FLuorescent Imaging of Critical Cleanliness Areas – FLICCA

A major issue occurring during the COVID-19 pandemic is a global shortage in Personal Protection Equipment (PPE). This has mostly been due to the sudden nature of the onset and rapid progression to pandemic status, coupled with a supply chain prepared to accommodate the requirements for industry and healthcare, rather than mass public panic buying. There are several solutions to this global shortage going forwards; increase the supply chain, but this must be sustainable, produce different products for the mass market or make better use of the available PPE, either through re-use or better understanding of how often PPE needs replacing. The latter also helps combat another global threat, climate change, by reducing waste and encouraging increased re-use.

Whilst front line healthcare professionals obviously require appropriate PPE to ensure their own and their patient's safety, accurately assessing the state of certain PPE could make a substantial difference to the availability as a whole. Whilst close contact PPE, such as gloves, must obviously be changed with extreme regularity, the guidance is less proscribed for other forms of PPE, such as face shields or reusable respirators. Here the advice is clear, but only qualitative (e.g. damaged, soiled, difficult to use). If the state of in-use PPE could be assessed quickly and reliably, waste could be reduced and contamination further minimised. Current CDC guidelines state it is preferable to use PPE beyond its lifetime rather than go without. Similarly, simple cleaning procedures may be sufficient to allow continued use of PPE that would previously have been discarded.

We propose to assess the feasibility of producing a simple device based on fluorescent imaging to measure the state of in-use PPE and PPE after simple cleaning processes that could be carried out in a healthcare setting. We further propose that the same technology could be used to assess the cleanliness of in-situ equipment/facilities after decontamination (e.g. monitors, beds). This device could also have applications in the food production industry to ensure that food preparation areas and packaging produces no onward contamination through the food supply chain.

As our project progresses the need for sustainable PPE has risen with the resurgence of the pandemic. However, even though sustainable PPE is being developed, the ability to use it is compromised by the lack of quality control technologies to confirm the suitability of reprocessed PPE. FLICCA will be extended to investigate if the technology is suitable for quality control by engaging with NHS Improvement to specify and test FLICCA against some of the proposed reprocessing concepts. A second issue, proposed by the NHS during the project, is to investigate wipe cleaning. The original project is looking for contamination on surfaces and confirmation of their removal through wiping, but the extension will examine wipe coverage by looking for fluorescence of the wipe residue. This may be a suitable gauge to ascertain if a given surface has been fully wiped (and thus cleaned and disinfected) or if further cleaning is required, similar to the training systems already used, but deployable in active sites. These two new avenues will provide vital functionality to the NHS but also significant additional revenue streams for the technology.