in Butaro. Both maintenance and effectiveness will be carefully monitored.

I am sorry that it appears there have been some problems with installation in SA and that this has led to a moratorium on what is a very useful approach to management of TB infection control.

While I understand the SA MoH Response I think it is a pity.

Dianne Longson
Nursing Education
PIH/Butaro Hospital
Rwanda

Can you say how effectiveness of the UVGI installations at Butaro Hospital will be measured/monitored?

Thanks,
Mlp

The best that we can do to assure effectiveness is: 1) attend to maintenance, 2) monitor UV output, and 3) assure good air mixing. I have not personally seen the installation to say more.

Sent from my iPhone

Very interseting development with regards to UVGI. Although I still support the use of Upper room UVGI,the fact that it has been installed so often in a wrong way, makes you think about it twice. I agree fully with Edward Nardell's three points, but we have to keep in mind that if the first installation is not done by qualified people, cleaning/monitoring/ventilation might not be of any use. I will take the CSIR point of view in consideration as we are currently working on Standard and Norms for Health Facilities in Namibia.

Hi Hans,

My e-mail address is . Please will you provide me with your contact details as I wish to discuss Norms and Standards. We have just embarked on a project to rewrite ours and there may be synergies. Apologies for irrelevance to other ghdonline site users.

In general I agree with the contents of Peta's reply but wish to add the
following comments:

The lack of UVGI legislation is a serious defect in the RSA health
system and that of most other countries in the world. This is a
disadvantage to healthcare workers.

It is correct that the persons procuring UVGI units do not have the
technical knowledge to differentiate between the units offered in
tenders or quotations. The tender documents or quotations must however
be prepared by trained technical personnel so that the procuring
personnel can clearly see the difference between products complying with
the specification and cheap and nasty units. The lack of trained
consultants and technical personnel is the biggest contributor to the
problem.

There is a general conception that a UVGI unit must emit blue light to
indicate that it is functioning. This is the reason why unscrupulous
companies install UV-A lamps in the UVGI units and sometimes mix them
with UV-C lamps to save manufacturing costs. UV-C can not be seen with
the human eye. The lack of radiometers to measure the UV-C irradiation
of the installed units is also a problem. Tenders/ quotations never call
for calibrated radiometers because ...

In general I agree with the contents of Peta's reply but wish to add the
following comments:

The lack of UVGI legislation is a serious defect in the RSA health
system and that of most other countries in the world. This is a
disadvantage to healthcare workers.

It is correct that the persons procuring UVGI units do not have the
technical knowledge to differentiate between the units offered in
tenders or quotations. The tender documents or quotations must however
be prepared by trained technical personnel so that the procuring
personnel can clearly see the difference between products complying with
the specification and cheap and nasty units. The lack of trained
consultants and technical personnel is the biggest contributor to the
problem.

There is a general conception that a UVGI unit must emit blue light to
indicate that it is functioning. This is the reason why unscrupulous
companies install UV-A lamps in the UVGI units and sometimes mix them
with UV-C lamps to save manufacturing costs. UV-C can not be seen with
the human eye. The lack of radiometers to measure the UV-C irradiation
of the installed units is also a problem. Tenders/ quotations never call
for calibrated radiometers because most authorities see it as a
unnecessary cost.

When managed correctly UVGI installations are low cost. For example the
energy consumption of a Philips TUV PL-S 9W is 0.17A @ 230V. The lamp
burning time and UV-C output depends on the installation environmental
conditions. The Philips graph indicating the relation between UV-C
output and burning time indicate a 15% drop in the UV-C output of the
TUV lamps after 12000 hours in laboratory conditions.

It is important to measure the UV-C irradiation at regular one or two
month periods after installation to determine the percentage drop in
output in the installed environment over a period of around 18 months.
The lamp replacement program can then be based on this info.

I found that in UVGI units with a 0.9 power factor correction and an
installed lamp temperature of 40°C (± 3%) the UV-C output dropped on
average less than 20% after 2 years.

There are several case studies on the internet which include the cost
effectiveness of UVGI installations.

The efficacy of any installation is depends on the manner in which it is
designed. operated and maintained.

Dries Meyer.

The most practical and cost effective way I know of is to to a bacterial
colony count with several petri dishes placed in strategic positions in
the room with the UVGI. If bacteria with a higher deactivation rate than
TB bacteria were deactivated it can be assumed that the TB bacteria were
also deactivated.

Dries Meyer.

Settling plates have never been shown to be effective in measuring anything relevant to upper room UVGI air disinfection and I would strongly suggest not to do this. Ambient air is loaded with environmental microbes that by definition are rather resistant to environmental stresses. Mostly you will grow mold and environmental mycobacteria.

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)

Dear Dries
As someone who has a keen interest in IPC especially for TB, several previous communications have reflected my concerns about UVGI. I think in SA, we leaped before we looked. Had we done a proper evaluation, considered all the consequences, we could have had a regulated and controlled entry of UVGI in areas where it would make a difference. I am not against UVGI per se, it is just that the infra structured required to maintain such systems are expensive and require considerable experience. Often UVGI was used as a substitute for good IPC practices- this was exemplified by Hans Mulder's investigation. I am sure there will come a time when we can use UVGI effectively, but at the moment we have neither the resources, nor the engineering skills to maintain UVGI in the public sector.
I would be most interested in your studies and findings.
Best Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences, Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 ...

Dear Dries
As someone who has a keen interest in IPC especially for TB, several previous communications have reflected my concerns about UVGI. I think in SA, we leaped before we looked. Had we done a proper evaluation, considered all the consequences, we could have had a regulated and controlled entry of UVGI in areas where it would make a difference. I am not against UVGI per se, it is just that the infra structured required to maintain such systems are expensive and require considerable experience. Often UVGI was used as a substitute for good IPC practices- this was exemplified by Hans Mulder's investigation. I am sure there will come a time when we can use UVGI effectively, but at the moment we have neither the resources, nor the engineering skills to maintain UVGI in the public sector.
I would be most interested in your studies and findings.
Best Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences, Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Visit the IPCAN website on
http://www.ipcan.co.za

Totally agree. Settle plates tell us nothing except that there are environmental bacteria, which should be there anyway. It is a very difficult problem and no easy solution, I am afraid, except the way the MRC's Air Lab is doing the studies. We await the results with abated breath.
S

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences, Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Visit the IPCAN website on
http://www.ipcan.co.za

Dear All

In response to this important discussion and in support of the
comprehensive postings from Peta and Dries, my own view is that we have
no option but to make UVGI 'work' in public sector health facilities
(referring specifically to the South African context without excluding
other countries or regions). We currently have a number of processes
under way both nationally and internationally; the challenge is to align
these to yield maximum benefit. Yes - there are issues around capacity
as well as regulation, design (both of UVGI fixtures and room
installations), in-situ assessments, testing and calibration,
procurement, maintenance, etc. but these are being addressed, with
support from important stakeholders. Yes, there will always be
Efficacy-Effectiveness Gaps in real-world situations, but again we must
put systems in place to keep these within manageable limits, through
relevant monitoring and evaluation processes and supported by informed
benchmarking and decision-making. As stated in an e-mail to this forum
some months ago, UVGI presents unique challenges from both health
technology assessment (HTA) and healthcare technology management (HTM)
perspectives. We owe it to the memory of Sidney Parsons (inter alia) to
find appropriate, affordable, equitable and sustainable solutions.
Working together, with guidance and counsel from ...

Dear All

In response to this important discussion and in support of the
comprehensive postings from Peta and Dries, my own view is that we have
no option but to make UVGI 'work' in public sector health facilities
(referring specifically to the South African context without excluding
other countries or regions). We currently have a number of processes
under way both nationally and internationally; the challenge is to align
these to yield maximum benefit. Yes - there are issues around capacity
as well as regulation, design (both of UVGI fixtures and room
installations), in-situ assessments, testing and calibration,
procurement, maintenance, etc. but these are being addressed, with
support from important stakeholders. Yes, there will always be
Efficacy-Effectiveness Gaps in real-world situations, but again we must
put systems in place to keep these within manageable limits, through
relevant monitoring and evaluation processes and supported by informed
benchmarking and decision-making. As stated in an e-mail to this forum
some months ago, UVGI presents unique challenges from both health
technology assessment (HTA) and healthcare technology management (HTM)
perspectives. We owe it to the memory of Sidney Parsons (inter alia) to
find appropriate, affordable, equitable and sustainable solutions.
Working together, with guidance and counsel from members of this forum,
we can do it. It really is "now or never".

Best regards

Mladen




MLADEN POLUTA
Director: HTM Programme, University of Cape Town
Dept. of Human Biology, Health Sciences Faculty, Anzio Road,
Observatory 7925 South Africa
Tel: +27 (0)21 406 6545 Fax: +27 (0)21 448 7226 Cell: +27 (0)82
353 8614

E-mail:
Website: www.htm.uct.ac.za

Please note that the UCT mail server blocks e-mails with zipped
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>>> On 2011/07/14 at 07:07 PM, <> wrote:




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Dear All
An interesting debate that moves from science to sentiment. I still maintain that in South Africa, as in the USA, UVGI is an adjunct and not a substitute for good IPC. It would help if we could have evidence of other matters before scarce resources on systems that require considerable infra structure to function.- Not once have I heard the word "education", "teaching" or evaluating understanding among the healthcare workers. The word "perspective" comes to mind.
Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Prevention and Control Africa Network (IPCAN)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences,  Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Register now for the 3rd IPCAN conference Namibia
1-3rd November, 2011
http://www.ipcan.co.za

Dear all
I absolutely agree that UGI is an adjunct to good IPC practice, not a
substitute. This is generally true for all technology.
Thanks for reminding us of this very salient fact, Shaheen.

--
We are what we repeatedly do. Excellence, therefore, is not an act but a
habit.
Aristotle

Dianne G. Longson
Tel.: +250 788507964 (mobile)

Dear Shaheen

I wish to avoid a public spat in this forum. Suffice to say that my
comments (I can only assume you were referring to my posting) are more
than sentiment. We all agree that UVGI is an adjunct to IPC, but an
important tool in the AIC arsenal nevertheless. Money is being wasted on
poorly planned and implemented UVGI installations as we speak, and that
is a concern. 'Education', 'teaching' and 'evaluating understanding' of
health workers are all part of the CSIR project. The words 'enquire
before judging' come to mind.

Regards

Mladen


###
UNIVERSITY OF CAPE TOWN

This e-mail is subject to the UCT ICT policies and e-mail disclaimer
published on our website at
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it is addressed. If the e-mail has reached you in error, please notify
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is not related to the business of UCT it is sent by the sender in the
sender's individual ...

I would add that for TB, all other transmission control activities are secondary to prompt diagnosis and institution of EFFECTIVE treatment based on (soon) rapid DST testing. No interventions are anywhere near as rapid or complete in their impact on transmission. Having said that, we need a full array of interventions, including separation and air disinfection by natural ventilation and, in many settings, mechanical ventilation or UVGI. Shaheen and Peta's comments noted, UVGI can be effectively and safely used in South Africa. It is not rocket science, but it does require good guidelines, honest and knowledgeable consultants, and effective and safe equipment. We absolutely know how to use UV safely and effectively. The results in South Africa that Shaheen refers to demonstrated 80% efficacy and another similar study in Peru showed 73% efficacy - the equivalent of many, many added air changes. In the AIR facility (Mpumalanga), which had 6 mechanical air changes per hour, 80% efficacy is the equivalent, roughly, of adding more than four times the ventilation, that is, the equivalent of 24 air changes per hour, or adding more than 18 air changes to the existing 6, at reasonable cost, and without noise or discomfort. There is ...

I would add that for TB, all other transmission control activities are secondary to prompt diagnosis and institution of EFFECTIVE treatment based on (soon) rapid DST testing. No interventions are anywhere near as rapid or complete in their impact on transmission. Having said that, we need a full array of interventions, including separation and air disinfection by natural ventilation and, in many settings, mechanical ventilation or UVGI. Shaheen and Peta's comments noted, UVGI can be effectively and safely used in South Africa. It is not rocket science, but it does require good guidelines, honest and knowledgeable consultants, and effective and safe equipment. We absolutely know how to use UV safely and effectively. The results in South Africa that Shaheen refers to demonstrated 80% efficacy and another similar study in Peru showed 73% efficacy - the equivalent of many, many added air changes. In the AIR facility (Mpumalanga), which had 6 mechanical air changes per hour, 80% efficacy is the equivalent, roughly, of adding more than four times the ventilation, that is, the equivalent of 24 air changes per hour, or adding more than 18 air changes to the existing 6, at reasonable cost, and without noise or discomfort. There is no one fix to TB transmission control (except perhaps rapid, effective treatment) and no reason to become polarized on this issue. Natural ventilation is great, but does not work if there is no breeze or if the windows are closed at night or in winter. Upper room UVGI is a near ideal complement to natural ventilation during those times. South Africa and Africa in general should not settle for second-rate TB control, in all its aspects. We have work to do to disseminate good standards, train consultants, and assure that good equipment is used, but it can be done.

Ed Nardell

Thank you Ed. My sentiments exactly! We are trying, and somewhat succeeded, in reducing occupationally acquired TB amongst healthcare workers with enforcing good IPC practices. We do not have UVGI but I am sure at some point, once the other aspects are in place, we will be able to establish a role for UVGI in our healthcare facility. In the meantime, it seems that vigilance, visit to each TB case (usually around 12 to 30 on any one day) seems to remind the staff of airborne precautions. We hope to be publishing our findings once we have gathered enough data.
My comments were more tongue and cheek than polarising- it was not meant to be controversial- just a tease! In the future I shall keep my macabre sense of humour to myself.
Regards

S

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences, Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Visit the IPCAN website on
http://www.ipcan.co ...

Hans
Could I please have your e-mail address.
S

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Prevention and Control Africa Network (IPCAN)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences,  Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Register now for the 3rd IPCAN conference Namibia
1-3rd November, 2011
http://www.ipcan.co.za

We will delete this response on Monday, which appears to be commercial. I don't know what the product is, but no ozone generation in occupied spaces is safe - although it is used for water purification. Again, this somewhat cryptic message will be deleted asap.

Ed (moderator)

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 8:20 AM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"Ozone Purification Technology manufactures lights
Testes by Sabs EC Pomliant Guaranteed For 12 Months
Lamps Must be Replaced Every 2.5 Years with 15-20% lamp life reduction over this ...

We will delete this response on Monday, which appears to be commercial. I don't know what the product is, but no ozone generation in occupied spaces is safe - although it is used for water purification. Again, this somewhat cryptic message will be deleted asap.

Ed (moderator)

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 8:20 AM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"Ozone Purification Technology manufactures lights
Testes by Sabs EC Pomliant Guaranteed For 12 Months
Lamps Must be Replaced Every 2.5 Years with 15-20% lamp life reduction over this period Rob

--
View this post online:
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This discussion is too narrowly focused and commercially taited for the large distribution of this group and will be deleted on Monday. My apologies to the community.

Ed (moderator)

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 9:00 AM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"to all in infection control.my name is Robert Spiteri
Aerobiological Tech/Eng.Manufacturer of UV. iam ashamed because of the practices my competitors have stooped to. The late Dr parsons of CSIR started to uncover the short falls.the use of UV-A ive pointed this out ...

This discussion is too narrowly focused and commercially taited for the large distribution of this group and will be deleted on Monday. My apologies to the community.

Ed (moderator)

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 9:00 AM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"to all in infection control.my name is Robert Spiteri
Aerobiological Tech/Eng.Manufacturer of UV. iam ashamed because of the practices my competitors have stooped to. The late Dr parsons of CSIR started to uncover the short falls.the use of UV-A ive pointed this out in no less than 6 facilities(to Whom do i cry to.I just Replace them with the correct lamps.Contractor is long gone)
Dr Parsons and i started to investigate a number of problems before he became ill his last lecture in June 2009 was partly are investigations into the problems Of UVC."

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Dear Robert,

Please STOP posting commercially-biased information in this website. I don't doubt what you say, but we would prefer to have unbiased reports from users or researchers than reports from either manufacturers or sales companies. Otherwise, this site could be viewed as an advertizing opportunity for industry and we do not want that. Your posts will be removed by the site administrators tomorrow. Please do not respond further. If you want to discuss with me personally, my email is .

Thanks,

Ed

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 12:12 PM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for ...

Dear Robert,

Please STOP posting commercially-biased information in this website. I don't doubt what you say, but we would prefer to have unbiased reports from users or researchers than reports from either manufacturers or sales companies. Otherwise, this site could be viewed as an advertizing opportunity for industry and we do not want that. Your posts will be removed by the site administrators tomorrow. Please do not respond further. If you want to discuss with me personally, my email is .

Thanks,

Ed

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 12:12 PM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"Good Evening Ed

Many thanks for replying. Ozone Purification Technology is a company that
employs both uvc ozone generating lamps for the water industry and non ozone
generating lamps.
The uvc non-ozone generating lamps(254Nm) are used in my upper air room
sanitiser. Website UV Ozone www.uvozone.co.za
My equipment is well known in the industry of air sanitation in both food
and medical.
This extremely versatile equipment that is ceiling mounted can be used with
or without louvers. The technology has moved away from four lamps to two
lamps. PLL.18w optimally matched to its ballast to give an extended lamp
life 24-7 for 2.5 years with a 15 to 20 % lamp life reduction over this
period unlike the 9w lamps that have a 40% lamp reduction in its first year,
deeming it necessary to replace lamps every year.

Kind Regards
Robert Spiteri
Aerobiological Tech Eng

-----Original Message-----
From: GHDonline (Edward Nardell, MD)
Sent: Saturday, July 30, 2011 4:03 PM
To: Robert Spiteri
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis:
Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for
Healthcare Settings

Edward Nardell, MD replied to the discussion "Environmental Control for
Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines
for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"We will delete this response on Monday, which appears to be commercial. I
don't know what the product is, but no ozone generation in occupied spaces
is safe - although it is used for water purification. Again, this somewhat
cryptic message will be deleted asap.

Ed (moderator)

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and
Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

-----Original Message-----
From: GHDonline (Robert Spiteri) [mailto:]
Sent: Saturday, July 30, 2011 8:20 AM
To: Edward Nardell
Subject: Re: [TB Infection Control] Environmental Control for Tuberculosis:
Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines for
Healthcare Settings

Robert Spiteri replied to the discussion "Environmental Control for
Tuberculosis: Basic Upper-Room Ultraviolet Germicidal Irradiation Guidelines
for Healthcare Settings" in the TB Infection Control community.

Reply contents:
"Ozone Purification Technology manufactures lights
Testes by Sabs EC Pomliant Guaranteed For 12 Months
Lamps Must be Replaced Every 2.5 Years with 15-20% lamp life reduction over
this period Rob

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Dear Prof. Mehtar,
I am looking at acceptability of masks and patient separation among TB
suspects anad patients. I am therefore, kindly requesting for your article
where you found that using a handkerchief and cloths are equally effective
to using masks .
Thanks
Esther Buregyeya

Dear Esther
Thank you for your enquiry. Being a clinician I do experiments which satisfy my own curiosity and I am afraid we did not publish it because it is anecdotal, however people far more capable than me have shown a 50% particulate reduction when wearing a mask- this I am sure will be published (right, Ed?) soon. Basically, my logic tells me that if I can contain the droplet and aerosol at the start of the cough, sneeze etc. then there should be minimum spread since the force of expulsion has been greatly reduced so the risk is reduced by the same proportion. Thankfully TB bacilli are not in the habit of floating off on their own!
I don't know if this helps.

Shaheen.

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Prevention and Control Africa Network (IPCAN)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences,  Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Register now for the 3rd IPCAN conference Namibia ...

Thanks Shaheethern. It has been very helpful.
Es

Dear Professor Mehtar,
Can i also have the references of your article in which you find that using cloths and handkerchief are equally effective to using masks. It is very interesting. Just give the title of the journal,the month and the volume so i can download it and read. Thanks.

Dr. Mehtar replied previously that there is no paper or study, just personal opinion, but she had asked me to comment based on our study of the efficacy of surgical masks on patients - recently submitted for publication.

We found about 56% efficacy of over-the-ear surgical masks on patients in preventing TB transmission to sentinel guinea pigs. However, this was under study conditions where nurses reminded patients to wear their masks. They were not asked to wear them when eating and surely did not wear them continuously despite monitoring. In the real world (not a study) I would expect less efficacy simply because they would be used less consistently. On the other hand, in a waiting room, I would expect that a patient would be very adherence for a few hours if given a surgical mask to wear - more so than if asked to wear it all day. Given the modest but useful reduction from enforced mask use, I would agree with Dr. Mehtar that a handkerchief or tissue may well be as effective IF the patient actually uses it. For patients who are very sick, weak, or confused, covering coughs may be difficult.

Hope this helps

Edward A. Nardell, MD ...

Dr. Mehtar replied previously that there is no paper or study, just personal opinion, but she had asked me to comment based on our study of the efficacy of surgical masks on patients - recently submitted for publication.

We found about 56% efficacy of over-the-ear surgical masks on patients in preventing TB transmission to sentinel guinea pigs. However, this was under study conditions where nurses reminded patients to wear their masks. They were not asked to wear them when eating and surely did not wear them continuously despite monitoring. In the real world (not a study) I would expect less efficacy simply because they would be used less consistently. On the other hand, in a waiting room, I would expect that a patient would be very adherence for a few hours if given a surgical mask to wear - more so than if asked to wear it all day. Given the modest but useful reduction from enforced mask use, I would agree with Dr. Mehtar that a handkerchief or tissue may well be as effective IF the patient actually uses it. For patients who are very sick, weak, or confused, covering coughs may be difficult.

Hope this helps

Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

617 432-6937 617 877-9412 (Cell)
(preferred) or

Dear Kalima
I think I have started something which I am not sure I intended to. By way of explanation, we did the work in-house and did not publish- anecdotal rather than research. But, it makes me wonder whether this work should be done. Ed and colleagues have done some work on this with surgical masks, perhaps he can comment.
Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Prevention and Control Africa Network (IPCAN)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital &Fac of Health Sciences,  Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
Register now for the 3rd IPCAN conference Namibia
1-3rd November, 2011
http://www.ipcan.co.za

Thank you very much for this information.

Dear all,
I am new to this forum and indeed 5 months into this area of expertise! So still a lot to learn!

As an architect on my first mission with MSF in Ulaanbaatar, Mongolia I have been asked to produce a series of proposals to improve Infection Control in the National TB hospital. There is a real problem here with IC so good mechanical ventilation systems as well as UVGI fittings need to be installed and well maintained to reduce the risk of infection.

A new ventilation system has been installed on 2 of 6 floors but the UVGI fittings that have been provided are left unplugged and I am not even certain that they are the right kind of UV, as no one has yet been able to supply me with the technical documents that came with the fittings.

More worrying still was the recent discovery that the specification of 60 new UVGI fittings for the hospial were the wrong specification altogether - 365 rather than 254nm. So Dries Meyer your comment that 'The lack of trained consultants and technical personnel is the biggest contributor to the problem.' certainly struck a chord!

I have a question related to in-duct ...

Dear all,
I am new to this forum and indeed 5 months into this area of expertise! So still a lot to learn!

As an architect on my first mission with MSF in Ulaanbaatar, Mongolia I have been asked to produce a series of proposals to improve Infection Control in the National TB hospital. There is a real problem here with IC so good mechanical ventilation systems as well as UVGI fittings need to be installed and well maintained to reduce the risk of infection.

A new ventilation system has been installed on 2 of 6 floors but the UVGI fittings that have been provided are left unplugged and I am not even certain that they are the right kind of UV, as no one has yet been able to supply me with the technical documents that came with the fittings.

More worrying still was the recent discovery that the specification of 60 new UVGI fittings for the hospial were the wrong specification altogether - 365 rather than 254nm. So Dries Meyer your comment that 'The lack of trained consultants and technical personnel is the biggest contributor to the problem.' certainly struck a chord!

I have a question related to in-duct UVGI, what are the benefits of installing UV lights inside extract ducts? I don't understand the importance of treating contaminated air that is being extracted especially if the extract is at high level above the top windows and into the atmosphere. I thought that if the air borne bacillus are extracted into the atmosphere above building height they would become so diluted and would no longer pose a threat?

The reason I ask is to help advise on future installations of of Mechanical Ventilation systems here as well as how to direct scarce funds to invest in UV lights for the most important locations.

Thanks very much in advance!

Sarah Newine Moore
BA(Cambs), MPhil(Cambs), MA(RCA),ARB

Architect for and on behalf of
Medecins Sans Frontieres
Ulaanbaatar, Mongolia

Brief answer for now. Thanks for real life indicator of difficulty of applying UVGI. Practical guidelines are desperately needed. Rarely a reason to disinfect exhaust air if properly vented away from people and air intakes. Most important interventions are: 1) active case findings, 2) rapid diagnosis, 3) separation, and 4) effective treatment based on rapid DSTs. If these are in place, much transmission can be averted.


Sent from my iPhone

Dear Sara,
 
In addition to what Dr. Nardell has just pointed out I would like to mention that if Mongolian regulations require high risk exhaust decontamination any way (like still in Russia now), in-duct UV-C irradiadiation is substantially less costly and much easier to maintain option than exhaust  HEPA-filtration. 

Regards,

Grigory


Dr. Grigory V. Volchenkov


Head Doctor
Vladimir Oblast TB Dispansery


Sudogodskoe shosse, 63
Vladimir 600023 RUSSIA


 
phone/fax work: +7(4922)323265
mobile +7 920 625 3227; +7 919 018 9226

Dear Professor Nardell and Dr Volchenkov,

Thank you both very much for your rapid feedback!

I think you must be right - it's most likely in the regulations to decontaminate high risk air exhaust - that would explain it. I will check with the Global Fund team and The Infection Control Consultant, who coincidentally, also works in Vladimir I believe!

Prefilters as well as the UV lights are installed in the ducts. Perhaps this is a case of 'overkill'?(if you'll excuse the pun)

In terms of the 4 key interventions - there is a lot of work being done by different medical teams, including MSF, to improve case finding, DST and rapid diagnosis (a MGIT machine has recently been introduced in the lab here). These are all issues that are being tackled by the specialists in those areas. Your third point - separation - forms the key part of the proposals I have put together - introducing a new entrance, stair and lift etc. Now all that's needed is funding!

Thanks again!

Sarah newine Moore
BA(Cambs), MPhil(Cambs), MA(RCA),ARB

Architect for and on behalf of
Medecins Sans Frontieres
Ulaanbaatar, Mongolia

Hi Sarah,

I apologise for my late reply. I attended the airflow course at Harvard
and could for some unknown reason not send or receive some e-mails on my
e-mail address.

I would gladly assist you with the UVGI design for the hospital and I
think it will be an interesting project. I will not charge anything for
the info and it will be a pleasure to do it.

I would appreciate it if you could forward the following info if available:

Floor plans of the building, indicating dimensions and a North, or other
wind direction, indicator.
Average summer and winter temperatures.
Floor to ceiling heights.
The manufacturer of the UVGI units installed, but not connected. Look on
the units to try and find a name or series number.
The type of units.
The units must emit 253.7nm UV-C (the germicidal wave length) and no
Ozone. Please send info on the lamp types so that I can obtain the
technical specs.
The normal supply voltage.
A photo of a unit if possible.
Paint finishes of the room ceilings and floors.

Drawings of the areas where air conditioning or ventilation was
installed will also be welcome so that I could ...

Hi Sarah,

I apologise for my late reply. I attended the airflow course at Harvard
and could for some unknown reason not send or receive some e-mails on my
e-mail address.

I would gladly assist you with the UVGI design for the hospital and I
think it will be an interesting project. I will not charge anything for
the info and it will be a pleasure to do it.

I would appreciate it if you could forward the following info if available:

Floor plans of the building, indicating dimensions and a North, or other
wind direction, indicator.
Average summer and winter temperatures.
Floor to ceiling heights.
The manufacturer of the UVGI units installed, but not connected. Look on
the units to try and find a name or series number.
The type of units.
The units must emit 253.7nm UV-C (the germicidal wave length) and no
Ozone. Please send info on the lamp types so that I can obtain the
technical specs.
The normal supply voltage.
A photo of a unit if possible.
Paint finishes of the room ceilings and floors.

Drawings of the areas where air conditioning or ventilation was
installed will also be welcome so that I could advise you on the airflow
direction and the positions of the outlets. The outlet positions
determine the fact of weather UVGI is required in the outlet duct. If
the outlets are at a safe position above roof level or in a position not
frequented by people, UVGI will also not be required. Do you know it
HEPA filters were installed ?

A site plan of the hospital will help me to scrutinise the outlet positions.

A drawing indicating patient and personnel flow.

Any other information that you can think of.

As far as languages are concerned: I can speak any language except
Greek, unfortunately Mongolian, Chinese or Russian is Greek to me. If
you could write the room names by hand on the drawings it will help a lot.

Regards,
Dries Meyer.