1. Development of Predictive Maintenance
Management System for Tackling MRSA
in British Hospitals
Dr Ghasson Shabha
Birmingham School of the Built Environment
Faculty of Technology, Engineering and the
Environment
Birmingham City University
Ghasson.Shabha@bcu.ac.uk

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

3. 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.

4. 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.

5. Type A.
Effective with greater
functionality but often
costly
Type C
Risky with performance
penalties.
Type B
Effective and can be low impact
but often small scale.
Type D
Can be thoughtful and
imaginative, but sometimes
less user-friendly.
Management
More Less
More Cost
Cost
Less Cost
Technological Complexity of Buildings based on (Bordas & Leman 2001) model

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

7. School buildings
Catering facilities
Public toilets

8. 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.

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

10. 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.

11. 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

12. Managerial Factors
Sharing Sanitary Appliances
& Shower units
Hygiene Protocols
Cleaning Management.
• Cleaning vs Deep Cleaning
• Antibacterial Agents
• Segregation
• Disinfectants Management
• Micro-fiber technology

13. 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

14. Environmental Factors
• Humidity level (RH)
• Temperature.
• Surface material and texture.
• Availability of nutrients and
food particles.

15. 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.”

16. 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.

18. Controlling the spread of
infection through
ventilation & AC systems

19. Filtration

20. Air Purification

21. Anti-bacterial filters
Filters based on silver nano-particles held in plasmaA multi-stage filtration air-conditioning system
by Toshiba

22. www.tri-airdevelopments.com

23. Ultraviolet catalysis
UVGI Technology
Under ceiling unit
UVG Heating Ventilation Unit

24. 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

25. 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.

26. 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.