Evaluation of Environmental Evaluation of Environmental Controls: Controls:

Effectiveness and CostEffectiveness and Cost

Grigory V. VolchenkovGrigory V. VolchenkovOblast TB Dispensary, Vladimir, RussiaOblast TB Dispensary, Vladimir, Russia

Goal of the presentationGoal of the presentation

To overview engineering controlsTo overview engineering controls testedtestedTo describe the testing method usedTo describe the testing method usedTo present the testing results of some To present the testing results of some engineering controls availableengineering controls available and an and an attempt of their cost effectiveness analysisattempt of their cost effectiveness analysis

BackgroundBackgroundHigh level of nosocomial transmission in TB High level of nosocomial transmission in TB facilitiesfacilitiesUnacceptable occupational TB incidence among Unacceptable occupational TB incidence among staffstaffBoth increased availability and lack of resources Both increased availability and lack of resources for the infection control programs in TB facilitiesfor the infection control programs in TB facilitiesIncreasing and diversifyingIncreasing and diversifying commercialization of commercialization of room airroom air--cleaning devicescleaning devicesLack of independent reliable information about Lack of independent reliable information about efficacy of available environmental controlsefficacy of available environmental controls

VentilationVentilationVladimir Oblast TB dispensary, Vladimir Oblast TB dispensary, ““Alternativa Alternativa –– Klimat LtdKlimat Ltd””, Vladimir, Vladimir

General ventilation with heating of General ventilation with heating of air, negative pressure wards, UVGI air, negative pressure wards, UVGI units for air decontamination from units for air decontamination from high risk zoneshigh risk zonesReconstructionReconstruction 2005 2005 –– 2007 2007 Capital costCapital cost –– 345000 USD345000 USDMaintenance cost Maintenance cost –– 4425 USD per 4425 USD per yearyearPower consumptionPower consumption –– 37 KW/h 37 KW/h (electricity) and 0,8 GCal/h(electricity) and 0,8 GCal/h (heat)(heat)Service capacity Service capacity –– 17053 17053 мм33 of building space

Shielded UVGI fixtureShielded UVGI fixture((ModifiedModified ООBNBN--150, 150, P.P. Jensen, Jensen, ““Realnost LtdRealnost Ltd””, Vladimir, Vladimir

2 UVGI lamps2 UVGI lamps Philips TUVPhilips TUV--30W, 30W, one is one is shieldedshieldedUVGI level for shielded lamp complies to UVGI level for shielded lamp complies to Russian and international regulationsRussian and international regulations::

In occupied areaIn occupied area –– less thanless than 0,2 0,2 μμW/cmW/cm22In upper room unoccupied area In upper room unoccupied area ––higher than higher than 150 150 μμW/cmW/cm22 at the at the distance of distance of 1 1 mm

Cost Cost -- 200200 USDUSDPower consumptionPower consumption –– 60 60 WW

PotokPotok 150150MM--01 01 ((««PotokPotok--InterInter»»,, MoscowMoscow))

CapacityCapacity –– додо 150150 mm33//hhPower consumption Power consumption -- 40 40 WWWeight Weight -- 9 9 KgKgDimensions Dimensions -- 420420хх322322хх360 360 mmmmCostCost -- 4800 4800 USDUSD

Function principle:Function principle:

1 1 stage in inactivation zone stage in inactivation zone ––intensively fluctuating electric intensively fluctuating electric field and ionsfield and ions

2 2 stage in filtration zone stage in filtration zone ––electrostatic catching of electrostatic catching of particlesparticles

TreeTree ((««EOL LtdEOL Ltd»», , Korolev) Korolev) Tree Tree –– 100 (100 (‘‘single modulesingle module’’):):

CapacityCapacity: 100: 100±±10 10 mm3/3/hh; ; DimensionsDimensions: 430: 430хх300300хх150 150 mmmm; ; Power consumption Power consumption -- 40 40 WW..Cost Cost -- 450 USD450 USD

Electrostatic air cleaner based on Electrostatic air cleaner based on germicidal action of intensive germicidal action of intensive ““ionic windionic wind””and intense voltage electric fieldand intense voltage electric field

AerolifeAerolife LL (L(L -- 9024 C9024 C))««Aerolife LtdAerolife Ltd»», , LipetskLipetsk

Power consumptionPower consumption -- 2929WWAir flow capacityAir flow capacity: : night night / / daytimedaytime modemode 65/90 65/90 mm33//hhUV lamp light wave lengthUV lamp light wave length 320 320 –– 400 400 nmnm..DimensionsDimensions 470 470 хх 160 160 хх 170 170 mmmmWeightWeight 1.9 1.9 KgKgRecommended room volume Recommended room volume –– no more than no more than 9090 mm33CostCost -- 1270 USD1270 USD

Air cleaner based on UVAir cleaner based on UV--induced photoinduced photo--catalytic oxidation of air particles and gases catalytic oxidation of air particles and gases on the photoon the photo--catalysator surfacecatalysator surface

Testing methodTesting methodRoom: Room:

Negative pressure patient wardNegative pressure patient ward S=11S=11 mm22 хх H=H=22,,99 mm ((Volume = Volume = 32m32m33))

Equipment: Equipment: 1 1 compressorcompressor1 Collison nebulizer 1 Collison nebulizer 55 oil electric pumps oil electric pumps 4 4 Andersen OneAndersen One--Stage Viable (Microbial) Particle Sizing Stage Viable (Microbial) Particle Sizing SamplersSamplers1 1 Andersen SixAndersen Six--Stage Viable (Microbial) Particle Sizing Sampler Stage Viable (Microbial) Particle Sizing Sampler Swinging mixing fanSwinging mixing fanAnemometerAnemometerTimerTimer

Testing method (2)Testing method (2)

MaterialsMaterials::Sterile Petri dishes with nutrient soy agarSterile Petri dishes with nutrient soy agarSuspensions of indicator microorganisms:Suspensions of indicator microorganisms:

Bacillus subtilisBacillus subtilisSerratia marcescensSerratia marcescens

Testing method (3)Testing method (3)DesignDesign::

3 replicates of:3 replicates of:

2 2 microorganismsmicroorganismsVentilation Ventilation ON ON OFFOFFUVGIUVGI ONON OFFOFFPotokPotok ONON OFFOFFMixing Fan Mixing Fan ON ON OFFOFF----TreeTree ONON OFFOFF

Total Total -- 144 144 experiments,experiments,12960 air samplings12960 air samplings

Testing method (4)Testing method (4)

Protocol approved by P.Jensen (CDC), V.A. Protocol approved by P.Jensen (CDC), V.A. Puzanov (CTRI) and manufacturersPuzanov (CTRI) and manufacturers

Testing method (Testing method (55))

F=ke-ACHt,• F – remaining fraction of viable microorganism particles;• ACH – equivalent air changes per hour;• t – elapsed time (hours)

Testing method (6)Testing method (6)

Air Changes

per Hour

POTOK Air Cleaner Testing Results (ACH equivalent, B. subtilis)

1,09 1,25

2,452,92

3,59 3,78

4,87 5,04

6,56 6,577,34 7,55 7,61 7,61

8,99

0,00

1,00

2,00

3,00

4,00

5,00

6,00

7,00

8,00

9,00

10,00

Ventilation 1 1 1 1 1 1 1

POTOK 1 1 1 1 1 1 1 1

UVGI 1 1 1 1 1 1 1

Mixing fan 1 1 1 1 1 1 1

Mean ACH 1,09 1,25 2,45 2,92 3,59 3,78 4,87 5,04 6,56 6,57 7,34 7,55 7,61 7,61 8,99

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

POTOK Air Cleaner Testing Results (ACH equivalent, B. subtilis)

1,09 1,25

2,452,92

3,59 3,78

4,87 5,04

6,56 6,577,34 7,55 7,61 7,61

8,99

0,00

1,00

2,00

3,00

4,00

5,00

6,00

7,00

8,00

9,00

10,00

Ventilation 1 1 1 1 1 1 1

POTOK 1 1 1 1 1 1 1 1

UVGI 1 1 1 1 1 1 1

Mixing fan 1 1 1 1 1 1 1

Mean ACH 1,09 1,25 2,45 2,92 3,59 3,78 4,87 5,04 6,56 6,57 7,34 7,55 7,61 7,61 8,99

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

TREE Air Cleaner Testing Results (ACH equivalent, B. subtilis)

1,09

2,41

3,36 3,56 3,63

4,88 4,95 5,225,56

6,88

8,09

0

1

2

3

4

5

6

7

8

9

Ventilation 1 1 1 1

TREE 1 1 2 2 2 2 2 2 2 2

UVGI 1 1 1 1

Mixing fan 1 2 2 2 2

Mean ACH 1,09 2,41 3,36 3,56 3,63 4,88 4,95 5,22 5,56 6,88 8,09

1 2 3 4 5 6 7 8 9 10 11

TREE Air Cleaner Testing Results (ACH equivalent, B. subtilis)

1,09

2,41

3,36 3,56 3,63

4,88 4,95 5,225,56

6,88

8,09

0

1

2

3

4

5

6

7

8

9

Ventilation 1 1 1 1

TREE 1 1 2 2 2 2 2 2 2 2

UVGI 1 1 1 1

Mixing fan 1 2 2 2 2

Mean ACH 1,09 2,41 3,36 3,56 3,63 4,88 4,95 5,22 5,56 6,88 8,09

1 2 3 4 5 6 7 8 9 10 11

Actual Detected EfficacyActual Detected Efficacy((equivalent Air Changes per Hour, ACHequivalent Air Changes per Hour, ACH))

VentilationVentilation Shielded Shielded UVGI fixtureUVGI fixturePotok Potok

150M150M--0101 Tree Tree --100100 AerolifeAerolife--LL

Capacity Capacity according to according to official official manufacturer manufacturer documentationdocumentation

7,57,5 -- 44,,6868 3,133,13 2,812,81

Actual capacity by Actual capacity by testing resultstesting results 22,45,45 6,566,56 3,593,59 3,633,63 2,202,20

Importance of good air mixing Importance of good air mixing (impact of mixing fan)(impact of mixing fan)

Влияние вентилятора на эффективность обеззараживания воздуха (%)

0%10%20%30%40%50%60%70%80%90%

100%

UVGI Potok TREE Ventilation

With Mixing FanNo Mixing Fan

Влияние вентилятора на эффективность обеззараживания воздуха (%)

0%10%20%30%40%50%60%70%80%90%

100%

UVGI Potok TREE Ventilation

With Mixing FanNo Mixing Fan

Improvement 16% 5,3% 39,4% 19,2%

Relative cost of each evaluated Relative cost of each evaluated environmental control environmental control ((USD/ACH)USD/ACH)

Engineering controls

Capital and installation cost

Maintenance cost per m

onth

Cost of m

aterials per month

Cost of supplies per year

Unit life

Electrical energy consumption

(W)

Heat energy consum

ption(Kcal/h)

Relative C

apacity (patient wards S

32m3)

Determ

ined Efficacy(AC

H)

Cost of using (U

SD per year)

Relative cost (U

SD / equivalent 1 AC

H

during 1 year in one 32 m3 patient w

ard)

UVGI 200 0,5 0,3 15 10 60 0 1 6,56 94,69 14,44

Ventilation 345000 369 22,5 0 10 37000 800000 533 2,45 177475,25 135,91

Potok 150M-01 4800 2 1 0 5 40 0 1 3,59 1029,40 286,74

Tree 100 450 25 6 34,6 5,7 40 0 1 3,63 518,94 142,96

Aerolife-L 1270 3 3 17,2 10 29 0 1 2,20 240,41 109,28

Cost effectiveness of tested controlsCost effectiveness of tested controls

Cost of 1 equivalent ACH in the patient room

14,44

135,91

286,74

142,96109,28

050

100150200250300350

UVGI Ventilation Potok150M-01

Tree 100 Aerolife-L

Environmental controls

USD

Relative economical efficiency (Ventilation = 1,0)

9,41

1,000,47 0,95

1,24

0123456789

10

UVGI Ventilation Potok150M-01

Tree 100 Aerolife-L

ConclusionsConclusionsActual capacity of various engineering controls in the Actual capacity of various engineering controls in the particular hospital settings can differ remarkably from the particular hospital settings can differ remarkably from the officially declared by manufacturer dataofficially declared by manufacturer dataIndependent adequate testing method of their efficacy is Independent adequate testing method of their efficacy is neededneededCombined use of different controls does not assume the Combined use of different controls does not assume the simple sum of their efficacysimple sum of their efficacyMixing fan and appropriate installment can substantially Mixing fan and appropriate installment can substantially improve the performance of engineering controlsimprove the performance of engineering controlsShielded UVGI fixtures remain the most effective and the Shielded UVGI fixtures remain the most effective and the least costly engineering control for TB facilitiesleast costly engineering control for TB facilities

Thanks to Paul A. Jensen, CDC Thanks to Paul A. Jensen, CDC for idea, expert and technical for idea, expert and technical

support of this researchsupport of this research

Questions?Questions?