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.

.

A main problem especially in longer operations is

the contamination of surgical instruments due to

human presence and their activity within the

operating room.

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

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

(70 % of the bacteria found in the

patients wound are coming

indirectly (e.g. instruments!) via

the air Stafilococco Aureo

Pseudomonas

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

Author Number of

Patients

Conventional

operating room

(%)

Charnley 5.800 7 %

Nelson 15.520 5,8 %

D. Lew et al. 1.880

2.730

5,8 %

Jenny et al. 1.354

5,7 %

Studies of infection with conventional operating

room

In an conventional operating room you can expect about 50 to

200 CFU/m3.

Laminar Air flow

Author 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 %

Studies of infection with Laminar air flow

≤ 20 UFC/m3 (it depends on the number of persons and

the duration of the operation

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

Conventional

operating room

Laminar

Flow

Toul Instrument

table

50-200

CFU/m3

(depending on the

duration of the operation

and the number of

persons in the O.R.

≤ 20

CFU/m3

< 1 CFU/m3

CFU’s on the instrument table

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

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

Hospitals do have more and

more bacteria's with resistance

against 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.

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.

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€

Type of operation

S S I

Risk factors 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-

Operation from 21 to 27

April 2005

OP Results in CFU/m3

Operation 1 0,5

Operation 2 1

Operation 3 0

Operation 4 1,5

Operation5 0

Operating Room

233 (99-383)

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

150

160

170

180

190

200

210

220

230

240

250

Operation

1

Operation

2

Operation

3

Operation

4

Operation

5

2005-04-27

CFU/m³ withToul 400

CFU/m³ withToul 300

CFU/m³reference

CFU-measurements at Södersjukhuset hospital

Reference: Measurements without Toul 400

Pacemaker implant

Measurements performed by Karolinska university hospital hygienedep.

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

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Instrument table Wound area Patient area

Surface contamination of bacteria

during surgery in cfu/m2/h2

With Toul Without Toul

Advantages

2

3

4

6

7

8

Quick and easy solution for producing sterile air

Keeps the operating field sterile even in extreme conditions

Sterile air in wound area

Elimination of smoke during electro surgery

Easy to use

Easy to clean

1 Reduction of the contamination on surgical site

5 Easy to move

Use 1

2

3

4

5

6

7

8

10

9

Day-Hospital

Field hospitals

After natural catastrophes

Keeping sterile conditions for instruments during surgery

Emergency department

High risk patients

Burned Patients, e.g. after terrorists attack

Implantation surgery

Patients who are undergoing chemotherapy

Field hospitals

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

Oftalmology

Othopaedics

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