1) The document discusses the transmission of H1N1 influenza A virus indoors and the role of HVAC systems. It describes how low indoor humidity in winter increases the level of infectious airborne droplet nuclei which can spread via HVAC systems. 2) Various methods for capturing and deactivating airborne viruses are discussed, including MERV filters, UV lights, photocatalytic oxidation, and bi-polar ionization, and their effectiveness when used individually or in combination. 3) Preventive measures for healthcare workers are outlined, such as patient isolation, protective equipment, hand hygiene, and environmental cleaning.

1. H1N1 Influenza A Virus,H1N1 Influenza A Virus,
It's Transmission in Indoor AirIt's Transmission in Indoor Air
& Role of HVAC& Role of HVAC
By
Dr Anjum Hashmi
MBBS,CCS(USA),MPH
Infection Control Director
Maternity & Children’s Hospital
Najran KSA

2. Airborne Germ
Bacteria vs. Viruses

9. Influenza A virus & the way it kills
• Influenza A causes disease primarily in lungs as it
infects the lower respiratory system. It multiply
at 98.6o
F which is the temperature of LRT.
• It is not a Rhinovirus which primarily causes
infection in nose and upper respiratory system.
Rhinovirus multiply at 93o
F which is the
temperature of URT.
• Influenza A virus infects and destroys lung tissue
leading to pneumonia or massive bacterial
infection.
• Victim may die from staph infections like MRSA.

10. Manifestations of H1N1 Influenza
(swine flu)
• These are similar to those of seasonal influenza.
• Patients present with symptoms of acute respiratory
illness, including at least 2 of the following:
• Fever
• Cough
• Sore throat
• Body aches
• Headache
• Chills and fatigue
• Diarrhea and vomiting (possible)

11. Manifestations of H1N1 Influenza
(swine flu)
• In children, signs of severe disease include apnea,
tachypnea, dyspnea, cyanosis, dehydration,
altered mental status, and extreme irritability.
• Influenza should be considered as a diagnosis in
children with neurologic symptoms, even when
few or even no respiratory symptoms are noted.
• The duration of illness is typically 4-6 days.
• The infectious period is form 1 day prior to the
onset of symptoms to 7 days after onset.

12. CDC criteria for suspected H1N1
Influenza
• Onset of acute febrile respiratory illness within 7
days of close contact with a person who is a
confirmed case of H1N1 influenza A virus
infection. or
• Onset of acute febrile respiratory illness within 7
days of travel to a community
(locally/internationally) where one or more H1N1
influenza A cases have been confirmed. or
• Acute febrile respiratory illness in a person who
resides in a community where at least one H1N1
influenza case has been confirmed.

23. Toilet water Viral Aerosolization
• Since 1959, many studies have documented how
a toilet flush aerosolizes bacteria and viruses
into the air above the bowl….
• British Scientist John Barker in 2005, replicated
the viral load and consistency of diarrhea. He
flushed the toilet and took air samples to
capture the aerosolized droplets.
• Samples were full of thousands of viruses.
• He was surprised by the fact that samples taken
after 30 minutes of each flush contains more
viruses, means porcelain is porous enough to
harbor viruses (and bacteria also.)

24. Toilet water Viral Aerosolization
• The 2003 SARS epidemic has showed the lethality
of toilet water aerosolization in following
conformed & published accounts:
• 1. Liu Jianlun was the Chinese Doctor who initiated
the worldwide SARS epidemic when he stayed in
Hong Kong at The Metropole Hotel in February
2003.
• Infected with SARS and having diarrhea, he
probably infected 12 fellow hotel guests through
toilet water aerosolization.
• These travelers flew around the world and one
brought SARS to Toronto thereby devastating the
city.

25. Airborne SARS Transmission at
The Metropole Hotel 22 Feb.2003

26. Toilet water Viral Aerosolization
• 2. Wang Kaixi was infected with SARS at the
same hospital which was treating a SARS
infected patient who visited a hotel guest’s
whose room was on the same floor where
Dr Liu Jianlun stayed at the Metropole hotel.
• Infected with SARS and having diarrhea, he
probably infected over 200 fellow residents
through toilet water aerosolization.
• Many were over 160 feet away from his
apartment but on same floor.

27. Airborne SARS Transmission at Amoy
Gardens Apartments 19-20 March 2003

28. WHY IS THERE A FLU SEASON??
• Does Flu take a vacation in each
summer?
• Are there Flu epidemics in Summer?
• What changes in late spring &
summer occur which reduces flu
morbidity and mortality?
• Is indoor Humidity goes in winter Up!
• NO

29. Low Indoor Humidity Increases
Droplet Nuclei Levels (winter)
● Viruses Evaporate faster in Low Humidity levels
thus creating More Droplet Nuclei.
● Low humidity allows droplet nuclei to stay
airborne longer.
● 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.

30. Correlation between low indoor humidity
& increased influenza morbidity &
mortality in winter
• 1. Indoor humidity levels in the Northern
Hemisphere especially in North America and
Europe are between 15-35%.
• 2. Studies have showed that there is no “flu
season” in the tropics where indoor humidity
levels stay above 40% year long.
• 3. This logic gives the correlation of airborne
droplet nuclei creation and available contagion.

31. WHAT SYSTEMS ARE AVAILABLE TO
STERILIZE, CAPTURE AND/OR KILL AIRBORNE
FLU VIRUSES?
• 1. MERV Rated Filters, H.E.P.A.
• 2. Germicidal UV Lights
• 3. Cold Plasma Bi-Polar Ionization.
• 4. Photo-Catalytic Oxidation(PCO).

32. Mechanical Filters Used in our
Home/office HVAC system
• MERV 1 or 2 filters which used in our
home/offices are nearly worthless in
capturing airborne human germs.
• The higher the MERV rating, like a
MERV 13 than, a mechanical filter
really reduce airborne viruses.

33. Mechanical Air Filters can trap
this % of Swine Flu Viruses

34. Ultraviolet Light and
How does it work?
• Ultraviolet Germicidal (germ-killing) light
at “C”band (254 nanometers) frequency
kills germs.
• UV-C light sterilizes germs by destroying
the A to T bond in their DNA.
• This prevents them from replicating and
they die.

35. Airborne Flu viruses can be captured &
sterilized with a combination of
MERV Filter & UV-C Light
• Adding filters and UV together in
successive layers can provide a lethal
force to prevent distribution of airborne
viruses.
• A MERV 16 alone can get 76% capture
/sterilize rate.
• Adding UV lamps we can achieve a total
single pass capture/sterilize of 99.9%.

36. Proactive Droplet Nuclei
Infection Prevention

37. Photocatalytic Oxidation (PCO) and
Bi-Polar Ionization & How do they work?
• Photcatalytic Oxidation is created when
Ultraviolet light photons strike Titanium
Di-Oxide to create Hydroxyl radicals. These
airborne Hydroxyl radicals destroys the
cellular material of any virus/germs.
• Bi-Polar Ionization is creates positively and
negatively charged oxygen molecules
which destroy the virus/germs by
damaging their cell wall and inner cellular
material.

38. Air Filters, UV Lights, Photocatalytic Oxidation
(P.C.O.) & Bi-Polar Ionization Can Kill, Sterilize
& Capture Viral Droplet Nuclei

39. Preventive measures for Health
Care Personnel
• Place patients in a single-patient room with the
door kept closed & air should be exhausted
directly outside.
• An isolation room with negative-pressure.
• Patients should wear a surgical mask when
outside their room.
• Encourage patients to wash their hands
frequently and to follow respiratory hygiene
practices.

40. Preventive measures for Health
Care Personnel
• Standard, airborne, droplet, and contact
precautions should be used for all patient care
activities and maintained for 7 days after
illness onset or until symptoms have resolved.
• Health care personnel should wash their
hands with soap and water or use hand
sanitizer.
• Routine environmental cleaning and
disinfection strategies should be applied.

41. NEW STRAIN OF BIRD FLUNEW STRAIN OF BIRD FLU
• In China a new strain of bird flu previously
unknown in humans has emerged, this new
strain of H7N9 bird flu is likely to be able to
spread swiftly among human populations.
• 18 cases of H7N9 bird flu confirmed in
China, including six deaths until 7th
April
2013.
• Scientist said H7N9 virus is harder to track
because of its ability to spread among
poultry without showing any signs.

42. LL Ori and the Orion Nebula THANK YOU