FIGHTING COVID-19
waste to ensure that each type is discarded, transported, and destroyed properly, preventing larger health issues arising from mislabelled medical waste. Staff training is key to ensure successful implementation.
Drainage
Effective drainage systems should be designed to ensure that the venting to atmosphere has been considered. Pressure fluctuation in pipes can cause water traps to be ‘pulled’, leading to open air paths between drainage pipework and habitable spaces creating a transmission route for airborne viruses. To effectively manage positive and negative air pressure transients within the pipework, PAPA (positive air pressure attenuator) drainage systems may prove beneficial.
Plumbing
The introduction of hand sanitiser has reduced the number of washhand basins and the frequency at which they are used. This can result in water stagnation and a risk of bacterial growth. ‘Looped’ or ‘daisy chain’ pipework can encourage full circulation of water through the system and pipe insulation, while system-wide temperature monitoring, or a circulating return domestic wholesome water system, can maintain appropriate temperatures.
Personal and respiratory protective equipment
PPE – There is engineering expertise in the materials and designs for masks, gloves, aprons, visors etc, which must be designed with user fit and comfort in mind. ‘Donning and doffing’ are the riskiest times for virus transmission for health workers, and thus need effective design solutions. Globally, the engineering community has rapidly responded to the demand for PPE, contributing to the design and production of medical grade PPE, ‘creating novel solutions that lend themselves to reuse’.
Environmental decontamination n Air cleaning – Ultraviolet germicidal irradiation lamps are part of a strategy to reduce contact between hospitalised patients and microbial agents by decreasing the concentration of infectious airborne organisms. These are commonly installed on the upper side of rooms, with careful installation of lamp fixtures to prevent patient exposure to stray UV-C rays. UV lamps’ effectiveness depends on their interaction with HVAC systems, as high relative humidity can attenuate UV, and different air flows can expose more or less air volume to direct UV irradiation in the upper side of rooms.4
There is a
range of portable air cleaning and disinfection technologies that remove
18 Health Estate Journal September 2020 Engineering a resilient future
IHEEM’s part in the ‘Rapid Review’ was highlighted in a National Engineering Policy Centre (NEPC)/Royal Academy of Engineering paper, COVID-19: Engineering a resilient future – From ideas and insights to collective engineering advice, published on 9 June. The paper not only ‘championed the important role the engineering community had already played’ in advising the UK government during the COVID-19 pandemic, but also drew on ‘evidence, insights, and case studies’ from across the NEPC partnership to set out ‘how engineers can transform their ideas into collective advice, minimising the risks and impact of COVID-19 for the UK, to secure a more resilient future’. The NEPC is led by the RAE, and collectively represents 450,000 engineers across the UK. The case studies included illustrated how the engineering community had ‘already provided rapid support and advice on the COVID-19 pandemic’. Among the varied areas covered were ‘Identifying interdependencies across national infrastructure to support resilience planning’, ‘Cybersecurity in a COVID-19 world’, ‘Supply chain vulnerability’, and ‘Managing the transmission of COVID-19 in hospital environments’. The paper presented the ‘engineering response’ to the pandemic in three stages, outlining how engineers could contribute in each. The ‘stages’ were: n Lessening the impact; n Easing the lockdown, and n Building a resilient future.
As a National Engineering Policy Centre partner, IHEEM is credited in the paper as having been highly active in the support and actions it had taken since the coronavirus outbreak began. In addition to having participated in the aforementioned ‘Rapid Review’, the paper noted that the Institute had already, or planned to: n Issued national and international ‘call-outs’ to its individual and corporate members for technical and professional support to both NHS England & Improvement (NHS E&I) and the World Health Organization (WHO). On the paper’s publication, approximately 150 offers of help and support had already been forwarded directly to NHS E&I and WHO via the International Federation of Healthcare Engineers (IFHE).
n Effectively engaged with NHS E&I and the Devolved Administrations ‘to quickly and effectively disseminate their key messages out to the membership’.
n Developed free toolkits to support frontline engineering staff – for example the ‘Medical Gas Oxygen COVID-19 Demand Tool’, and the ‘Medical Gas Cylinder Management and Tracking Tool’.
n Published a fortnightly international newsletter ‘to share intelligence, best practice, and personal experiences’ with its global membership.
n Established a focused specialist Technical Panel to respond to national and local calls for specialist advice and guidance on the technical engineering challenges raised by COVID-19.
n Developed and published factsheets on key topics – for example, reprocessing of PPE.
n Worked closely with the NHS E&I Estates and Facilities team to develop future standards guidance and policy, and, in collaboration with RAE, influence Government engineering policy, including STEM.
n Hold (virtual) events focusing on lessons learned and key engineering themes resulting from the pandemic.
microbial particles from the air, which could boost ventilation’s effectiveness in smaller rooms.
n Room decontamination – Chemical cleaning is the primary decontamination mechanism, supported by a series of other technologies. Many hospitals already use UV robots to clean and sterilise rooms between patients. An Innovate UK-funded company has developed FinsenTech THOR UVC, which delivers UVC light to ‘hard-to-reach’ places using radar technology to map its surroundings to establish that they
are clean and eliminate human error.5 Additionally, hydrogen peroxide vapour systems are used. Robotic fogging devices are being explored, but have not been widely deployed in clinical settings yet. These can be further aided by cold plasma technology, a form of advanced electric air filtration that can be used alongside ventilation to collect and kill air contaminants.
n Equipment decontamination – Decontamination of equipment used to treat patients, such as ventilator suction units, must be undertaken in approved sterile services departments. If a
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