JOURNAL CLUB

26 Nov.
th

Dr. Prateek Bhatia

Sr. Resident
Department of Hospital Administration
 Cold oxygen plasma technology
efficiency against different
airborne respiratory viruses
O. Terrier , B. Esserea,, M. Yvera,, M. Barthélémya, M. Bouscambert-Duchampa,
P. Kurtz, D. VanMechelene, F. Morfina, G. Billauda, O. Ferraris,
B. Lina, M. Rosa-Calatrava, V. Moulesa,
Université de Lyon, Lyon, France

Journal of Clinical Virology 45 (2009) 119–124

 Why this article?
Airborne Biological Contaminants
 Air borne fine droplets are the
main source of respiratory
infections and these biological
contaminants range in size from
0.022 μm (for small viruses) to
100 μm in diameter.
 INCREAESD MORBIDITY &
MORTALITY:
INFLUENZA &
PARAINFLUENZA VIRUS
PANDEMICS/ RSV-Bronchiolitis
in children
Methods of “AIR DISINFECTION”

PLASMA
DISINFECTION
WHAT IS PLASMA TECHNOLOGY
 Plasma is an ionized gas, a gas into which
sufficient energy is provided to free electrons
from atoms or molecules and to allow both
species, ions and electrons, to coexist.
 Plasma production Heat/UV-Radiation

High electric field pulse

The sun's enormous heat rips electrons off the

hydrogen and helium molecules that make up the
sun. Essentially, the sun, like most stars, is a
great big ball of plasma.
 US EPA: "Highly Efficient, And Cost-Effective
Means To Eliminate Disease-Causing &
Contaminating Microorganisms From Indoor Air
Streams. ...Cannot Be Overstated."
 When a modulated electric field/ High Energy UV RAYS are applied
to a pair of electrodes, a plasma is formed( IONISED GAS & its
Electrons), which makes the Oxygen molecules of the air passing near
the electrodes break down into reactive oxygen species (ROS).
Organic substrates such as bacteria, viruses and mold spores that
become exposed to these ROS are destroyed or rendered harmless on
contact, and the same reaction convert the ROS back into oxygen.
 Other than ROS, Ozone, OH-radicals (PURIFIERS IN TRUE
SENSE) and UVGI (if UV used) is also produced.
 These DESTROY ORGANISMS by MEMBRANE
PEROXIDATION/ NUCLEIC ACID DAMAGE.
 COP TECHNOLOGY
 Biozone scientific firm has developed a new process for
the generation of a cold oxygen plasma (COP) by
subjecting air by high energy deep-UV light with a
effective radiation spectrum between 180 nm and 270
nm.
 This cold gas plasma is composed of several species like
negative and positive ions, free radical molecules,
electron, UV-photons and ozone. The ozone production is
controlled and maintained to a maximum level of
0.04ppmv (parts per million by volume). This technology
is dedicated to be used in human environment for the
decontamination of both surface and air.
 AIM OF THE STUDY
 To evaluate / test
the efficiency of
Biozone technology COP against
nebulizated preparation of three
respiratory viruses of significant
clinical importance: RSV, hPIV-3 and
A (H5N2) influenza viruses.
 STUDY DESIGN
Cells & Virus LLC-MK2 & MDCK
cell lines were infected
production & with Hpiv3, RSV &
purification H5N2 strain
respectively.
COP Nebulization device
(Suspension aerolised
Experimental with compressed air to
device produce droplets of 1.9
um size); Feeder area;
Reactor area;
The amount of infectious
Determination virus in each batch was
of viral performed by limit-dilution
titration test and
infectious titers determination of the
dilution of virus required to
infect 50% of inoculated
cells (TCID50/mL).
Supernatants harvested 3
days post infection;
centrifuged, suspended
in PBS and purified.
Upstream &
Downstream outlet to
test air samples before &
after reaction( air speed
fixed at 0.9m/s and virus
flow sampled after 3 min
using sampling pump)
For this purpose, virally
induced cytopathic
effects (CPE )were
checked until 96–120 h
post-infection.
 COP EXPERIMENTAL DEVICE

Three different experimental conditions were tested four times : (A) the internal classic UV
germicide UV-C light lamp, (B) a COP from an external device (gas plasma only) and (C) a COP
from an internal device (gas plasma and UV light).
 RESULTS

Evaluation of the viral loss due to the Nebulization in the experimental device.
The important loss rates could be partially explained by a rapid aggregation and consecutive
particles settling between the upstream and the downstream outlets and also the liquid
impingement samplers
that have been used to sample the air. The loss rates could be explained by a probable high
relative humidity of our experimental condition that is known to affect the infectivity of airborne
 RESULTS
3.5
3.1
LOG
LOG

6.5
LOG

2.1
2.0
LOG
LOG

3.8
LOG

2.4
2.1
LOG
LOG
4.0
LOG
 RESULTS
 Percentage efficiency of inactivation in the
different experimental conditions
% efficiency
 Classic UV lamp COP only Biozone
COP
 H5N2 99.60 99.20 >99.99
 hPIV-3 99.97 99.92 >99.99
 RSV 99.20 99.00 99.98
Percentage efficiency = (infectious titer in A− infectious titer in B,
C or D)/(infectious titer in A)×100
 DISCUSSION
 The first set-up experiment showed that it was possible to
harvest, after Nebulization of a high concentrate viral
suspension, significant quantities of infectious viruses, despite
important loss rates.
 The UV-C light irradiation capacity to inactivate airborne viruses
was 99.60%, 99.97% and 99.20% for (H5N2) influenza virus,
hPIV-3, and RSV. Jensen et al had shown that the inactivation
rate of UV-C on influenza (WSN strain) was greater than 99.99%
but used six lamps in their exp.
 Gas plasma generated by the Biozone UV lamp is responsible for
an important decrease of the viral titer for all the three
respiratory viruses; but slightly less than UV-C.
 The combined effects of gas plasma and internal UV, in the
Biozone device brought a high level of inactivation rate.
 DISCUSSION
 Altogether, the results of this study revealed
marked differences in inactivation rates amongst
A (H5N2), hPIV-3 and RSV.
 But the highest inactivation rates, in the three
experimental conditions, were always obtained
for hPIV-3.(? Variation of virus str. Or exp.
Condtns)
 Limitation- The efficiency against non-enveloped
virus, e.g. adenovirus is not explored.
 THE TECHNOLOGY –HOLDS
PROMISE !!
Biozone® Air Purifiers clean the air in 2
ways, inside and outside of the unit.
Air inside the purification chamber is
exposed to intense germicidal UV (UVGI)
light that produces a purifying plasma.
This destroys bacteria, fungi, viruses, and
other pollutants (including unpleasant
odors). ENERGY EFFICIENT
This 'ultra-pure' air then carries the NO HARMFUL EFFECTS
purifying plasma and its purifying results
AFFORDABLE PRICE
to the air and surfaces throughout your
home or office. EASY TO CLEAN 7 REPLACE
LAMPS
 TYPES OF COP DEVICES
 PORTABLE BIOZONE PURIFIERS
 MOBILE PURIFYING UNITS

(AirINspace Techonologies)- IMMUNOAIR

PLASMAIR
FDA 510(k) FDA-Clearance
Clearance, Pending
Class II Not currently
device available for
commercial
sale in the U.S.
It can decontaminate a standard room in less than an
hour, and guarantees low airborne microbial levels over
prolonged periods of time and daily perturbations.
 MOBILE PURIFYING UNITS

 Unique HEPA - MD Technology

 High E"ciency Particulate Arrestance combined with
Microbial Destruction
CONTAINS THE PLASMER™ REACTOR
 This integrated system of air decontamination and
particulate collection uses cold plasma technology
combined with amplified electrostatic fields. It can be
used either inside mobile decontamination units or in
in-duct systems.
 Cost- MOBILE UNITS- 16,000 Euro/ 12 Lakhs

IN- DUCT UNITS- 8,000 Euro/ 6 Lakhs

 ADVANTAGES & OTHER USES
OF COP TECH.
 Other than the decontamination and eradication of bacteria
and other infectious agents, there is emerging clinical
research showing the positive response cold plasma is
having on interaction with animal as well as human tissue.
 Initial clinical studies have shown to eradicate infection in
open wounds and to reduce the healing time of an average
wound by up to 60% .
 Other than CD wards/EMG to stop spread of air borne
particles; other use is in immuno- haematology, oncology,
transplant hospital departments, operating theatres,
cytotoxic preparation rooms, research labs, intensive care,
and sterilization rooms to help contain infection risks and
meet air quality standards.
 SUCCESS STORY-COP
To date, AirInSpace has over 50 hospital clients in France, a leading
position in Hematology (75% penetration), and more than 80 %
repeat customers over the last 24 months.
 Dijon University Hospital saved 90% of the anticipated capital
investment required to revamp its haematology protected areas by
switching to Plasmair based mobile solutions, and confirmed
satisfactory performance after more than 2 years of exploitation.
AirInSpace has sold to date more than 34 units to Dijon.

 Tarbes Regional Hospital adopted Plasmair solution in two

Operating Rooms saving 50% of investment budget to meet new
NFS 90 351 French air Quality standard for Class III rooms
(Conventioanl Surgery). It took AirInSpace less from 4 weeks
between initial audit to final validation to meet Tarbes demand,
minimizing O.T. downtime and subsequent forgone revenue.
Publications
AirInSpace device performance has been documented through a long list of validation studies
 1) Sixt N, Dalle F, Lafon I, Aho S, Couillault G, Valot C, Danaire V, Vagner O, Cuisenier B, Sautour M, Besancenot JP,
Ollivier C, Caillot D, Bonnin A, Reduced fungal contamination of indoor environment in adult and paediatric clinical
haematology units with the Plasmair™ system. J. Hospital Infect., Submiited August 2006.
 2) Poirot, JL, Gangneux, JP, Fischer, A, Chaillier, S, Laudinet N, Bergeron V, Evaluation of a new mobile system for
protecting immune-suppressed patients against airborne contamination. J. Hospital Infect., Submitted November 2006.
 3) Chalfine A, Carlet, J, Goldstein F, Laudinet L, Bergeron V, Effective and Rapid Airborne protection strategy for patient
isolation in negative pressure environment. International Society for Infectious Diseases, Proceedings of the 12 International
Conference, Lisbonne, Portugal June 15-18, 2006.
 4) Poirot JL, Reboux G, Mallaret MR, Labrousse, Laudinet N, Prevention of airborne fungal infection and
crosscontamintation using the Plasmair™ unit. International Society for Human and Animal Mycology, Proceedings of the
16th Congress of the International Conference, Paris, France, June 25-29, 2006.
 5) Poirot JL, Gangneux JP, Laudinet N, Immunair™: a novel protection against airborne fungal contamination for immune-
compromised patients. International Society for Human and Animal Mycology, Proceedings of the 16th Congress of the
International Conference, Paris, France, June 25-29, 2006.
 6) Lina B, Moules V, Bergeron V, Testing efficiency of a commercial air purification system against avian flu aerosols. CNRS
report N° 04182006-1 April 19, 2006.
 7) Fischer A, A Multi Centre Clinical Evaluation of the Immunair Mobile Unit for the Protective Isolation of Immune
Compromised Patients; Clinical Test Report Centre N°1 – University Hospital Necker, Paris, France, April 15, 2004.
 8) Challier S, Poirot JL, Le Guinche, Malbernard M, Laudinet N, Bergeron V, Une nouvelle unite mobile de decontamination
de l’air pour applications medicales. Techniques Hospitaliere, March 2004.
 9) Ortu S, Moutard K, La Qualification d’un système de décontamination se l’air. Salles Propes Jan., 2004.
 10) Bergeron V, Laudinet N, Décontamination biologique de l’air pour patients immunodéprimés. La revue des Anciens
Elèves de l’Institut Pasteur, Nov. 2003.
 11) Bergeron V, First M, Starinsky A, Biological decontamination of air using a multistage high-voltage reactor. Federation of
European Microbiological Societies, Proceedings of the 1st International Conference July 2003.
 12) Poirot JL, Fullana, L, Aéropollution fongique : évaluation de l’Immunair. Société française d’hygiène hospitalière,
Proceedings of the 14th International conference. June 2003.
In Preparation:
 Reboux G, Poirot JL, Laudinet N, Bergeron V, Lowering airborne contamination in hospital high-risk areas using a
 novel mobile air-treatment unit. To be submitted in the Infection Control and Hospital Epidemiology Nov 2006.
 Chalfine A, Carlet, J, Goldstein F, Laudinet L, Bergeron V, Preparation for rapid patient isolation in the wake of an
 Avian flu outbreak. Emerging Infectious Dieases to be submitted Nov. 2006.
 Bergeron V, First M, Moules V, Bennett A, Laudinet N, Lina B, Extensive performance evaluation of a novel air
 decontamination technology. Applied Environ. Microbiology to be submitted Dec. 2006.
 Caillot D, et.al., Prevention of invasive pulmonary aspergillosis in severely neutropenic patients using Plasmair™ air
 decontamination units in a haematology ward. J. Infect. Control & Hospital Epidemiology to be submitted Dec. 2006
 Prevention of invasive pulmonary aspergillosis in severely neutropenic patients using Plasmair™ air decontamination
 units in a haematology ward.
THANKS FOR
PATIENCE…..