Development of Predictive Maintenance Management System for Tackling MRSA in

British Hospitals

Dr Ghasson ShabhaBirmingham School of the Built Environment

Faculty of Technology, Engineering and the Environment

Birmingham City University

Ghasson.Shabha@bcu.ac.uk

How can the spread of MRSA in health facilities be effectively monitored and managed on a day-to-day basis to reduce fatalities?

Aims and Objectives• To assess the commercial viability of integrating MRSA

predicative management module into CAFM.

• To develop a Predicative Maintenance Management module which can be integrated into CAFM software to monitor the spread of MRSA in health care facilities with particular emphasis on hygiene protocols (e.g. cleaning, disinfecting and decontamination).

• To generate a web-based knowledge management system easily accessible by facilities managers (FM) in addressing infection control in the light of the wealth of MRSA knowledge-base generated over the past few years.

Setting the Scene– Health Facilities are very complex

organisations.– Technologically-led – Highly-serviced.– 24/7 management input to ensure effective

functionality.– Difficult and costly to manage.

Type A.Effective with greater functionality but often

costly

Type CRisky with performance

penalties.

Type BEffective and can be low impact

but often small scale.

Type DCan be thoughtful and

imaginative, but sometimes less user-friendly.

ManagementMore Less

More Cost

Cost

Less Cost

Technological Complexity of Buildings based on (Bordas & Leman 2001) model

Where else?

• Schools.• Leisure and sport facilities.• Public toilets.• Community centres.• Others????

School buildings

Catering facilities

Public toilets

What is MRSA?

• MRSA is Gram-positive bacterium which can be transmitted through cross-contamination and direct contact.

• It thrives on relatively non-humid environment and feeds on flakes of dead dry human skin (Dancer, 1999).

• It can withstand desiccation at a higher temperature of 18-37 c and is thus a frequent component of hospital dust.

The spread of infection in a hospital relies on trio of factors: Source. Mode(s) of transmission. Susceptible recipient(s).

Source• A person.• An Object.• Environment.• Substance from which the infectious.

agent is transmitted to the host.

When host- the primary source of cross-infection are factored into any equation the laws which represent logic are constantly being moved

and become more difficult to predict and manage.

Direct contact leading to cross-infection through

Touch.

Cross-contamination.

Air-borne through ventilation and AC systems

a combination of one or more …

Mode(s) of transmission

Managerial Factors

Sharing Sanitary Appliances & Shower unitsHygiene Protocols Cleaning Management.

• Cleaning vs Deep Cleaning • Antibacterial Agents• Segregation • Disinfectants Management• Micro-fiber technology

Almost 50% of adults in the UK failing to dry their hands after using a public toilet.

One in six adults admitting that they do NOT wash their hands every time they use the toilet.

Germs from the toilet are left on the door handles, the flush handle and the taps, spreading germs on to the hands, and then into everyone who touches the contaminated items. Cross- contamination

Environmental Factors

• Humidity level (RH)• Temperature.• Surface material and

texture.• Availability of nutrients and

food particles.

MRSA- Ventilation and Air-conditioning• Environmental conditions can affect the survival and persistence of

hazardous micro organism on surfaces or indoor environment.

• Indoor air quality (patients spend 90% of their time indoor).

• Airtightness (to comply with part L of Building Regulations which might compromise environmental qualities) air permeability down to 3m³/h/m² at 50 Pa.

• Indoor Relative Humidity (RH) (keeping the relative humidity below 60%).

“Humidity levels are known to influence microbial survival and growth such as mould, mildew and bacteria inside ductwork and ventilations diffusers leading to high concentration of the production of allergens, odour and toxins in the ambient environment.”

MRSA is more likely to spread via ventilation and air-conditioning

systems, internal surfaces of ducts and diffusers as much as cross-

contamination via hard surfaces and floors.

Controlling the spread of infection through

ventilation & AC systems

Filtration

Air Purification

Anti-bacterial filters

Filters based on silver nano-particles held in plasmaA multi-stage filtration air-conditioning system by Toshiba

www.tri-airdevelopments.com

Ultraviolet catalysis

UVGI Technology

Under ceiling unit

UVG Heating Ventilation Unit

What have we learnt so far?• Both hard surfaces and ventilation/AC systems might be influential to

MRSA transmission.

• There seem to be a multiplicity of interrelated factors involved in the spread of MRSA.

• Lack of critical evaluation of the spread of MRSA and other infections in public and community facilities

• Methods of interventions are quite limited in scope and are either preventive or corrective. Monitoring the efficacy of intervention is no-existence and largely ad hoc.– Highly fragmented (cleaning vs finishing specifications) .– Prescriptive in their scope ignoring the role of human factor in spreading

MRSA- might simultaneously act as a trigger for spreading the infection

What needs to be done? Better understanding of the mechanism of how MRSA infection is

spreading in health care facilities.

A robust Infection monitoring management strategy over the lifespan cycle health care facilities

Predicative Management System for monitoring and managing the spread of MRSA and other air borne infection.

Future Action Plan

• An intelligent “safety by design” management system for tackling the spread of MRSA in health care facilities.

• A real-time predicative intelligent system for managing the spread of MRSA in ventilation and air-conditioning systems in specific.

• An integrated web-based MRSA knowledge management system  to enable maintenance and facilities managers to access the latest state of affair and know-how about the best way for tackling community MRSA.