Why a change in respiratory protection practice is vital for healthcare

Dr Andy Davies of Mackwell Health argues that UV-C disinfection could provide a more-sustainable and cost-saving solution for decontaminating safety equipment for healthcare staff

Infection prevention and control in hospitals has rightly come under the spotlight as a result of the COVID-19 pandemic

It is estimated that the NHS and social care sectors spent roughly £500m on disposable respiratory protective equipment (RPE) in 2020 alone.

But despite this figure, and millions more spent on personal protective equipment (PPE), the World Health Organisation estimated in May this year that at least 115,000 healthcare workers had died around the world after contracting COVID-19.

And this has led to calls in the UK for stricter guidelines on respiratory protection and other personal protective equipment (PPE) for those in the healthcare industry, in particular more widespread access to the highest-grade protection for healthcare professionals.

But is this approach the best one?

Dr Andy Davies, commercial director at Mackwell Health, argues that the answer to keeping healthcare workers and patients safe lies with UV-C disinfection as a sustainable and cost-saving alternative that increases the volume of quality equipment for healthcare staff.

Challenges facing healthcare

“Healthcare finds itself at an impasse,” he said.

“For the highest-risk environments, the currently-recommended RPE is the tight-fitting FFP3-grade respirator, which works by creating a tight seal between the user’s face and the mask to avoid transmission of airborne viruses.

From chemical agents, such as bleach, hypochlorous acid and IPA wipes, through to the use of washer disinfectors; there are numerous methods available to healthcare that decontaminate re-usable elastomeric masks

“However, to make these respirators more widely available would result in a huge uplift in cost.

“Nobody wants to put any healthcare staff at risk, but the bottom line is that the upgrade is simply not affordable when only disposable RPE is considered.”

To further complicate this issue, disposable RPE also creates a major environmental challenge.

Each mask, regardless of whether it is tight fitting or loose fitting, contains significant amounts of single-use non-recyclable plastic materials, all of which have to be disposed of as infectious waste, requiring incineration.

There are, however, many reusable solutions already on the market, with more being launched, that are actually more effective than disposable FFP3 respirators.

For example, at the recent Health & Safety conference at Birmingham’s NEC, new products that offer both inhale and exhale protection were fit tested and consistently achieved a fit factor of over 2000. That’s more than a 99.9% reduction in infectious particles, at least an order of magnitude better than FFP3.

And new innovations, such as UV-C respirators, are also being developed, which can offer further orders of magnitude protection for the highest-risk areas and where longer wear times are required.

Nobody wants to put any healthcare staff at risk, but the bottom line is that the upgrade is simply not affordable when only disposable RPE is considered

The healthcare segment has, however, expressed concerns over the ability to effectively decontaminate items in between use.

“Of course, the duty to keep health workers safe remains paramount,” said Dr Davies.

Dr Andy Davies

“However, it must be done in a sustainable manner that doesn’t complicate usability and slow down what is, at the best of times, an incredibly-busy sector that is doing incredibly-important work.”

He added: “Many methodologies for effective decontamination of re-usable RPE already exist.

“From chemical agents, such as bleach, hypochlorous acid and IPA wipes, through to the use of washer disinfectors; there are numerous methods available to healthcare that decontaminate re-usable elastomeric masks.

“And, given the environmental and economic challenges, there should already be plenty of incentive to deploy these more commonly throughout the healthcare system and adopt re-usable RPE to achieve the safety, environmental and economic targets that are currently being missed.

“Nevertheless, there does remain a need for more-practical solutions.”

UV-C disinfection as a decontamination solution

Though invisible to the human eye, ultraviolet (UV) light has a range of uses, categorised on the types of rays used and all based on wavelength.

UV-C radiation, which is based on very-short wavelengths below 280 nm, has been proven as a means of disinfection for more than 100 years, winning a Nobel Prize in 1903 .

Given the environmental and economic challenges, there should already be plenty of incentive to deploy these more commonly throughout the healthcare system and adopt re-usable RPE to achieve the safety, environmental and economic targets that are currently being missed

For most of that time, UV-C has been an effective-but-often-impractical solution to deploy in decontamination chambers.

Today, however, it is possible to utilise UV-C disinfection in a quick and efficient manner using a combination of the latest LED technology, advanced optics, and 3D CAD modelling.

Dr Davies explains: “By implementing compact and portable UV-C disinfection chambers around hospitals, medical practices, or wherever necessary, health workers can gain access to reusable PPE.

It is estimated that the NHS and social care sectors spent roughly £500m on disposable respiratory protective equipment in 2020 alone

“A small chamber, smaller than a microwave, that can be placed on a benchtop, is now a possibility.

“Healthcare staff simply need to place their respirators inside the chamber, select the correct programme, and seconds later the item will be disinfected.

“Advanced optics that work with the LED chips allow the UV-C radiation to be directed to previously-difficult-to-reach parts of the surface of the RPE.

Optical modelling techniques can combine with 3D CAD models of the masks, using laboratory data as evidence to predict the time needed for effective decontamination.

“This is available in an affordable package available at the point of use, negating the need to move potentially-contaminated RPE around the facility.

“Additionally, programmes can be automated and tailored to the item being treated, making each decontamination event repeatable and traceable.”

As we emerge from the pandemic and continue to recover, there are opportunities to learn lessons so that a positive legacy can at least be achieved from a disastrous period in our history

And UV-C disinfection is not exclusive to RPE.

It can be used to disinfect a wide range of products - dental implements, stethoscopes, anything that might need disinfecting.

“The entire healthcare sector can benefit from a low-cost, long-term alternative to the current wasteful processes,” said Dr Davies.

Looking to the future

He adds: “As we emerge from the pandemic and continue to recover, there are opportunities to learn lessons so that a positive legacy can at least be achieved from a disastrous period in our history.

“The healthcare industry now has the opportunity to adopt innovative solutions that dramatically improve the safety of its workers.

“Re-usable RPE and UV-C disinfection can be steps in the right direction, but the onus is on the entire sector to continue to push the envelope of innovation and continue to improve processes that make healthcare excel.”