Evaluating Disinfection Technologies Amid Future Pandemic Mitigation Strategies

Beth Krah

Frank Zappa once said, “Without deviation from the norm, progress is not possible.” That is true when it comes to advancing technologies. The Fire Department Instructors Conference (FDIC) this year saw the Vector by REV — a fully electric fire truck; Darley had their popular robotic dog that could correct itself and stand back up if it was bumped into, and Horton had the bare bones of an ambulance without cabinetry so that you could see the detailed craftsmanship behind the scenes.

Author Tim O’Reilly, the founder of O’Reilly Media, once said, “What new technology does is create new opportunities to do a job that customers want to be done.” New technologies give us the opportunity to accomplish the same goals more effectively and with less risk to the environment and our crews.

Fire and EMS are two of the toughest industries for new technologies to break into. In the healthcare market, the average length of time for a new technology to be accepted and utilized is approximately 17 years. We’ve all seen the latest and greatest gadgets show up at trade shows with a bang and fizzle out after a few years. Some technologies are ahead of their time and may take decades before an industry identifies the need and recognizes viable solutions. Other technologies have been around for decades, but until the onslaught of the Coronavirus, drew little attention. Well-known industry-specific technologies will cross over into other industries when the need arises but may appear new and unproven. As panic reverberated throughout the world, many were flying by the seat of their pants and couldn’t breathe, let alone take the time to do proper research. How many of you felt like you took a technological stab in the dark, crossed your fingers, and held your breath?

WHICH TECHNOLOGIES ARE LEGIT?

Within the infection prevention and control realm, we’ve got everything from robots to foggers and electrostatic sprayers to technologies you can’t even see working. Not many were able to take the time to review white papers and clinical trials to see if a new gadget was worth considering - and sifting through all the data left you frustrated and confused as you pushed it aside and resolved to get back to it later.

Anytime there’s an impending need, there are droves of companies ready to sell you the latest gadget, but who can be trusted to provide you with tailormade solutions for your specific needs and budget? How much of it is hype, and which ones have been proven with a strong history of doing what they claim to do?

Like talking to your local mechanic before deciding on a car brand, speak to your ambulance and fire apparatus dealers. Many have been around for decades and have seen which products work well and which ones have little to offer. We now see that some systems are causing rips in vinyl, peeling off chrome plating, and hazing or discoloring acrylic cabinet windows. Other systems are causing headaches. Talk to those who have used the system for several years before making your decision.

TECHNOLOGY ATTRIBUTES

- Passive vs. Aggressive: Does the system require the pathogen or contaminant to pass by or through the unit to be treated, or do they aggressively go out and attack contaminants in the air and on surfaces? Does it handle your air space as well, or just surfaces? - Chemicals vs. Chemical-Free:

What is the agent doing the deactivating or killing? Many chemicals will kill contaminants but often require the user to don

PPE to use the system. Consider how these chemicals affect sensitive equipment and surfaces and if they have any residual effects worth noting? - Repeated Treatments (for unoccupied spaces) vs.

Continuous Treatments (for occupied spaces): Can the treatment be used while the area is occupied, or is there a need to take the truck out of service for treatment, and for how long?

How often do these treatments need to take place for your rig to be safe? Are there continuous, non-toxic options that are a good fit for your fleet? - Made in Country or

Internationally: Consider supply chain capabilities and how a natural disaster or a political occurrence may affect getting the product in the door. In-country products typically have greater abilities to supply on demand when the world is in turmoil.1

CONSIDERATIONS

Maintenance: Even the most effective technologies can be ineffective if not used properly or maintained to the manufacturer’s instructions. I’ve heard many stories of healthcare facilities spending plenty of money on robots that rarely come out of the closet because the bed was needed immediately, and treating the room just took too much time. A new patient has a 39-353% chance of contracting the previous patient’s pathogen in a hospital bed2 – how does that translate to the back of an ambulance? It is essential to get a copy of the manufacturer’s instructions to be clear on how to keep the system up to par on a consistent basis. If the technology was installed at the factory or through a dealer, ask them to forward you the manual or contact the manufacturer to see what needs to be maintained.

Some technologies require an annual replacement of the air purification cell to keep the unit performing at optimal levels. How often do you need to replace the filter or change the UV bulb? Please make a point to put it in your maintenance schedule. When do you need to re-apply any antimicrobial coatings?

Replacement Parts and Residual Costs: Between maintenance, replacement cells, UV bulbs, chemical solutions, filters, etc., annual costs can add up. Be sure to have residual costs accounted for in your budget.

Training and Man Hours: Which systems require training your crew

Quick Reference Guide

Use the following chart as a quick reference guide and investigate further to make an informed decision. Please perform your own due diligence before deciding on which avenue to pursue. Often, a bundled approach will be your best defense against a harmful environment.

Technology UV/UV-C Electrostatic Sprayers

Description Uses UV energy to inactivate viral, bacterial, and fungal microorganisms.

Effectiveness on Surfaces Effectiveness in the Air Yes

No Applies a small electrical charge to aerosol particles (65-85 in size) that pass through a nozzle & stick to or wrap around surfaces. Yes

No Foggers Vaporized H2O2 (VHP, HPV)

Uses a fan and a liquid solution to create aerosol particles (10-60 microns in size), an ultra-fine aerosol disinfectant. Vapor form of hydrogen peroxide is used for lowtemperature disinfection.

Yes Yes

Yes Yes Dry H2O2 & Purifying Molecules w TiO2 Purification molecules (or gas) that attack membrane lipids, DNA, and other cell components. Some utilize Titanium Dioxide. Yes

Yes

Treatments Cyclical or 24/7 in HVAC Cyclical Cyclical Cyclical Continuous

PPE Required No Yes

Contact Time Needed 30-50 min. 10 min. Yes 10 min. Yes

No 30-45 min. N/A

Used in Occupied or Unoccupied Spaces Avail. for HVAC Install Unoccupied Unoccupied Unoccupied Unoccupied Occupied

Yes No No No Yes

Training Required Yes, on portable models Leaves a Residue No Adverse effects on materials Discoloration Possible Considerations Requires direct exposure (shadowed areas not treated); complex surfaces may need multiple passes. Yes Yes Yes No

Yes Yes

(No Space) No Possible Corrosion Possible Not likely None Reported

Wash surfaces before treatment. Confirm chemicals were designed for each purpose desired. Wet or dry options avail. Confirm chemicals were designed for each purpose desired. Cover electrical equipment to prevent damage. Doors, outlets, and ventilation systems must be sealed while in use. Should be used only in healthcare or laboratory settings.

[3,4] Choose carefully as some systems may interfere with the airflow in the HVAC system.

for proper use? Some technologies require taking the truck out of service for treatment, and other systems treat continuously without requiring downtime. How will that fit into your schedule?

Thoroughly investigate claims and test data on various technologies to make informed decisions, as large marketing budgets don’t necessarily mean adequate technology. Manufacturers must back up claims definitively and readily provide supporting documentation with real-world test results. Focus on health-promoting environments and preventative measures with upstream solutions.

At the end of the day, think of mitigation strategies as a cousin to a mass casualty or disaster training: • Research ahead of time – when disaster strikes, it’s too late. • Keep a small supply of the product you choose in stock,

but check the shelf life for any components. Do they have an expiration date? • Keep supplier cell phone numbers in your back pocket – you’ll need to act yesterday. When Covid showed up, the entire world wanted something to combat it at the same time. The supply chain couldn’t keep up, and the only ones who were able to procure the technology they wanted were the ones who had already done their research and had plans in place to act immediately.

Others got left behind.

Some may think the pandemic is over, and there’s no need to make a fuss; others feel it’s just a matter of time before the next one rolls around and are preparing firm strategies for when it does. Did the pandemic catch you completely off-guard, or did you have plans in place ready to go when it reared its ugly head? One of the most important factors when preparing and training for disasters (or pandemics) is to alter your thinking from “if it happens” to “when it happens.” If you train for something that might happen (to someone else) without expecting it will happen to you, your crews will be hard-pressed to take it seriously, and the effectiveness of your response will greatly suffer when it counts, with no time allotted for playing catch-up.

Research, strategize, prepare, and train like your life depends on it – because it does.

REFERENCES

[1] Shih, Willy C., Harvard Business Review (2020) Global Supply Chains in a Post-Pandemic World. Retrieved from https://hbr.org/2020/09/ global-supply-chains-in-a-post-pandemic-world

[2] Rutala, William A., Ph.D., MPH (2017) Disinfection and Sterilization: What’s New?

Beth Krah is founder and CEO of The Krah Corporation (dba Krah Health Solutions). She has served the healthcare community for over a decade providing non-toxic infection prevention measures with a special focus on EMS, Disaster Preparedness/ Response, Medical Care Facilities and the Military. Previously employed by Solvay Pharmaceuticals in their Quality Assurance/Quality Control group, her passion to serve is of utmost importance for her and her team’s role in serving their customers and keeping them healthy so they can focus on the pressing needs of saving the lives of others. She can be reached at beth@krahcorp.com.

[3] Centers for Disease Control and Prevention (CDC) (Updated 2021) Safety Precautions When Using Electrostatic Sprayers, Foggers, Misters, or Vaporizers for Surface Disinfection During the COVID-19 Pandemic. Retrieved from https://www.cdc.gov/coronavirus/2019ncov/php/eh-practitioners/sprayers.html

[4] US Environmental Protection Agency (EPA) (2021) Protocol for Room Sterilization by Fogger Application. Retrieved from https://www. epa.gov/pesticide-registration/protocol-roomsterilization-fogger-application