FLuorescent Imaging of Critical Cleanliness Areas – FLICCA

2019冠状病毒病大流行期间出现的一个主要问题是全球个人防护装备（PPE）短缺。这主要是由于疫情突然发作并迅速发展为大流行状态，再加上供应链准备满足工业和医疗保健的需求，而不是大规模的公众恐慌性购买。对于这种全球短缺，未来有几种解决方案；增加供应链，但这必须是可持续的，为大众市场生产不同的产品，或者通过重复使用或更好地了解PPE需要更换的频率，更好地利用现有的PPE。后者还有助于通过减少浪费和鼓励增加再利用来应对另一个全球威胁——气候变化。虽然一线医疗保健专业人员显然需要适当的个人防护装备来确保他们自己和患者的安全，但准确评估某些个人防护装备的状态可能会对整体可用性产生重大影响。虽然密切接触的个人防护装备（如手套）显然必须极有规律地更换，但对于其他形式的个人防护装备，如面罩或可重复使用的呼吸器，该指南的禁止程度较低。这里的建议是明确的，但只是定性的（例如损坏，污秽，难以使用）。如果能够快速可靠地评估使用中的个人防护装备的状态，就可以减少浪费并进一步减少污染。目前美国疾病控制与预防中心的指导方针指出，个人防护装备的使用期限超过使用期限，比不使用要好。同样，简单的清洁程序可能足以允许继续使用以前已经丢弃的个人防护装备。我们建议评估生产一种基于荧光成像的简单设备的可行性，该设备可以在医疗保健环境中进行简单的清洁过程后测量使用中的PPE和PPE的状态。我们进一步建议，同样的技术可用于评估除污后现场设备/设施（例如监测仪、床）的清洁度。该设备还可以应用于食品生产行业，以确保食品制备区域和包装不会通过食品供应链产生后续污染。随着我们项目的进展，对可持续个人防护装备的需求随着大流行病的重新爆发而增加。然而，尽管正在开发可持续的个人防护装备，但由于缺乏质量控制技术来确认再加工个人防护装备的适用性，使用它的能力受到损害。通过与NHS改进合作，将FLICCA扩展到调查该技术是否适合质量控制，以指定和测试FLICCA与一些拟议的再处理概念。NHS在项目期间提出的第二个问题是调查擦拭清洁。最初的项目是寻找表面上的污染，并通过擦拭确认其清除，但扩展将通过寻找擦拭残留物的荧光来检查擦拭覆盖范围。这可能是确定给定表面是否已完全擦拭（因此清洁和消毒）或是否需要进一步清洁的合适标准，类似于已使用的培训系统，但可部署在活动场所。这两条新途径将为NHS提供重要的功能，同时也为该技术提供重要的额外收入来源。

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.