151 Transcript

151 Transcript


Transcript Disclaimer: This Transcript is provided and copied from YouTube, grammar and mistakes are present.

scaled up nation
we are professional water treaters and
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scaling up
to scaling up h2o of course
everybody’s favorite water treatment
podcast
and folks we are smack dab in the middle
of august
and we as the scaling up nation have
deemed august legionella awareness
month i hope you are taking some time
learning more about legionella
legionnaires disease and how we as water
treatment professionals
can prevent it and folks i’ve received
so many questions about legionella i
appreciate those questions from the
initial show where i started off where
we just did a very
basic what the heck is legionella
to today i’ve received some great
questions
and the last show of this month it’s my
intention to
answer those questions but some of the
questions i want to try to answer
with some guests and i know that we’ve
heard
from some really fantastic people
in the legionella community already
previously on scaling up
h2o well a question that i get is about
the different
types of tests that are out there
and the one that came up over and over
and over again
is the test that spartan will do and
that’s that very
quick test that you can run in there
they call it the cube
and there were questions about it so i
asked
spartan if they could come on the show
and talk a little bit about that
and dr paul lim was very gracious he is
our guest today he’s going to take some
of the questions
you have about his product and
get you some answers so nation
i hope you enjoy your questions of me
asking to dr lim
today my lab partner is paul lim
co-founder and chief executive
officer of spartan how are you paul i’m
great
thanks for having me on your show
absolutely i know
lots of things going on right now we
appreciate you taking the time to come
on
we’re going to talk a lot about
legionella testing and around legionella
but before we do do you mind sharing
with the scaling up nation
a little bit about yourself yeah so i’m
a medical doctor by training my
specialty was infectious disease and
microbiology
i’ve been a biotech entrepreneur almost
20 years now so some of the things i’ve
done
if you’ve ever gotten a test from
23andme or ancestry.com
that’s spit cup i’m the co-inventor of
it i wrote the patents
very cool how about that yeah so we
don’t know if that
i have spit in your cup oh perfect yeah
so i think millions of people i think
it’s the top selling thing on amazon
prime day now
and yeah i got it as a gift a couple of
christmases ago
really cool all the information that
comes back
yeah it just shows you how dna is
getting to the mainstream everyone
is getting touched by it well very cool
so what brought you
to start the company spartan that’s a
smart we’ve been around for about 15
years and our vision was always how do
you bring the power
of molecular testing so dna testing out
of the lab
away from those mainframe dna analyzers
to onsite
point of care where people with no
technical training can actually run
these tests
interesting so i’ve been familiar with
you guys for
i don’t know maybe two years or so i
think i met you originally at
an ashrae conference where i saw a demo
of your rapid test so we’re going to
talk about that today we’re going to
talk all around legionella testing
i feel like i cut you off a little bit
though when you were telling us a little
bit about yourself so any more you want
to share
oh i think that was a pretty good
background i was just going to talk
about founding spartan bioscience out of
my apartment
and growing it up took a while and now
we’re here
paul you were telling me earlier that
spartan’s doing some work with
covid19 can you tell us a little bit
about that
yes what we have is this portable dna
analyzer so
we spent many years developing it what
happened when
kobit 19 the pandemic started hitting
the world we
noticed that the cdc had published a
recipe
for a copa 19 pcr test so that’s a
molecular diagnostic test
and so we adapted the cdc’s recipe onto
our device and that’s what let us
quickly release this fast portable
very accurate copy 19 test now we hear
on the news where
their release are they’re relaxing
what they’re allowing tests to come to
market with now we hear that on the news
and we say okay we really don’t know
what that means
so your experience in you being in
developing those actual tests what does
that mean and
and how does it really help getting more
tests on the market
normally what happens is it takes called
a year or more to actually develop on
these tests and then validate it and the
validation what normally takes a long
time
is you have to perform a clinical study
where you take
your device you compare it against a
lab-based test
on several hundred patients and then you
have to submit that vfd and takes the
months to review
in contrast because coca-19 is such a
public health emergency crisis
the fda has relaxed those rules where
you don’t have to run that big clinical
study with hundreds of patients you can
just run it on
as few as 30 samples where you just
spike some of the code 19
rna onto the sample so it’s much faster
and also the fda turns around approvals
within
i believe it’s 15 days so that’s what’s
getting all these tests come to market
well to shift our conversation a little
bit towards legionella
i want to ask the question if somebody
gets legionnaires disease today
what’s the likelihood that a doctor is
going to think they have
coveted over legionella and hence they
don’t get the right treatment
that’s a great point so cova 19 is so
top of mind now and i think a lot of
doctors also
they just think of pneumonia and they
just treat it as
a typical pneumonia and what a lot of
doctors as a speaking as a doctor myself
don’t realize is that probably around 13
percent
maybe as high as 20 percent of all these
pneumonia patients are actually
legionnaires disease so i think there’s
significant under diagnosis
of region errors well let’s talk about
the different tests so what are the
different
legionella tests available today i think
it falls into
three broad categories so the one that’s
most commonly used is you take that
water sample you shipped off the lab
they put on a petri dish and it grows so
that’s called regional culture testing
it takes about 10 to 14 days to get a
result because we just know it takes
time to grow on that petri dish
second form of testing is what’s called
luigi noah qpcr testing
stands for quantitative polymerase chain
reaction or pcr
pcr’s nobel prize winning dna
amplification
chemistry so that can give you results
very quickly within
call it 30 to 60 minutes the
challenge has been historically it
detects live and dead bacteria so that’s
where a company like our spartan has
come up with some innovations where we
don’t have those issues
and finally the third major class of
technology is these
rapid dip slides so it’s kind of a
version
of culture testing but it’s on this
little culture-based slide
i can get results in 48 hours it’s
really fast very cheap but
historically been extremely inaccurate
so why would you use one test
over another when we talk to our
customers it seems like most of them are
using
the culture-based testing because that’s
what’s in standards it’s in regulations
people are very familiar with it
people do know that there’s significant
limitations first limitation
takes so long 10 to 14 days whereas we
know from the science that regional can
grow to outbreak levels and water
systems in as few as seven days
second major problem with culture
testing is it’s rather inaccurate
so the cdc did a big proficiency study
of their elite certified legionella labs
we found that on average the labs were
under county amount of regional by 17
times and results were differing between
values by
six times and then our company spartan
did a
study with the government of canada
where we showed that the reason for the
inaccuracy of culture testing is
those biocides that you add to water
systems actually starts killing the
bacteria
as you transport to the lab even if you
use sodium thiosulfate even if you put
it on ice
people have known there’s been these
problems with culture testing that leads
us to qpcr
which is our company has developed the
first qpcr test that addresses the
historical limitations
first it gives results on-site in 45
minutes instead of having to ship it off
the lab and take days for the mainframe
dna analyzer results
second it’s calibrated culture so it’s
directly equivalent to whatever the
readout in colony forming units is
our test gets the same and the final
thing is we have a way of
getting rid of the dead bacteria so we
only report the live material
paul earlier you mentioned three
different types of tests
are they all legally defensible in terms
of legally defensible
it appears that it’s best to follow
guidelines such as the ashrae 188
guideline
and right now the ashrae when a
guideline talks about how you can use
things like culture testing
and also qpcr based testing and so
if you point to those things i think
that’s your best defense
there’s a term that comes up all the
time when we talk about legionella
testing and it’s the gold
standard what exactly does that mean
this is a phrase that
commonly comes from the medical
diagnostic industry so the gold standard
refers to
what does the majority of the experts
think is the best way to diagnose
something
and i think for legionella testing right
now most people would say the gold
standard
is culture testing that being said over
the last 10 or 15 years
in medical diagnostics culture has
stopped being the gold standard
and we have migrated over to these pcr
based tests because they’re just
so much more accurate and also faster
and so i think we’re in this transition
period
for regional testing where we are going
to migrate from culture to
qpcr tests and as an example cdc
new york state department of health
regional experts when they actually go
on site and investigate outbreaks
generally the tests that they’re running
is qpcr based tests actually trace the
outbreak
then they use culture testing as a
follow-up what does it take for a new
test to become the new
gold standard generated from the new
gold standard that’s where there has to
be enough publications enough experts
using the test
that the general consensus becomes that
this test
is now the new gold standard i think
we’re seeing that with
regional qpcr testing so there’s dna
based on what you’re based testing
companies like ours we’re getting our
technology in the hands of enough of the
world’s experts
such as the cdc new york state
department of health they’re getting
familiar with it
papers are being published it’s starting
to be written into guidelines so over
time i think
the industry will transition to this i
think the big advantage of spartan’s
on-site regional qpr test is
provides very fast results it’s
calibrated to cause so you can use your
existing action levels
and attacks live not dead bacteria and
these advantages of our test
are why we have customers like the cdc
new york state department of health and
a lot of the world’s regional experts
they actually go on site and they
investigate outbreaks with our test
we’re also members of top regional
standards committees around the world
such as the ashrae 188 committee
i’m a member and also the iso 12869
committee
for regional testing what are some
lessons that you’ve learned as you’ve
developed
these tests one of the things we’ve
noticed comparing our tests to other
legionella
pcr tests is historically in the
literature it’s been reported that
regional pcr tests
they are often prone to inhibition and
they often have
false negative rates and in the study we
did with the government canada we
noticed the biggest problem was
when you ship sample to a lab and you
test it with any technology so whether
in the lab you test it with
pcr culture testing or even our test
you get this false negative problem
because the biocides in the water
start killing the bacteria right away no
matter if you have sodium thiosulfate no
matter if you’re shipping on ice
it’s really any guide-based test that
suffers from that shipping problem
and then problem is unique to lab-based
qpcr is the detectable i’m not dead
bacteria so often overcalls
the amount of regional there and it’s
also not calibrated to culture so
different regional pcr labs can report
wildly different numbers that are not
really grounded in reality
and so that’s why we aim to solve all
those problems with our on-site
very fast very accurate regional qpcr
test do you mind explaining what the
process of taking that test is
with our test you take a water sample
and then
we ship you this single use disposable
kit that concentrates
20 ml of water down to a 20 microliter
cartridge put that cartridge into our
device
hit go and then you get results in 45
minutes so really fast
really accurate index live not dead
bacteria
and so you see how this can be
advantageous over conventional culture
based testing
that takes 10 to 14 days under counts
the amount of regional by an average of
17 fold
and also as is prone to that false
negative problem
because the bacteria dies as you’re
shipping it to the lab
i think one of the great things about
our testing procedure is we’re now
deployed all around the world
all sorts of expert organizations but
also real estate companies
and we have people with no technical
training running our tests every day
around the world so it shows
it’s a really robust test really easy to
use
been used in very high profile outbreaks
to actually trace the source of the
problem
and there’s more and more research
papers that are coming out validating
our technology
so we think we have a solid choice for
anyone who wants fast and accurate
detection of legionella contamination
so right now new york is the only one
that i’m aware of that’s requiring
people to register their cooling towers
with the health department and
have a a plan in regards to their
cooling tower
are a lot of your tests being used in
the new york area
some there and i would also say we’re
getting
more interest and customers
in industries where they can’t afford
downtime so things like data centers
oil and gas companies hospitality groups
and also
the healthcare sector and i believe it
was a few years ago
that medicare and medicaid mandated that
all
hospitals and long-term care facilities
that receive medicare dollars they
actually have to implement a legionella
management
program that includes testing and that’s
really spurring the rise of that
market segment some of our listeners
might be wondering if they start using
this type of test and since it’s not yet
considered the gold standard
and something happens is that going to
be
defensible is that considered that
they’re doing the best practices how
would you answer that question
the way to answer that question is the
ashrae one at eight standard
i think in the last few days actually
just published an update
that includes new testing methods such
as
pcr so now i think people can actually
point to the
widely followed ashrae standard and that
would be defensible for them if they
incorporated something like our onsite
qpcr test
into their legionella testing program
what are some
common errors that you’ve seen people
make when it comes to not only your
tests but other tests
one of the most common errors we see is
people just don’t test enough so if you
look at let’s say the new york state
regulations
requires a culture test every 30 days
and then also a dip side test every week
and the problem there is with 30 days
regional we know can grow to outbreak
levels in as few as 7 days
and so every 30 days is just not
frequent enough and that’s why those new
york city new york state regulations
they recognize this by trying to do a
weekly dip slide test
of course the biggest problem with dip
side tests is the sensitivity is so poor
you have to be 10 to 100 times outbreak
levels before you can even revive we
detect it
and so if i had one piece of advice
that’s people should be testing probably
every two weeks for legionella
that’s the best balance between cost and
also making sure you minimize your risk
so we’ve got a doctor on the line right
now so i want to ask you what do you
consider to be best practices in in
these
types of facilities so the the three i
want to ask you about
are starting up a brand new facility
and then something that we’re going to
have to deal with a lot in this country
because
things are shut down water systems are
dormant and now they’re coming back
online so what are best practices for
bringing those
back online and then specifically
caring for a facility that has high
risk factors in it my personal opinion
is best practices we should look to what
the medical diagnostics industry does
because in medicine
its patients lives are at risk so we use
the best
technology and that best technology has
been established for the last 10 to 15
years to be
qpcr based testing not culture testing
we’ve really migrated away from culture
testing
it’s just too slow too inaccurate even
though it’s a lot less expensive
so for the legionella management
i think if you really want to minimize
your risk your best bet would be to do
some sort of regional qpcr testing every
two weeks on your water system
it’s by far the most accurate and it’ll
make sure you have early detection
before regional grows out of control
anything special that you would do for a
system that’s been dormant for
an extended amount of time for a system
that’s been dormant i think it’s really
important to do that regional
qpcr test right away before you start it
up because
it’s the water’s been sitting there
regional could be growing out the
biofilm could be growing
the last thing you want to do is start
your system and air supplies all that
know and people breathe it in
i think this is why for the government
of canada they have regulations for
federal government buildings that before
startup all these buildings actually
have to
perform a regional qpcr test and get
those negative results back before the
cooling tower can be started up
so where’s the best place to take a
sample in a dormant system
i think this is where people often
sample from
different points so somewhere like a
distal
place and then also closer to from your
cooling tower
paul you’ve got tens of thousands of
water treaters listening to you right
now what’s the best piece of advice
that you have for the scaling up nation
the best piece of advice i have is
people should be regularly testing for
legionella
and you probably want to do it every two
weeks 30 days is not enough i even see
people sometimes test like twice a year
but that i think is ridiculous we just
know it can grow to outbreak levels
as few as seven days and especially now
as
you’ve had all those water systems
dormant or stagnant because of coba 19
it’s more important than ever to test
especially once you’re starting up
paul if somebody wanted to learn more
about testing what advice do you have
for them where should they go
i think if you want to learn more about
testing the ashrae 188 guideline does a
really good job
of summarizing the different types of
regional testing technologies and their
pros and cons
and there’s been a new update to the
ashrae 188 guideline 12
just came out a few days ago and as a
member of the committee i think our
committee
really did a good job on educating
people you don’t need a technical
background you can read that and get up
to speed relatively quickly
i’ll make sure to have links to that on
our show notes page
paul i really appreciate you coming on
scaling up h2o
i think we gave some new information to
a lot of listeners
and i know you’re busy making sure that
we’ve got plenty of cova tests we’ve got
plenty of legionella tests so i just
want to thank you for all you do
it’s my pleasure to be on your show
thank you
nation i think it’s safe to say that you
are
never done learning when you decide
you’re going to be
a professional water treater and we
thought we knew
everything about how legionella was
tested well as
science comes out as things get proven
more
in court we get to use different testing
so the spartan cube might be something
that you
may want to look into now i
have had several people in my mastermind
group
use this type of testing and it seems
like right now what most people are
doing
are they are trying to figure out where
a contamination source is coming from so
let’s say there’s a cooling tower
and it was positive for legionella they
did
their remediation schedule and they just
simply weren’t able to get those numbers
where they wanted them to be so they’ve
used the
spartan product to backtrack
where that possible legionella was
coming from
and in the three cases that i know of
they were able to find
a dead leg that they did not know
existed
and because of that they were able to
flush that dead leg out
they were able to add some plumbing so
it wasn’t a dead leg anymore and now it
was seen
regular by a side and that product was
able to help them in that situation
as we talked about as that becomes and
newer tests become more
of the standard we are probably going to
be able to run
different types of tests however those
same people
that i spoke of that ran the spartan
test to figure out where the dead leg
was
once they got everything remediated they
still use the culture method by sending
that off to an affiliated lab
and they were able to verify using the
standard culture method
that everything was where it needed to
be according to
their plan so they were kind of using a
one-two punch if you will
they were making sure that they had
something
that the courts have deemed legally
defensible so folks whenever you’re
looking
at new technology make sure you
understand what is out there
make sure that you understand what your
customers asking for what
you need to do and above all else
what you’re trying to do with it when
it’s all
said and done dr lim thanks again for
coming on and sharing
more about your product and folks i
hope that you keep those questions
coming
the very last episode of the month
i am going to be answering your
questions for
legionella so no questions off base i’ll
try to answer what i can
and i will get some experts to help me
answer the ones that i can’t
so you can do that by going to scaling
up h2o.com
and i was going to say forward slash but
there’s no forward slash you could just
go
straight to that home webpage
and there’ll be a pop-up right on the
right side it says record voicemail
and you can record your own voice there
you can do it on your desktop you can do
it from your mobile device
just do it make sure i have you
asking that question and something else
that people are asking about is
what’s going to happen now that awt the
association of water technologies has
decided
to put their annual convention and expo
online
and folks we’re learning more about this
i’m going to have awt’s president tom
branvold on and he is going to share
what the awt
is doing how the convention will be
unique this year
and how they’re adding on some very
interesting items so
it will feel like you are there and
you’re still going to be able to take
advantage of many of the reasons that
you
come to the convention in the first
place so please join me when i have tom
on to tell me
all of that in the meantime you can go
to awt.org to find out more about
what they are doing folks thank you so
much for listening today
and i will bring you another
legionella episode next week on scaling
up
h2o
scouting up nation on episode 136 you
heard from
four members of the rising tide
mastermind
one of those members was eric russo and
eric
is an extremely busy individual and i
asked him the question how he found the
time
and why he decided to join the rising
tide
mastermind here’s what he said like most
people in the water treatment industry
there’s always a struggle with work and
life and
i had a daughter on the way and i was
probably a little more mindful of how
much i was working
and how i can adjust my schedule or make
it in such a way that was sustainable
for my family
and this conversation is a little more
difficult when you don’t have
people in the water treatment industry
because they don’t understand the
travel aspect the service aspect the
technical
uh knowledge need to be successful it’s
a little more difficult to balance that
so to have a group of like-minded
individuals to work through
with the goal of self-development it’s
really helpful to kind of hash through
those problems for me
have you ever noticed that if you want
something done
you give it to a busy person why is that
why do busy
people always seem to get
something done and we always wonder why
but there’s a secret to that most busy
people
if they’re busy on the right things it
means that they are successful
and they’ve learned to say yes to the
things that help
with their success however they define
success
think about that when was the last time
you thought to yourself how do
i define success well those are some of
the questions that we
ask in the rising tide mastermind
and eric asked himself if i joined the
rising tide mastermind
will this make me a better husband will
this make me a better father will this
make me
a better water treater and eric has told
me that it has done
all of those things and he is sure glad
that he decided to join folks
i cannot say enough good things about
being involved in a mastermind group i
ask that you go to
scalinguph2o.com forward slash
mastermind to see if being a member of
the rising tide mastermind is right for
you
and if you decide that it is not please
find a group that is right for you
when we get together with other people
that are concerned
about everyone’s success everyone
gets better and the tide rises all boats