Carole Hallamargues that the use of air decontamination systems to improve indoor air quality should be considered as part of Trusts’ infection prevention and control strategies. She warns that hand hygiene and surface cleaning are not enough. Click here to read the full article.
The burden of healthcare associated infections (HCAI) is a major concern across the world with an estimated 8.8 million patients affected across Europe in both acute and long-term care facilities with more than half being preventable.
Not only does HCAI result in poor outcomes for patients in terms of morbidity and mortality and but it also has a huge cost to healthcare providers. Modelled annual costs to the NHS are in the region of £2.7 billion and an estimated extended length of hospital stay of up to 25 days – what else could that money be usefully spent on and how else could the hospital beds be better utilised?
In addition to the costs and extended length of stay for patients with an HCAI, there is an even bigger concern around the growing incidence of antimicrobial resistance (AMR).
One in three microorganisms causing HCAI are resistant to at least one antibiotic making these infections harder to treat. With an estimated 4.95 million deaths globally associated with bacterial AMR in 2019 there has never been a more important time to prevent HCAIs.
Therefore, the principles of infection prevention and control are an essential strategy for preventing infections and the cornerstone in combating the spread of AMR. The SARS-CoV-2 pandemic has seen an increase in HCAI and an overuse of antibiotics increasing the risk of AMR, so they could not be a better time review infection prevention and control practices and to act.
One of the tallest skyscrapers, as part of one of the world’s most iconic skylines, opened for business during the COVID-19 pandemic with a high level of uncertainty surrounding what comes next.
WhenOne Vanderbilt, the second-tallest office tower in New York City, unlocked its doors in East Midtown Manhattan in September 2020, it was during a stage of the pandemic when many employees were working from home as questions persisted about when they would return to the office.
The Novaerus Defend 400 is a CE marked device that combines WellAir’s patented NanoStrike™ Technology with a triple-stage filtration system to optimize the health of indoor spaces
Dublin and Stamford, Conn. — WellAir, the leading health technology company that provides indoor air disinfection solutions, today announced the European launch of its Novaerus Defend 400. Novaerus has been a pioneer in combatting airborne and surface transmitted hospital-acquired infections world-wide for over 10 years. The air cleaning device is CE marked and is 99.9% effective at inactivating airborne pathogens such as SARS-CoV-2 proxy virus (MS2 Bacteriophage), MRSA, bacteria, and fungi; while also purifying the air of particulate matter, volatile organic compounds, gases, and odours. With the launch, WellAir continues to chart a new path forward for healthy indoor environments at a time when air quality has never been a bigger priority.
Recent research published in the Journal of Hospital Infection also found that Novaerus air disinfection devices utilizing NanoStrike technology – a transformational method of air disinfection that bursts airborne pathogen cells, rapidly inactivating them to help ensure they are no longer a threat of infection – may contribute to the prevention of hospital-acquired infections by reducing the microbial load in the air. The study is the first of its kind to examine portable air cleaning and disinfection devices in an intensive care unit.
“We are bringing the Defend 400 to the European market at a turning point for indoor air quality, as more people are recognizing the role it plays in health and wellness,” said WellAir Chief Science Officer Felipe Soberon. “Given that much of this technology was developed in Dublin laboratories, it is great to see this technology now available in Europe, following a successful U.S. launch.”
Unlike other air cleaning technologies, NanoStrike’s effectiveness lies in its ability to inactivate nanosized pathogens on contact. The Defend 400’s four-stage pathogen inactivation and filtration process also utilizes medical-grade filters in order to capture bacterial debris, fine and large particles, VOCs, gases, odours, and impurities.
“COVID-19 has focused more attention on indoor air quality and has elevated the importance of safer indoor environments by reducing the risk of exposure to airborne pathogens. This is exactly what the Defend 400 is designed to do”, said WellAir President and CEO Todd M. Pope. “This portable device expands our product portfolio, delivering powerful air cleaning in multiple device sizes.”
The Novaerus Defend 400 is ideally suited for healthcare settings but is effective in a wide array of indoor environments, such as schools and offices. It is available through WellAir’s Novaerus global distributor network. For more information, visit https://www.novaerus.com/novaerus-defend-400.
WellAir’s mission is to make the indoor world cleaner and safer. The company’s broad range of clean air and surface products are scientifically proven to help safeguard how people work, live and play. WellAir, headquartered in Dublin, Ireland, with offices in Research Triangle Park, North Carolina, and Stamford, Connecticut, is a leading provider of infection control solutions.
TB patients have rationed medication, yet another practice known to spur antibiotic resistance. During the pandemic, most countries have reported sharp drops in tuberculosis cases, which means huge numbers of patients are going undiagnosed. In 2020, an estimated 500,000 more people than usual may have died of TB, and the number receiving TB treatment dropped by over 1 million.
“The more [patients] you leave undiagnosed and untreated, the more you will have next year and the year after,” warns Lucica Ditiu, M.D., of Stop TB Partnership.
Before COVID, tuberculosis ranked as the world’s leading infectious disease killer; it’s now number two. Drug-resistant forms of the disease account for about 29% of all deaths worldwide caused by bacterial infections. Treatment can last over 2 years and is both highly toxic and often ineffective.
Far worse is XDR-TB, extensively drug-resistant tuberculosis. Now found in 127 countries, this strain is resistant to four anti-TB drugs and represents 6% of all multidrug-resistant tuberculosis cases.
The TB Alliance calls XDR-TB “an extremely deadly and costly global health threat that the world must mobilize rapidly to tackle.”
Instead, understandably, the world is mobilizing against COVID-19.
Before the pandemic, the pipeline for antibiotic development had slowed to a trickle. Now, it’s essentially dry. When COVID emerged, the United States launched Operation Warp Speed to develop a vaccine; no such urgency has been mustered to fight TB or MRSA.
That’s because no incentive exists for drug companies to invest. Antibiotics, after all, must be used sparingly. In the United States, the development of a single antibiotic can cost $985 million, for an annual sales return of perhaps $50 million.
The global economic crisis, driven by COVID, has further dimmed investor enthusiasm. With all hands on deck to fight the pandemic, antimicrobial trials have been delayed. Reagents and researchers alike have been redeployed.
“Very few new innovative anti-bacterial treatments will come to the patients’ bedside in the coming years, and even fewer are targeting the most dangerous resistant bacteria,” warns Peter Beyer, Ph.D., a senior adviser to WHO on antibiotic resistance.
The Silver Lining: COVID Shines Spotlight on Airborne Pathogens
Yet, all is not bleak in the fight against superbugs.
While COVID-19 has suppressed antimicrobial research, the pandemic also has sparked awareness of airborne pathogens.
Hospitals now know: It’s not just door handles, bed rails, and scalpels that can be teeming with lethal microbes. The air we all share — in the emergency department, the operating theatre, the ICU — may be contaminated, too.
Of course, airborne superbugs have long been implicated in the transmission of hospital-acquired infection. As Iranian scientists observed well before the pandemic, “Antibiotic-resistant airborne bacteria can survive in the various hospital environments and remain suspended in the air for long periods of time.”
In fact, airborne superbugs posed such a danger that these scientists urged hospitals to deploy stand-alone air cleaning devices: “Use of advanced air purification and ventilation equipment, their constant monitoring, as well as a continuous microbial sampling of the hospital air are strongly recommended for preventing nosocomial infection.”
The COVID-19 pandemic has strengthened the case, prompting hospitals worldwide to install air dis-infection technology, such as NanoStrike™ Technology by Novaerus.
After all, the same devices that remove SARS-CoV aerosols also inactivate airborne superbugs.
MRSA, C. difficile, Acinetobacter species, and tuberculosis are among the bacteria shown by independent testing to be obliterated by Novaerus’ ultra-low energy NanoStrike™ Technology. Common viruses such as influenza and norovirus are removed by the same process.
NanoStrike™ Technology harnesses a range of physical concurrent pathogen inactivation processes to safely disinfect the air. NanoStrike coils provide a powerful strike that works to burst airborne pathogen cells, rapidly inactivating them, ensuring they are no longer a threat of infection.
Mounted above ICU beds, or wheeled into operating theatres, installed in wards and emergency rooms, Novaerus units safely operate 24/7 proximity to even the most vulnerable patients and protect medical staff as well.
It’s clear that both antibiotic stewardship and infection prevention are critical to slowing the rise of antibiotic resistance. Some experts argue that of the two approaches, infection prevention is the more urgent.
“Antimicrobial resistance is affected by many factors, but too much of our focus has been on antimicrobial usage,” two Australian physicians have asserted in JAC-Antimicrobial Resistance. “The major factor that drives resistance rates globally is spread.”
The countries most burdened by antimicrobial resistance, these doctors note, are those in which pathogen spread, rather than antibiotic overuse, is the dominant factor.
One of the most effective, most accessible, and least expensive, weapons against transmission is air disinfection.
Right now, all attention is focused on taming COVID-19, but the world cannot wait for the pandemic to subside before tackling the rise of superbugs. As a Harvard University scientist notes, “The antibiotic resistance crisis will continue well beyond the resolution of the COVID-19 pandemic.”
COVID-19 Has Amplified the Superbug Crisis. Hospitals Must Respond.
When the world gains control over COVID-19, infection control experts won’t get a reprieve. To the contrary, hospitals will need to confront the “pandemic lying in wait”: antibiotic resistance.
For decades, pathogens have been outwitting the antibiotics that revolutionized medicine in the 1940s. Well before COVID-19 emerged, drug-resistant “superbugs” were a global menace, costing 700,000 lives a year and straining hospital resources. Resistance had arisen to over 70% of bacteria — and to every antibiotic ever developed for use in the ICU setting. Infections once easily treated were requiring more toxic and complex regimens. None of this stopped when SARS-CoV-2 exploded.
“In the shadows of the COVID-19 pandemic,” Croatian scientists have warned, “there has been an ongoing antimicrobial resistance pandemic.”
Actually, the superbug crisis isn’t just “ongoing”; it’s primed to accelerate. Even more patients have taken antibiotics they don’t need. At the same time, those in dire need — patients with drug-resistant tuberculosis, for example — have seen their treatments interrupted. Research on new antibiotics, already lagging, has been halted.
In combination, these developments may well spawn new lethal variants and vexing nosocomial outbreaks. Without immediate action, common procedures — caesarean sections, knee replacements, cancer chemotherapy — will become riskier.
“We might be soon headed towards a post-antibiotic era, where a simple wound or a dental infection can be fatal,” warns Hatim Sati, M.D., a member of a World Health Organization (WHO) task force on antimicrobial resistance. “That is what’s at stake here.”
In response, hospitals must act on two fronts, dispensing antibiotics more judiciously while deploying more robust precautions against infection spread. Critical among these precautions is air disinfection.
Hand hygiene and surface cleaning remain important, but as the COVID-19 catastrophe has laid bare, all the antibacterial rub in the world won’t halt the transmission of an airborne pathogen.
Among the most worrisome superbugs, deemed “urgent” or “serious” threats by the U.S. Centers for Disease Control and Prevention (CDC), are Mycobacterium tuberculosis, Methicillin-resistant Staphylococcus aureus (MRSA), Carbapenem-resistant Acinetobacter and Clostridium difficile — all readily spread via air currents.
“The uncontrolled movement of air in and out of the hospital environment makes the bacterial persistence worse,” a research team noted in the Annals of Clinical Microbiology and Antimicrobials, “since these infectious microorganisms may spread easily through sneezing, coughing, talking and contact with hospital materials.”
Routine activities — mopping a floor, making a bed, cutting a bandage, removing a glove — can propel drug-resistant bacteria into the air. These aerosols can hover for hours and travel far.
Hospitals must be equipped to destroy airborne superbugs on a continual basis before these bacteria infiltrate open wounds, are inhaled by vulnerable patients, or mutate into strains that are impossible to treat.
How COVID-19 Has Amplified The Superbug Crisis
Antibiotics, of course, are worthless against viral infections, whether COVID-19, influenza or the common cold. Yet these drugs are routinely prescribed for patients infected by a virus, a practice that fuels antibiotic resistance.
Prior to the pandemic, over 30% of oral antibiotic prescriptions were unwarranted. Then COVID struck, and the percentage shot up.
Initially, doctors had trouble distinguishing COVID-19 from bacterial pneumonia, often prescribing antibiotics as a default. Or, antibiotics were prescribed for fear COVID patients might have bacterial co-infections. In most cases, the drugs were administered before tests confirmed, or ruled out bacterial infection.
This scenario was repeated on a global scale. Among COVID patients at 38 U.S. hospitals, 56% of patients received antibiotics early on, though just 3.5% actually turned out to harbour bacterial infections. In Europe, 75% of severe COVID patients received antimicrobials, though only 15% had documented infections. Similar numbers were reported in Asia.
Rampant overprescribing of antibiotics to COVID patients has largely stopped, but the damage may already have been done.
What’s more, the pandemic-driven increase in telemedicine has increased antibiotic use among non-COVID patients. In the absence of physical exams or lab tests, doctors reflexively prescribe these drugs for a wide range of symptoms.
“Antimicrobial stewardship may be another casualty of the COVID-19 pandemic,” the Croatian team observed.
An additional casualty: the treatment of patients who actually require antibiotics. Microchips, sofas, and stoves aren’t the only commodities in short supply these days. Antibiotics and diagnostic tests have been scarce, too, what with manufacturing interrupted, stockpiles depleted, travel restricted, and medical clinics shuttered.
For decades, a surgical patient’s risk of becoming infected was considered largely a factor of the patient’s own health, the surgical team’s skill, and the sterility of the surgical instruments.
Certainly, these factors matter. Patients who smoke, are obese, or have poorly controlled diabetes are at greater risk for infection. Procedures performed meticulously and with sterile instruments lead to fewer infections. However, as Danish scientists have noted, when it comes to infection risk factors, air quality is often disregarded.
It shouldn’t be.
In orthopedic and cardiothoracic operations, in particular, “the risk of surgical site infection is strongly correlated with the amount of airborne bacteria being present in the operating room and the surgical field,” asserts Mikael Persson, Ph.D., a Swedish mechanical engineer.
For example, research confirms airborne transmission of Mycobacterium chimaera from contaminated heater-cooler units commonly used in open-heart surgery. Patients have become infected even when the operating theatres were equipped with ultraclean air ventilation (laminar airflow).
With abdominal and breast surgeries, too, OT air contamination has been directly correlated with surgical site infection.
A team from Denmark and Ghana collected air samples during 124 surgical procedures, 11 of which (9%) resulted in confirmed infection. Substantially more air contamination was detected during the procedures that resulted in infection than during the procedures that did not.
Cementing the link, the scientists used genetic methods to match the bacteria captured in the air with the bacteria collected from the wounds.
In 8 of the 11 infection cases, a species match was found between bacteria isolated from the infection and the corresponding air isolates. In 6 cases, matching ribotypes were found.
The authors note that the hospital, a major teaching facility in Ghana, took great care to prevent infection. The scrub team wore sterile gowns and gloves. Incision sites were disinfected three times. Antibiotics were administered prior to first incision. Between procedures, surfaces and floors were cleaned with a 10% chlorine solution. The room was equipped with HEPA filtration.
Nonetheless, air sampling detected “high levels of airborne bacteria,” far higher, on average, than maximum levels recommended by the Healthcare Infection Society. Pathogens included S. aureus, Klebsiella spp. and Acinetobacter spp.
How do these bacteria infiltrate the operating theatre air and find their way into open wounds?
Airborne pathogens have many sources, including skin scales, dust, textile fibers, and aerosols produced by coughing and talking.
Particles can circulate via the convection currents created by the temperature differences between the body and the environment, explains French surgeon Dominique Chauveaux. In addition, particles settled on an unsterile floor can be dispersed by air eddies generated from opening doors and foot traffic.
In about 30% of SSI cases caused by airborne contamination, infection can be attributed to “direct settling of the particles on the wound,” according to Chauveaux. In the other 70% of cases, bacteria settle on the instruments and surgeon’s hands, “followed by transfer to the wound.”
Helping to Prevent Airborne Infection in the Operating Theatre
For years, surgeons have relied largely upon prophylactic antibiotics to prevent surgical site infection. However, given the rise of antimicrobial resistance, overuse of antibiotics has become a serious problem.
“Everyone just wants to [use] more antibiotics, [but surgeons] have to be good antibiotic stewards so that we are not the ones who are complicit in creating antimicrobial resistance,” cautions Bryan Springer, M.D., an American orthopedic surgeon.
Recently, attention has turned to keeping the OT air clean, so pathogens don’t have the opportunity to infiltrate wounds or settle on surgical instruments.
“Measures that decrease airborne particle counts are central to diminishing the risk of contamination by airborne microorganisms,” asserts Chauveaux.
Some of these measures rely on the behavior of surgical staff. For example, the surgical team should limit door openings, talk only when necessary, and enter the theatre one by one, rather than as a group. Healthcare workers should remove their gloves away from the surgical instruments and avoid cutting or stretching bandages near the surgical site.
But these strategies can only accomplish so much. As American surgeons have noted, behavioral measures have had just “a marginal impact” in reducing OT contamination or the risk of infections related to joint replacements.
What would have a larger impact? Air disinfection, particularly NanoStrike technology from WellAir.
WellAir’s Novaerus devices utilize NanoStrike Technology to inactivate airborne viruses, bacteria and mould spores. The technology harnesses a range of physical concurrent pathogen inactivation processes to safely disinfect the air. NanoStrike coils provide a powerful strike that works to burst airborne pathogen cells, rapidly inactivating them, ensuring they are no longer a threat of infection. Installed in operating theatres and ICUs worldwide, Novaerus devices safely operate next to the most vulnerable patients.
Though HEPA filtration is considered the gold standard in air purification, filters only trap pathogens. NanoStrike technology inactivates them, one reason Novaerus units are a critical addition to environmental control in the operating theatre.
Cleared by the FDA as a Class II Medical Device, the Novaerus Defend 1050 also protects OT personnel from exposure to “surgical smoke,” the toxic mix of volatile organic compounds (VOCs), other gases, and ultrafine particles emitted by lasers and cautery devices. As the U.S. Centers for Disease Control and Prevention confirms, these particles can cause headache, asthma-like symptoms, and eye, nose and throat irritation.
Surgical site infections are a global problem, affecting countries of all income levels. The cost of these infections, to patients and hospitals alike, is enormous, and hospitals must deploy every possible precaution, including air disinfection.
Writing in The Lancet Infectious Diseases, an American surgeon, Robert Sawyer, describes the magnitude of the SSI crisis, imploring hospitals worldwide to implement more robust measures. “An ounce of prevention,” he asserts, “is worth a pound, yuan, birr, or peso of cure.”
“Air quality deserves close attention”: Preventing Airborne Infection in the Operating Theatre
A few years back, in an operating theatre at a Japanese hospital, two physicians and two nurses donned gowns and gloves and prepared for a total knee replacement surgery. As the surgical team readied the instrument table and wrapped the patient’s leg, a highly sensitive camera filmed the action — not the team’s performance but rather the whirl of airborne particles stirred up by their movements and illuminated by a green laser.
Nobody’s knee was actually replaced in that room. The procedure was a simulation, designed to determine which movements spawn the most airborne particles which cause airborne infection in the operating theatre (OT) and where in the room these particles congregate.
Preventing Airborne Infection in the Operating Theatre
These are vital concerns. Airborne particles — dust, bandage fibers, skin scales, respiratory aerosols — can transport dangerous bacteria onto a surgeon’s gloves or scalpel or directly into an open wound, triggering serious infection.
Surgical site infections (SSI), the costliest and most feared of all healthcare acquired infections, plague hospitals worldwide. In low-income countries, over 10% of surgical patients become infected; in some regions a C-section or GI surgery might carry an infection risk of 19% or 23%. Even in wealthy countries, 2% to 4% of surgical patients develop infection; in emergency trauma surgery, that risk may rise to 15%.
Treatment for SSI can require a lengthy hospital stay and complex revision surgery. In the United States, surgical site infections are associated with nearly 1 million additional inpatient days, and 3% of surgical site infections turn lethal. In Africa, the death rate is nearly 10%.
Mortality rates are highest among patients infected with drug-resistant bacteria, such as Methicillin-resistant Staphylococcus aureus (MRSA), a common scenario and grave concern in the superbug era.
Even when hospitals take extreme care to disinfect wounds, sterilize devices, and clean the operating theatre, infections can take root. That’s because in most SSI cases — perhaps 80% to 90% — infections are triggered by pathogens that descended from the air.
“Contamination by airborne microorganisms plays a central role in the pathogenesis of surgical site infections,” asserts Dominique Chauveaux, a French orthopedic surgeon, who urges hospitals to make SSI prevention a “major priority.”
U.S. surgeons, writing in the American Journal of Infection Control, consider bacterial contamination of OT air “an underappreciated factor” in the origin of prosthetic joint infections.
Air quality deserves close attention
How do airborne pathogens infiltrate the operating theatre despite high disinfection standards and use of HEPA filters? Most important, how can the particle count be reduced?
The Japanese knee-replacement simulation offered some insight. Even the smallest movements — removing a glove, cutting a bandage, lifting a patient’s leg — can unleash an abundance of particles. When a surgical team files into the operating theatre, another study found, the particles stirred up by their shoes and gown hems drift to the level of the operating table.
Certainly, moving less, talking less, and limiting OT personnel can minimize air contamination. Still, measures like these aren’t enough. Neither are ventilation and air-filtration systems.
As U.S. surgeons point out, traditional precautions “have thus far resulted in failure to reduce the risk of microbial aerosols or contamination of implantable devices during arthroplasty surgery.”
A clean, quiet operating theatre and skilled surgical staff can do much to protect a patient from infection. Air disinfection technology that inactivates pathogens at the DNA level can amplify that protection considerably.
Appendectomy, abdominal hysterectomy, craniotomy, coronary bypass — all surgical procedures carry a risk of infection. However, prosthetic joint infections are “particularly devastating,” as Japanese scientists observe. Reducing these infections is both urgent and challenging.
“Since fighting infections depends on blood flow (which artificial implants obviously don’t have), both for an effective immune system response and to deliver antibiotics to the area, joint replacements can become safe havens for bacteria,” explains Jonathan Cluett, M.D., an American orthopedic surgeon.
What’s more, as the global population ages and obesity rates rise, hip and knee replacements will become increasingly common. Experts project a 13% increase in joint replacements and a 14% increase in resulting infections by 2030. A single infection can cost over $400,000. The death rate in these cases is an estimated 2% to 7%.
“A periprosthetic joint infection can be as medically challenging to the patient as having cancer,” says Jeremy M. Gililland, M.D., a American orthopedic surgeon. Though the infection risk is 2% for a low-risk patient, “if that patient gets an infection, it is 100% detrimental to them.”
In many cases, the surgeon must remove the infected implant, cleanse the joint cavity, and implant a temporary joint spacer that is removed after 6 weeks of IV antibiotic treatment. About 10% of all arthroplasties are revisions. For these surgeries, the infection risk rises to 15% to 20%.
It’s not just joint replacements that often require re-operation after infection. In a British study, for example, 8% of neurosurgery patients became infected, and 9 out of the 20 infected patients required reoperation.
Since the early days of the covid-19 pandemic, singing has been a super-spreading culprit leading to an effect on the future of live entertainment.
What about Singing?
Until Covid-19 emerged, just one study, conducted in 1968 and prompted by choir-related TB outbreaks, had analyzed particles generated by singing. The study involved just three singers, none of them professionals.
Forty years later, the explosion of choir-related coronavirus outbreaks prompted larger, more robust, and more sophisticated studies. These trials, in combination with prior flu-focused research, provide insight on the safest way to reopen live entertainment and dining venues.
Scientists at Sweden’s Lund University, for example, compared respiratory emissions from 12 vocalists, including seven opera singers, under three conditions: singing, reading a book out loud, and breathing silently.
With metal funnels fitted around their faces, the volunteers performed for 2 minutes at a time while a vacuum pump continually introduced fresh air into the funnel. A high-speed camera imaged the emissions produced by five of the singers.
Overall, the results were unsurprising: “Normal singing generated significantly more aerosol particles than normal talking. Loud singing produced more particles than normal singing.” Also, the professional singers generated about twice as many particles as the amateurs.
One finding, though, was intriguing. While loud singing and loud talking both generated vastly more particles than normal talking and breathing, the difference between both types of loud vocalization was relatively small. In other words, infection might spread as readily at a noisy pub as at musical performance.
University of Bristol scientists obtained similar, but even more dramatic, results when they studied emissions from 25 professional singers from a broad range of genres — gospel, opera, jazz, and pop, among them.
Performing in a highly filtered operating theatre, volunteers sang single notes at different pitches. They also sang and spoke the “Happy Birthday” song at multiple volumes.
Like the Swedish scientists, the UK team found singing generates more aerosol than talking — about 1.5 to 3 times more. These differences, however, were “eclipsed by the effect of volume on aerosol production.”
Both loud singing and loud talking produced an astonishing 20 to 30 times more aerosolized particles than vocalizing at a typical volume.
Why Pubs and Future Live Entertainment Music Venues Must Clean the Air
Loud singing and loud talking — those are the hallmarks, along with exuberant merrymaking. TradFest, Dublin’s annual 5-day celebration of Irish music and culture. Since 2005, the festival has drawn top bands and massive crowds to historic churches, castles, and pubs. It’s an aerosol eruption of the highest order. Yet when the pandemic struck, organiser Martin Harte was determined not to cancel. With the right precautions, he felt, live performances could happen, even if live audiences could not.
At the time, plastic dividers and relentless surface cleaning protocols were all the rage in entertainment and hospitality. “Everyone was obsessed with handwashing and hygiene, as opposed to cleaning air,” Harte recalls. Even today, more than a year into the pandemic, “disinfectant mania” persists while ventilation, filtration, and air dis-infection are undervalued.
“Some people still don’t get it,” asserts microbiologist Emanuel Goldman, Ph.D., of Rutgers New Jersey Medical School. “They’re distracting the public from the measures that can really protect them.”
Among the most protective measures is air dis-infection, particularly NanoStrike technology, used in Novaerus portable devices.
Inside Novaerus’ sleek, compact units, coil tubes produce an electrical discharge that obliterates pathogens at the molecular level. Instantly, the DNA of a virus or bacteria becomes inert, harmless debris, and clean air is released back into the room.
Noaverus technology has been used in over 60 countries to fight Covid-19, particularly in hospital operating rooms, Covid wards, emergency departmentes, waiting rooms, and surgical theatres.
That’s largely why Harte chose Novaerus as his solution for TradFest 2021. For five days, musicians performed at Dublin Castle, with portable Novaerus units parked in the castle’s historic rooms but out of camera range.
“Novaerus isn’t a hygiene product,” says Harte. “This is something you’ll find in an ICU, in a neonatal unit. That was the level of protection we wanted.” The devices featured prominently in TradFest’s safety proposal to the Office of Public Works, the government agency that operates Dublin Castle.
“Novaerus helped us hugely in securing approval to use the castle and made all the difference in getting musicians to agree to perform,” Harte says.
In independent laboratory testing, the Defend 1050 has demonstrated a 99.99% reduction of live SARS-CoV-2 virus, within 30 minutes. Like other Novaerus units, the Defend 1050 shown similar efficacy with other airborne pathogens, including influenza, Clostridium difficile, Aspergillus, and surrogates for Measles virus, tuberculosis, and Methicillin-Resistant Staphylococcus Aureus (MRSA).
NanoStrike technology also destroys surrogates fortuberculosis and measles — two deadly pathogens that, while tamed, were never eradicated and continue to plague the globe, infecting millions each year. That may be the destiny of SARS-CoV-2, a virus expected to circulate well beyond the end of the pandemic.
For this reason, Harte says, and because he knows that noisy conversation itself can generate highly infectious aerosol plumes, he has encouraged bars and restaurants throughout Temple Bar, Dublin’s primary tourist district, to deploy Novaerus devices.
“I don’t think you can safely open any establishment, anywhere, without cleaning the air.”
If you are interested in learning more about the Novaerus products, additional information can be found here, or please contact Novaerus.
“Particles shoot out like a geyser”: Singing, Covid-19, and the Future of Live Entertainment
Since the early days of the covid-19 pandemic, singing has been a super-spreading culprit leading to an effect on the future of live entertainment.
Around the world, choristers have become infected at remarkably high rates. At a rehearsal in the United States, 53 of 61 singers contracted Covid-19, and a practice in France infected 19 of 27. A choir seminar in Austria left 43 of 44 singers infected, and after the Amsterdam Mixed Choir performed Bach’s St John Passion, 102 of 130 members fell ill.
Karaoke, too, has sparked numerous outbreaks, including an explosion of cases traced to a popular Quebec City bar. In the coronavirus era, noted Quebec City’s health director, “All singing poses a problem.”
Science shows that’s true. Singing emits high volumes of aerosol, and infectious particles generated by one singer can sail across a choir hall, as far as 13 meters, only to be inhaled by another. But is singing more hazardous than, say, loud conversation at a pub? Not substantially.
As British scientists have found, aerosol transmission of disease is “equally possible” whether the particles are produced by singing or loud speaking — a finding of importance to anyone who operates an establishment noisier than a library.
With vaccinations underway, we can plan for a time when choirs reconvene, karaoke bars reopen, restaurants operate at full capacity, and musicians get back on the road. But post-pandemic, the landscape for entertainment and hospitality will look different than it did before.
Moving forward, building operators will need a working knowledge of SARS-CoV-2 transmission and of the precautions, such as air dis-infection, proven to mitigate the risks of singing and socializing indoors.
“Covid is here to stay, in some shape or form, and we need to adapt,” says Martin Harte, CEO of The Temple Bar Company, the not-for-profit organiser of TradFest, Ireland’s largest festival of traditional music. Harte adapted by installing medical-grade air dis-infection devices at Dublin Castle, the historic fortress where TradFest musicians performed indoors, with government permission, amidst the pandemic. The sessions, livestreamed to a global audience, did not lead to a single infection.
“Music travels through the air, and so does the coronavirus,” says Harte. “I wasn’t going to put our performers or crew at risk.”
From TB to Covid: The Super-Spreading Power of Singing
In 1962, at an American boarding school, two boys, feverish and coughing, were diagnosed with tuberculosis and admitted to the hospital. Testing at the school turned up 25 more cases. A medical team was dispatched to study the outbreak. At the time, conventional wisdom held that TB was transmitted via large respiratory droplets and close contact. But intriguing rodent studies suggested otherwise. If guinea pigs could become infected from afar, perhaps humans could, too.
But how? What behaviors might spread the disease?
At first, the medical team was stumped. Though all 153 students slept in a single, poorly ventilated dormitory, the TB cases were randomly distributed. Classroom and chore groupings revealed no patterns, either.
But further analysis yielded a clue: Among members of the school choir, 60% contracted TB, compared to just 20% of the student body as a whole. Reporting in the Journal of the American Medical Association, the doctors noted that three other mid-century TB outbreaks had been associated with choir singing.
“It seems quite possible,” the doctors wrote, “that vigorous singing could be an effective generator of fine particles in large quantity.”
Today, we know that’s not just “possible” — it’s a fact.
“When you sing, microscopic particles burst forth from your mouth in a fountain of mist . . . shooting out like a geyser,” explains James Hamblin, M.D., an American public health physician. “The rush of exhaled air creates an aerosolized mixture of everything that’s lingering in the mucus membrane of your pharynx.”
This location, he notes, is “exactly where the coronavirus attaches and replicates.” Until Covid-19 began rampaging through choirs, the connection between singing and disease transmission had largely been forgotten.
Instead, aerosol scientists focused on more ordinary sources of respiratory emissions — coughing, sneezing, talking, and breathing. Studies were conducted for the purpose of helping reduce spread of the flu.
As one prescient research team, from the U.S. National Institute for Occupational Safety and Health, noted: “To prepare for a possible influenza pandemic, a better understanding of the potential for the airborne transmission of influenza from person to person is needed.”
What that study found: while coughing generated more viable influenza particles than mere breathing, the difference was not large and “both respiratory activities could be important in airborne influenza transmission.”
Another flu-focused study compared emissions while speaking at various volumes. “We showed that as you talk louder, no matter what you say, you will release more particles,” reported chemical engineer Sima Asadi, Ph.D., the study’s lead author.
The key take-away, Asadi said: “Talking is potentially as important as sneezing and coughing for influenza transmission.
“We Need to Face Reality Here”: Hospitals Must Prepare for the Next Pandemic
What Hospitals Must Do to Avert the Next Pandemic
Certainly, many critical pandemic precautions fall beyond the scope of hospitals. Governments, for example, must invest in more robust pathogenic surveillance — that is, sampling of animal populations to detect viruses that lurk — and in the development of vaccines that protect against multiple viruses at once. At the same time, much can be done at the hospital level.
Covid-19 Pandemic Effect On Hospitals
When Covid-19 struck, overrun emergency departments not only lacked the staff to care for infected patients but also lacked sufficient personal protective gear. On top of that, public-health experts assumed SARS-CoV-2 did not spread via aerosol, the same deadly and erroneous assumption that had been made decades earlier with measles and tuberculosis.
As a result, Covid-19 ripped through hospitals. A review of early cases in China found 44% of Covid-19 infections were hospital acquired. At a hospital in South Africa, a single case led to 119 infections and 15 deaths among staff and patients at five hospital wards, a nursing home, and dialysis unit. Eventually, precautions and protocols changed. Today, lessons learned from the early Covid period are driving hospital planning for the next pandemic.
Increasing surge capacity is a top priority, and plans run the gamut. Some hospitals are training rheumatologists and pediatricians to jump to intensive care in a pinch. Others are looking to architectural solutions, such as airport-like docking stations with interlocking modules that could quickly expand the emergency department — an improvement over the tent-in-the-parking-lot approach hospitals deployed at the height of the Covid crisis.
“Most EDs are poorly designed to protect staff, other patients, and visitors from highly contagious airborne transmission of an epidemic disease,” says Frank Zilm an architect specializing in healthcare design at the University of Kansas in the United States.
A hospital in Italy installed a “plug-in biocontainment pod” devised from a shipping container. In Los Angeles, architects are working on a way to erect, within days, a medical mini-city that could accommodate 1,000 patients and 6,000 staff.
Less grand and expensive ways of defending against pandemic disease include zero-contact intake systems, which allow for remote triage and patient registration. At one Boston hospital, for example, an iPad-equipped robot named Spot acts as intermediary between medical staff and potentially infectious patients. Still, all the innovations in architecture, robotics, and telemedicine won’t change reality: Hospitals are full of human beings, including infectious ones who need to be cared for, up close, by medical staff, and who share the same air as vulnerable patients on the premises.
That’s why hundreds of hospitals have turned to air dis-infection, particularly Novaerus NanoStrike technology by WellAir, as a means of preventing spread of Covid-19 and other airborne diseases, current and future.
Even before SARS-CoV-2 emerged, hospital-acquired infections — whether caused by viruses, bacteria, or fungi — were endemic. Each year in high income countries, 5% to 10% of hospitalized patients, including 30% of patients in intensive care units, were contracting an infection during their stay. Before Covid-19, in Europe and the United States, hospital pathogens were infecting nearly 6 million patients annually and were responsible for 140,000 deaths.
Covid-19 has only amplified the crisis and brought more attention to the airborne route of transmission.
NanoStrike is the unique, patented technology at the core of all Novaerus portable air dis-infection devices. The nanotechnology harnesses a range of physical concurrent pathogen inactivation process to safely dis-infect the air. Hospitals in over 65 countries have deployed Novaerus devices, particularly in operating rooms, intensive care units, emergency departments, waiting rooms, and surgical theatres.
Independent laboratory testing shows that within 15 minutes, the Novaerus Defend 1050 achieves a 99.99% reduction of the MS2 bacteriophage RNA virus, an accepted surrogate for SARS-CoV-2.
NanoStrike technology has shown similar efficacy with other airborne pathogens that hover in hospitals, including influenza, Clostridium difficile, Aspergillus, and surrogates for Measles virus, Mycobacterium tuberculosis, and Methicillin-Resistant Staphylococcus Aureus (MRSA).
In a 2015 article titled “The Next Pandemic: Hospital Management,” three physicians wrote: “The threat of pandemic infectious disease lurks quietly beneath the surface of everyday hospital operations and society at large.”
Though “moments of panic inspire waves of planning,” the doctors continued, the waves inevitably crest, planning becomes submerged by daily demands, and ultimately, nothing changes.
Post-Covid, of course, complacency is impossible. Hospitals, nursing homes, society at large — we’ve all experienced a tidal wave, and the threat of the next one can’t be ignored.
Even when the Covid pandemic ends, SARS-CoV-2 will remain among us, and the next pandemic pathogen will almost certainly be airborne as well. No matter what other precautions hospitals invest in, they must also upgrade their air dis-infection technology, one of the least expensive and most effective defenses against the spread of deadly disease.
If you are a medical or healthcare facility interested in learning more about the Novaerus products, additional information can be found here, or please contact Novaerus.