Hospital Testing Report

Sustained reduction of Microbial Burden on High Touch Surfaces

through the Introduction of Photocatalytic Conversion technology

PROPRIETARY & CONFIDENTIAL • FOR INTERNAL USE ONLY • NOT FOR DISTRIBUTION
© 2017 CASPR Group

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 1

ABSTRACT

Background: The contribution of surface contamination with pathogens

to the development of HAI has increasingly been linked in recent research (1).

Methods: The microbial burdens (MB) associated with commonly touched

surfaces in both OR rooms and Patient rooms were determined by initially
sampling 10 objects in each of the 5 rooms of a Houston Hospital. Each
location was swabbed and then expedited to Microchem Laboratory for full
quantitative aerobic bacterial (TSA) and fungal (PDA) enumerations, in
addition to selective media plating. Selective media was plated using the -1
dilution and the full quantification was plated with -1,-2, and -3 dilutions.
Selective media types included CHROMagar MRSA and standard C. difficile
media, BHI-YHT. Once a baseline MB was established the H2O2 emitting
continuous disinfection device was installed in the rooms and the effect that
this solution had on the MB of the high touch points in the subject rooms was
assessed at regular and consistent intervals over the following 2 months.

Results: In concert with regular cleaning and disinfection practices, the

average Bacteria MB found on the high touch surfaces in the pre-intervention
environmental testing was 11 times higher (64,881 CFU/2in.2) than the
average levels found during the intervention (6918 CFU/2in.2). the average
Fungal MB found on the high touch surfaces in the pre-intervention
environmental testing was 135 times higher (147,466 CFU/2in.2) than the
average levels found during the intervention (1087 CFU/2in.2). The
continuous disinfection from low levels of Hydrogen Peroxide found to exert
a significant 89% reduction in Bacteria MB and a 99.3% reduction in Fungus
MB on the high touch surfaces as compared to pre-intervention levels.

Conclusion: The introduction of a continuous application of low levels

of Hydrogen peroxide on high touch surfaces in hospitals reduced the overall
MB on a continuous basis thereby providing a potentially safer environment
for hospital patients, HCWs and visitors.

INTRODUCTION

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 2

 Despite heightened attention to improving and promoting environmental cleaning
and disinfecting protocols (2), Hospital Associated Infections (HAI) remain a major
complication of hospital care occurring at an estimated rate of two-million annually in the
US resulting in more than 70,000 hospital patient deaths (3) at a cost of between $28.4 to
$45 billion (4). In our search for the source of the microbes responsible for HAIs many
studies have focused on the transfer of microbes from the healthcare workers (HCWs)
and vice versa. Increasing evidence points to environmental surfaces being a significant
reservoir for these microbes. The levels of burden on a common surface have no
correlation with the frequency of touching (5).

Microbes have an inherent ability to colonize on any surface. Studies show that
most pathogens can live on surfaces for weeks and even months (6). The longer a
pathogen lives on a surface the higher the chance that it becomes a source for of
transmission to a susceptible patient or HCW (7). Daily disinfection of high touch
surfaces like bed rails, phones, call buttons and other areas reduced the acquisition of
pathogens on the hands after contact with surfaces and hands of the patients during
treatment potentially reducing the chance of transmission of the pathogens (8).

CDC guidelines for Disinfection and Sterilization of Healthcare Facilities (9), lays out
protocols for reducing HAIs through proper cleaning and disinfection and sterilization
of the patient environment. These guidelines follow a strategy that was devised more than
40 years ago (10) on the predicted degree of risk involved in the use of inanimate objects:
critical, which include items that enter sterile tissue (surgical instruments); semi-critical,
which includes items that come into contact with mucous membranes or non-intact skin
(endoscopes); and non-critical, which includes items that only come in contact with skin.
Environmental surfaces fall into the non-critical category. When examining the levels of
risk it is apparent that surfaces are in fact a major contributing factor in the spread of
nosocomial pathogens (1,12). Despite new focus on enhanced disinfection regimes to
reduce the amount of pathogens on surfaces it is clear that we do not effectively remove
MB from the surfaces of patient areas. In multiple studies researchers marked high touch
surfaces with markers that can be seen under ultraviolet light to determine if the location
had been cleaned. In one study they examined 1404 locations in 157 patient rooms after
routine cleaning and they found only 47% of the locations had been cleaned (11).

The contribution of surface contamination with pathogens to the development of

HAI has increasingly been linked in recent research (1).
HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 3
A Healthcare Associated Infection (HAI) is an infection that is acquired in a
hospital or other health care facility. In the United States, the Centers for Disease
Control and Prevention estimated roughly 1.7 million hospital-associated
infections, from all types of microorganisms, including bacteria and fungi
combined, cause or contribute to 99,000 deaths each year ( [Link]
hai/surveillance/[Link]).
Surgical site infections (SSI) are caused by Microbial contamination and account
for 21.8% of HAIs. They threaten the lives of millions of patients each year and
contribute to the spread of antibiotic resistance. If you have surgery, the chances
of developing an SSI are about 2% to 5% (Cosgrove 2015 ). In the United States,
HAIs result in incremental avoidable costs of between $6.5B and $31.5B annually.

The contribution of surface contamination with pathogens to the development of

HAI has increasingly been linked in recent research (1).

This study was conducted to determine whether the NC2I® Technology could
continuously reduce or eliminate microorganisms on surfaces in a hospital. Surface
microorganisms are a major cause of Hospital Acquired Infections (HAI),
including Surgical Site Infections (SSI), Central Catheter Related Blood Stream
Infections (CLABSI), Catheter-associated Urinary Tract Infections (CAUTI) and
Ventilator-associated Pneumonia. The bacteria Staphylococcus and Methicillin
Resistant Staphylococcus were the most common pathogens found.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 4

The results show material reduction of bacteria, MRSA and fungi after the
installation of the CASPR units with NC2I® Technology; significantly reducing the
risk of infection from pathogens to those exposed in the hospital.

Individual results of high touch surfaces within the test rooms showed significant
reductions ranging from 90% to over 99.99%. In concert with regular cleaning and
disinfection practices, the average Bacteria Microbial Burden (MB) found on the
high touch surfaces in the pre-intervention environmental testing was 9 times
higher (64,881 CFU/2in2) than the average levels found during the intervention
(6918 CFU/2in2). the average Fungal MB found on the high touch surfaces in the
pre-intervention environmental testing was 136 times higher (147,466 CFU/2in2)
than the average levels found during the intervention (1087 CFU/2in2). The
continuous disinfection from low levels of Hydrogen Peroxide were found to exert a
significant 89% reduction in Bacteria MB and a 99% reduction in Fungus MB on
the high touch surfaces of the rooms with the solution as compared to the levels
found prior to activation of the solution.

Study Methods: The microbial burden (MB) associated with commonly

touched surfaces in both Operating rooms (ORs) and Patient rooms was
determined by initially sampling 10 objects in each of the 4 rooms of Altus
Baytown Hospital. Each location was swabbed and then expedited to Microchem
Laboratory for full quantitative aerobic bacterial (TSA) and fungal (PDA)
enumerations, in addition to selective media plating. Once a baseline MB was
established the Photocatalytic Devices with inherent antimicrobial properties were
installed in the 4 rooms as well as the administrative work space and the effect that
this solution had on the intrinsic MB of the pre-selected high touch points in the
subject rooms was assessed at regular and consistent intervals. Census was
continued in all rooms and the high touch surfaces in each room were routinely
swabbed for two months.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 5

 Materials and Methods
The selected locations focused on high touch areas as designated by the CDC most
likely to have routine physical contact during normal hospital operations. The Pilot
was conducted in two operating rooms and two patient rooms. In addition an
administration office area was included in the study. All samples were grown and
analyzed by Microchem Laboratory in Round Rock, Texas.

Pre-Treatment Protocols

On June 5th , 2017 surface samples were collected from pre-determined high touch
surfaces in Altus Baytown Hospital in Baytown, Texas, to establish a baseline and
determine if and to what degree bacteria (including MRSA) and fungi exist within
that environment. During the pilot, normal cleaning and disinfecting practices
continued and census continued.

To evaluate and measure the levels of contaminants, five individual surface

locations inside each medical operating room, five individual surface locations
inside the administration area and seven individual surface locations inside each
patient room, were selected for sample collection. The particular surface locations
were selected based on CDC check list and recent research for being considered
high-touch areas in a hospital environment.
The surface locations included:
- Operating rooms: nurse mouse, nurse phone, main door, anesthesia med
cart, supply cabinet handle
- Patient rooms: bed rail, call button, bedside table handle, room sink handle,
toilet flush handle, bathroom light switch, floor corner under sink
- Offices: copier keypad, shredder pro edge, refrigerator handle, employee1
keypad, employee2 phone

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 6

Surface samples were collected according to appropriate protocols established by
Microchem Laboratory to prevent contamination during collection and handling.
Microchem Laboratory located in Round Rock, Texas is an independent and
accredited third party test laboratory.

For each individual surface sample collected, a sterile swab was inserted into a sterile
wetting agent; the swab was then applied to the selected surface area and moved in
an overlapping 2x2 inch pattern while rotating the swab. The swab was then placed
in a tube containing a solution of a diluted (1:10) neutralizer broth of Dey Engley
(D/E) to keep the microorganisms alive while in transit to the lab. The samples were
packaged in a cold thermal container to ensure the collected microorganisms did
not replicate during transit. Upon arrival at Microchem Laboratory, microbiologists
unpacked and prepared the samples for full quantitative aerobic bacterial (TSA) and
fungal (PDA) enumerations, in addition to selective media plating. Selective media
was plated using the -1 dilution and the full quantification was plated with -1, -2, and
-3 dilutions.
Selective media types included CHROMagar MRSA. The heterotrophic plate
counts were incubated for 5 days at 24 ± 5°C. CHROMagar plates were incubated
for 48 hours at 36 ± 1°C. Only swabs 1, 4, 8, 9, 10, 16 & 17 were plated using the
CHROMagar media per sponsor request.
The incubated plates were removed and the Colony Forming Unit (CFU) count
was determined and recorded.

Treatment Protocols

Upon completion of the June 5th baseline sampling, we installed one CASPR unit
with NC2I® Technology in the HVAC system of each operating room, two CASPR
units in the HVAC system of the administration area and one CASPR unit in the
HVAC system of each patient room . These units utilize the NC2I ® Technology,
which generates safe oxidants that move through the air and onto surfaces,
remediating pathogens. NC2I® is derived from technology used on the
International Space Station. The five surface and air purification units were turned

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 7

on and allowed to operate continuously for seven days, and normal hospital census
continued as well as normal cleaning and disinfecting practices. On June 12th, 26th,
and July 10th 2017, surface samples were again collected from each room using the
same protocols as used in pre-treatment. Measurements were taken to determine
whether, and to what degree, the use of the CASPR units reduced surface
contamination from bacteria (including MRSA) and fungi within the hospital
environment .

NC2I® Technology utilizes a revolutionary and doped hydrophilic photo catalytic

coating, consisting of titanium dioxide with a proprietary combination of
additional transition elements to enhance efficacy. Activated by multiple specific
wavelengths of ultraviolet light, oxygen and humidity are extracted from the air to
create a plasma of powerful hydroxyl oxidizers that targets air and surface
pathogens. No ozone is produced. These oxidizers are extremely effective at
destroying bacteria, viruses, fungi, volatile organic compounds (VOCs) and other
environmental contaminants.
Most significantly, they are not harmful to humans, pets and plants, and are
completely safe for indoor use in occupied spaces.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 8

 Results after 1 week
The difference between the baseline samples and the samples after running the
CASPR units for seven, twenty-one and thirty-five days shows a significant
reduction of pathogens on surfaces throughout the areas tested.

Total Bacteria

During the sampling on June 5th to establish a baseline, a combined total of

1,816,060 CFUs of bacteria were discovered as a result of the surface sampling.
During the same test period time on June 12th, one week after installing the
CASPR units, the combined total bacteria count was reduced to 24,680 CFUs.
This equates to a reduction in total bacteria of 98.64%.
Baseline With CASPR

98.64%
REDUCTION

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 9

 Methicillin Resistant Staphylococcus Aureus (MRSA)

During the sampling on June 5th to establish a baseline, a combined total of 200
CFUs of MRSA were discovered as a result of the surface sampling.
During the same test period time on June 12th, one week after installing the
CASPR units, the combined MRSA count was reduced to 20 CFUs. This equates
to a reduction in total MRSA of 90%.
Baseline With CASPR

90%
REDUCTION

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 10

 Fungi

During the sampling on June 5th to establish a baseline, a combined total of

4,274,680 CFUs of Fungi were discovered as a result of the surface sampling.
During the same test period time on June 12th, one week after installing the
CASPR units, the combined Fungi count was reduced to 3,420 CFUs. This
equates to a reduction in total fungi of 99.92%.
Baseline With CASPR

99.92%
REDUCTION

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 11

 Results after 5 weeks
Baseline With CASPR

99.31%
REDUCTION

Baseline With CASPR

95%
REDUCTION

Baseline With CASPR

99.64%
REDUCTION

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 12

 Results per room over a 7-week
period

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 13

 Patient Room 2

Fungi Bacteria

MRSA

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 14

 Patient Room 1

Fungi Bacteria

MRSA

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 15

 Operating Room 2

Fungi Bacteria

MRSA

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 16

 Operating Room 2

Fungi Bacteria

MRSA

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 17

 Administration

Fungi Bacteria

MRSA

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 18

 Conclusion
Testing results indicate that the CASPR units with NC2I ® Technology materially
reduces or eliminates microorganisms on surfaces in a hospital environment.
Results showed Bacteria was reduced over 99.31%, Fungi was reduced over
99.64% and Methicillin Resistant Staphylococcus (MRSA) was reduced over 95%
on surfaces during the test period.

The CASPR NC2I® Technology was very effective in eliminating bacteria

(including MRSA) upon contact on all surfaces, as well as providing continuous
protection of the surfaces and air against future contamination.
The continuous generation of low levels of hydrogen peroxide through the HVAC
system and its effectiveness on high touch surfaces in hospitals, reduced the overall
microbial burden on a continuous basis thereby providing a potentially safer
environment for hospital patients, healthcare workers and visitors.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 19

 Note on sampling in OR#2 and
PSU#1
On week 3, we noticed elevated levels of pathogens on some surface locations in
the operating room 2 (OR#2) and the patient room 1 (PSU#1). When doing the
testing, both rooms were being occupied at the time: OR#2 was being prepared for
a surgical intervention and PSU#1 was being used as a lounge by the nursing staff
of the hospital.
Even though the test results showed an increase of pathogens on surfaces due to
the insults on those surface locations by the hospital staff, the following test results,
2 weeks later, showed that the CASPR NC2I® Technology was incredibly effective
(up to 99.4% reduction) at controlling those insults and reducing the bio burden in
those rooms. Thus demonstrating the continuous efficacy of the NC2I ®
Technology at reducing or eliminating pathogens on surfaces, during normal
hospital operations.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 20

 Appendix A - Lab Results

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 21

 Page 3 of 4
© Microchem Laboratory, LLC.
Altus Health Week 1 Results

CHROMagar
Swab Bacteria Fungal
Sample Location MRSA
ID CFU/Sample CFU/Sample CFU/Sample
18 Bed Rail Control 3.44E+03 1.27E+03 N/A
19 Call Button 3.00E+01 1.00E+01 N/A
20 Bedside Table Handle 2.00E+01 <1.00E+01 N/A
21 PSU Room Sink Handle 1.00E+01 1.00E+01 N/A
#2
22 Toilet Flush Handle <1.00E+01 <1.00E+01 N/A
23 Bathroom Light Switch 1.00E+01 <1.00E+01 N/A
24 Floor Corner Under Sink 6.00E+01 1.00E+01 N/A
25 Xerox Keypad 3.18E+03 1.00E+01 N/A
26 Refrigerator Handle 1.00E+02 8.00E+01 N/A
Cube
27 Cortez Keypad 2.05E+05 2.00E+01 N/A
Farm
28 Moncivais Phone 2.00E+02 4.00E+01 N/A
29 Shred Pro Edge 1.55E+03 9.50E+02 N/A
Note: The limit of detection for TSA and PDA is 10 CFU/Swab and the limit of detection for CHROMagar is 20
CFU/Swab. Values less thanthe limit of detection are shownas <1.00E+01 and <2.00E+01 resppectively on
the table above . Values listed as >500 in the table above indicate too many colonies were present to provide
a discernible count of microorganisms.

1304 W. Industrial Blvd Phone: (512) 310-TEST

Round Rock, Texas 78681 [Link]

CHROMagar
Swab Bacteria Fungal
Company Name: CASPR Group Sponsor: Dan Marsh Sample Location MRSA
ID CFU/Sample CFU/Sample CFU/Sample
E-mail(s): dmarsh194@[Link]
1 Nurse Mouse 3.00E+01 1.00E+01 <4.00E+01
2 Nurse Phone 2.00E+01 <1.00E+01 N/A
Test Information 3 OR OR Door Handle <1.00E+01 1.00E+01 N/A
#2
Test(s) Performed: Environmental Sampling Study with Heterotrophic Plate Count and 1 selective media type 4 Anesthesia Med Cart 1.00E+01 <1.00E+01 <4.00E+01
Performed by: T. Barfels 5 Supply Cabinet Handle 1.00E+01 <1.00E+01 N/A
6 Nurse Mouse 2.00E+01 <1.00E+01 N/A
Sample Information 7 Nurse Phone <1.00E+01 <1.00E+01 N/A
8 OR OR Door Handle <1.00E+01 <1.00E+01 <4.00E+01
Test Substance ID: Altus Health Test 2 Date Sampled: 26 JUN 2017
#5
Samples Taken: 29 environmental samples taken from various locations 9 Anesthesia Med Cart 3.00E+01 <1.00E+01 <4.00E+01
10 Supply Cabinet Handle 1.00E+01 1.00E+01 4.00E+01
Parameters 11 Bed Rail Control <1.00E+01 <1.00E+01 N/A
Sampling Media: 1:10 Dey Engley Broth Sample Locations: See Results. 12 Call Button <1.00E+01 <1.00E+01 N/A
Plate Inc. Media: See notes Swabbed Area: 2 x 2 in or 1 x 4 in 13 Bedside Table Handle <1.00E+01 1.00E+01 N/A
14 PSU Room Sink Handle 1.00E+01 <1.00E+01 N/A
Plate Inc. Temp.: 30 ± 2°C or 36 ± 1°C Incubation Period: 5 days #1
15 Toilet Flush Handle 1.00E+01 <1.00E+01 N/A
Controls 16 Bathroom Light Switch <1.00E+01 <1.00E+01 <4.00E+01
N/A Growth Control: N/A 17 Floor Corner Under Sink 6.10E+02 1.00E+01 <4.00E+01
Neutralized:
18 Bed Rail Control 5.00E+01 <1.00E+01 N/A
19 Call Button <1.00E+01 <1.00E+01 N/A
Test Results
20 Bedside Table Handle <1.00E+01 <1.00E+01 N/A
Bacteria/Yeast Identification? Not Performed PSU
21 Room Sink Handle 2.00E+01 <1.00E+01 N/A
and Mold Present? See Results Test(s) Valid? Yes #2
22 Toilet Flush Handle <1.00E+01 <1.00E+01 N/A
23 Bathroom Light Switch <1.00E+01 2.00E+01 N/A
24 Floor Corner Under Sink 2.00E+01 1.00E+01 N/A
Note Swabbing was performed by an CASPR Group representative on 29 different surfaces. Swabs were then packaged
under refrigerated conditions, and expedited back to Microchem Laboratory for full quantitative aerobic bacterial (TSA) 25 Xerox Keypad 2.30E+03 5.60E+03 N/A
and fungal (PDA) enumerations, in addition to selective media plating. Selective media was plated using the -1 dilution and 26 Refrigerator Handle 3.80E+03 1.70E+02 N/A
the full quantification was plated with -1, -2, and -3 dilutions. Selective media types included CHROMagar MRSA. The 27 Cube Cortez Keypad 1.16E+05 1.07E+04 N/A
heterotrophic plate counts were incubated for 5 days at 24 ± 5°C. CHROMagar plates were incubated for 48 hours at 36 Farm
28 Moncivais Phone 9.00E+01 1.00E+01 N/A
± 1°C. Only swabs 1, 4, 8, 9, 10, 16 & 17 were plated using the CHROMagar media per sponsor request.
29 Shred Pro Edge 2.00E+01 <1.00E+01 N/A

Note: The limit of detection for TSA and PDA is 10 CFU/Swab and the limit of detection for CHROMagar is 40
Tests Completed: 03 JUL 2017 Report Sent: 07 JUL 2017 CFU/Swab. Values less than the limit of detection are shown as <1.00E+01 and <4.00E+01 respectively on
the table above.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 22

1304 W. Industrial Blvd Phone: (512) 310-TEST 1304 W. Industrial Blvd Phone: (512) 310-TEST
Round Rock, Texas 78681 [Link] Round Rock, Texas 78681 [Link]

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 23

 Microbiology Study Report NG8943 Page 2 of 3
Page 1 of 3 © Microchem Laboratory, LLC.
© Microchem Laboratory, LLC. Altus Health Baseline Results
Client Information

CHROMagar
Swab Bacteria Fungal C. difficile
Company Name: CASPR Group Sponsor: Dan Marsh SampleLocation MRSA
ID CFU/Sample CFU/Sample CFU/Sample CFU/Sample
E-mail(s): dmarsh194@[Link]
1 Bed Rail Control 3.40E+02 4.50E+02 <2.00E+01 <2.00E+01
2 Call Button 3.80E+02 2.60E+02 <2.00E+01 <2.00E+01
Test Information 3 Bedside Table Handle 1.39E+03 5.90E+03 <2.00E+01 <2.00E+01
4 Room Sink Handle <1.00E+01 3.00E+01 <2.00E+01 <2.00E+01
5 In-room Light Switch 6.95E+04 1.39E+05 <2.00E+01 <2.00E+01
Test(s) Performed: Environmental Sampling Study with Heterotrophic Plate Count and 2 selective media types 6 PSU 1 Toilet Flush Handle 6.10E+04 1.78E+05 <2.00E+01 <2.00E+01
7 IV Pump Control 6.90E+02 2.56E+04 <2.00E+01 <2.00E+01
Performed by: T. Barfels
8 BP Cuff House 1.75E+05 6.40E+04 <2.00E+01 <2.00E+01
9 Bathroom Light Switch 1.56E+03 1.95E+04 2.00E+01 <2.00E+01
Sample Information 10 Floor Corner Under Sink 1.60E+02 4.00E+01 2.00E+01 <2.00E+01
Test Set ID: Altus Health Baseline Date Sampled: 05 JUN 2017 11 Bed Rail Control 1.38E+03 9.10E+03 <2.00E+01 <2.00E+01
12 Call Button 4.10E+02 3.40E+03 <2.00E+01 <2.00E+01
Samples Taken: 42 environmental samples taken from various locations
13 Bedside Table Handle 9.20E+03 3.79E+05 <2.00E+01 <2.00E+01
14 Room Sink Handle 1.39E+03 1.21E+04 <2.00E+01 <2.00E+01
Parameters 15 In-room Light Switch 1.31E+05 4.65E+05 <2.00E+01 <2.00E+01
Sampling Media: 1:10 Dey Engley Broth Sample Locations: See Results. 16 PSU 2 Toilet Flush Handle 3.80E+03 1.82E+04 <2.00E+01 <2.00E+01
Plate Inc. Media: See notes Swabbed Area: 2 x 2 in or 1 x 4 in 17 IV Pump Control 2.80E+03 1.17E+05 <2.00E+01 <2.00E+01
Plate Inc. Temp.: 30 ± 2°C or 36 ± 1°C Incubation Period: 5 days 18 BP Cuff House 1.54E+03 2.25E+04 <2.00E+01 <2.00E+01
19 Bathroom Light Switch 2.00E+02 5.60E+04 <2.00E+01 <2.00E+01
20 Floor 3.40E+04 8.10E+04 <2.00E+01 <2.00E+01
Controls
Neutralized: N/A Growth Control: N/A

Test Results
Bacteria/Yeast Identification? Not Performed
and Mold Present? See Results Test(s) Valid? Yes Note: The limit of detection for TSA is 10 CFU/Swab and the limit of detection for PDA, CHROMagar, and C. difficile media is 20 CFU/Swab.
Values less than the limit of detection are shown as <1.00E+01 and <2.00E+01 respectively on the table above.

Note Swabbing was performed by an CASPR Group representative on 42 different surfaces, packaged under refrigerated
conditions, and expedited back to Microchem Laboratory for full quantitative aerobic bacterial (TSA) and fungal (PDA )
enumerations, in addition to selective media plating. Selective media was plated using the -2 dilution and the full
quantification was plated with -1, -2, and -3 dilutions. Those media types include CHROMagar MRSA, and standard C.
difficile media, BHI-YHT. The heterotrophic plate counts were incubated for 5 days at 24 ± 5°C. CHROMagar plates were
incubated for 48 hours at 36 ± 1°C. The C. difficile plates were incubated anaerobically at 36 ± 1°C for 48 hours. Samples
from the “Cube Farm” location were not tested using the C. difficile media.

Tests Completed: 12 JUN 2017 Report Sent: 20 JUN 2017

1304 W. Industrial Blvd Phone: (512) 310-TEST 1304 W. Industrial Blvd Phone: (512) 310-TEST
Round Rock, Texas 78681 [Link] Round Rock, Texas 78681 [Link]

Page 3 of 3
© Microchem Laboratory, LLC.
Altus Health Baseline Results
CHROM agar
Swab Bacteria Fungal C. difficile
SampleLocation MRSA
ID CFU/Samp le CFU/Sample CFU/Sample
CFU/Sample
21 Xerox Keypad 1.34E+03 1.58E+04 <2.00E+01 N/A
22 Shred Pro Edge 2.05E+03 2.30E+04 <2.00E+01 N/A
23 Refrigerator Handle 4.00E+01 <1.00E+01 <2.00E+01 N/A
24 Pitney Bowes Keypad 2.80E+02 6.00E+01 2.00E+01 N/A
Cube
25 Farm File Drawer Top 2.00E+01 1.00E+01 <2.00E+01 N/A
26 Light Switch 6.00E+01 2.70E+02 <2.00E+01 N/A
27 Cortez Keypad 6.78E+05 1.13E+06 <2.00E+01 N/A
28 Moncivais Phone 8.18E+05 1.70E+06 <2.00E+01 N/A
41 Nurse Mouse 2.00E+01 1.00E+01 4.00E+01 <2.00E+01
42 Supply Cabinet Handle <1.00E+01 <1.00E+01 <2.00E+01 <2.00E+01
43 Nurse Phone 2.00E+01 2.00E+01 <2.00E+01 <2.00E+01
44 OR OR Door 3.00E+01 2.00E+01 <2.00E+01 <2.00E+01
45 #2 Anesthesia Med Cart 5.50E+02 1.80E+03 2.00E+01 <2.00E+01
46 Supply Cabinet Handle 4.00E+01 1.00E+01 <2.00E+01 <2.00E+01
47 Arm Board <1.00E+01 <1.00E+01 <2.00E+01 <2.00E+01
51 Nurse Mouse 4.50E+02 1.20E+04 <2.00E+01 <2.00E+01
52 Supply Cabinet Handle 1.18E+04 2.59E+04 2.00E+01 <2.00E+01
53 Nurse Phone <1.00E+01 <1.00E+01 <2.00E+01 <2.00E+01
54 OR OR Door <1.00E+01 <1.00E+01 4.00E+01 <2.00E+01
55 #5 Anesthesia Med Cart 2.54E+05 6.22E+05 4.00E+01 <2.00E+01
56 OR Bed 1.60E+04 7.36E+05 <2.00E+01 <2.00E+01
57 Arm Board <1.00E+01 1.00E+01 <2.00E+01 <2.00E+01

Note: The limit of detection for TSA is 10 CFU/Swab and the limit of detection for PDA, CHROMagar, and C. difficile media is 20
CFU/Swab. Values less than the limit of detection are shown as <1.00E+01 and <2.00E+01 respectively on the table above.

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 24

1304 W. Industrial Blvd Phone: (512) 310-TEST
Round Rock, Texas 78681 [Link]

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 25

 Microbiology Study Report NG8983 Page 2 of 4
Page 1 of 4 © Microchem Laboratory, LLC.
© Microchem Laboratory, LLC. Altus Health Week 1 Photos
Client Information

Company Name: CASPR Group Sponsor: Dan Marsh

E-mail(s): dmarsh194@[Link]

Test Information
Test(s) Performed: Environmental Sampling Study with Heterotrophic Plate Count and 1 selective media type
Performed by: T. Barfels

Sample Information
Test Substance ID: Altus Health Test 1 Date Sampled: 12 JUN 2017
Samples Taken: 29 environmental samples taken from various locations

Parameters
Pictures above depict representative growth seen on PDA (left) and TSA (right) media types.
Sampling Media: 1:10 Dey Engley Broth Sample Locations: See Results.
Plate Inc. Media: See notes Swabbed Area: 2 x 2 in or 1 x 4 in
Plate Inc. Temp.: 30 ± 2°C or 36 ± 1°C Incubation Period: 5 days

Controls
Neutralized: N/A Growth Control: N/A

Test Results
Bacteria/Yeast Identification? Not Performed
and Mold Present? See Results Test(s) Valid? Yes
Above, colony of MRSA as identified on CHROMagar MRSA.

Note Swabbing was performed by an CASPR Group representative on 42 different surfaces, packaged under refrigerated
conditions, and expedited back to Microchem Laboratory for full quantitative aerobic bacterial (TSA) and fungal (PDA)
enumerations, in addition to selective media plating. Selective media was plated using the -1 dilution and the full
quantification was plated with -1, -2, and -3 dilutions. Selective media types included CHROMagar MRSA. The heterotrophic
plate counts were incubated for 5 days at 24 ± 5°C. CHROMagar plates were incubated for 48 hours at 36 ± 1°C. Only
swabs 1, 4, 8, 9, 10, 16 & 17 were plated using the CHROMagar media per sponsor request.

Tests Completed: 19 JUN 2017 Report Sent: 21 JUN 2017

1304 W. Industrial Blvd Phone: (512) 310-TEST 1304 W. Industrial Blvd Phone: (512) 310-TEST
Round Rock, Texas 78681 [Link] Round Rock, Texas 78681 [Link]

Page 3 of 4
© Microchem Laboratory, LLC.
Altus Health Week 1 Results

CHROMagar
Swab Bacteria Fungal
Sample Location MRSA
ID CFU/Sample CFU/Sample CFU/Sample
1 Nurse Mouse >500 >500 <2.00E+01
2 Nurse Phone 1.70E+03 9.00E+01 N/A
3 OR OR Door Handle >500 >500 N/A
#2
4 Anesthesia Med Cart >500 3.25E+03 <2.00E+01
5 Supply Cabinet Handle 1.00E+01 1.00E+01 N/A
6 Nurse Mouse 1.00E+01 1.00E+01 N/A
7 Nurse Phone 2.00E+01 <1.00E+01 N/A
8 OR OR Door Handle 4.00E+01 <1.00E+01 <2.00E+01
#5
9 Anesthesia Med Cart 1.00E+01 <1.00E+01 <2.00E+01
10 Supply Cabinet Handle <1.00E+01 <1.00E+01 <2.00E+01
11 Bed Rail Control 2.70E+04 1.10E+02 N/A
12 Call Button 8.55E+04 8.50E+02 N/A
13 Bedside Table Handle 2.00E+01 4.00E+01 N/A
14 PSU Room Sink Handle <1.00E+01 1.00E+01 N/A
#1
15 Toilet Flush Handle 2.90E+02 <1.00E+01 N/A
16 Bathroom Light Switch 6.00E+01 <1.00E+01 2.00E+01
17 Floor Corner Under Sink 1.75E+03 <1.00E+01 <2.00E+01
Note: The limit of detection for TSA and PDA is 10 CFU/Swab and the limit of detection for CHROMagar is 20
CFU/Swab. Values less than the limit of detection are shownas <1.00E+01 and <2.00E+01 resppectively on
the table above . Values listed as >500 in the table above indicate too many colonies were present to provide
a discernible count of microorganisms.
 HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 22
W. Industrial Blvd Phone: (512) 310-TEST
Rock, Texas 78681 [Link]
 Contact Information

CASPR Group Inc

3100 Monticello Ave, Suite 310
Dallas, Texas 75205
USA
tel: +1(214)396-3311
info@[Link]

HOSPITAL TESTING REPORT PROPRIETARY & CONFIDENTIAL 23