Toul mobile laminar air flow

Toul mobile laminar air flow Toul pendant system Toul steristay Toul mobile «operio»

A system from Sweden to reduce the infections in the operating room and field hospitals New 2014!

The main source of airborne microbial contaminants is microscopic skin fragments given of by staff theatre. The patient is not usually a significant source of airborne contamination; their movement is usually minimally. Movement can shed up to 10 000 skin scales per minute, of which 10 % carry clusters of micro-organisms. These will contain Staphyloccocus aureus and coagulase-negative staphylococci which are frequent causes of infection. (Noble W.C.: Dispersal of skin microorganism (Review). Brit. J. Dermatol. 93: 477-490, 1975.)

MRSA in Europe 2002 2005

. Extreme reduction of bacteria contamination Conventional airflow systems do mostly not arrive at the operating field as they are hindered by the surgical light and the heads of the operating team. Toul is positioned very close to the operating field and therefore it is possible to reduce the contamination level by almost 95 % for the operating field and Toul instrument table.

As few as 10 colony forming units (CFU/m3) are sufficient to cause a deep infection*. Gosden PE, Mac GowanAP Bannister GC J. Hosp Infect 1998; In an conventional operating room you can expect about 50 to 200 CFU/m3. This number is rising the more people are in the operating room and the longer the operation last. A main problem especially in longer operations is the contamination of surgical instruments due to human presence and their activity within the operating room.

An English Study from Whyte has been estimated that 98 % of bacteria found in the patient s wounds come directly (30 %) or indirectly (70 %, instruments!) from the air. There is a clear relationship between the quality of the air and the degree of sepsis encountered. Under normal circumstances, the main source of airborne microbial contaminants is microscopic skin fragments given off by staff in theatre. Richard I. Whyte Stanford University Medical Center, Cardiothoracic Surgery Stafilococco Aureo Pseudomonas (70 % of the bacteria found in the patients wound are coming indirectly (e.g. instruments!) via the air

Toul guarantees sterile conditions in the operating field and on the instrument table even in extreme conditions. Toul can be used immediately due to sterile screens which are to be exchanged just before the operation starts and guarantee a maximum sterility.

Conventional operating room ventilation In an conventional operating room you can expect about 50 to 200 CFU/m3. Studies of infection with conventional operating room Author Number of Patients Charnley 5.800 7 % Nelson 15.520 5,8 % Conventional operating room (%) D. Lew et al. 1.880 5,8 % 2.730 Jenny et al. 1.354 5,7 %

Author Laminar Air flow 20 UFC/m3 (it depends on the number of persons and the duration of the operation Studies of infection with Laminar air flow Number of Patients Laminar Air Flow (%) Charnley 5.800 0,5 % Nelson 15.520 0,7 % D. Lew et al 1.880 2.730 0,7 % Lidwell 8000 0,6 % Jenny et al. 1.354 0,9 %

Contamination level in the operating room Conventional Operating room Laminar Flow With Toul 50-200 CFU/m3 (depending on the duration of the operation and the number of persons in the O.R.) 20 CFU/m3 < 5 CFU/m3 CFU s on the instrument table Conventional operating room 50-200 CFU/m3 (depending on the duration of the operation and the number of persons in the O.R. Laminar Flow 20 CFU/m3 Toul Instrument table < 1 CFU/m3

Mobile unit for laminar sterile air -Filter HEPA: 99,999% DOP - Air quantity: max.480mc/h -Speed of air: 0,5mt/sec -Power supply: 230 VAC,50Hz -Consumption: 260W -Weight:42Kg

Hospitals do have more and more bacteria's with resistance against antibiotics The use of antibiotics in surgery represents about 40-50% of the total consumption of antibiotics in hospitals. This increases the risk of resistance against antibiotics like Staphilococcus aureus, Pseudomonas, Escherichia coli e Acinetobacter baumanii

Aprile 2006, Antibiotics in 10 to 15 years without use? According to an information of the WHO which was published in April 2006 we risk that in 10 to 15 years the antibiotics are useless. The germs have become more and more resistant to antibiotics. (CBS) In 1974, only two percent of staph germs were MRSA. By 1995, 22 percent were, and now that number is over 60 percent, and still rising. Patients who survive these drug-resistant germs sometimes have to spend months in the hospital and go through many surgeries to cut out infected tissue. 37 new antibiotics were put on the market in the years 80-90. In the nineteen's there were 7 new antibiotics and for the next 10 years there are only two new antibiotics foreseen!! The research for a new antibiotic costs more than 500 million Euro and ten years of studies. A lot of big companies are not ready to invest anymore in this sector as it is not lucrative anymore.

Hospital Infection Deaths USA Infections contracted in hospitals are the fourth largest killer in the U.S., causing as many deaths as AIDS, breast cancer and auto accidents combined. Hospital infections are now the fourth leading cause of death in the United States, behind heart disease, cancer and strokes, according to the Centers for Disease Control Nationwide more than 90,000 people every year die, 2 million people annually become ill from hospital-acquired infections. That's more than auto accidents and murders combined. Serious cases of antibiotic resistant infections cannot be cured, may destroy flesh and bones, require multiple surgeries, and often result in death. (CBS NEW YORK, June 8, 2005 ) (

ANTIBIOTIC RESISTENTENCE IN EUROPA (Verona, 20-21 November 2005 Maria Luisa Moro)

Costs of Infections The average cost to treat a Pennsylvania hospital (USA) patient who developed an infection was $29,000, compared with $8,300 for those who did not, the report found. Ceci Connolly Washington Post, July 13, 2005; TORONTO, Ont. -- Duke University Medical Center researchers "We found that average hospital stay due to methicilin-resistant S. aureus (MRSA) was 12 days longer, compared to four days longer for methicilin-susceptible S. aureus (MSSA)," "In terms of added cost, the average due to MRSA infections was $27,082, compared to $9,661 for MSSA.(Dr. Murray Abramson, Duke infectious disease physician 9/28/1997) As an example, Abramson cited penicillin, the first effective antibiotic. "When penicillin was first introduced in the 1940s, it was effective against almost all S. aureus strains. Today, about 99 percent of S. aureus is resistant to penicillin Estimates from South Australia indicate each hospital-acquired infection costs $22,000, making the annual bill $150 million (Dr Collignon, an infectious diseases specialist and microbiologist at Canberra Hospital April 9, 2005) A study from the hospital Sacco di Milan (2006) estimates that every infection costs about 9.000

S S I Risk factors Type of operation Duration of operation Condition of Patient

Clinical tests and CFU-values Sedimentation plate with cfu/m3 Sartorius

Karolinska, Sweden OP Result CFU/m3 1 <1 2 <1 3 <1 4 1 5 <1 6 50 * 7 <1 *TOUL switched off

Pacemaker Hospital Stockholm- OP Results in CFU/m3 Operation 1 0,5 Operation 2 1 Operation 3 0 Operation 4 1,5 Operation from 21 to 27 April 2005 Operation5 0 Operating Room 233 (99-383)

CFU-measurements at Södersjukhuset hospital Measurements performed by Karolinska university hospital hygienedep. Pacemaker implant 250 240 230 220 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 Operation 1 Operation 2 Operation 3 Operation 4 Operation 5 2005-04-27 CFU/m³ with Toul 400 CFU/m³ with Toul 300 CFU/m³ reference Reference: Measurements without Toul 400

Mobile zoned/exponential LAF screen - a promising new concept in ultra-clean air technology for additional operating room ventilation B. Friberg*, M. Lindgren*, C. Karlsson, A. Bergström* and S. Friberg *Departments of Nursing, Clinical Microbiology and Orthopaedic, Umeå University, S-901 86 Umeå, Sweden Surface contamination of bacteria during surgery in cfu/m2/h2 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Instrument table Wound area Patient area With Toul Without Toul

Advantages 1 Reduction of the contamination on surgical site 2 3 Quick and easy solution for producing sterile air Keeps the operating field sterile even in extreme conditions 4 5 6 7 8 Sterile air in wound area Easy to move Elimination of smoke during electro surgery Easy to use Easy to clean

Use 1 2 3 4 5 6 7 8 9 10 Day-Hospital Field hospitals After natural catastrophes Emergency department Burned Patients, e.g. after terrorists attack Implantation surgery Patients who are undergoing chemotherapy High risk patients Field hospitals Keeping sterile conditions for instruments during surgery

Toul guarantees sterile conditions in the operating field and on the instrument table even in extreme conditions. Toul can be used immediately due to sterile screens which are to be exchanged just before the operation starts and guarantee a maximum sterility.

Othopaedics

Cardiology

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Othopaedics

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