By Dr. Dineshani Hettiarachchi Sirisena
Over 100 countries are now dealing with the Covid-19 crisis. Low-resource countries are increasingly recognised as sources of frugal healthcare innovations. These innovations offer the potential for cost savings. There has been an extraordinary demand for personal protective equipment (PPE), and deficiencies in their supply chain could potentially collapse a healthcare system as protecting the frontline staff is critical in our fight against Covid-19.
However, necessity is the mother of all inventions, and healthcare workers have stepped up to meet this growing demand by making cost-effective medical supplies such as masks, protective gear, disinfection chambers, etc. These improvised PPE need to be efficient and cost-effective at the same time.
Delving into this matter, we spoke to Dr. Sajith Edirisinghe, who is a lecturer at the Department of Anatomy of the Faculty of Medical Sciences at the University of Sri Jayewardenepura (USJ). Dr. Edirisinghe has been one of the pioneers in this field in response to the growing demand.
Safety of healthcare workers
Healthcare workers in the frontline should be protected as their exposure to hazards put them at risk of infection with Covid-19. These particular occupational constraints include not only the exposure to the pathogen, but also long working hours, psychological distress, fatigue, occupational burnout, and stigma, to name a few. It is a national responsibility that they’re provided with adequate IPC (infection prevention and control) and PPE supplies (masks, gloves, goggles, gowns, hand sanitiser, soap and water, and cleaning supplies) and that too in sufficient quantity.
The World Health Organisation (WHO) and other global stakeholders, including governments, are evaluating and investigating the usefulness of early preventive measures, which are of paramount importance to provide timely advice on measures to protect people’s health and prevent the spread of this outbreak. In light of this, healthcare workers mustn’t become carriers of this infection. Wearing a medical-grade mask is one of the preventive measures to limit the spread of certain respiratory diseases, including Covid-19.
However, according to the rational use of PPE for the coronavirus disease, an interim guideline issued by WHO on 19 March 2020 has highlighted the importance of covering the rest of the face using a face shield while wearing a surgical mask, to provide the adequate level of protection for the health staff who are in direct contact with Covid-19 patients or the procedures that stimulate coughing and promote the generation of aerosols performed on them. However, the commercially available face shields are costly and are not freely available in large quantities on a scale required in the face of a pandemic such as this.
This need prompted Dr. Edirisinghe to develop a low-cost reusable face shield to protect the eyes and the face of the wearer from accidental exposure to said pathogens and even toxic chemicals they might come in contact with. This invention also helps frontline staff when communicating with patients and obtaining their samples.
Dr. Edirisinghe gives special thanks to the support rendered by Nugegoda Sarasavi Communication Proprietor Konara M. Dayarathna by funding this venture. The shields were donated to the National Hospital of Sri Lanka, Colombo South Teaching Hospital in Kalubowila, Sri Jayewardenepura General Hospital, Colombo East Base Hospital, Air Force Hospital in Rathmalana, Army Hospital in Narahenpita, Panadura Base Hospital, Ratnapura General Hospital, Central Dispensary in Karawanella, Colombo JMO (Judicial Medical Officer) office, MOH (Medical Officer of Health) office in Seeduwa, and many other hospitals islandwide.
He also mentioned that the shields were reusable as they were resistant to disinfection solutions (TCL or alcohol-based disinfection solutions). Also, the upper end of the shield is made of a chemical-resistant rubber material. The rubber also provides a small space between the shield and the face so it doesn’t hinder the use of specs or the face mask worn beneath it. Most importantly, the refraction of light is very minimum since the thickness of the sheet is less than 100 microns.
Therefore, there are no visual difficulties while wearing the shield. Since the shield can be reused several times, the accumulation of plastic and polythene in the environment is minimal. So it is an eco-friendly product compared to single-use plastic face shields. The head strap is made out of elastic or ribbon with a locking mechanism. Therefore, the shield is adjustable to the circumference of the head without any difficulty.
Furthermore, Dr. Edirisinghe has developed a portable single-person-operating Covid-19 sample collection chamber. This collection chamber overcomes the need for a minimum of two healthcare workers to operate such a unit. Additionally, commercially available entities are usually non-portable. Thus, the new unit enables a single healthcare worker to easily take the sample, disinfect the anterior side of the chamber, and send the next sample-collecting bottle to the outside through the channel with patient details on it, while obtaining the next sample. This method could minimise the use of PPE.
As currently used PPE are made out of plastic and polyethylene, it (new collection chamber) can reduce the environmental damage caused by these products. Hence, this is not only cost-effective, but also environmentally sustainable. The other advantage of this machine is that it is lightweight and portable, therefore it can be moved from one ward to another or easily carried to the field for sample collection. The chamber has a built-in lighting system to visualise the inside of the person’s mouth to facilitate proper sampling. It also has an air cooling system to reduce the heat and humidity inside the chamber. This chamber was handed over to National Institute of Infectious Diseases (IDH) Director Dr. Hasitha Attanayake on 16 April 2020.
Another such innovation was made by D.L. Dimbulgasthenna who works at the Department of Anatomy of the Faculty of Medicine at the University of Colombo (UoC), where he developed a disinfection chamber which costs Rs. 16,000 as opposed to the commercially available chambers which range from Rs. 50,000 to 75,000. A variety of approaches have been invented to facilitate the disinfection process, physically via box, chamber, tunnel, or confined space. The automated dispersion of disinfectants to individuals is activated once a person steps in. Motion sensors are usually placed at the entrance to facilitate this process. The spraying takes place for approximately 20 to 30 seconds in each cycle of disinfection.
There is a claim that this technology could have potential benefits in preventing and limiting the spread of infectious diseases. However, its exact use is being explored in the current context. These prototype chambers are lightweight and transportable as they can be easily installed and uninstalled.
Given the wide variety of low-cost, high-value innovations originating in low and middle-income countries, we need a concerted effort to identify potential reverse innovations such as these and fund their pilot testing in the local context. This is also a source of new ideas, enabling middle-income countries to broaden their horizons while levelling the playing field in global knowledge production. The resource constraints faced by health systems can benefit by adopting frugal innovations which are timely and needed.
A system should be put in place to harness local hidden talents and encourage the development of more such need-based equipment. Such ideas should be evaluated by experts and resources should be allocated as needed. Such innovations can be useful not only for Covid-19, but also for other diseases.