Why a Change in Respiratory Protection Practice is Vital for Healthcare

Aside from all the business and economic impacts of COVID-19, the virus has been relentless with millions of people affected globally. The World Health Organisation estimated in May 2021 that at least 115,000 healthcare workers had died around the world after contracting COVID-19^[1]. Among discussions in the UK is the call for stricter recommendations on respiratory protective equipment (RPE) for those in the healthcare industry, calling in particular for more widespread access to the highest grade protection for healthcare professionals^[2].
 
It is estimated that NHS and social care segments spent roughly £500 million on disposable respiratory protective equipment (RPE) in 2020. This was spent on a combination of higher performance tight fitting FFP3 grade respirators and disposable loose fitting surgical masks. However, FFP3 respirators only accounted for a small percentage of the RPE, so an uplift in share would create a significantly increased cost burden for disposable masks and respirators.

Healthcare finds itself at an impasse. 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. 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 disposable 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 event 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. 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.
 
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. 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.

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. Given the environmental and economic challenges described above, 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.
 

Though invisible to the human eye, ultraviolet (UV) light has a range of use cases - categorised on the types of rays used, 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^[1]. 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. By implementing compact and portable UV-C disinfection chambers around hospitals, medical practices, or wherever necessary, health workers can gain access to reusable PPE.
 
A small chamber - smaller than a microwave that can be placed on a benchtop, is now a possibility. Health staff simply need to place their respirators inside the chamber, select the correct program 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. 
 
Furthermore, 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.

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.