This trial has many facets and, to help you understand what happened, here are some Frequently Asked Questions (FAQs) we have answered to try and second-guess your questions.
The trial was the result of a well known fact that UV light can be used to kill bacteria. However a method for safely delivering the correct UV frequency that kills viruses and bacteria in an effective way, has only recently been developed for use in clinical areas accommodating patients and is being viewed as an important milestone in infection control.
Consequently with this in mind the three-month research project set out to test the innovative Medixair air sterilisation units, which use UV technology, to see if they would control MRSA in the environment and was the first controlled study of its kind.
Many hospitals remain troubled with the problem of hospital-acquired infection and in particular MRSA. With a constant flow of staff, patients and visiting relatives constantly passing through, the challenge of preventing infection from entering and spreading throughout a hospital complex.
Dr Nielsen has always been convinced that a number of hospital infections, including MRSA, are spread not only through the traditionally recognised route of direct contact, such as through touching surfaces, but also through the air.
In turn Dr Nielsen was keen to test his theory that airborne environmental MRSA contributed significantly to MRSA infection and re-infection in hospitals and so was intrigued to discover if UV light could significantly reduce this problem.
The trial involved the comparison of two identical, single-bed side rooms in a general medical ward, which were both occupied over the course of the three-month study by a series of patients.
One room was fitted with a single mobile Medixair UV air sterilisation unit, whilst the other was not, otherwise known as the control room. The Medixair device is used to sterilise the air and reduce the incidence of pathogens in a given location.
Prior to the two rooms being occupied by patients, Dr Nielsen’s microbiology team identified and swabbed seven selected surfaces to test for the presence of environmental MRSA. These swab tests were then repeated in the pre-determined locations three times per week for the duration of the trial. The trial was to measure the presence of MRSA in the environment and, as part of that environment, the 12 patients who were involved in the trial were swabbed for MRSA.
We know that the patients registered "clean" from their first MRSA swab so any subsequent contamination must have come from the room or from visiting family and staff.
The Medixair room measured positive for MRSA one third of the time and no patient in the Medixair room ever tested positive for MRSA during the duration of the trial.
The trial took place at Northwick Park Hospital in Harrow renown for clinical research. It is a major 900 bed acute hospital, part of the North West London Hospitals NHS Trust. Following approval by the Regional Ethics Committee, the trial commenced January 2007 for a total of three months concluding at the end of March 2007.
Dr Peder Bo Nielsen MD, MRCPath MSc DLSHTM DipHIC , initially qualified in 1974 as an MD at the University of Copenhagen. As a consultant microbiologist and infection control doctor, he has accomplished many achievements one being the introduction of a programme to reduce MRSA at Peterborough Hospitals NHS Trust, resulting in the Trust achieving the second best record in the country. In addition, from 2004 to 2007 Dr Nielsen is Director of Infection Prevention and Control for North West London Hospitals NHS Trust.
MRSA stands for methicillin-resistant Staphylococcus aureus and is a bacterium.
MRSA can survive on skin and in the environment for long periods of time and can be found typically on the skin and in wound secretions. As a result the bacteria can be located where it falls for example a blanket, bedside table or on the floor.
Once deposited there it can lie waiting to be destroyed by cleaning, transferred to another surface or made airborne again by disruption.
If we are able to remove such bacteria from the environment then the chances of a patient becoming infected drop considerably.
There is a common misnomer that you either have MRSA or you do not.
In fact MRSA is a very versatile bacterium that may live in peaceful cohabitation on the skin of a person. However in other situations, it could also produce the most life threatening infection.
The presence of MRSA may be categorised into six different levels:
Level 1 Colonisation-Temporarily present on the skin.
Level 2 Carrier- Present on the skin for a prolonged period.
Level 3 Chronic Carrier- Persistently present on the skin without producing infection.
Level 4 Wound surface infection- Present on the surface of a wound producing light infection which may be treated topically e.g. leg ulcer.
Level 5 Deep Wound Infection- The infection is beneath the skin in subcutis or other body sites not accessible from the surface e.g. post surgical wound or abscesses.
Level 6 Bacteraemia- MRSA is in the blood stream and can go on to create septicaemia, a very serious infection, which is potentially life threatening.
In this trial the patients in the control room were found at times to have level 1 colonisation with MRSA and one patient developed a wound infection (Level 5).
In the Medixair room with air sterilisation at no time did any of the occupants become colonised with MRSA.
The media will typically tell you that one third of the population has MRSA.
This is not true in fact it is recognised that between 30 and 40 % of the population do have SA (Staphylococcus aureus), which is treatable by antibiotics.
The level of contamination amongst the general public of MRSA is in fact less than 1 % however when we look at the element of the population that are in or have frequent exposure to the hospital environment this rises to 10%.
In short one person in ten, be they patients, visitors or staff in the hospital, is likely to have MRSA and be a possible carrier of infection.
Ultimately the reason infections appear more common in places such as hospitals is often due to the massive use of antibiotics. Only the more resistant bacteria will survive, so the antibiotics have changed the bacterial flora and patients in hospital are exposed to this flora of multiresistant bacteria. Hospital populations tend to consist of those that are older, sicker and weaker than the general population and as a result have compromised immune systems. Consequently these people are most vulnerable to infection.
Secondly, hospitals are often highly populated, with people living in close quarters. What’s more, with doctors and nurses examining many patients one after the other, the perfect conditions for the transmission of bacteria is created.
Additionally with the constant influx of visiting relatives passing through, the hospital faces a constant uphill battle.
As a patient becomes infected they cannot help but spread it to the environment, the staff that nurse them and any visitors and so the chain of contamination continues. This is why cleaning and hygiene practices need to be stringently managed and now with the advent of this scientific research so does the air!
Medixair is a unique and innovative ultraviolet air steriliser. It works by passing air through a chamber and kills micro-organisms with UVc light. Many pathogens, especially viruses, are so small that they can slip through traditional filtration systems. What makes Medixair unique and effective is the way in which it concentrates the UV energy to kill virtually all micro-organisms. What’s more Medixair not only kills the MRSA bacteria but is also wholly effective against a whole host of infections including colds, flu and measles. It is already being deployed around the world.
As far back as 1877 it was discovered that sunlight (UV light) was an effective control of bacteria. As micro-organisms are exposed to the band of invisible light, the UV disrupts the bonds of DNA to the extent that replication cannot take place. Without the ability to grow and due to the short lifespan of most micro-organisms, their population are rapidly extinguished.
MRSA like most pathogens does not like sunlight, which is why in sunlight in the open it is unlikely you would contract it. We have known for over a hundred years that it is the UV rays that the pathogens cannot stand. Saying that neither can we! In the wavelength needed to kill these pathogens if we looked at the light we would be blinded. Therefore the challenge has been to encase this powerful light in a casing that does not expose the rays to us, yet allows the air to be circulated through it at a certain rate guaranteeing that any air entering the bottom of the device leaves the top sterile. It then should be portable and durable and run off a standard power source. This is what the Medixair unit is and now we have the results we also know what a good job it does to.
MRSA is a bacterium and typically we test for its presence by using a growth culture and viewing the results. As a result of its size, should a colonised or carrier human shed skin (which happens continually) they leave a trail of contaminated "dust" in the air ready to contaminate when and where it falls. The Medixair units suck in such dust and may exterminate all pathogens that may be present. As a result both the incidence of any infected dust particles in the air and the chance of a resulting infections are significantly reduced.
No, it isn't. As the air is pushed through the device at a relatively slow rate to guarantee that all air is exposed to the UV rays and all pathogens destroyed, it takes a while to circulate the air in the whole room. As a result we would expect to see some effect after 8 hours but it would be after 24 hours when the real difference is established.From then on it is a constant recycling of air.
Well no, as it isn't able to kill all types of mould, however neither have thermo nuclear explosions managed to do that, so in this case we would say that it will kill all levels of micro organism that can be killed!
The Medixair room measured positive for MRSA on one third of the times that the control room did and as stated no patient in that room was ever tested positive for MRSA contamination during the duration of the trial.
In addition whilst we have commented on the fact that patients were protected from contamination of MRSA in the Medixair room, there is also the point that the Medixair unit offers 24-hour protection for hospital staff from a range of bacteria and viruses. As a result there would be less risk involved with nursing for hospital staff and their overall health and well-being would be significantly improved.
We are afraid not, whilst a unit will turn a one bedded side room into a virtual isolation unit, for real effect in an open ward structure we would suggest one mobile Medixair unit per patient/bed.
Well to survive in a very hostile environment such as a hospital the device must be rugged and capable of being cleaned with corrosive chemicals daily. Over its five-year development cycle we believe that the new units will last for a period of five years.
Is the Medixair expensive to run?
The unit consumes 105 Watts being 4 times 25 watts for the tube and 5 watts for the fan. This device uses the latest circuit board technology to minimise its power drain.
Infection is a huge concern to disabled and ill people around the world; to any person with a damaged immune system or reduced mobility an infection can be a major crisis certainly reducing their quality of life and possibly adversely affecting their long term prognosis. These units are now beginning to be used domestically and it is hoped that a domestic version will be produced next year in a slightly less robust form, enabling us to reduce the unit cost due to reduced materials and assembly costs.
Chemotherapy and other such treatments involving periods of risk from infection have resulted in a number of people requesting the loan of such equipment. At present we do not rent or hire Medixair equipment but are in negotiations with a company to do so. When they are completed you will see full details on the web.
No, but then again neither can a perfume or tobacco but both smells will cross a room in an instant. Where does that leave the invisible MRSA on a wafer of skin floating in the breeze caused by the door opening or the blanket being straightened?
No Clostridium difficile is a bacterium of the gut and takes hold and thrives when patients are weak and their immune systems are low.
It has been noticed, coincidentally that the aggressive medical intervention required to treat MRSA infections can lead to a lowering of the body’s natural defences as the powerful medicines do not discriminate which bacteria they destroy. As a result the patient cured of MRSA can then find themselves with a whole new battle against a Clostridium difficile infection.
Whilst Medixair is successful at eliminating all bacteria and viruses in the air, it is still essential that the strict cleaning regimes and the use of alcohol hand wash gels, which are already in place in hospitals as part of the hygiene regime, continue. As a result this device will play an essential part in further reducing potential cross infection.
At approximately 70cms high by 20cms square, the Medixair unit is very compact and mobile. It can either be fixed to a wall or placed free-standing on the floor on casters and simply requires plugging in to a mains power source.
Yes, the Medixair air sterilisation unit is very safe. The unit has extensive safety features built in and is incapable of operating once the lid has been opened so no UVc will come into direct contact with patients or staff.
What effect would Medixair have on a side room
Due to Medixair’s air sterilising effectiveness, an area of 75m3 will become a complete isolation room and with air constantly being passed through the UV light chamber the air will be cleaned every three hours. Medixair units have the potential of not only saving substantial money for the NHS but will also reduce patient infections, thus improving the quality of patient care.