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Indoor Air Quality Assurance In A
     Dental Environment

                   www.somamedical.net
Indoor Air Quality Assurance In A Dental Environment.Dental.presentation ( october 2012) by somamedical.net
Fundamental Principle Of Dental
               I.A.Q.( Indoor Air Quality).
Environmental Surfaces
Contaminated patient care items and surfaces pose different degrees of risk for infection
transmission based on their location and potential to transmit pathogens. With regard to
environmental surfaces, the latest precautionary dental guidelines also provide a better
understanding of how to discriminate between the two categories of environmental
surfaces: clinical contact surfaces and housekeeping surfaces

Categories of Contaminated Environmental Surfaces
Category                       Definition                      Examples
Clinical contact               Surfaces that are directly      Dental unit surfaces, laboratory
                               contacted by contaminated       equipment, reusable containers of
                               instruments, devices, hands,    dental materials, drawer handles,
                               or gloves                       heavily used countertops, pens,
                                                               telephone handles, doorknobs
Housekeeping                   Surfaces that require regular   Floors, walls, lightly used
                               cleaning to remove soil and     countertops
                               dust but that rarely contact
                               dental personnel or patients
Environmental Decontamination In Dentistry

“A high level of general cleanliness must be maintained in dental surgery.
Working surfaces, bracket tables and countertops should be disinfected. The
use of sterilize-able trays or disposables are recommended. Floors, walls and
sinks must be routinely cleaned. All spilt blood or body fluids must be
attended to immediately.“

The phrase “risk of aerosols contamination“ means :
1. “General cleanliness”, “routinely cleaned” are not enough.
2. “Spilt blood and body fluids” might not be attended too immediately.
3. Aerosol dispersal is not completely prevented by Using high-volume
     suction and dental dam.
4. How many of dental clinics follow the exact IAQ preventive instructions?
5. Air conditioners make the air dryer (higher risk of droplet nuclei formation
     because of fluctuating humidity levels)
Why is I.A.Q important in a
                dental environment?
The execution of dental work and the use of various chemical compounds leads to
exposure levels for dentists, staff and patients to a range of potentially harmful airborne
contaminants. Especially for dental staff this exposure to potentially harmful air pollutants
can be significantly higher than that of individuals in most indoor environments.
Microorganisms
The use of high-speed drills and ultrasonic scaling equipment generates fine droplets which
are light enough to stay airborne for hours. Bacteria and viruses, which are contained in
these micro-droplets, are easily inhaled and constitute a potential source of infection.
Mercury
Numerous studies show that dentists and their staff have higher than average levels of
inorganic mercury (Hg) in their blood and urine. Mercury vapours can be released by the
placement and the removal of amalgam fillings. They may also be released from indoor
surfaces, where they may have accumulated over years of usage.
Disinfectants
Chemical disinfectants in a dental environment are responsible for a generally unpleasant
odour. Some disinfectants may also cause irritation and may have a sensitising potential
especially for staff.
Journal- Extract
Indoor air quality in a dentistry clinic.
Helmis CG, Tzoutzas J, Flocas HA, Halios CH, Stathopoulou OI, Assimakopoulos VD, Panis V, Apostolatou M, Sgouros
G, Adam E.
Source
Division of Applied Physics, Department of Physics, University of Athens, University Campus, Build.Phys-5, Athens 157 84,
Greece. chelmis@phys.uoa.gr <chelmis@phys.uoa.gr>

Abstract
The purpose of this work is to assess, both experimentally and theoretically the status of air quality in a dentistry clinic of the
Athens University Dentistry Faculty with respect to chemical pollutants and identify the indoor sources associated with dental
activities. Total VOCs, CO(2), PM(10), PM(2.5), NO(x) and SO(2) were measured over a period of approximately three months
in a selected dentistry clinic. High pollution levels during the operation hours regarding CO(2), total VOCs and
Particulate Matter were found, while in the non-working periods lower levels were recorded. On the contrary, NO(x) and
SO(2) remained at low levels for the whole experimental period. These conditions were associated with the number of
occupants, the nature of the dental clinical procedures, the materials used and the ventilation schemes, which lead to
high concentrations, far above the limits that are set by international organizations and concern human exposure. The indoor
environmental conditions were investigated using the Computational Fluid Dynamics (CFD) model PHOENICS for inert gases
simulation. The results revealed diagonal temperature stratification and low air velocities leading to pollution stratification,
accompanied by accumulation of inert gaseous species in certain areas of the room. Different schemes of natural ventilation
were also applied in order to examine their effect on the indoor comfort conditions for the occupants, in terms of air renewal and
double cross ventilation was found to be most effective. The relative contribution of the indoor sources, which are mainly
associated with indoor activities, was assessed by application of the Multi Chamber Indoor Air Quality Model (MIAQ) to the
experimental data. It was found that deposition onto indoor surfaces is an important removal mechanism while a great
amount of particulate matter emitted in the Clinic burdened severely the indoor air quality. The natural ventilation of the
room seemed to reduce the levels of the fine particles. The emission rates for the fine and coarse particulates were found to be
almost equal, while the coarse particles were found susceptible to deposition onto indoor surfaces.
PMID:
 17434576 [PubMed - indexed for MEDLINE]
The Dental I.A.Q. Solutions
Temporary Solutions:
Using of disinfectants on surfaces. (Time
consuming and costly )

Long-lasting preventive solutions :
Slow releasing active chemicals (Titanium
Dioxide, TiO2), air filters, UV-C light and
negative ions.
Legend:
          Titanium
          Dioxide

          Cleanature
          SM767B

          Uvmax
          SM212


   Medilite GFL
So what is IAQ ?
Indoor Air Quality as defined by OSHA Malaysia,
OSHA Singapore and ASHRAE standard 62-1989.

“Wherein it is stated that air in which there are
     no known contaminants at harmful
concentrations”. So quality air is always related
                   to fresh air.
3 main causes of IAQ problems

      • Source of contamination

       • Susceptible occupants

• Mechanism transport of contaminants
Type of IAQ contaminants
Gases
    Volatile Organic Compounds (V.O.C).
    Potential VOC’s come from gases of building furnishings i.e. carpets,
    furniture etc. and life cycle byproducts of micro-organism that lives in
    the building (or its HVAC system).
    Aldehyde vapors are typical byproducts of both off gassing and
    chemical processes, that occur inside or outside the building.
Particles
    Mostly counted in the diameter range from 0.1 micron or greater.
     Bio-aerosol are defined as airborne particles, which are living
     organisms, spores and fragments of organisms released from living
     organisms.
    These include pathogens (disease causing viruses), fungi (mold) and
    bacteria.
What I.A.Q problems should we be
            concerned about?
1. How can people eject flu viruses into the air.
2. What different forms can airborne viruses take.
3. How far can those viruses travel & how can they
   circulate within buildings and inside their HVAC
   units.
4. What conditions increase airborne flu virus
   survival.
5. What systems are available to sterilize, capture
   and/or kill airborne flu viruses.
Airborne transmission depends on people to
launch viruses into the air. People can shed
      this many flu virus into the air:

1. Coughing          3,000+
2. Sneezing          3,000+
3. Breathing         200+ natural sterilization , nose hair & mucus.
4. Talking/Singing   1,000+
5. Vomiting          1,000+
6. Diarrhea          *20,000+
How far can Airborne Viruses Travel?
                                    Large/Small Droplets        Droplet Nuclei

1.   Coughing                       1-5 feet                    160+ feet

2.   Sneezing                       8-15 feet                   160+ feet

3.   Singing, Talking               1-3 feet                    160+ feet

4.   Mouth Breathing                1-3 feet                    160+ feet

5.   Diarrhea*                      5 feet+                     160+ feet

     *As a result of toilet water aerosolization, air contamination in toilets
     need to be effectively sterilized and contained.
Stages of Infectious Droplets
     & Droplet Nuclei
Infectious Droplets & Droplet
    Nuclei Travel Lengths
Droplet Nuclei Viruses are 0.3μ or less, it can
  penetrate deeply into the human lungs




          A μm is a micron or 1/1,000,000 of a meter.
          The smallest particle you can see is 30μm.
Let’s not forget the detrimental effects of swine
                       flu!
How do Occupant Droplet Nuclei travel both within indoor
        spaces and then throughout a building?




                                                           Source
So, is there a flu season?
 Does flu take a vacation?
Why are there flu epidemics?
The answer is found in
  HUMIDITY LEVELS
Optimum Humidity




For optimum air quality, Indoor Relative Humidity should always be
maintained between 40% and 60%!
Low indoor humidity increases
         Droplet Nuclei Levels
• Viruses evaporate faster in low humidity levels
  thus creating More Droplet Nuclei.
• Low humidity allows droplet nuclei to stay
  airborne longer as the droplets do not absorb
  water weight which would cause them to fall to
  the ground.
• Indoor Air currents both created by HVAC
  systems and people movement assure that
  droplet nuclei will remain airborne Indefinitely.
• This allows HVAC systems to remove and
  redistribute droplet nuclei throughout the
  building to infect more occupants.
So, is there a solution to resolve
         I.A.Q.A problem?
Yes!
According to Environmental Protection Agency
  These are the recommended technologies
     According to EPA guidelines…
 1. MERV (Minimum Efficiency Reporting Value) Rated Filters
    (H.E.P.A)
 2. Germicidal UV Lights (UV-C)
 3. Magnetized Air Media Filtration (ELECTROSTATIC FILTERS)
 4. Bi-Polar Ionization (GERMICIDAL MEDICAL LAMP)
 5. Photo-Catalytic Oxidation (NANO TiO2)
So in essence, if we follow all five sterilization recommended by
  EPA, we would effectively have a 24/7 sterilization solution
                             protocol


                      MERV                  UVC

                            24/7 IAQA
                             solution
               Bi-polar                           Photo-
               Ionization
                             Protocol
                                                  catalyst


                            Electrostatic
                                filter
Lets explore and understand each of
the 5 technologies recommended by
  Environmental Protection Agency
               (EPA)
1. MERV (Minimum Efficiency Reporting
        Value) Rated Filters (H.E.P.A)
• Particulate matter contain pathogens (viruses,
  bacteria and infectious organisms), allergens and
  carcinogens.
• Mechanical air filters, like High Efficiency Particulate
  Air (HEPA) filters, remove 99.97% of all airborne
  particulates of 0.3 microns and above in size.
• They trap the particles in filters made out of tightly
  woven fibers.
2.Germicidal UV Lights (UV-C)
           How does UV-C Work?
• UV-C light emits germicidal wavelengths
  between 200-300nm. This reacts with the
  DNA and permanently alters the structure and
  the molecular bonds of microbiological
  contaminants such as bacteria, viruses, germs,
  molds and mildews.
Its scientifically proven that Ultraviolet Germicidal
lamps (UVC) working at 253.7 nanometers at the
correct intensity can effectively prevent cross
contamination of the following airborne diseases:-
                • Aspergillosis Niger
                    • Legionella
                       • SARS
                • Bacillus Anthracis
                    • Dust Mites
                • Allergy & Sinusitis
                 • Tuberculosis (TB)
                       • H1N1
UV dosage for the inactivation of various microbes
Sourced from: Centre for Disease Control (CDC) & World Health Organization (WHO)
                        Bacteria                                UV Dose                                 Bacteria                UV Dose
Agrobacterium lumefaciens 5                                       8,500            Pseudomonas aeruginosa (Environ.Strain)      10,500
                                                                                        1,2,3,4,5,9
Bacillus anthracis 1,4,5,7,9 (anthrax veg.)                       8,700            Pseudomonas aeruginosa (Lab. Strain) 5,7      3,900
Bacillus anthracis Spores (anthrax spores)*                      46,200            Pseudomonas fluorescens 4,9                   6,600
Bacillus megatherium Sp. (veg) 4,5,9                              2,500            Rhodospirillum rubrum 5                       6,200
Bacillus megatherium Sp. (spores) 4,9                             5,200            Salmonella enteritidis 3,4,5,9                7,600
Bacillus paratyphosus 4,9                                         6,100            Salmonella paratyphi (Enteric Fever) 5,7      6,100
Bacillus subtilis 3,4,5,6,9                                      11,000            Salmonella Species 4,7,9                     15,200
Bacillus subtilis Spores 2,3,4,6,9                               22,000            Salmonella typhimurium 4,5,9                 15,200
Clostridium tetani                                               23,100            Salmonella typhi (Typhoid Fever) 7            7,000
Clostridium botulinum                                            11,200            Salmonella                                   10,500
Corynebacterium diphtheriae 1,4,5,7,8,9                           6,500            Sarcina lutea 1,4,5,6,9                      26,400
Dysentery bacilli 3,4,7,9                                         4,200            Serratia marcescens 1,4,6,9                   6,160
Eberthella typhosa 1,4,9                                          4,100            Shigella dysenteriae - Dysentery 1,5,7,9      4,200
Escherichia coli 1,2,3,4,9                                        6,600            Shigella flexneri - Dysentery 5,7             3,400
Legionella bozemanii 5                                            3,500            Shigella paradysenteriae 4,9                  3,400
Legionella dumoffill 5                                            5,500            Shigella sonnei 5                             7,000
Legionella gormanil 5                                             4,900            Spirillum rubrum 1,4,6,9                      6,160
Legionella micdadei 5                                             3,100            Staphylococcus albus 1,6,9                    5,720
Legionella longbeachae 5                                          2,900            Staphylococcus aureus (incl. MRSA) 3,4,6,9    6,600
Legionella pneumophila (Legionnaire's Disease)                   12,300            Staphylococcus epidermidis 5,7                5,800
Leptospira canicola-Infectious Jaundice 1,9                       6,000            Streptococcus faecaila 5,7,8                 10,000
Leptospira interrogans 1,5,9                                      6,000            Streptococcus hemolyticus 1,3,4,5,6,9         5,500
Dosage table continued….
Micrococcus candidus 4,9                   12,300    Streptococcus lactis 1,3,4,5,6        8,800

Micrococcus sphaeroides 1,4,6,9            15,400    Streptococcus pyrogenes               4,200

Mycobacterium tuberculosis 1,3,4,5,7,8,9   10,000    Streptococcus salivarius              4,200

Neisseria catarrhalis 1,4,5,9               8,500    Streptococcus viridans 3,4,5,9        3,800

Phytomonas tumefaciens 1,4,9                8,500    Vibrio comma (Cholera) 3,7            6,500

Proteus vulgaris 1,4,5,9                    6,600    Vibrio cholerae 1,5,8,9               6,500

Molds                                      UV Dose   Molds                                UV Dose

Penicillium expansum 1,4,5,6,9             22,000    Oospora lactis 1,3,4,6,9             11,000

Penicillium roqueforti 1,2,3,4,5,6         26,400    Penicillium chrysogenum              56,000

Mucor racemosus (A & B) 1,3,4,6,9          35,200

Protozoa                                   UV Dose   Protozoa                             UV Dose

Chlorella vulgaris (algae) 1,2,3,4,5,9     22,000    Nematode Eggs 6                      40,000

Virus                                      UV Dose   Virus                                UV Dose

Adeno Virus Type III 3                      4,500    Influenza 1,2,3,4,5,7,9               6,600

Bacteriophage 1,3,4,5,6,9                   6,600    Rotavirus 5                          24,000

Coxsackie                                   6,300    Infectious Hepatitis 1,5,7,9          8,000

Yeasts                                     UV Dose   Yeasts                               UV Dose

Baker's Yeast 1,3,4,5,6,7,9                 8,800    Saccharomyces cerevisiae 4,6,9       13,200

Brewer's Yeast 1,2,3,4,5,6,9                6,600    Saccharomyces ellipsoideus 4,5,6,9   13,200

Common Yeast Cake 1,4,5,6,9                13,200    Saccharomyces sp. 2,3,4,5,6,9        17,600
3. Magnetized Air Media Filtration
         (ELECTROSTATIC FILTERS)
• Electrostatic air precipitators use a process called
  electrostatic attraction to trap charged particles.
• They draw air through an ionization section where
  particles obtain an electrical charge.
• The charged particles then accumulate on a series of
  Flat plates called collectors that are oppositely
  charged.
4. Bi-Polar Ionization (Medilites)
• Air ion generators, or ionizers disperse negatively charged ions
  (anions) into the air, similar to the electronic air cleaners but
  without a collector plate.
• These ions attach to airborne particles, making them heavier
  and causing them to settle on the ground faster, away from
  the nasal breathing zone.
• Negatively charged oxygen molecules will behave like hydroxyl
  radicals to neutralize odors and destroy the DNA of pathogens
  and allergens.
• Studies have shown that anions can freshen indoor air, reduce
  tiredness, relieve stress, alleviate affective depression,
  reinforce collagen, and strengthen the functions of autonomic
  nerves and the immune system.
5. Photo-Catalytic Oxidation
      -NANO Titanium Dioxide (TiO2)
• Nano Titanium Dioxide (TiO2) transforms biological
  and gaseous pollutants into harmless products by a
  process called photo catalytic oxidation (PCO).
• When applied as a coating and exposed to ultra-
  violet or ambient light, Nano-TiO2 produces hydroxyl
  radicals and superoxide ions that will neutralize
  biological and gaseous contaminants in indoor air.
• We now know IAQA problems exist!
• We now understand the
  recommendations by EPA for effective
  sterilization!
• So, what kind of equipments and
  technologies does Soma Medical have to
  resolve these IAQA problems?
Benefits

•   Cost efficient
•   Long lasting
•   Low maintenance
•   Good indoor air quality
Cleanature SM767A
              All 5 EPA recommended
              solutions.

                  Bipolar ionization

                  MERV filter + TiO2


                  Electrostatic


                  Ultraviolet light (UVC)
Medilite GFL
               Bipolar ionization

                TiO2
Medilite GML




               Bipolar ionization

               TiO2
UVmaxTM Series
                Ultraviolet light (UVC) for
                   various applications
                                   UvmaxTM SMT8



UvmaxTM SM212




      UvmaxTM SM313       UvmaxTM SM40W


                             UvmaxTM SM14-H

          UvmaxTM SM14
Customized UVC Series
                    Ultraviolet light (UVC) for
                   projects based applications

Double Ended UVC


                                   Single Ended UVC


UVC SM15C                        Submersible UVC
SM Nano 1152 Titanium Dioxide
The proof is in the pudding!!
  Our recommended sterilization
  solution protocol and products
can be effectively tested through a
 pre and post microbial challenge
     test, VOC count test and
         particulate testing
Our equipments used for testing


                    Particle Scanner


                    Negative Ion Tester


                    IAQA VOC Tester
The importance of testing for
Volatile organic compounds (VOC)
Volatile organic compounds (VOCs) refers
to organic chemical compounds which have
significant vapor pressures and can affect the
environment and human health.
The importance of testing for
          negative ions
Negative ions help freshen and purify the air by
neutralizing allergens such as pollen, mold
spores, dust, and animal dander floating in the
air. Negative ions will cause floating particulates
to be attracted and stick to each other, forming
'clumps', this eventually falls to the ground and
thus purifies the air.
The importance of testing for
         Particulate count
Particle counters are used to determine the air
quality by counting and sizing the number of
particles in the air. This information is useful in
determining the concentration and micron size of
particulates since it has a direct relationship to
human well being and IAQA.
ISO 14644-1 clean room standards
                                               maximum particles/m³                                  FED STD
   Class                                                                                               209E
                 ≥0.1 µm         ≥0.2 µm        ≥0.3 µm        ≥0.5 µm       ≥1 µm        ≥5 µm     equivalent
ISO 1                    10                2
ISO 2                   100               24             10              4
ISO 3                 1,000             237             102           35             8               Class 1
ISO 4               10,000            2,370            1,020         352             83              Class 10
ISO 5              100,000          23,700         10,200           3,520         832         29 Class 100
ISO 6           1,000,000          237,000       102,000          35,200        8,320        293 Class 1000
                                                                                                      Class
ISO 7                                                            352,000       83,200       2,930
                                                                                                     10,000
                                                                                                      Class
ISO 8                                                           3,520,000     832,000      29,300
                                                                                                     100,000
ISO 9                                                          35,200,000    8,320,000    293,000 Room air
Sourced from: http://en.wikipedia.org/wiki/Cleanroom
THANK YOU
SOMA MEDICAL SDN. BHD.
  www.somamedical.net
  info@somamedical.net

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Indoor Air Quality Assurance In A Dental Environment.Dental.presentation ( october 2012) by somamedical.net

  • 1. Commercial & Office Buildings Schools Daycare Centres Hospital & Clean Rooms Smoking Environment Manufacturing/Factories Government Buildings & Facilities Fire Departments Police Departments Indoor Air Quality Assurance In A Dental Environment www.somamedical.net
  • 3. Fundamental Principle Of Dental I.A.Q.( Indoor Air Quality). Environmental Surfaces Contaminated patient care items and surfaces pose different degrees of risk for infection transmission based on their location and potential to transmit pathogens. With regard to environmental surfaces, the latest precautionary dental guidelines also provide a better understanding of how to discriminate between the two categories of environmental surfaces: clinical contact surfaces and housekeeping surfaces Categories of Contaminated Environmental Surfaces Category Definition Examples Clinical contact Surfaces that are directly Dental unit surfaces, laboratory contacted by contaminated equipment, reusable containers of instruments, devices, hands, dental materials, drawer handles, or gloves heavily used countertops, pens, telephone handles, doorknobs Housekeeping Surfaces that require regular Floors, walls, lightly used cleaning to remove soil and countertops dust but that rarely contact dental personnel or patients
  • 4. Environmental Decontamination In Dentistry “A high level of general cleanliness must be maintained in dental surgery. Working surfaces, bracket tables and countertops should be disinfected. The use of sterilize-able trays or disposables are recommended. Floors, walls and sinks must be routinely cleaned. All spilt blood or body fluids must be attended to immediately.“ The phrase “risk of aerosols contamination“ means : 1. “General cleanliness”, “routinely cleaned” are not enough. 2. “Spilt blood and body fluids” might not be attended too immediately. 3. Aerosol dispersal is not completely prevented by Using high-volume suction and dental dam. 4. How many of dental clinics follow the exact IAQ preventive instructions? 5. Air conditioners make the air dryer (higher risk of droplet nuclei formation because of fluctuating humidity levels)
  • 5. Why is I.A.Q important in a dental environment? The execution of dental work and the use of various chemical compounds leads to exposure levels for dentists, staff and patients to a range of potentially harmful airborne contaminants. Especially for dental staff this exposure to potentially harmful air pollutants can be significantly higher than that of individuals in most indoor environments. Microorganisms The use of high-speed drills and ultrasonic scaling equipment generates fine droplets which are light enough to stay airborne for hours. Bacteria and viruses, which are contained in these micro-droplets, are easily inhaled and constitute a potential source of infection. Mercury Numerous studies show that dentists and their staff have higher than average levels of inorganic mercury (Hg) in their blood and urine. Mercury vapours can be released by the placement and the removal of amalgam fillings. They may also be released from indoor surfaces, where they may have accumulated over years of usage. Disinfectants Chemical disinfectants in a dental environment are responsible for a generally unpleasant odour. Some disinfectants may also cause irritation and may have a sensitising potential especially for staff.
  • 6. Journal- Extract Indoor air quality in a dentistry clinic. Helmis CG, Tzoutzas J, Flocas HA, Halios CH, Stathopoulou OI, Assimakopoulos VD, Panis V, Apostolatou M, Sgouros G, Adam E. Source Division of Applied Physics, Department of Physics, University of Athens, University Campus, Build.Phys-5, Athens 157 84, Greece. chelmis@phys.uoa.gr <chelmis@phys.uoa.gr> Abstract The purpose of this work is to assess, both experimentally and theoretically the status of air quality in a dentistry clinic of the Athens University Dentistry Faculty with respect to chemical pollutants and identify the indoor sources associated with dental activities. Total VOCs, CO(2), PM(10), PM(2.5), NO(x) and SO(2) were measured over a period of approximately three months in a selected dentistry clinic. High pollution levels during the operation hours regarding CO(2), total VOCs and Particulate Matter were found, while in the non-working periods lower levels were recorded. On the contrary, NO(x) and SO(2) remained at low levels for the whole experimental period. These conditions were associated with the number of occupants, the nature of the dental clinical procedures, the materials used and the ventilation schemes, which lead to high concentrations, far above the limits that are set by international organizations and concern human exposure. The indoor environmental conditions were investigated using the Computational Fluid Dynamics (CFD) model PHOENICS for inert gases simulation. The results revealed diagonal temperature stratification and low air velocities leading to pollution stratification, accompanied by accumulation of inert gaseous species in certain areas of the room. Different schemes of natural ventilation were also applied in order to examine their effect on the indoor comfort conditions for the occupants, in terms of air renewal and double cross ventilation was found to be most effective. The relative contribution of the indoor sources, which are mainly associated with indoor activities, was assessed by application of the Multi Chamber Indoor Air Quality Model (MIAQ) to the experimental data. It was found that deposition onto indoor surfaces is an important removal mechanism while a great amount of particulate matter emitted in the Clinic burdened severely the indoor air quality. The natural ventilation of the room seemed to reduce the levels of the fine particles. The emission rates for the fine and coarse particulates were found to be almost equal, while the coarse particles were found susceptible to deposition onto indoor surfaces. PMID: 17434576 [PubMed - indexed for MEDLINE]
  • 7. The Dental I.A.Q. Solutions Temporary Solutions: Using of disinfectants on surfaces. (Time consuming and costly ) Long-lasting preventive solutions : Slow releasing active chemicals (Titanium Dioxide, TiO2), air filters, UV-C light and negative ions.
  • 8. Legend: Titanium Dioxide Cleanature SM767B Uvmax SM212 Medilite GFL
  • 9. So what is IAQ ? Indoor Air Quality as defined by OSHA Malaysia, OSHA Singapore and ASHRAE standard 62-1989. “Wherein it is stated that air in which there are no known contaminants at harmful concentrations”. So quality air is always related to fresh air.
  • 10. 3 main causes of IAQ problems • Source of contamination • Susceptible occupants • Mechanism transport of contaminants
  • 11. Type of IAQ contaminants Gases Volatile Organic Compounds (V.O.C). Potential VOC’s come from gases of building furnishings i.e. carpets, furniture etc. and life cycle byproducts of micro-organism that lives in the building (or its HVAC system). Aldehyde vapors are typical byproducts of both off gassing and chemical processes, that occur inside or outside the building. Particles Mostly counted in the diameter range from 0.1 micron or greater. Bio-aerosol are defined as airborne particles, which are living organisms, spores and fragments of organisms released from living organisms. These include pathogens (disease causing viruses), fungi (mold) and bacteria.
  • 12. What I.A.Q problems should we be concerned about? 1. How can people eject flu viruses into the air. 2. What different forms can airborne viruses take. 3. How far can those viruses travel & how can they circulate within buildings and inside their HVAC units. 4. What conditions increase airborne flu virus survival. 5. What systems are available to sterilize, capture and/or kill airborne flu viruses.
  • 13. Airborne transmission depends on people to launch viruses into the air. People can shed this many flu virus into the air: 1. Coughing 3,000+ 2. Sneezing 3,000+ 3. Breathing 200+ natural sterilization , nose hair & mucus. 4. Talking/Singing 1,000+ 5. Vomiting 1,000+ 6. Diarrhea *20,000+
  • 14. How far can Airborne Viruses Travel? Large/Small Droplets Droplet Nuclei 1. Coughing 1-5 feet 160+ feet 2. Sneezing 8-15 feet 160+ feet 3. Singing, Talking 1-3 feet 160+ feet 4. Mouth Breathing 1-3 feet 160+ feet 5. Diarrhea* 5 feet+ 160+ feet *As a result of toilet water aerosolization, air contamination in toilets need to be effectively sterilized and contained.
  • 15. Stages of Infectious Droplets & Droplet Nuclei
  • 16. Infectious Droplets & Droplet Nuclei Travel Lengths
  • 17. Droplet Nuclei Viruses are 0.3μ or less, it can penetrate deeply into the human lungs A μm is a micron or 1/1,000,000 of a meter. The smallest particle you can see is 30μm.
  • 18. Let’s not forget the detrimental effects of swine flu!
  • 19. How do Occupant Droplet Nuclei travel both within indoor spaces and then throughout a building? Source
  • 20. So, is there a flu season? Does flu take a vacation? Why are there flu epidemics?
  • 21. The answer is found in HUMIDITY LEVELS
  • 22. Optimum Humidity For optimum air quality, Indoor Relative Humidity should always be maintained between 40% and 60%!
  • 23. Low indoor humidity increases Droplet Nuclei Levels • Viruses evaporate faster in low humidity levels thus creating More Droplet Nuclei. • Low humidity allows droplet nuclei to stay airborne longer as the droplets do not absorb water weight which would cause them to fall to the ground. • Indoor Air currents both created by HVAC systems and people movement assure that droplet nuclei will remain airborne Indefinitely. • This allows HVAC systems to remove and redistribute droplet nuclei throughout the building to infect more occupants.
  • 24. So, is there a solution to resolve I.A.Q.A problem?
  • 25. Yes! According to Environmental Protection Agency These are the recommended technologies According to EPA guidelines… 1. MERV (Minimum Efficiency Reporting Value) Rated Filters (H.E.P.A) 2. Germicidal UV Lights (UV-C) 3. Magnetized Air Media Filtration (ELECTROSTATIC FILTERS) 4. Bi-Polar Ionization (GERMICIDAL MEDICAL LAMP) 5. Photo-Catalytic Oxidation (NANO TiO2)
  • 26. So in essence, if we follow all five sterilization recommended by EPA, we would effectively have a 24/7 sterilization solution protocol MERV UVC 24/7 IAQA solution Bi-polar Photo- Ionization Protocol catalyst Electrostatic filter
  • 27. Lets explore and understand each of the 5 technologies recommended by Environmental Protection Agency (EPA)
  • 28. 1. MERV (Minimum Efficiency Reporting Value) Rated Filters (H.E.P.A) • Particulate matter contain pathogens (viruses, bacteria and infectious organisms), allergens and carcinogens. • Mechanical air filters, like High Efficiency Particulate Air (HEPA) filters, remove 99.97% of all airborne particulates of 0.3 microns and above in size. • They trap the particles in filters made out of tightly woven fibers.
  • 29. 2.Germicidal UV Lights (UV-C) How does UV-C Work? • UV-C light emits germicidal wavelengths between 200-300nm. This reacts with the DNA and permanently alters the structure and the molecular bonds of microbiological contaminants such as bacteria, viruses, germs, molds and mildews.
  • 30. Its scientifically proven that Ultraviolet Germicidal lamps (UVC) working at 253.7 nanometers at the correct intensity can effectively prevent cross contamination of the following airborne diseases:- • Aspergillosis Niger • Legionella • SARS • Bacillus Anthracis • Dust Mites • Allergy & Sinusitis • Tuberculosis (TB) • H1N1
  • 31. UV dosage for the inactivation of various microbes Sourced from: Centre for Disease Control (CDC) & World Health Organization (WHO) Bacteria UV Dose Bacteria UV Dose Agrobacterium lumefaciens 5 8,500 Pseudomonas aeruginosa (Environ.Strain) 10,500 1,2,3,4,5,9 Bacillus anthracis 1,4,5,7,9 (anthrax veg.) 8,700 Pseudomonas aeruginosa (Lab. Strain) 5,7 3,900 Bacillus anthracis Spores (anthrax spores)* 46,200 Pseudomonas fluorescens 4,9 6,600 Bacillus megatherium Sp. (veg) 4,5,9 2,500 Rhodospirillum rubrum 5 6,200 Bacillus megatherium Sp. (spores) 4,9 5,200 Salmonella enteritidis 3,4,5,9 7,600 Bacillus paratyphosus 4,9 6,100 Salmonella paratyphi (Enteric Fever) 5,7 6,100 Bacillus subtilis 3,4,5,6,9 11,000 Salmonella Species 4,7,9 15,200 Bacillus subtilis Spores 2,3,4,6,9 22,000 Salmonella typhimurium 4,5,9 15,200 Clostridium tetani 23,100 Salmonella typhi (Typhoid Fever) 7 7,000 Clostridium botulinum 11,200 Salmonella 10,500 Corynebacterium diphtheriae 1,4,5,7,8,9 6,500 Sarcina lutea 1,4,5,6,9 26,400 Dysentery bacilli 3,4,7,9 4,200 Serratia marcescens 1,4,6,9 6,160 Eberthella typhosa 1,4,9 4,100 Shigella dysenteriae - Dysentery 1,5,7,9 4,200 Escherichia coli 1,2,3,4,9 6,600 Shigella flexneri - Dysentery 5,7 3,400 Legionella bozemanii 5 3,500 Shigella paradysenteriae 4,9 3,400 Legionella dumoffill 5 5,500 Shigella sonnei 5 7,000 Legionella gormanil 5 4,900 Spirillum rubrum 1,4,6,9 6,160 Legionella micdadei 5 3,100 Staphylococcus albus 1,6,9 5,720 Legionella longbeachae 5 2,900 Staphylococcus aureus (incl. MRSA) 3,4,6,9 6,600 Legionella pneumophila (Legionnaire's Disease) 12,300 Staphylococcus epidermidis 5,7 5,800 Leptospira canicola-Infectious Jaundice 1,9 6,000 Streptococcus faecaila 5,7,8 10,000 Leptospira interrogans 1,5,9 6,000 Streptococcus hemolyticus 1,3,4,5,6,9 5,500
  • 32. Dosage table continued…. Micrococcus candidus 4,9 12,300 Streptococcus lactis 1,3,4,5,6 8,800 Micrococcus sphaeroides 1,4,6,9 15,400 Streptococcus pyrogenes 4,200 Mycobacterium tuberculosis 1,3,4,5,7,8,9 10,000 Streptococcus salivarius 4,200 Neisseria catarrhalis 1,4,5,9 8,500 Streptococcus viridans 3,4,5,9 3,800 Phytomonas tumefaciens 1,4,9 8,500 Vibrio comma (Cholera) 3,7 6,500 Proteus vulgaris 1,4,5,9 6,600 Vibrio cholerae 1,5,8,9 6,500 Molds UV Dose Molds UV Dose Penicillium expansum 1,4,5,6,9 22,000 Oospora lactis 1,3,4,6,9 11,000 Penicillium roqueforti 1,2,3,4,5,6 26,400 Penicillium chrysogenum 56,000 Mucor racemosus (A & B) 1,3,4,6,9 35,200 Protozoa UV Dose Protozoa UV Dose Chlorella vulgaris (algae) 1,2,3,4,5,9 22,000 Nematode Eggs 6 40,000 Virus UV Dose Virus UV Dose Adeno Virus Type III 3 4,500 Influenza 1,2,3,4,5,7,9 6,600 Bacteriophage 1,3,4,5,6,9 6,600 Rotavirus 5 24,000 Coxsackie 6,300 Infectious Hepatitis 1,5,7,9 8,000 Yeasts UV Dose Yeasts UV Dose Baker's Yeast 1,3,4,5,6,7,9 8,800 Saccharomyces cerevisiae 4,6,9 13,200 Brewer's Yeast 1,2,3,4,5,6,9 6,600 Saccharomyces ellipsoideus 4,5,6,9 13,200 Common Yeast Cake 1,4,5,6,9 13,200 Saccharomyces sp. 2,3,4,5,6,9 17,600
  • 33. 3. Magnetized Air Media Filtration (ELECTROSTATIC FILTERS) • Electrostatic air precipitators use a process called electrostatic attraction to trap charged particles. • They draw air through an ionization section where particles obtain an electrical charge. • The charged particles then accumulate on a series of Flat plates called collectors that are oppositely charged.
  • 34. 4. Bi-Polar Ionization (Medilites) • Air ion generators, or ionizers disperse negatively charged ions (anions) into the air, similar to the electronic air cleaners but without a collector plate. • These ions attach to airborne particles, making them heavier and causing them to settle on the ground faster, away from the nasal breathing zone. • Negatively charged oxygen molecules will behave like hydroxyl radicals to neutralize odors and destroy the DNA of pathogens and allergens. • Studies have shown that anions can freshen indoor air, reduce tiredness, relieve stress, alleviate affective depression, reinforce collagen, and strengthen the functions of autonomic nerves and the immune system.
  • 35. 5. Photo-Catalytic Oxidation -NANO Titanium Dioxide (TiO2) • Nano Titanium Dioxide (TiO2) transforms biological and gaseous pollutants into harmless products by a process called photo catalytic oxidation (PCO). • When applied as a coating and exposed to ultra- violet or ambient light, Nano-TiO2 produces hydroxyl radicals and superoxide ions that will neutralize biological and gaseous contaminants in indoor air.
  • 36. • We now know IAQA problems exist! • We now understand the recommendations by EPA for effective sterilization! • So, what kind of equipments and technologies does Soma Medical have to resolve these IAQA problems?
  • 37. Benefits • Cost efficient • Long lasting • Low maintenance • Good indoor air quality
  • 38. Cleanature SM767A All 5 EPA recommended solutions. Bipolar ionization MERV filter + TiO2 Electrostatic Ultraviolet light (UVC)
  • 39. Medilite GFL Bipolar ionization TiO2
  • 40. Medilite GML Bipolar ionization TiO2
  • 41. UVmaxTM Series Ultraviolet light (UVC) for various applications UvmaxTM SMT8 UvmaxTM SM212 UvmaxTM SM313 UvmaxTM SM40W UvmaxTM SM14-H UvmaxTM SM14
  • 42. Customized UVC Series Ultraviolet light (UVC) for projects based applications Double Ended UVC Single Ended UVC UVC SM15C Submersible UVC
  • 43. SM Nano 1152 Titanium Dioxide
  • 44. The proof is in the pudding!! Our recommended sterilization solution protocol and products can be effectively tested through a pre and post microbial challenge test, VOC count test and particulate testing
  • 45. Our equipments used for testing Particle Scanner Negative Ion Tester IAQA VOC Tester
  • 46. The importance of testing for Volatile organic compounds (VOC) Volatile organic compounds (VOCs) refers to organic chemical compounds which have significant vapor pressures and can affect the environment and human health.
  • 47. The importance of testing for negative ions Negative ions help freshen and purify the air by neutralizing allergens such as pollen, mold spores, dust, and animal dander floating in the air. Negative ions will cause floating particulates to be attracted and stick to each other, forming 'clumps', this eventually falls to the ground and thus purifies the air.
  • 48. The importance of testing for Particulate count Particle counters are used to determine the air quality by counting and sizing the number of particles in the air. This information is useful in determining the concentration and micron size of particulates since it has a direct relationship to human well being and IAQA.
  • 49. ISO 14644-1 clean room standards maximum particles/m³ FED STD Class 209E ≥0.1 µm ≥0.2 µm ≥0.3 µm ≥0.5 µm ≥1 µm ≥5 µm equivalent ISO 1 10 2 ISO 2 100 24 10 4 ISO 3 1,000 237 102 35 8 Class 1 ISO 4 10,000 2,370 1,020 352 83 Class 10 ISO 5 100,000 23,700 10,200 3,520 832 29 Class 100 ISO 6 1,000,000 237,000 102,000 35,200 8,320 293 Class 1000 Class ISO 7 352,000 83,200 2,930 10,000 Class ISO 8 3,520,000 832,000 29,300 100,000 ISO 9 35,200,000 8,320,000 293,000 Room air Sourced from: http://en.wikipedia.org/wiki/Cleanroom
  • 50. THANK YOU SOMA MEDICAL SDN. BHD. www.somamedical.net info@somamedical.net