Patent CA-3086557-A1 (CA)
Title: Methods for organizing the disinfection of one or more items contaminated with biological agents
Inventor: JINEDATHA CHETAN
IPC: G06K19/07
Filed: 2013-08-01
Abstract: The invention provides devices comprising a wireless communication receiver, a changeable display, first circuitry to alter the changeable display from exhibiting a first particular status of the device to exhibiting a second particular status of the device after a predetermined amount of time, and second circuitry to alter the changeable display from exhibiting the first particular status of the device to exhibiting the second particular status of the device upon receipt of a unique signal at the wireless communication receiver that indicates relocation of the device. The invention further provides methods for organizing the disinfection of one or more items contaminated with a biological agent using the disclosed devices.similar to the 433 MHz RFID  Domino Tag Active 124010 by GAO RFID Inc. The invention also provides methods for organizing (manually or through automated means) the disinfection of a designated area(s) contaminated with biological agent(s) comprising attaching one or more radio-frequency ID (RFID) tags to a designated arca to be disinfected. The method further comprises exposing the designated area or portion thereof to a disinfecting means for a period sufficient to disinfect the designated area_ Further, the method cornpnses obtaining a signal from the tagged designated area when disinfection is complete thereby organizing the disinfection of the designated space. In one embodiment, the designated area(s) contaminated with biological agent(s) may be disinfected by the method of the invention. The invention also provides methods for organizing (manually or through automated means) the process of disinfection of a designated area(s) contaminated with biological agent(s) comprising exposing the designated area or portion thereof having one or more RFID tags to a disinfecting means for a period sufficient to disinfect the designated area. The method further comprises obtaining a signal from the tagged designated area or portion thereof when disinfection is complete. in one embodiment, the method for organizing the disinfection of a designated space contaminated with biological agent(s) may be an automated method.    Date Recue/Date Received 2020-07-08 In accordance with the practice of the invention., the space or room to be cleaned may be coated with a reflective coating of paint (UVC 360, Lumacept, TN). This coating enhances reflectivity of the UVC thus improving the overall disinfection and thoroughness of disinfection. Additionally, the designated space to be disinfected may be a room or portion thereof, The room may be enclosed or open. For example, the room rnay be a hospital room (for humans and veterinary animals). In yet another example, the room may be in a day care center or nursery or school. In one embodiment, the disinfecting means may be an ultra-violet light or hydrogen peroxide system as mentioned previously. In various embodiments, the micro-organism or biological contaminant may be as mentioned previously. In various embodiments, the RHD tag may communicate with the disinfection means. In another embodiment, the RFID tag may communicate the initiation or completion of the cleaning or disinfection cycle to a computer or data warehouse. In a further embodiment, the method com.prises processing the signal from the tagged designated area to create a log of the cleaning or disinfecting history of each RFID tagged item through a computer. In yet another embodiment, comprising processing the signal from the tagged designated space or portion thereof to create a log of the cleaning or disinfecting history of each RH]) tagged item through a computer. In yet another embodiment, the RFID tag permits the creation of a log of the cleaning or disinfecting history of each RFID tagged space or patient room or reusable medical equipment through a computer or data warehouse. in another embodiment, the RFID tag may be attached to a patient or located in a patient room or unclean piece of equipment and resets the status of the designated space for future disinfection.  In another embodiment, the disinfection means may communicate with multiple RFD tags and automatically cleans the entire room.   Date Recue/Date Received 2020-07-08 In an embodiment of the invention, the REID tags) in the designated area may be passive. In another embodiment, thc RFID tag(s) in the designated area are active. The advantage of the invention includes the ability to keep track of clean and dirty equipment log; ability to distinguish clean and dirty equipment at the end user level with or without having to manually scan equipment; ability to prevent errors by introducing various safety mechanisms like alarms if equiptnent that is not clean is going to be used; ability to communicate with the environmental services personnel on a real time basis; ability for the hospital management and infection prevention and control teams to keep track of cleaning processes on a real time basis, for both equipment and patient rooms;  and/or provides complete automation of the process thus preventing or reducing medical errors that can be fatal. The following examples are provided to further illustrate aspects of the invention. These examples arc non-limiting and should not be construed as limiting any aspect of the invention. EXAMPLES    For example, patient X is admitted to the hospital and is in Room A. Patient X  has MRSA and has spent 5 days in Room A. During the course of his/her hospitalization, patient X touches several surfaces in Room A and also requires IV antibiotics which are delivered by an IV pump attached to an IV pole. Patient X is ready for discharge on day 5. This information is electronically entered in the hospital medical records. This electronic entry updates the housekeeping database alerting the environmental services personnel that Room A will soon be ready for cleaning_ Once patient X has left the hospital, the software on the Jangarna's display unit or Jangama integrated into a no-touch device such as Xenex or Bioquell displays that Room A is now available for cleaning. The environmental services personnel are alerted, and one then Date Recue/Date Received 2020-07-08 takes the no-touch device with/without Jangama (depending whether Janganta is integrated or standalone) to Room A for cleaning. Room A is tagged with an active RFID tag, which updates the tirne of entry of device for cleaning. Once cleaning of Room A is in progress, the hospital bed database indicates the same. Once room A is terminally cleaned per protocol and the no-touch device is taken out of the room, the room RFID tag updates the hospital bed database regarding the availability of that room. This interrogation upon entry and exit is provided by the RFID reader in the jangama or no-touch device with Jangama incorporated within it. The bed management system may further have several disinfection positions that need to be completed before the room is marked as completely disinfected for certain type of disinfection systems; e.g., the Xenex device has three to four positions and the. Tru-D has two positions. Merely by way of example., the disinfecting means may be arranged as follows: one. for a bathroom, two in living rooms (one on either side of the bed) and one in an anteroom, if present. The bed management system shows the progress on the display as each position is completed. A protocol for disinfecting medical equipment and obtaining a signal that disinfection is complete is as follows: I.        Medical equipment of interest tnay be tagged with a unique identifier. Examples of suitable identifiers include: RFD tag or tags (active, passive or combined), or R.FID  equivalents like: RTLS tags, Bluetooth ID, Wi-Fi tags, near field communication technologies or infrared tags. Active RFID tags may include LED display technology or E-ink display technology. 2.    The tagged equipment may be able to communicate with both a mobile RFID  reader(s) and/or fixed RFID reader(s) as shown in Figures 5 and 6, each of which in turn may communicate with a central data warehouse (management system). The mobile and the fixed RFID rcader(s) may also have the capacity to communicate with each other. A facility's existing Wi-Fi technology may be used to enable such communications. 3.    Equipment holding rooms may have a fixed RFID reader. 4.    Each UV device or equivalent device of interest may incorporate a mobile RFID reader in the lona of an incorporated jangama or standalone jangarna (Figure 9). 5,    This uniquely tagged RME may have a communication range of 20-30 feet with a mobile RFID reader and a range of e.g. 4-6 feet for the fixed reader.   Date Recue/Date Received 2020-07-08 6.    The mobile reader may also have the capacity to transmit or emit signals back to the REID tagged RME. It also may have storage and display capacity. 7.    The fixed readers may also have the capacity to transmit or emit signals back to the REID  tagged equipment. 8,    The portable reader/transmitter/storage/display device (Jangama) may have many functions: a. Receive and recognize each of these uniquely tagged ID equipment: b. Ability to measure UV radiation around it or Hydrogen peroxide levels around it; c. Ability to send signals to the uniquely tagged equipment while in the vicinity of e.g.      4-6 feet; d. Ability to communicate with fixed reader/transmitter; e. Ability to communicate with managetnent systems (data warehouse); L Ability to store information in its hardware to later tran.smit to the management system in case there are Wi-Fi issues; and/or g. Ability to display live information about bed management as well as the ability to identify unclean equipment in the. vicinity (e.g., about 20-30 feet). 9.        The fixed sensor/emitter may have these fun.ctions: a. Receive and recognize each uniquely tagged RME within the room. at entry and exit (choke holder): h. Communicate with the RME being removed from/broug,ht in the holding area, and changing the signal on (he RM.E appropriately; c. Communicate with the mobile reader; and/or d. Communicate with management to provide a real time feed about equipment cleaning necessity. 10.    The tagged equipment may have a receiver for a unique signal. Once the unique signal is received it may display e.g. a green light and or display the word "CLEAN".  The signal 'nay be valid for 24 hours but may be customizable, for example, up to 72 hrs. 11.       The tagged RME may return to unclean or red display representing unclean in the following exemplary scenarios: a. No unique signal from mobile. reader/transmitter or fixed reader/transmitter;   Date Recue/Date Received 2020-07-08 b. 24 hours have elapsed since the last signal (automatically change status to either red light or display "Unclean" at the end of 24 hours or the customized time); c. The equipment leaves a designated area (i.e.. holding area): and/or d. The equipment was not within 4-6 feet of the 'UV unit or in the ease of Hydrogen peroxide within the contained room. 12.                                                                       The rootn itself may be lined with unique aluminum screen with panels at 45 degrees (Figure 2) or coated with t_IV reflective paint. The aluminum and paint are great reflectors of UV light and may make the process of disinfection more effective as the equipment may be cleaned through the reflectivity of the panels or paint. 13.                                                                   The mobile reader/transmitter/recorder (Jangama) may log each activity. For example, equipment # 1 was in the vicinity (e.g. 4 feet) of the sensor at this time date, receives a total radiation of x units (0-5000 millijoules/crn2 or other comparable units) for y time (O-NO minutes) and receives the clean signal at z time. If taken out of the area, the central database may record the last time taken out of clean area and record it and merge the data with the mobile unit_ A data log may be maintained in MS Excel format or equivalent tabular format in the central data warehouse and may be printable for regulatory (Joint Commission/Center for Medicaid and Medicare Services) compliance and available on request during an inspection. 14.    The centrai data warehouse may be equipped with appropriate software to recognize all tagged equipment, their location and searchable properties like some of the current RHO vendors. The database may also be able to locate each UV or equivalent device and be able to update device maintenance logs. 15.    lfunclean equipment is accidentally wheeled out of the designated home area then it may produce an auditory signal (e.g., beeping noise) for designated period of time and a visual signal (e.g., a light signal such as a red light signal) may blink for a designated time period to alert the handler that the equipment is not clean. Active management of clean and unclean inventory using Pulsed xenon UV device:  (Figure 1 and 12) Each RFID tagged equipment is managed by a Wi-Fi or similar technology enabled central data warehouse through a fixed reader in each of the equipment holding rooms. Once the UV device Date Recue/Date Received 2020-07-08 equipped with the Jangama is used to clean the RME it records each uniquely tagged RME and transmits that information to the central database/Management system. This database may be updated on a real time basis, meaning, e.g., that it updates with each cleaning and each movement of the REED tag:ed RME. An UV operator may he able to access this information on the UV device using the mobile reader/transmitter/storage/display unit (Jaagama) on a real time basis as well, thereby alerting the operator to the holding areas in need of clean equipment. Also, if the UV device is in the vicinity of a holding area with a high volume of unclean equipment, an instant beep/message (like a text message) may alert the operator handling the device. This may help with active managernent of clean/unclean equipment especially near high turnover areas such as Operating Rooms. The same device may also display a feed as to where the next room needs to be cleaned. This feed may be fed to the display screen on Jangama from bed control or bed management as well as central data warehouse servers. The mobile sensor/emitter/storage device (Jangama) may also communicate with the fixed readers and all the RMEs in disinfection range (e.g., 4-6 feet) which rnay be targeted for cleaning. The. fixed readers as shown in Figure 6 may change. the status of these visible RME :in the central database to "BEING DISINFECTED". Once the disinfection process is completed, the portable sensor of jangania may cotnmunicate the completed cycle to the fixed readers and the database may be updated to "CLEAN" for these visible equipment and the resets the timer cm the database and the tagged RIVE. It may be necessary to relocate the UV  device to different sections of the holding roorn to effectively clean all the equipment (as the room. may be bigger than e.g. 6 x 6 feet), as all equipment in need of cleaning may not be within UV ran.ge. At the pre-determined time, the fixed sensor may be able to turn off the "green signal" on all equipment that would no longer be considered clean. Alternatively, the equipment may be manually reset for cleaning. All this communication may occur over the pre-existing Wi-Fi ccumnunications available at the facility. For example, if patient Y in room B needs IV fluids, the nurse may go to the utility/equipment storage room to get an IV pole that can be used for patient Y. A11 IV poles stored in the storage room have active RPM tags which illuminate "GREEN" for clean and "RED" for unclean as shown in Figure 10. The storage room entrance/exit area has an active RFID  reader. The nurse Date Recue/Date Received 2020-07-08 takes an IV pole which has the "RED" illuminated on it, but fails to notice it. As this IV pole is taken out of the utility room, the RFID reader interrogates the RFID tag on the IV pole and sounds out an alarm that an unclean pole is being taken out of the room.  Should the "GREEN"  illuminated pole be taken, no alarm will sound. The active tag on the IV pole now is in use in room B, which will result in software update of its exact location. In another example, patient Y in room B needs IV fluids. The nurse goes to the utility/equipment storage rootn to get an IV pole that can be used for patient Y. All IV poles stored in the storage room have active RFID tags which display "Clean" and "Dirty" on an E-ink-based RFID tag as shown in Figure 10. The storage room entrance/exit area has an active RFID  reader. The nurse takes an IV pole which has the word "DIRTY" displayed on it, but fails to notice it. As this IV  pole is taken out of the utility room, the REID reader interrogates the RFID  tag on the IV pole and sounds out an alarm indicating that an unclean pole is being taken out of the room. Should a "Clean" displayed pole be taken, no alarm will sound. The active tag on the IV  pole now is in use in room B, which will result in a software update of its exact location. The fixed readers have ability to receive signals from 2 sources. One from fixed R.FID reader or Blue tooth device and the other from the mobile reader/transmitter (iangarna). The fixed reader may communicate all the information with a central server/manatzernent system through the facility's Wi-Fi. The mobile reader/transmitter (Jangama) may have the ability to communicate with RFID/Blue tooth equipment, fixed sensors, central server or management system through Wi-Fi. The received signal strength indication (RSSI) may be used to determine which room the equipment is in. Real Time Location Systems (RMS) Real Tirne Location Systems (RTLS) are used to determine the physical proximity of active RFID tags and can be used in conjunction with this invention. This can be accomplished by installing fixed RFID readers at strategic locations where the active tag can be read Date Recue/Date Received 2020-07-08 simultaneously by two or more readers. Pre-determined algorithins can then determine the exact location of the active RFLD tags by the RSSI level and triangulation. This would determine an approximate location within e.g. about 10 feet depending on the number of reader access points are used. For further accuracy, additional sensor technologies rnay be incorporated into the tag such as ultra-sound or infra-red. Cornponents:  1. RFID tag or equivalent for each equipment that needs to be tracked and disinfected; 2. IVIobile sensor/reader/signal emitter/storage device/display device (Jangama);      3. Clean/Unclean displayer; 4. Green/Red light displayer; 5. Beeper/this device is -unclean" announcer; 6. UV Reflectors/paint in the room; 7. Room readers: 8. Data warehouse master database/Management system.   Another way to communicate with the REID tagged RME may be through a no-touch disinfection (NTD) remote control mechanism where after the NTD device is done disinfecting, the tag sends a signal to the RFID tag and turns on a visual display (e.g., a LED light (green color)). In contrast, the default light signal may be a different color, such as red. The green and red light illuminates Clean and Unclean respectively as displayed below. The lights may be enclosed behind these wordings in a square box with these wording on the front and LED lights ..õ.. r4,7"!AIltr7.-________________________ behind them.      It inay also display the words clean or dirty using the E-ink technology. The mobile continuous RAID reader,rnobile display (Jangama) and the tagged equipment may communicate with each other within e.g. 20-30 feet vicinity on a real time basis. Another mobile Date Recue/Date Received 2020-07-08 reader may be activated just like the light after UV radiation for 2 seconds.  It may identify and transmit all the equipment ID for e.g. about less than 4 feet range and communicatc that information to the management system to verify the. equipment status as clean or dirty. .. At chokepoints, a reader may be connected to the same mechanism that turns the light off or turns it red if it moves outside of the chokepoint area. The off mechanism (or turning it red/unclean) is triggered by the reader and the reader sends a message to the management system to change the log status as moved and now unclean. The same reader may have a voice alert/beep when unclean equipment is moved from the holding area away from chokepoint.  Similarly, all the above information may display on E-ink based RFID tags.   The following is a description of a process for creating status updates using the RED tagged system of the invention. Process: The designated rooms will have unique identifiers: RFID tags (active, passive or combined), or 'WED equivalents       R1LS tags, Bluetooth ID, Wi.-Fi tags.  near field communication technologies or infrared tags. The n.umber of tags may range from 2-3 (with at least one in the main room and I in the bathroom). The exact number of tags :in each room will vary depending on the size of the room. For example, a room that is bigger than 6 x 6 feet may have at least 2 tags. Also, the central database management or bed management may have the information of number of tags and their locations (positions) in each room.  2.        The portable sensor/emitter/storage (Jangama) may have 3 functions: a.    Receive and recognize each of these unique tagged ID rooms. b.    Ability to measure UV light amount/exposure around it or Hydrogen peroxide levels around it.   Date Recue/Date Received 2020-07-08 c.              A RF1D reader may send a signal back to bed management systetn; via the existing facility's Wi-Fi; once the disinfection cycle is completed, thereby indicating the area that has been recently disinfected: on a real time basis. 3,    The mobile sensor (Jangama) may not recognize the RFID tags, which are not within e.g., 4-6 feet of the UV unit or in the case of Hydrogen peroxide within the contained room. 4.    The portable sensor/emitter/recorder (Jangama) may log each of the activity. For example, that room # 1 east wall was in the vicinity (about 4 feet) of the sensor at A time/date, may have received a total radiation of X many units for Y length of time, may have received the clean signal at Z time; room #1 west wall was in vicinity (about 4 feet) of the sensor at B  time/date, may have received a total radiation of X many units for Y length of time, may have received the clean signal at Z time; room #1 bathroom was in vicinity (about 4 feet) of the sensor at C time/date, may have received a total radiation of X many units for Y  length of time, may have received the clean signal at Z time. Combined data log may be maintained in Excel format or tabular format so it is printable and can be showed to regulatory authorities (IC/CMS) on request or during inspection. 5.    Once room. #1 is thoroughly disinfected. the mobile sensor (e.g..  including a Jangama) rnay update the central database/bed management system and display that particular room as "clean" for bed management and log when all the areas of the room are cleaned (it may remain in "Unclean" status if the EMS person missed a position for UV disinfection devices like Xenex). 6.    Once that particular room is assigned to a patient through bed management, the room may be displayed as "Occupied". 7.    Once the status of an Occupied room in changed to Unoccupied/discharged in bed management, the mobile sensor (Jangama) log tnay add the particular room to its "To be Cleaned" database, alerting the operator to rooms in need of cleaning.  Alternatively, the status of a patient room may be reset to "To be Cleaned" manually or after a predetermined time.    Date Recue/Date Received 2020-07-08 The "Jangama." may have the following components (Figure 9): 1. 'RFD reader 2. RFID Controller 3. Display pancl/unit 4. Wi-Fi network integrator (transmitter/receiver) 5. Microprocessor 6. Sensor signal processor 7. Sensors 8. Antennas 9. Memory The Jangama can be integrated into an existing no-touch disinfection device circuit board instead of a stand-alone device. Break down of th.e communication that occurs between different components of the system: The RFID reader or interrogator or controller could be the same unit. The rcadertinterrogator reads and retrieves information, whereas the controller can send a signal back to RFID tag to rewrite memory or change display settings. 1. Communication between the RFID Reader & Active Tag: The RFID Reader sends an enquiry which is received by a RFID tag. Active RFID  tags store memory values corresponding to clean or dirty that are accessed by the reader.  At the same time, each RPM tags unique ID is also accessed. This information is transmitted from the RFID reader to the tnobile unit as well as the data warehouse through. a Wi-Fi or wised network. 2. Cominunication between the RFID controller and Active tag: The controller sends an enquiry to a RFID tag, which replies to the controller the currently stored memory value (corresponding to clean or dirty) along with the unique ID for the tag. This information is also relayed to the microprocessor which in turn communicates with the. stored information in. the data warehouse through the existing Wi-Fi system.   Date Recue/Date Received 2020-07-08 Once the condition for disinfection is satisfied, the microprocessor asks the controller to issue a clean signal back to the active RFID tag and change the memory value to clean.  The signal will only be used to active 1F1D tags within a set distance parameter of 4 feet, but this could also be anywhere from 0-8 feet. The controller confirms the RFID tags unique ID/new memory value and sends it back to the processor. The microprocessor then relays the new values to the data.  warehouse to clean status for those RF1D tags which were in the set distance parameter with a titne and date statnp.      3. Communication between Sensor Signal processor and Sensors: Sensors can sense various external parameters like UV, Hydrogen peroxide. Once a certain upper limit threshold is reached in the sensor (10-500 mi11ijoules/cm2 for (JV or 10-20000 ppm for hydrogen peroxide), it sends a signal to the sensor signal processor, which changes the signal to a digital numerical signal for the microprocessor to know that certain values have been met (Figure 7). This is referenced to the stored upper threshold limit for that sensor. If above the threshold, the microprocessor asks the REID controller to issue a clean signal to the active RFTD tags in a certain distance parameter as described above. 4. Sensors: The sensors can sense various parameters like temperature, pressure, mercury based UV dose (continuous), pulsed xenon UV dose (cumulative dose of all pulses in a set time), or hydrogen peroxide concentration. The sensors transtnit the sensed dose to the sensor signal processor. 5. Sensor signal processor: The function of the sensor signal processor is to take th.e sensor input, convert it to a digital signal and reference it to the stored reference parameters for various external effects like UV or Hydrogen peroxide. Once the threshold is reached, the sensor signal processor will continue to send a signal of condition being met to the microprocessor for next 60 seconds or until. the sensor keeps sending the sitznals whichever is later. For those 60 seconds, the sensor value will be set as met, even if the sensors sense no additional UV or 11202. After 60 seconds, the. parameters will Date Recue/Date Received 2020-07-08 be set to below threshold until another sensing event happens (Figure 7). The sensor value could be set as met, for example, anywhere from 30 seconds to 300 seconds. In yet another example, the sensors and sensor signal processors may be optional, when time is used as a parameter to fulfill condition being met algorithm for the RFED  controller to transmit a signal to nearby R.FID tags. This is usually possible if the circuit board is integrated into a no-touch disinfection system such as Pulsed UV or Mercury based UV or Hydrogen peroxide systems thus eliminating the need to sense an external signal.      6. Display unit: The display unit will have the capacity to display various things similar to a notebook or tablet. It can display information newly created in the microprocessor or the live inform.ation it receives from the data warehouse servers through Wi-Fi or live bed management feed through the bed management servers. It can also display information about any dirty RME in the near vicinity of the mobile unit. It can also perform other functions of a display unit like other tablets or phones receiving text or video chat again through a Wi-Fi network or a cellular network. 7. Microprocessor: The microprocessor is like the brain of Jangama. Its functions as a central processing unit for all external signals and is also the origin of digital signal either generated intrinsically or with the help of algorithms in the data warehouse. The digital signals are then relayed to RFID  interrogator or controller for their actions to follow. Digital signals that originate from the microprocessor are continuously fed to the data warehouse for determining the location or position of a RFID tagged device much like a mobile RFID interrogator.  Similarly, the microprocessor has the ability to process the data warehouse algorithms and convert them to RFID signals through controller and interrogator to read or write a RFID tag or change the memory in a RFID tag to change the clean or dirty labeling on the RFID tags that tnet the condition. In another example, the microprocessor may take the form of a FPGA  (Field-Programmable Gate Array), ASIC (Application-Specific Integrated Circuit), or sorne other form of integrated analog or digital logic gates.   Date Recue/Date Received 2020-07-08 7. Data warehouse: Thc data warehouse houses all the information required to function. Certain new algorithms will need to be incorporated into existing real time location services algorithms.  A new algorithm to match the sensor values, distance, exposure time and choke point integration be added. Alternatively, these algorithms may be incorporated into the devices themselves. 8. The Active RFID with display: The RFID with display could be of many varieties as previously described in the detailed description.    9. Memory; The memory component is optional and will mainly interact with the microprocessor and store data for a limited period of tirne. It is crucial to have data stored in this backup memory in case there are transmission issues with the facility Wi-Fi. Data could be stored until a proper Wi-Fi connection is established or until the unit can be manually synced with the central data warehouse.   In another embodiment the invention would be used in conjunction with choke points. If tagged equipment is allowed to move from one area to another area after it has been designated as clean, or if clean equipment moves from one patient to another patient room for example, this may lead to cross contamination. To prevent this, the data warehouse will include a choke point algorithm. For example, a piece of clean equipment is taken out of a current patient room as it was not being used. Doing so carries the risk of cross contamination. To prevent this, each patient room will have a choke point, where an active reader will sense the movetnent of the tagged equipment beyond a certain point and send a signal to the data warehouse, which confirms the equiptnent movement out an area and that it should not have been moved. The data warehouse will send a signal back to the controller at the choke point to change the RFID memory to dirty as soon as the choke point is breached_ It will also sound an alarm to the end user about the equipment Date Recue/Date Received 2020-07-08 being dirty now. Such algorithms already exist in, for example, Avantc's RFID  "Access-Trakker," but such algorithms need to be modified to accommodate current aspects of invention as related to clean and dirty equipment. Integration of such concept will improve patient safety and prevent medical errors. Similarly clean equipment could be in a clean equipment room. If the clean equipment were to travel outside the clean equipment room, the reader at the choke point will send a signal to the data warehouse that the clean equipment was rernoved from the clean equipment room. The data warehouses algorithm will track this equipment's movements for next 5 minutes.  If the equipment enters another patient room, then the readers at the patient rooms' choke point will note this entry. Once this equipment enters the patient room, the data warehouse. will change the entry to dirty and should the equipment be taken out again beyond the patient room's choke point, a similar process as described above will happen. Similarly in the clean equipment room, if dirty equipment is being placed back in the room, the choke point reader will confirm with the_ data warehouse of the. equipment's dirty status, record the movement and change the display on equipment to unclean, and beep the equipinent han.dling person that the equipment is unclean. Various such alizorithms will he built to track the equipment at various stages olT its movement alerting the end user both visually as well as by noise about the current status of the equipment.   The following are algorithms that may be used in conjunction with the Sangaina invention:  Algorithm 1: UV dose fulfillment algorithm 1. Operator starts UV disinfection device 2. Sensor starting sensing UV and calculates the cumulative dose of UV 3. Once UV dose exceeds 100 mi11iwatts/em2 or millijoules/cm2 then required dose for disinfection is fulfilled.    Date Recue/Date Received 2020-07-08 Algorithrn 2: Hydrogen peroxide fulfillment algorithtn: 1. Operator starts hydrogen peroxide disinfection device 2. Sensor starting sensing hydrogen peroxide and calculates the cumulative dose of hydrogen peroxide. 3. Once hydrogen peroxide dose exceeds 2000 parts per million (ppm) then required dose for disinfection is fulfilled. The ppm range is 2-20,000 as it varies on the size of the room. Algorithm 3: Dirty to Clean Display Change Algorithrn 1. Once UV dose criteria is fulfilled the RFID controller will send a back to the RFID tags memory and it will change the stored value that re-presents "dirty" to stored value for i.nernory that represents "clean". References:    1.    Rutala WA, Weber DJ. Are Room Decontamination Units Needed to Prevent Transrnission of Environmental Pathogens? Infect Control Hosp Epideiniol. 2011 Aug;  32(8): 743-747. 2.    Parvez N. Jinadatha C. Fader R. et al. Universal MRSA Nasal Surveillance: Characterization. of Outcomes at a Tertiary Care Center and Implications for Infection Control. Southern Medical Journal, Volume 103, Number 11, November 2010. 3.    Otter jA, Yezti. S. French GL. The role played by contaminated surfaces in the transrnission of nosocomial pathogens. ICHE 201 I July; 32(7):687-699. 4,    'Boyce JM, Havill NL, Moore BA, Terminal Decontamination of Patient Rooms 'Using an Autornated UV Light. ICHE, 2011: 32(8):737-742. 5,    Morgan DJ, Rogawski E, Thom KA, et al. Transfer of rnultidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with en viromnental.  contamination. Crit Care Med, 2012 Apr; 40(4):1045-51. PubMed PMID: 22202707. 6.    Datta R, Platt R. Yokoe DS, et al. Environmental cleaning intervention and risk of acquiring rnultidrug-resistant organisins from prior rooni occupants. Arch Intern Med.      2011 Mar 28;171(6):491-4. PubMed PMID: 21444840.   Date Recue/Date Received 2020-07-08 7.    Zaidi M. Angulo M, Sifuentes-Osornio J. Disinfection and sterilization practices in Mexico. J. Hosp. Infect. 1995:31:25-32. 8.    McCarthy GM, Koval JJ, John MA, et al. Infection control practices across Canada: do dentists follow the recommendations? J. Can. Dent. Assoc. 1999;65:506-11. 9,    Spach DK Silverstein FE, Stamm WE, Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Arm. Intern. Med. 1.993;118:117-28. 1Ø      Weber DJ, Rutala WA.. Lessons from outbreaks associated with bronchoscopy. Infect.  Control Hosp. Epidemiol. 2001;22:403-8. 11.    Weber DJ, Rutala WA, DiMarino AJ, Jr. The prevention of infection following gastrointestinal endoscopy: the importance of prophylaxis and reprocessing.  In: DiMarino AJ, Jr, Benjamin SB, eds. Gastrointestinal diseases: an endoscopic approach.  Thorofare, NJ: Slack Inc., 2002:87-106. 12.    Meyers H, Brown-Elliott BA, Moore D. et al. An outbreak of Mycobacterium chelonae infection following liposuction. Clin. Infect. Dis. 2002;34:1500-7. 13.    Lowry PW, Jarvis WR, Oberle AD, et al_ Mycobacterium chetanae causing otitis media in an ear-nose-and-throat practice. N. Engl. J. Med. 1988;319:978-82, 14.       Centers for Disease Control and Prevention. Pseudo-lianas aeraginasa infections associated with transrectal ultrasound-guided prostate biopsies¨Georgia, 2005.  MMWR  CDC Surveill. SUMM. 2006;55:776-7. 15.    Mehta AC, Prakash UBS, Garland R, et al. Prevention of flexible bronchoseopy-associated infection. Chest 2006;128: 1742-55. 16.    Turner FJ. Hydrogen peroxide and other oxidant disinfectants. In: Block SS, ed.  Disinfection, sterilization, and preservation. Philadelphia: Lea & Febiger, 1983:240-50. 17.    Carling PC, Parry MF, Von Beheren SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. ICIIE 2008 Jan; 29(1): 1-7. 18.    Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation.  Infect Control Hosp Epidemiol. 2010 Oct; 31(10):1025-9. 19.    Stibich M. Stachowiak j, Tanner B, et al. Evaluation of a pulsed-xenon ultraviolet room disinfection device for impact on hospital operations and microbial reduction.  Infect Control Hosp Epidemiol. 2011 Mar; 32(3):286-8, Date Recue/Date Received 2020-07-08 20.    Rutala WA, Gcrgen MF, Tam:le BM, et al. Rapid hospital room disinfection using ultraviolet (UV) light with a nanostructured UV-reflective wall coating.  Infect Control Hosp Epideiniol. 2013 May; 34(5):527-9. 21.    'Holindahl T, Lanbeek P, Wirth M, et al. A Head to 'Head Comparison of Hydrogen Peroxide Vapor and Aerosol Room Decontamination Systems. ICHE, 2011; 32(9):      22.    Block SS. Peroxygen compounds. In: Block SS, ed. Disinfection, sterilization, and preservation. Philadelphia: Lippincott Williams & Wilkins, 200 l : I 85-204. 23.    US 20100.171586 Al.      24.    US 8416072 B2 25.    US 20100295943 Al 26.    US 7158030 B2 27.    US 7319397 B2 28.    US 7342497 B2 29.    US 6,696,954 30.    US 6,703,935 31.    US 6,943,688 32.    US 6,973,716 33.    US 6,665,1.93 34.    US 6,657,543 35.    US 6,883,710 36.    US 6,961,000 37.    US 7,036,729 38.    US 7,098,793 39.    US 7,154,046 40.    US 7,158,030 41.    US 7,319,397 42.    US 7,342,497 43.    US 7,423,535 44.    US 7,382,255 45.    US 20100171586 Al Date Recue/Date Received 2020-07-08 46.    EP 2504822 Ai Date Recue/Date Received 2020-07-08 What is claimed is: 1.    A device., comprising: a wireless communication receiver;      a changeable display; first circuitry to alter the changeable display from exhibiting a first particular status of the device to exhibiting a second particular status of the device after a predetermined amount of time; and second circuitry to alter the changeable display frotn exhibiting the first particular status of the device to exhibiting the second particular status of the device upon receipt of a unique signal at the wireless communication. receiver that indicates relocation of the device. 2.    The device of claim 1, wherein the second circuitry alters the changeable display from exhibiting the first particular status of the device to exhibiting the second particular status of the device upon receipt of the unique signal at the wireless communication receiver that indicates th.e device is exiting or has exited a designated area. 3.    The device of claim 1, further comprising an alarm and third circuitry to sound the alarm upon receipt of the unique signal at the wireless communication receiver. 4.    The device of claim 1 , further comprising third circuitry to: alter the changeable display from exhibiting the second particular status of the. device to exhibiting the first particular status of the device upon receipt of a different unique signal at the wireless communication receiver indicative of the first particular status; and start a timer associated with the first circuitry upon receipt of the different unique signal at the wireless cotnmunication receiver that is indicative of the first particular status, 5.    The device of claim 1, wherein the changeable display comprises an electronic visual display.    Date Recue/Date Received 2020-07-08 6.    The device of claitn 5, wherein the electronic visual display is electronic paper display. 7.    The device of claim 1. wherein the changeable display comprises at least one light source_ 8.    The device of claitn 1, wherein the wireless receiver is a wireless comtnunication tag. 9.    The device of claim 8, wherein the wireless communication tag is a radio-frequency identification (RFID) tag. 10.    Thc device of claim 9, wherein the RFID tag is a passive RFID tag. 11.    The device of claim 9, wherein the RFID tag is a semi-passive RFID tag. 12.    The device of claim 9, wherein the RFID tag is an active RFID tag. 13.    The device of claiin 1, further coinprising an ultraviolet light dose sensor to send a signal to affect a change of status on. the changeable display upon detecting a predetermined dose of ultraviolet light. 14.    The device of claim 1, further cotnprising a sensor to detect a presence of a fluidic disinfectant, wherein the sensor is configured to send a signal to affect a change of status on the changeable display upon detecting a predetermined amount of the fluidic disinfectant. 25    15.    The device of claiin 1, wherein the first particular status is a clean status for the device, and wherein the second particular status is an unclean status for the device. 16.    A method for disinfection of one or more iterns containinated with biological agent(s) comprising: 30        exposing an item to a disinfectant for a period sufficient to disinfect the item, said item having a wireless communication tag;   Date Recue/Date Received 2020-07-08 sending a first signal to the wireless communication tag when disinfection is complete to update a display on the wireless communication tag to be indicative of a clean status for the iteni; subsequently detecting movement of the item past a ehokepoint; and sending a second signal to the wireless communication tag to alter the display upon a lapse of a predetermined amount of thne after detecting movement of the item past the chokepoint. 17.    The tnethod of claim 16, wherein the step of sending the first signal to the wireless communication tag comprises manually activating the signal transmission. 18.    The tnethod of claitn 16, wherein the step of sending the first signal to the wireless communication tag is automated. 19.    The method of claim 18, wherein the step of sending the first signal to the wireless communication tag :is automated from a computer of a system that track.s disinfection of multiple items. 20.    The method of claim 16, wherein the item is a device, machine, or tool.    21.    The method of claim 20, wherein the device, machine, or tool is tnedical. equipment. 22.    The method of claim 21, wherein the medical equipment is a durable medical equipment or reusable medical equipment. 23.    The method of claim 16, wherein the disinfectant is ultra-violet light. 24.    The tnethod of claitn 23, wherein the ultra-violet light is from a pulsed xenon lamp. 25.    The method of claim 23, wherein the ultra-violet light is from a mercury lamp, Date Recue/Date Received 2020-07-08 26.    The method of claim 116, wherein the disinfectant is hydrogen peroxide. 27.    The method of chnin 26, wherein the hydrogen peroxide is hydrogen peroxide vapor, activated hydrogen peroxide, dry mist hydrogen peroxide, or vaporized hydrogen peroxide_ 28.    The method of clairn 16, wherein the biological agent is selected from a group consisting of a micro-organism, viral particles, fungal particles, an infectious agent, microbes in human secretion, human excretion, dust, and fecal material. 29.    The method of claim 16, further comprising recording the initiation or completion time of the disinfection period. 30.    The method of claim 16, further comprising processing the first signal so as to create a log of the cleaning or disinfecting history of the item. 31.    The :method of claim. 16, wherein the second signai is a signal to alter the display to be indicative of an unclean status for the itern. 32.    The method of claim 16, further comprising sounding an alarm upon sending the second signal. 33.    The method of clairn 16, wherein the step of sending the first signal to the wireless commuMcation tag is automated from a disinfectant sensor. 34.    The method of claim 33, wherein the disinfectant sensor is an ultraviolet light dose sensor. 35.       The method of claim 33, wherein the disinfectant sensor is a sensor for detecting a fluidic disinfectant_ Date Recue/Date Received 2020-07-08 36.    The method of claim 1.6, wherein the first signal is to change visual information exhibited on an electronic visual display of the wireless communication tag. 37.    The method of claim 16, wherein the first signal is to illuminate a tight source on the display of the wireless communication tag. 38.    The method of claim 116. wherein the wireless communication tag is a radio-frequency identification (RFID) tag. 39.    The method of claim 38, wherein the RFID tag is passive. 40.    The method of claitn 38, wherein the R.FID tag is semi-passive. 41.    The method of claim 38, wherein the R.FID tag is active. 42.    The method of claim 16, wherein the step of detecting movement of th.e item past the chokepoint comprises detecting the item entering a space associated with the chokepoint. 43.    The method of claim 42, further comprising sending a third signal to the wireless communication tag to alter the display upon detecting movement of the item past the chokepoint to be indicative of entry of the item into the space associated with the chokepoint. 44.    The method of claim 42, further cornprising detecting the item exiting a holding area prior to detecting the item entering the space associated with the chokepoint. 45.    The method of claim 44, further comprising sending a third signal to the wireless communication tag to alter the display upon detecting the item exiting the holding area. 46.    The method of claim 16, wherein the step of detectin.g movement of the item past the chokepoint comprises detecting the item exiting a space associated with the chokepoint.   Date Recue/Date Received 2020-07-08 47.    The method of claim 46, further comprising sending a third signal to the wireless communication tag to alter the display upon detecting movement of the item past the chokepoint to be indicative of the item exiting the space associated with the chokepoint. 48,    The method of claim 16, wherein the predetermined amount of time is approximately 24 hours or longer. 49.    The method of claim 16, wherein the chokepoint is associated with an area for storing medical equipment, 50.    The method of claim 16, wherein the chokepoint is associated with a patient room. 51.    The method of claim 16, wherein the chokepoint is associated with a patient room and wherein the method further comprises: receiving a third signal indicating a patient has been discharged from the patient room after detecting movement of the item past the chokepoint; and sending a fourth signal to the wireless communication tag to alter the display on the wireless communication tag upon receiving the third signal. 52,    A method for onzanizing the disinfection of one or more items contaminated with biological agent(s), comprising: exposing an item to a disinfectant for a period sufficient to disinfect the item, said item having a wireless communication tag; sending a first signal to the wireless communication tag when disinfection is complete to update a display on the wireless communication tag to be indicative of a clean status for the item; subsequently detecting movement of the item past a chokepoint; and sending a second signal to the wireless communication tag to alter the display to be indicative of an unclean status for the item upon detecting movement of the itern past the chokepoint.    Date Recue/Date Received 2020-07-08 53.    The method of claim 52, wherein the chokepoint is associated with a space in which the item is exposed to the disinfectant. 54.    The method of claim 52, wherein the step of detecting movement of the item past the chokepoint comprises detecting the item exiting a space associated with the chokepoint. 55.    The method of claim 54, further comprising detecting movement of the item past the chokepoint that is indicative of the item entering the space associated with the chokepoint subsequent to the step of sending the first signal to the wireless comm.unication tag and prior to the step of detecting movement of the item past the chokepoint that is indicative of the item exiting the space associated with the chokepoint. 56.    The method of claim 55, further comprising detecting the item exiting a holding area subsequent to the step of sending the first signal to the wireless communication tag and prior to detecting the item entering the space associated with the chokcpoint. 57.    The method of claim 52, wherein the space associated with the.  chokepoint is a patient room. 58.    The method of claim 57, further comprising: receiving a third signal indicating a patient has been discharged from the patient room after detecting movement of the item past the chokepoint; and sending a fourth signal to the wireless communication tag to alter the display on the wireless communication tag upon receiving the third signal. 59.       A method, comprising: exposing a designated space to a disinfectant, said designated space having one or more wireless communication tags; receiving a signal that a predetermined amount of the disinfectant has been detected; and subsequent to receiving the signal, sending a different signal of a predetermined strength to update displays only on a set of the one or more wireless communication tags Date Recue/Date Received 2020-07-08 that arc within a set distance from the source of the disinfectant, wherein the predetermined strength is loss than a signal strength constituting a maximum communication range of a transmitter sending the different signal, and wherein the different signal is to update the displays on the set of the one or more wireless communication tags to be indicative of a clean status for surfaces in the designated space comprising the respective set of one or more wireless communication tags. 60.    The method of claim 59, wherein the disinfectant is ultra-violet light.    61.    The method of clam 60, further comprising exposing the designated space to a fluidic disinfectant prior to exposing the itein to ultraviolet light. 62.    The method of claim 59, wherein the disinfectant is hydrogen peroxide.  63.    The :method of claim 59, wherein the different signal is to change visual information exhibited on an electronic visual display of the wireless corninunication tag. 64.    The inethod of claim 59, wherein the different signal is to illuminate a light source on the display of the wireless communication tag. 65.    The method of claim 59, wherein the set distance is equal to or less than an upper limit of a set disinfection range of a source of the ultraviolet light. 66.    The method of claim 59, wherein the set distance is less than a dimension of the designated space. 67.    The method of claitn 59, wherein the designated space is an area suitable for human occupancy. 68.    A portable disinfection apparatus, comprising:   Date Recue/Date Received 2020-07-08 a source of a disinfectant arranged in the portable disinfection apparatus to project the disinfectant into an ambient of the portable disinfection apparatus; a wireless communication transmitter; and a controller comprising processor-executable program instructions fi)r the wireless communication transmitter to send a signal of a predetermined strength into the ambient of the portable disinfection apparatus that is Less than a signal strength constituting a maximum transmission range of the wireless communication transmitter. 69.    The apparatus of claim 68, wherein the processor-executable program instructions are for the wireless communication transmitter to send the signal of the predetermined strength after a Lapse of a predetermined amount of time after the portable disinfection apparatus initiates or completes a disinfection cycle_ 60.    The apparatus of claim 68, wherein the processor-executable progra.m instnictions arc for the wireless communication tra.nstnitter to send the signal of the predetermined strength after receipt of a signal indicating disinfection. of an item or space in the ambient of the portable apparatus is complete. 61.    The apparatus of claim. 68, wherein the processor-executable program instructions are for the wireless communication transmitter to send the signal of the predetermined strength after receipt of a signal indicating a set amount of the disinfectant has been projected into the ambient of the portable disinfection apparatus. 62.    The apparatus of claim 68, further comprising an ultraviolet light dose sensor. 63.    The apparatus of claim 68, further comprising a sensor to detect a presence of a fluidic disinfectant.      64.    A method, comprising: receiving a first signal indicating a patient has been discharged from a patient room; and Date Recue/Date Received 2020-07-08 responsive to the first signal, sending a second signal to a wireless communication tag of an item in the patient room to alter a display on the wireless communication ta.g. 65.    The method of claim 64, wherein the second signal is a signal to alter the display to be indicative of an unclean status for the item. 66.    The method of claim 64, wherein the item is a medical device, machine, or tool. 67.    The method of claim 64, wherein the item is readily movable to be removed from the patient room 68.    The method of claim 64, wherein the step of sending the second signal comprises sending the second signal to wireless communication tags of multiple items in the patient room to alter displays on the wireless communication tags. 69.    The method of claim 64, further comprising: subsequent to the step of sending the second signal, exposing the patient room to a disinfectant for a period sufficient to disinfect the item; and sending a third signal to alter the display on the wireless communication tag when 21)         disinfection is complete. 70.    The method of claim 69, wherein the third signal is a signal to alter the display to be indicative of a clean status for the item. 71.    A method for disinfection of one. or more items contaminated with one or more biological agents, wherein the method comprises: exposing an item to a disinfectant for a period sufficient to disinfect the item, said item having a wireless communication tag;   Date Recue/Date Received 2020-07-08 sending a first signal to the wireless communication tag when disinfection is complete to update a display on the wireless communication tag to be indicative of a clean status for the item; subsequently detecting movement of the item outside a receiving range of a wireless communication reader; and sending a second signal to the wireless communication tag to alter the display after detecting movement of the item. outside the receiving range of the wireless communication reader. 72.       The method of claim 71, wherein the step of sending the second signal is upon detecting movement of the item outside the receivin.g range of the wireless communication reader. 73.    The method of clahn 71, wherein the step of sending the second signal is upon a lapse of a predetermined amount of time after detecting movement of the item outside the receiving range of the wireless communication reader. 74.    The method of claim 71, wherein the predetermined amount of time is approximately 24 hours or longer. 75.    The method of claim 71, wherein the second signal is a signal to alter the display to be indicative of an unclean status for the item. 76.    The method of claim 71, wherein transmission of the first signal to the wireless communication tag is automatically activated after receipt of a third signal from a disinfectant sensor.    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