A very interesting connection between Stainless Steel Sinks and Legionnaire's Disease

People think little of Stainless Steel on a day to day basis. I mean, it is a wonderful, class of alloy and surrounds all walks of our life. It is strong, durable and easily rolled, formed and otherwise manufactured into multiple shapes, sizes and devices. Add a little Chromium here or Vanadium there, mess with the Carbon percentages and you can extend the applicability, life or property of choice. Therefore, most people are at least a bit surprised when they find out that Stainless Steel too, is vulnerable.

Just today, I came across a rather interesting study, that makes a connection between Stainless Steel degradation and rust in sinks with Legionnaire's Disease. At first reading, this must seem quite odd, but if you consider that a Legionnaire's safety expert oversaw the study, the connection makes more sense. Well, let us take a look at both of these for a minute.

Legionnaire's Disease

Legionella, a genus of gram-negative bacteria, has several species that have been known to cause the disease, with symptoms ranging from headaches to pneumonia, and rarely mortality. Luckily, under most conditions, it doesn't get transmitted from patient to patient. And apparently, the disease is present in bathtubs, sinks, showers and other places we wash up, shower, etc. I learn something new every day. I will provide a couple of reference links at the bottom, if you were not familiar with Legionnaire's Disease as well.

Stainless Steel

Now, as an Engineer, with enough experience on the applications side, I can speak with some strength on Stainless Steel. Everyone who studies Materials Engineering is taught that Chromium (Cr), when added to Stainless Steel can make it resistant to rust. However, when you try to balance its properties you can't just keep adding Chromium. There is an upper limit.

Passivation on the other hand, is a process, I like many Engineers became familiar with. Using diluted strong acids such as Nitric Acid or weak acids such as Citric Acid, Stainless Steel is made rust-resistant through the addition of a very thin layer of oxide that prevents further rusting. For those interested, there are ASTM standards and plenty of reading materials out there.

The Study

The study, performed over 3 years, found that when tested on rusted taps, Legionella survived quite well. Non-rusted stainless steel taps were not inclined to serve as breeding grounds. The same was true of brass. I tend to know a little bit about brass as well. My undergraduate education involved a heavy dose of industrial training. And, I was accustomed to encountering brass impellers in submersible and other pumps designed for use along Oceans and Seas. Perhaps it is the presence of Zinc, but whatever it is, brass is wonderful in that, it can also be machined easily, like cutting into butter. Understandably, brass is expensive!

Therefore, your options are limited. Expensive sinks, or ceramic sinks. Most ceramic sinks still have stainless steel fittings, such as drains, etc. Perhaps you can limit the alloy portion of ceramic sinks to brass. It will make for both great looks and infection prevention.

How about re-passivation? Is that a thing?

I am not sure. Also, the problem is that you can't expect people to check their sinks and use Citrate to passivate their Stainless Steel bathtubs, sinks etc. And what about large buildings with many such sinks, such as, say Hospitals? There is already a big battle going on with Hospital Acquired Infections, and this ups the challenge.

It is a bit unclear that there is a single solution, but it appears, material substitution and regular inspection and servicing are the minimum requirements here. Maybe on-spot passivation can be a thing. Perhaps nanotechnology based coatings and solutions will emerge. Only time can tell!

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References:

1. Legionnaire's Disease: https://www.cdc.gov/legionella/about/causes-transmission.html

2. A slightly different take on Legionnaire's: http://www.mayoclinic.org/diseases-conditions/legionnaires-disease/home/ovc-20242041

3. An article on the study: https://www.newscientist.com/article/2145448-stainless-steel-sinks-may-up-your-risk-of-legionnaires-disease/

4. Image Courtesy, Pexels: https://www.pexels.com/photo/blur-bubbles-cleaning-close-up-545021/

Looking for a lucrative, socially responsible healthcare opportunity? How about healthcare-associated-infections?

Last week I was invited to review a site by Kimberly-Clark on healthcare associated infections. As I started going through it, I was reminded of some news on the availability of federal funds for Healthcare Associated Infection remedies. I thought I would talk a little bit about both and let you know of the opportunity space ahead.

MRSA

A few years ago, MRSA entered our vocabulary and Hospital Acquired Infections or, as I guess the kids now call them "Healthcare-Associated Infections" became famous. Why did they become famous?

It was found out that the developed nations were not much better off than developing nations when it came to HAI. The condition is defined as infections that you pick up as a consequence of being treated in a healthcare setting, that is, infections that you did not have when you first went in for treatment.

It is also a big deal because the current strains of HAI that infect people are much more resistant than they used to be. Some scary statistics portend that more people die from HAI in the US than from AIDS itself, on an annual basis.

Just what the heck is MRSA?

MRSA, at least in the medical field stands for Methicillin-resistant Staphylococcus aureus. Over the last few decades hospitals have been treating every possible disease condition with antibiotics. Methicillin is just one such antibiotic in the same family as penicillin and is very commonly used in the treatment of staphylococcal bacteria. Over years of treatment, the bacteria, which have the freedom to evolve much quicker than we can, have developed an amazing amount of resistance to antibiotics.

Antibiotic resistant bacteria represent a deadly threat to anyone who comes under attack by them. As I mentioned before, people do not really stand much of a chance in this battle, and even if they recover, it is a long and hard battle. MRSA is just one example out of what really exists out there. It is also just one example of the possibilities that exist for drug-resistant microorganisms to evolve in the future with much more vigor than they have already done.

The Broader Outlook

Healthcare Associated Infection or abbreviated HAI, by definition, goes broader than MRSA and other resistant strains. Any disease condition acquired in a healthcare setting is termed HAI. This is key. Why?

It is quite possible that any strain of any microorganism that you pick up in a healthcare setting can be quite harmful to you. It is also not a function of healthcare to cure you of one condition and leave you with another, possibly worse.

How do we fight HAI?

Alright, now that you are reasonably scared, you might wonder as to the methods you can adopt to fight HAI, not just on a temporary basis, but on a more permanent basis. Let us take a look.

1. Awareness - The first step, as with everything is learning about and acknowledging the problem exists. Doctors, Hospital Managers and people in the general healthcare know the problem exists. However, there is more to awareness than simply acknowledging that it exists.

This is where I believe the website I mentioned, and similar efforts come into frey.

http://haiwatchnews.com/

It appears to be a website developed by Kimberly Clark, and while they themselves benefit from more awareness about HAI, I think it is a good move, and looks very much like well-fulfilled corporate social responsibility.

The impact information is all on the website - a predicted 100,000 deaths in the US, much worse across the world, and an annual impact of $6.7bn to the economy.

How exactly can awareness be spread? HAIwatchnews is part of a larger website:

http://www.haiwatch.com/

Haiwatch contains a lot of information, resources for clinical information and so on, that will not only be useful for people that work in healthcare, but also to you, the medical device designer.

2. Prevention

I am tempted to call this section "Opportunities" because you can take a look at the causes and think of them as opportunities. The three major HAI sources seem to be:

2.1.1 Ventilator Associated Pneumonia
2.1.2 Surgical Site Infections
2.1.3 Cross Contamination

Surgical Site Infections and Cross Contamination are rather easy to understand and obvious. Ventilator Associated Pneumonia happens in patients who have been intubated and have a tube flushing oxygen through to their lungs. Unfortunately, this opens up a can of microorganisms, so to speak, since this simply provides them direct access to the lungs, and consequently causes pneumonia.

So, the prevention part comes in two different ways:

2.2.1 Good medical/clinical practices, and
2.2.2 Medical Device and Bioengineered solutions

3. The Opportunity Landscape

Obviously, there are a few opportunities available in the landscape here:

How about, say better ventilation systems? A very good microfiber that rests in the tube as a one-way filter, filtering out particulate matter, bacteria and anything else that they can capture.

How about specific types of coating and sealing that make it impossible for bacteria to reside on hospital surfaces? This appears to be a tried and tired idea. Obviously, it's not working, so there are some big gaps somewhere, right?

There are several other brainstorms that I can think of (and you can pay me for.. :) ), but the general landscape is wide and is something more interesting to get into, rather than yet another half-baked, ineffective piece of drug-coated plumbing, balloon or cement that has you faking and contorting clinical trial results, lying to the FDA and other wonders that "major players" are constantly getting into....

4. Federal Funding

You didn't think I was going to wind you up and send you off empty handed, did you? Not at all!

The funding, about $40 million, is of course not directly available for the design of the next solution, but it is available for states to create awareness, improve processes etc. So, if you did develop a quick and "definitely not" dirty solution to the HAI problem, you could find it easy to convince healthcare service providers to apply for the funds that may in turn see your device or solution getting used...

http://www.fiercehealthcare.com/story/feds-offer-40m-stimulus-funds-fight-healthcare-associated-infections/2009-09-02?utm_medium=nl&utm_source=internal

And then again, there's the NIH, and of course the venture capitalists...