If we are to learn from history and experiences, the pandemic has recalibrated the focus and importance of cleaning, disinfection and built environment protection as well as challenging current practices with single-use disposable items and chemical use in terms of sustainability and environmental protection. 

Lessons learned from the pandemic need to be prioritised to validate processes and develop competency-based training to a ‘Healthcare’ standard for all building types including public transport.

If we apply Healthcare Infection Prevention risk assessment to the built environment and how people behave and engage with those facilities, functional risk can be clearly identified and steps to mitigate risk taken and break the potential chain of infection. Either from direct surface contact contamination or via airborne aerosols.

The principal lesson learned during the pandemic was the risk of airborne infectious transmission and the challenge of achieving and maintaining good air quality. The enclosed built envelope presents the challenge of balancing the need for optimised space utilisation, achieving suitable ventilation air change requirements for occupant safety while managing sustainability challenges of energy and cost. 

Enter the ‘Smart’ WELL Building

How we use built environments will have an impact. As facilities are designed to be more flexible and dynamic in their utility, these demands need to be measured, quantified and managed in real-time. The trend towards hybrid working time within the workplace environment, scaling down or redesigning workspace facilities to suit with increased sharing of space, demands greater agility in building management. Not just monitoring the built facilities but also how the facilities are being flexibly used. The emergence of the ‘Smart’ building brings IoT connected monitoring of facilities together with utilisation activity and behavioural activity taking place, captured in real-time via sensors. From room booking to scheduling cleaning, measuring air quality and monitoring hygiene compliance. The data is captured and communicated in real-time to provide accurate insights into dynamic activity and utilisation as well as monitoring risk and managing wellbeing standards.

Several technologies have advanced during the pandemic which supports a proactive approach to environmental hygiene and infection prevention and has the potential to significantly improve the safety of area decontamination practices in both healthcare and public spaces.

Ultra Violet germicidal irradiation (UVGI) and the potential for Far UV-C proactive environmental  protection

UV has been used extensively in water purification treatment and within enclosed ventilation systems. In recent years mobile UVGI emitter systems have been used for area decontamination within healthcare environments. With the advent of SARS CoV-2 mobile UV-C robots have been deployed in commercial building public areas.  These systems emit UV-C in the 254nm wavelength range which is harmful to skin and eye exposure and limits the use to areas and times when areas are unoccupied. 

Far UVC emits a shorter wavelength of 222nm which can eliminate pathogens from the environment but is non-hazardous to human health from exposure and is safe for use when the facility is occupied.

The sensitivity of the coronaviruses to far-UVC light suggests that it may be feasible and safe to use overhead far-UVC lamps in occupied indoor public places to reduce the risk of person-to-person transmission of coronaviruses, as well as other viruses such as influenza and norovirus.

Far-UVC lights can autonomously and continuously inactivate viruses, bacteria, or fungi in occupied spaces. This provides protective coverage to shared workspaces or public areas where individuals may be in proximity and risk exposure to viable airborne viral particulate.

Anti-Microbial Surface modification.

To mitigate Infection caused by direct contact with common frequently touched surfaces, frequent cleaning and disinfection is required or alternatively surfaces modified to inhibit and prevent microbial surface contamination. Silane based antimicrobials have gained focus and adoption during the pandemic. The silane antimicrobial technology presents several beneficial environmental characteristics being water-based, non-leaching, permanently bonding to surfaces on contact and providing rapid-acting antimicrobial activity. The silane antimicrobial physically destroys the microbe on contact, eliminating the risk of resistance or mutation.

Antimicrobial surface protection provides the first-line defence in infection prevention. When combined with frequent hand hygiene the risk of infection from contact with surfaces is significantly reduced.

The antimicrobial treatment can also provide a protective and in some cases a restorative nano-coating which improves ‘cleanability’. When used in conjunction with professional microfibre surfaces can be maintained effectively to disinfected standards without the need for environmentally impacting chemicals. 

Bio-Cleaning, Environmental Sustainability & Wellbeing

The emergence of SARS CoV-2 required a rapid response to public health measures to contain and reduce the risk of infection. Until the character of the virus was clearly understood the initial response was substantially reliant on a broad spectrum of chemical disinfection practices incorporating disposable surface wipes, chemical sprayers and vapour aerosolised area decontamination methods.

These protocols have continued to be employed. The result has been an exponential growth in disposable wipes containing harsh chemicals resulting in damage to surfaces and increased chemical exposure to cleaning support services staff providing the increased frequency of touch-point cleaning.

As we look at the future of cleaning and disinfection post-pandemic, we can envisage a more holistic approach to building design and maintenance, incorporating the wellbeing of personnel and environmental sustainability as primary considerations. 

Bio-Cleaning is an approach that focuses primarily on the removal of soil and contaminants from surfaces without the need for chemical agents. Bio-Cleaning can achieve the same level of disinfection using professional microfibre textiles and water. Where rapid disinfection is needed, electrolysed water or Hypochlorous can achieve high-level disinfection, which is safe in use and compatible with all surfaces. The pandemic experience and lessons learned presents the opportunity to review and revise current standards, placing environmental sustainability and personnel wellbeing as priority values.

About the author:

Michael Rollins is an independent consultant specialising in invalidation and implementation of healthcare hygiene technology, environmental Infection prevention and integration with patient safety quality improvement initiatives. He has a background in design and healthcare international marketing, visual communications and training.

Michael Joined UCLH Infection Directorate in 2004 as Project manager for Dept of Health commissioned Research studies into emerging cleaning technologies).  Study of enhanced patient environment cleaning and impact on HCAI within the ICU.

Michael is an active member of the Infection Prevention Society UK, Patron of the National Association of Healthcare Cleaning Professionals (AHCP) UK and member of the Education and Training advisory group.

Michael is also an Associate Subject Matter Specialist (Environmental Infection Prevention) for Nahdat al Tamayuz, a Healthcare Professional training and development company, Abu Dhabi, UAE, and Environmental Education Excellence Ltd, Training company UK.