The role of air sterilisation in the fight against Covid-19
When trying to figure out what ‘best’ to do for the UK and globally in these unprecedented times, it is easy to become paralysed with indecision at the options. Do we prioritise the NHS while keeping the economy closed and people at home, or is it ‘best’ to open the economy and try to save jobs, knowingly increasing pressure on healthcare workers?
Add to this the threat of a ‘twindemic’ with seasonal flu and that indecision deepens. The biggest challenge is people. People spread the pandemic, the pathogens, and the possibility of more problems, and no amount of cleaning, face masks, or hand sanitising can fully eliminate risk as long as people keep interacting. So, what should we do?
Air sterilisation might just be the unsung hero for this problem, both within and beyond the healthcare setting, and both as a short-and long-term solution to support the economy reopening without deepening the risk.
How long will people be prepared to wear masks in public or stick with the rule of six? Shouldn’t we be looking ahead to see how we create long-term pathogen controls in public places and offices, not only to reduce the immediate risk and deliver infection control, but also to generally decrease infection risk and absenteeism within the economy?
This can then go hand in hand with the longer-term proactive measures like vaccine and medicine developments which will no doubt help to reduce and treat cases, minimising deaths in the coming years.
What is air sterilisation and how does it help?
Aside from the emergence of new, unseen pathogens like Covid-19, the biggest challenge in infection control stakes is the movement of people. An area is only ‘clean’ in the moments after it has been cleaned, before people make their way through it; coughing, spluttering, and touching, when aerosolised spores and pathogens start to resettle on surfaces.
Add to this the long-tail incubation period of Covid-19 and a single infected individual is unknowingly spreading the virus for days before they show any symptoms.
Current guidance for managing infection risk has three core focuses: cleaning, accurate record-keeping, and space adaptations such as Perspex screens. The question is whether these steps are enough, or whether they just create the perception of safety within an environment.
According to research by King’s College London, who ran an antibody testing study, at least one in five people from the group didn’t show any symptoms at all of Covid-19 despite having, or having had the virus. Meanwhile more than 25 per cent who did fall ill, did so without having any of the three core symptoms that commonly identify those with Covid-19. The average business cannot claim to be infection control experts, so how can we manage the real risk of infection effectively?
Air sterilisation is not actually a new solution, but it is in my opinion a severely underutilised one. It involves the installation of a discrete, standalone unit which works by using a series of air and surface purification technologies to help manage infection risk in a room.
Each brand varies slightly in terms of what techniques are used and how effective they are, but they will have a set purpose to neutralise microbes, bacteria, dust or even odours. We are the UK distributors for a brand called AIRsteril for example, which works both for air sterilisation and surface sterilisation by producing plasma quatro.
The AIRsteril technology specifically combines sterilising, cleaning, and purifying technologies, including germicidal UV light, dual UV operation, Photocatalytic Oxidation (PCO) and a purifying plasma of superoxide ions and optimal ozone. These techniques together kill up to 99.9 per cent of germs and viruses, before releasing the purified air back into the room as a plasma.
The plasma then kills airborne pathogens, viruses, bacteria, fungi, mould spores and allergens, and decomposes odours and harmful gases. Its effectiveness was tested by Leeds University and shows that airborne microorganisms were undetectable after just 60 minutes.
This is where things get really cool, as the process not only manages airborne infection risk, but also sanitises surfaces and the wider environment. The purified plasma breaks down microorganism cell walls, destroying the cells and preventing them from reproducing. As the plasma moves over surfaces – any surfaces including hard and soft materials – it also kills the germs which are left behind by touching, breathing and coughing or which have settled in the environment.
The core advantage is that it works constantly, so even if people move around and leave pathogens behind in between cleaning schedules, viruses and bacteria will likely be eliminated in a matter of minutes if not hours. To put this into context, AIRsteril was tested in a quantified NHS call centre environment, prior to the pandemic; constant air sterilisation resulted in a 42 per cent reduction in absenteeism, particularly for asthma, cold, cough, influenza, chest, and respiratory problems.
While the priority here was managing absenteeism, this model translates to significantly reduced infection transfer, and significantly reduced disruption through suspected Covid-19 cases.
For me, the solution isn’t simple, but I genuinely believe that we can successfully minimise infection risk through a combined effort of public and private measures, medicine and vaccines, and with the addition of active technologies like air sterilisation to manage the overall risk.
Driving sustainability in medical device production
Environmental protection and stewardship are rapidly rising to the top of the corporate agenda and medical device businesses are no exception. The healthcare sectors of the United States, Australia, Canada, and England combined emit an estimated 748 million metric tons of greenhouse gases each year, an output greater than the carbon emissions of all but six nations worldwide. In order to curb this situation various European standards have been introduced.
The Waste Electrical and Electronic Equipment (WEEE); Restriction on Hazardous Substances (RoHS); Registration, Evaluation, and Authorisation of Chemicals (REACH) and the Energy Using Products (EuP) regulations have all significantly altered manufacturing processes, specific labelling, compliance with disposal restrictions, and creation of instructions for end-of-life management and recycling.
At the moment many medical devices are currently exempt from these regulations but several directives, including RoHS and WEEE, are in the process of being reviewed and could be applicable in future. This is especially relevant for devices that are ‘connected’ and have a digital monitoring component which then brings them under the regulatory purview of authorities that govern devices with electronic components.
Safety, Usability and Sustainability
While medical device manufacturers have been working to respond to increasing demand for environmental sustainability from the market, they also have to contend with a key element of their mission: to ensure safety and usability to healthcare workers and patients. Parenteral and other invasive devices are strictly regulated to help reduce the risk of Healthcare Acquired Infection which typically runs as high as 5% and 8% in most developed countries, according to the European Centre for Disease Prevention and Control. As a result, they typically contain disposable single-use plastic elements.
At the same time, many hospitals and purchasing organisations have started to recognise that sustainable purchasing practices play a pivotal role in reducing costs over time. Many GPOs have appointed and empowered Senior Directors of Environmentally Preferred Sourcing who are successfully implementing the sustainable purchasing business case. In addition global pharmaceutical companies are increasingly creating senior positions with sustainability objectives as key to the role.
Medical device disposal is a particularly burning issue; generally carried out through incineration in the EU, it typically releases nitrous oxide, as well as known carcinogens including polychlorinated biphenyls, furans and dioxins. Some of the strategies trialled by manufacturers to reduce waste matter destined to incineration include sterilisation and reprocessing.
Sterilisation, however, falls short on the environmental front, and may consume more energy and produce more emissions than incineration itself. In the United States for example, 50% of all sterile medical devices are sterilised with ethylene oxide but since this method releases harmful emissions, the US Food and Drug Administration is now encouraging the development of new methods or technologies. Many other established sterilisation methods use glutaraldehyde that is not only harmful to the environment but also tends to be regulated by strict usage and disposal rules such as COSSH guidelines.
Focus on Recycling
The outlook on recycling is changing significantly thanks to new research and technologies enabling, for example, monomer extraction. Recycled polymers can be broken down to their constituent monomers promoting an almost limitless recyclability of some polymers. In addition to this, Polyvinyl chloride (PVC), renewable polyethylene and polyethylene terephthalate (PET) can be recycled several times without losing critical properties.
Reducing the impact of packaging can also significantly reduce the materials that need to be dealt with through either waste or recycling. Packaging manufacturers are decreasing packaging volume by favouring sealed trays instead of pouches, laser-etching instructions directly on to the tray where regulation permits it, or reducing the number of components required overall. In addition to this, for recycling plans to be successful it important to have a full understanding of the practices surrounding device use and to establish, where possible, closed loop recycling systems that recover the waste materials from hospitals or patients and bring them back into the recycling process.
Sustainable Manufacturing: Technology and Research
Greater employment of fast degrading plastics or material from other sources is a key strategy to reduce harmful pollutants both at production and disposal stage. Bio-based materials can in fact offset the carbon emitted during processing as the monomer source grows, and a growing range of sources for bio based monomers -such as wood pulp or sugar cane- is available. However, when assessing the most suitable material for a part, the entire lifecycle of the product needs to be considered. For example: bio-degradable polymers can contaminate a recycling stream and emit methane when incinerated.
The use of environmentally friendly materials should also be supported by an increase in clean renewable energy sources. Lower energy consumption means fewer carbon emissions but also financial savings, making this an appealing measure for manufacturers. New technologies are proving a major gamechanger on this front, helping manufacturers marry their environmental stewardship with cost savings and efficiency. 3D printing, for example, can help develop optimum product moulds more quickly, refining production parameters to minimise raw materials volumes and maximising output productivity.
Similarly, ‘digital twin’ production software uses inline sensors to create a virtual, real-time mirror of the production environment to enable inline refinements. The objective is to achieve “zero defect”, waste-free manufacturing. In addition to this, LEAN manufacturing methodologies are already helping to optimise inventory management and reduce overproduction.
Sustainability by Design
It is increasingly clear that effective environmental sustainability in the medical device sector cannot exist without a full view of the product life cycle from concept development, material selection, design and engineering to manufacturing, packaging, transportation, sales, use, and end-of-life disposal. These evaluations are typically made for factors such as manufacturing efficiency, time to market, or safety and regulatory compliance, packaging and transportation costs, but should be extended to energy efficiency and environmental impact by means such as life cycle analysis.
In addition to this, with devices rapidly becoming more digitally connected, developers need to be aware that the costs of disposable electronics would simply not be viable, or indeed acceptable in the light of electronics disposal regulations. Design therefore should focus on creating a simple, repeatable interface between the two component sections so as not to impair the functionality or efficacy. As reducing waste and harmful emissions continues to exert businesses and governments globally, the medical devices industry cannot stand by. The environmental but also commercial implications of inaction are too serious and the array of solutions now available is exciting and diverse.