after fumigation. However, this was zero to 3.7 ppm after being left to aerate overnight in the test chamber. This was found to be between 0.5 and 4.2 ppm after being stored in plastic bags. “The take home message, here, is that there needs to be processes in place to ensure the masks are thoroughly aerated before being returned to the users,” he commented.

The pass criterion for the FFP3 filter penetration tests was <1% penetration and all passed. There was no strong evidence of progressive decline in filter penetration performance. However, there were some reductions in fit test values for three out of five respirator models after decontamination, with greater reduction after 20 cycles. Crook pointed out that this was only statistically significant for one respirator model. Due to the innate variability in fit test values and the relatively small number of masks and volunteers, changes in fit test value would need to be relatively large to be statistically detectable – therefore, the differences should not be over-interpreted. In summary, the small scale ‘proof of

principle’ study showed: l VHP fumigation effectively eliminated or greatly reduce microbiological contamination on FFP3s;

l FFP3s could withstand 10 to 20 cycles of VHP fumigation without any visible deterioration or deleterious effect on filter penetration;

l There was some reduction in fit test values, but no strong evidence of significance;

l There was some damage to FFP3s from simulated donning, not VHP effects;

l There was absorption and off-gassing of hydrogen peroxide from FFP3s, requiring thorough aeration before re-bagging and return to the user.

l Potentially, this VHP approach could be applied using FFP3s with rigorous protocol.

Crook concluded that VHP fumigation of normally single-use FFP3 respirators could offer a solution to PPE supply chain issues during emergency/pandemic situations. It also offers an environmental alternative to disposal of resources. However, this would

need to be driven by a rigorous and validated protocol and must include selection criteria for reuse respirators – not all respirator types were tested and not all will be suitable. He reported that pilot studies are now being undertaken with NHS Trusts and different VHP system providers to test the practicalities of this approach.

Creating a surge hospital Clive Morgan, deputy director of therapies and health science, at Cardiff and Vale UHB, gave a personal insight into his incredible experience of creating a surge hospital in Cardiff City Centre – the Dragon’s Heart Hospital.

“By 18 March, the mission was clear: to build a 2,000-bed hospital in four weeks. The first thing we had to do was establish a model of care and this was determined to be adult step down and non-bariatric,” he explained.

Morgan presented an array of slides demonstrating the scale of the transformation and the huge achievement of the teams that worked on the project. The surge hospital opened on the 13 April 2020 with space to

COVID-19: demands on the built environment

John Prendergast AE(D), a senior decontamination engineer at NHS Wales, chaired the final sessions of the CSC Virtual Study Day, which looked at the challenges posed by COVID-19, in terms of the built environment and infrastructure, and the lessons learnt during the pandemic. Focussing on the health estate, David

Fancis, an engineering supervisor at Betsi Cadwaladr University Health Board gave an overview of how the health board is improving hospital services in response to COVID-19. Betsi Cadwaladr University Health Board comprises three acute hospitals across North Wales and 14 community hospitals. Some of the community hospitals were “hit quite hard” in the first wave of infections. Despite pressures being faced in maintaining the existing hospitals, three field hospitals were successfully established, in just three weeks – at a leisure centre, theatre and university. COVID improvement work is now ongoing at all three critical care units, in order to meet the challenges of a second wave. Increased oxygen demand has necessitated infrastructure upgrades and modifications have been made to implement new oxygen lines for the critical care areas. “The HTMs talk about flow rates and

diversity, but from our experiences, during a pandemic, diversity goes out of the


window. We are making sure we are sizing our pipes to ensure we have the ability to give the flow rate required at every bedside. This has been an important learning curve,” said Francis.

“In terms of ventilation, there has also been an increase in awareness of air change rates in all settings across the health board. We now classify ventilation in ward areas as essential,” he continued. Air change rates on the wards were evaluated and a programme of upgrade projects has been subsequently implemented. This has included a move away from natural ventilation to mechanical ventilation. “In recent years, a focus on carbon emissions has driven a shift away from mechanical ventilation in hospitals. However, during the winter, when the windows are closed, we wouldn’t be able to guarantee the six air changes required, so we have moved back to mechanical systems,” Francis explained. There were also fire considerations associated with the ventilation improvement work, that needed to be factored into upgrades. To oversee these improvements, a Ventilation Safety Group was appointed with the formal appointment of authorised persons. Other considerations, during the pandemic, have included requests for additional wash hand basins and the installation of additional renal dialysis water supplies. Estates also had to

ensure that flushing was carried out for closed buildings to prevent legionella contamination as these areas reopened, after the first wave. Red and green areas required appropriate access control measures, which needed to be integrated with the design of fire systems, while additional electrical sockets were also required to meet demand for the extra ventilators. A key lesson learned has been the location of specialist equipment that requires maintenance. If this is located close to medical areas and these areas are designated as ‘red’, getting people in, to undertake maintenance in the event of a fault, can prove to be difficult. He noted that there have also been some positive outcomes: “Estates and facilities have really risen to the challenge. There has been an opportunity to get into parts of the hospital to tackle issues, such as flooring and renovation, in those parts of the buildings that have been closed during the pandemic. We have also learnt important lessons around medical gasses and ventilation – the pandemic has highlighted areas for improvement. Capital project progress has been maintained and we have been able to demonstrate the ability to perform effectively, while moving to virtual meetings and flexible working. I am proud of what we achieved over the past six months,” he concluded.


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