Environmental hygiene learnings of the COVID-19 pandemic from the perspective of an IPC solution provider.
Author: Duncan Holdsworth, BSc, MRSC, Head of Technical, GV Health
Introduction:
GV Health is a science and technology company developing and supplying a wide range of different products and services for infection prevention and control (IPC) in the UK Healthcare sector. This includes environmental hygiene products (such as cleaners and disinfectants) and hazardous waste management products (such as clinical waste bags.) GV Health was a key supplier of these products and services to the NHS throughout the COVID-19 pandemic, providing us with various perspectives of the challenges and solutions. As a science and technology company, we continually strive to innovate our products and services, so regularly perform retrospectives to learn from past experiences to inform future development strategy.
The COVID-19 pandemic was an event that we can clearly all learn from, so this article examines the causes, future risks, challenges and new strategies we can implement to improve our future IPC preparedness.
In the UK COVID-19 enquiry, some of Baroness Hallett’s findings from Module 1, which examines resilience and preparedness include: “There was a failure to fully learn from past civil emergency exercises and outbreaks of disease” and “Ministers, who are often without specialised training in civil contingencies, did not receive a broad enough range of scientific advice and often failed to challenge the advice they did get.” One of the recommendations that came from this was to “Bring in external expertise from outside government and the civil service to challenge and guard against the known problem of groupthink”
There is therefore a clear need to discuss how we change our approach to dealing with future pandemics, which needs to be more broadly informed by a wider range of experts, including those with crucial insight into environmental hygiene.We don’t claim to have all the answers but hope to be a constructive voice in the wider conversation.
The UK was under-prepared for the COVID-19 pandemic and slow to react in the early stages, even though evidence of the threat was quickly becoming clear in nearby countries. Considering the root causes of the COVID-19 pandemic, I believe the next pandemic is inevitable. Given that the world’s population and industrial globalisation will continue to grow and expand, we’re also likely to see more frequent pandemics in the future.
Those who don’t learn from history are doomed to repeat it, so we should ask ourselves whether we’ve learned the lessons from the COVID-19 pandemic and made the necessary preparations for the next. These measures come under the umbrella of biosecurity, which refers to a set of precautions that protect us from biological risks, further clarified by the 2023 UK Biological Security Strategy1. Biosecurity is the salient term in this conversation, because security in any form needs both upfront and ongoing investment, continual work and vigilance and is always at risk of being undervalued, leading to complacency.
Preparation requires investment, which is easy to justify when reacting to problems, but less so for preventative measures to avoid future problems. It’s also challenging to justify return on investment for preventative measures, when the outcome is difficult to measure. The lessons learned from the COVID-19 pandemic are therefore critical in justifying investment in our future biosecurity.
Since the COVID-19 pandemic has subsided, we see signs of hygiene protocols relaxing back to pre-pandemic levels within the UK and further afield. For example, although healthcare providers initially increased their stock holding of critical IPC products in response to the COVID-19 pandemic, we’ve more recently seen a regression back to a ‘just-in-time’ model, exposing them to future biosecurity threats. Whilst this is happening, we see worrying signs in others in other areas, such as surging infection rates from pathogens including MRSA and C. Difficile in the UK, both of which were reported at significantly higher rates in 2024 compared to the previous year2.
Causes of pandemics and likelihood of reoccurrence:
We occupy an increasingly populated planet, with the space between us reducing. With increasing global temperatures from man-made global warming, pathogens are also able to survive and spread in previously inhospitable environments3. Global warming is also increasing infection risks from waterborne pathogens in different parts of the world, for example, communities in arid climates being increasingly forced to drink water from unsafe sources and, communities located nearer to sea level experiencing a combination of rising sea levels whilst also expanding in lower lying areas, increasing risk of flooding. Widening social inequalities across the globe also prevent poorer communities accessing critical IPC products, placing them at greater risk, increasing the likelihood of them becoming reservoirs of pathogens which evolve faster and subsequently spread globally.
With improving living standards, demographics are changing, with people living longer, increasing the proportion of those with weakened immune systems, escalating rates of transmission, infection, disease. With expanding globalisation and transport infrastructure enabling us to travel longer distances at shorter notice, individuals can arrive at their destination in a shorter period than the incubation time of many pathogens, with infected individuals more likely to remain asymptomatic and therefore undetectable prior to arrival.
Authorities are therefore already behind the curve when they first become aware, confining their options to limitation rather than prevention. It takes time to develop scientific understanding of new pathogens, limiting the pace at which informed strategy can be assembled, which can be frustrated by limited transparency within and between governments and wider disinformation. Our growing use of antibiotics adds a further strand of risk, increasing the rate at which antibiotic resistance develops in pathogens, highlighting the need for effective antimicrobial stewardship (AMS).
An infectious disease model, known as the epidemiological triad, outlines that three components are required order for a pathogen to spread, which are the host, the pathogen and the environment. The aforementioned examples affect all 3 components simultaneously, which in combination, significantly escalate risk, with pathogens able to spread faster and further, evolving at accelerated rates, increasing the likelihood of encountering future strains which can be: (i) more infectious, (ii) more dangerous and (iii) more resistant to antimicrobials or vaccine-induced immunity. Understanding the causes, their interdependencies and ability to precipitate exponentially with little warning indicates it’s only a matter of time before the next pandemic.
We should therefore view the COVID-19 pandemic as a warning of things to come. Given that over 230 thousand people died in the UK and Northern Ireland during the COVID-19 pandemic and 7 million people died globally, government and industry owe it those we lost to learn the lessons9. In order to maintain the highest level of biosecurity, we must hope for the best and plan for the worst, so have no choice but to operate under the assumption that the next pandemic will be worse.
SARS-CoV-2 virus:
The SARS-CoV-2 virus (Severe acute respiratory syndrome coronavirus 2) was responsible for the COVID-19 disease (Corona virus disease 2019). Being an airborne respiratory virus, its primary route of transmission was via aerosolised respiratory droplets, commonly spread by sneezing and coughing. Research also proved the SARS-CoV-2 virus could survive on surfaces for days, presenting a potential risk of surface transmission, particularly from high frequency touch points, giving rise to the need for effective environmental disinfectants 4-7. When environmental surfaces have the potential to become reservoirs for pathogens, surface disinfection becomes a highly effective approach for breaking the chain of infection.
Environmental disinfectants:
We were lucky in some respects that the SARS-CoV-2 virus, was an enveloped virus, with an outer lipid bilayer susceptible to disruption from various chemicals, particularly by either lysis or solubilisation, enabling a number of existing disinfectants to work against it. Specifically, any disinfectant certified to EN 14476:2013+A2:2019 enabled claims of efficacy against all enveloped virus, included SARS-CoV-28.
However, if the pandemic had been caused by a more chemically resistant pathogen (of which many exist), the results could have been very different. The environmental disinfectants we use for future pandemics should be high-level, and broad-spectrum to account for the potential variety of pathogens we may encounter, including virucidal, bactericidal, mycobacteriacidal, sporicidal, yeasticidal and fungicidal. For certainty on their capabilities, their claims of antimicrobial performance must be backed up by independent third party testing according to EN standards, as outlined in the UKs biocidal product regulations. Customers need to be equipped with this knowledge to avoid using disinfectants which only kill a portion of the dangerous pathogens in their environment, particularly when there is no visual feedback during use to confirm the performance of a disinfectant.
Ensuring effectiveness of critical support structures during the COVID-19 pandemic:
Our focus on effective IPC solutions needs to be as much on the point of healthcare delivery as the support structures behind it, because all parties need to remain operational in order for the system to work. We could only support UK Healthcare if our own teams and facilities remained operational, which were at significant risk from infection. This required various new internal measures, including enhanced environmental hygiene, hand sanitisers, social distancing, face masks, remote working (wherever possible), split shift patterns, regular testing and isolation contingencies. Remote working was a new dynamic, needing new communication tools, requiring pragmatism and quick decisions.
Increasing needs for robust supply chains:
The Healthcare sector relies on a substantial number of third-party products and services. These products in turn rely on numerous components, which in turn rely on numerous raw materials, all of which require different manufacturing techniques, often performed by different parties.
Supply chains are becoming increasingly complex, interdependent and decentralised across the globe, increasing their susceptibility to disruption from external pressures, such as the cost and availability of transportation. It only requires the smallest link in the chain to break to prevent the delivery of a critical product. The COVID-19 pandemic outlined the importance of maintaining robust supply chains to mitigate risk. GV Health achieved this by creating contingencies in our manufacturing infrastructure, qualifying multiple facilities across different locations to produce the same products, coupled with maintaining high levels of stock domestically to create a substantial buffer.
Based on the product demand we experienced during the COVID-19 pandemic, it became clear that many healthcare organisations had struggled to maintain sufficient stock of critical IPC products and we’re concerned this may have been driven in-part by the need to minimise cost. One approach was to push the responsibility for holding the lion’s share of stock on to the supplier, but suppliers had their own storage limitations, due to either capacity and/or the financially prohibitive cost of long-term storage.
Individual customer sites are also experiencing their own storage challenges, due to limited storage space in their facilities, combined with growing needs to store an ever-widening range of products. This limits the quantity of any single product stored at a local level, meaning sudden increases in product usage force sites to reorder sooner and more frequently. We’ve also noticed organisations procuring multiple IPC products performing similar functions, when a single product would suffice, introducing unnecessary complexity and further exacerbating storage challenges at a local level.
As a result, when the COVID-19 pandemic emerged, stock quickly ran out when usage increased, creating supply gaps and panic buying, increasing the number of order errors, restricting supply and inflating prices. Two key learnings come from this, firstly – healthcare organisations should establish and maintain sufficient stock of critical IPC products, taking joint ownership with suppliers. Secondly – healthcare organisations should aim to prevent overcomplicating their ranges of stocked IPC products, and wherever possible, simplify ranges through consolidation. A recent example of an effective approach for product consolidation was GV Health’s Life Protected Cleaner (LPC), which due to it performance, safety, compatibility and simplicity, offered a system with unparalleled versatility, enabling it to replace dozens of existing cleaning products used by our customers.
Working with the right partners:
During the initial rush to acquire essential IPC products, GV Health leveraged its long-established manufacturing partnerships, scaling-up production volume at short notice to meet our customers’ increasing demand. Although our overheads were also increasing at the time from soaring transportation costs, we accepted lower margins to prevent price barriers for our customers. It also became clear that some customers were attempting to overbuy products, which meant we had to carefully manage their distribution to prevent one customer overstocking at the expense of another becoming understocked.
With ramping international demand, there was also a temptation for UK suppliers to export critical IPC products and services internationally due to greater margin potential. GV Health ringfenced our volumes to our domestic customers to safeguard continuity of supply.
There is an evident risk that customers view IPC solution providers simply as product suppliers, creating the temptation for them to source materials separately to reduce cost. This approach severely undervalues the technical knowledge and support delivered by IPC solution providers and risks undermining effectiveness, ultimately placing customers at higher risk. Chasing short term benefits at the expense of long-term safety is not sustainable.
A key learning from this, is that healthcare organisations need to identify the most capable third-party suppliers of critical IPC products and services and proactively collaborate to inform approach and establish more effective contingencies. This doesn’t simply equate to a customer-supplier relationship, but rather partners working together to leverage the best capabilities our country has to offer.
Environmental hygiene professionals:
Hygiene professionals are responsible for implementing systems on the ground, protecting everybody within the environment they maintain, whilst placing themselves at risk, which was inevitably heightened during the COVID-19 pandemic. They are the guardians of the cleaning standards to which facilities must adhere to the maintain the safest possible environments.
Our hygiene professionals are heroes in our industry and an indispensable resource. However, because their work often occurs in the background with limited visibility, we’re at risk of undervaluing their contributions. It’s critical to recognise the value of our hygiene professionals, because it reaffirms the importance of supporting them with the necessary tools and knowledge. It also underlines the impact of losing them (even temporarily) through illness, injury or moving into different industries. The reduced availability of hygiene professionals compromises our ability to maintain safe environments, which puts everybody at risk (including other hygiene professionals), creating a downward spiral. Safety and effectiveness are therefore highly interdependent factors, to which we must pay equal consideration.
During my recent discussions with Delia Cannings, Chair on the British cleaning council; she described our hygiene professionals as ‘Environmental Ninjas’, which resonated, particularly in light of the COVID-19 pandemic. This is because certain qualities of a Ninja include: high levels of training and skill and the ability to move without being seen. The parallels with our hygiene professional are clear.
Over recent years, the UK cleaning industry has been experiencing staff shortages, contributed to in part by burnout from the COVID-19 pandemic. There is clearly a growing need to attract new talent to the hygiene industry, and recognising the value of hygiene professionals, coupled with training and support is key to this. As IPC solution providers, we can play a role in helping to educate our hygiene professionals about the science underpinning the products and best practice. For example, disinfection has rightly been a focus of IPC, but ensuring surfaces are effectively cleaned prior to disinfection is equally important to deliver the required healthcare outcomes.
The system approach:
Patient outcomes are the ultimate measure of infection prevention and control, which comes from systems not individual components. Taking the example of environmental disinfection, even the most effective disinfectant won’t achieve its desired outcome without the necessary training, methodology and auditing. The process is therefore as important as the product. Our approach to IPC therefore needs to be holistic at its core, combining the most effective people, technologies, support and policy to deliver fully integrated solutions greater than the sum of their parts.
Pre-pandemic stock:
The lack of IPC product stock prior to the COVID-19 pandemic clearly needs addressing. We’re also seeing an escalating likelihood of future supply chain disruption from geopolitical events outside our control, further increasing our reliance on domestic stock. The global economic headwinds we’re seeing in 2025 create further financial pressure on maintaining sufficient stockpiles. The timing is highly salient, given that whilst writing this article, the UK COVID-19 inquiry is currently exploring Module 5, which examines the procurement and distribution of key equipment and supplies.
UK target volumes of pre-pandemic stock have been agreed at a ministerial level for 2025-2026. For example, in a recent letter sent by Professor Chris Witty to the Chair of Public Accounts Committee in January of this year (21/01/25), he states: “The Department must, within the next six months, develop, and implement, a clear and cost-effective plan, including adequate controls, for stockpiling items required to plan for a future pandemic.”10
This is reflected in the Department of Health & Social Care’s commercial procurement pipeline, which earlier this year released a contract for: “Procurement of personal protective equipment (PPE) and hygiene consumables products where there is a shortfall between the current volume held in pandemic preparedness stockpiles and target volumes needed in preparation for a future pandemic.”11
The challenges of maintaining high stock levels include the potential write-off for unused, expired stock and the cost and carbon footprint associated with storing and transporting large volumes of products on an ongoing basis. One approach to mitigate the cost of write-off is dynamic stocking, using a FIFO (first in, first out) model, releasing a portion of stock nearing expiry back in regular distribution whilst topping-up existing stock with fresh products.
Certain aspects of the product itself can also assist with this process; for example, products with longer shelf lives are less likely to expire before they’re used, reducing cost of write-off. Products occupying less space have a reduced cost and carbon footprint associated with storage and transportation and are less costly to dispose if written off. Smaller products are easier and faster to load and unload in transport vehicles and can also be delivered in smaller vehicles. These aspects enable critical IPC products to be distributed faster, improving response times.
Products which are solid rather than liquid remove the risk of leakage, spillage and cross contamination, mitigating wastage and increasing internal efficiency. GV Health’s SoChlor disinfectant range of Hypochlorous acid releasing NaDCC tablets is a good example of a product that helped toward this initiative, because it’s a solid waterless technology that occupies minimal volume with a shelf life of 5 years, which is over double the maximum quoted shelf life of most liquid disinfectants.
Future development strategy
The previous sections outline that we need to react faster and more effectively to emerging biosecurity threats such as pandemics and we need to maintain these capabilities through ongoing investment. Given the strategically critical overlap between UK Healthcare and industry, the need to protect all links in the chain to maintain operational effectiveness further highlights the need for effective and accessible IPC solutions at all logistical stages of a product’s lifecycle. Learnings from the previous sections recommend the following strategies to achieve these goals:
- From the perspective of environmental hygiene, we require high-level, broad-spectrum disinfectants and customers need to know how to select the correct disinfectant for their environment, which requires education.
- Wherever possible, we need to optimise the cost/performance ratio of critical IPC products to ensure we don’t unnecessarily increase cost, due to the barriers this potentially creates for cost sensitive markets.
- We need to maintain robust supply chains with the ability to quickly and effectively scale-up the supply of critical IPC products at short notice, whilst remaining operational amidst external pressures.
- We need to maintain sufficient quantities of ringfenced IPC products, stocked domestically, with effective management and distribution to create a protective buffer, enabling us to quickly react to emerging pandemics.
- We need to avoid complicating the number of IPC products used and simplify them wherever possible through consolidation.
- Customers need to identify the most competent IPC solution providers with the right motivations and collaborate in partnership.
- We need to understand the real value of our hygiene professionals and appreciate that protecting them ultimately enables us to protect the environments they maintain, whilst also making it an attractive industry to incentivise new talent coming in.
- We must maintain the system perspective to improve healthcare outcomes by focusing on the product, knowledge, training, support and monitoring in combination.
New IPC products
When considering the attributes of an IPC product to facilitate the strategies summarised in the previous section, three themes emerge, which are (i) reducing space, (ii) reducing waste and (iii) reducing complexity. It’s neither a coincidence nor a surprise that all three themes relate to reduction.
In the arena of chemical cleaners and disinfectants, solid waterless chemical technologies, such as GV Health’s Life Protected Cleaner (LPC) and SoChlor disinfectant range of Hypochlorous acid releasing NaDCC tablets offer real solutions, underlining their equal utility towards both sustainability and biosecurity. The Healthcare industry’s transition to solid waterless chemical technologies wherever possible should therefore form a strategic goal in our future pandemic preparedness.
The challenge however is that transitioning from liquids to solids has the potential to incur additional process time during the preparation of ready-to-use solutions, increasing labour time, increasing the overall cost of the process, potentially creating barriers to more cost sensitive markets. Insoluble residues are also a risk commonly encountered with solid products. New innovations are required to meet these challenges head on.
GV Health has already embarked on this journey with SoChlor and LPC and is currently developing further technologies in our laboratories planned for release later this year. We couple these new technologies with our deep scientific understanding to educate and support our customers, ensuring the entire IPC system is provided to deliver the healthcare outcomes we seek.
In the arena of infectious waste management and protective equipment, a significant quantity of polythene film is used. We believe there is future scope to improve the mechanical strength of these films, enabling us to reduce their thickness, reducing their storage volume, presenting further opportunity to leverage the space saving approach. However, customers often stipulate film thickness as a requirement, which I believe is currently informed by older polythene technology, which at the time, required a higher film thickness to achieve the required strength. Polythene technology has since evolved, but customer requirements haven’t necessarily changed to reflect this, meaning they’re at risk of mandating the use of films containing more material than required, unnecessarily inflating storage space requirements, carbon footprint and cost. Hence, the need for collaborative engagement between suppliers and customers is greater than ever before.
| REFERENCES
|
|
| 1 | https://questions-statements.parliament.uk/written-statements/detail/2023-06-12/hcws841# |
| 2 | https://www.gov.uk/government/statistics/mrsa-mssa-gram-negative-bacteraemia-and-cdi-quarterly-report/quarterly-epidemiological-commentary-mandatory-gram-negative-bacteraemia-mrsa-mssa-and-c-difficile-infections-data-up-to-april-to-june-2024 |
| 3 | https://lordslibrary.parliament.uk/uk-biosecurity-infectious-disease-threats |
| 4 | N. van Doremalen, T. Bushmaker, D. H. Morris, M. G Holbrook, A. Gamble, B. N. Williamson, A. Tamin, J. L. Harcourt, N. J. Thornburg, S. I. Gerber, J. O. Lloyd-Smith, E. de Wit, V. J. Munster, New Engl J Med., 2020, 382(16), 1564-1567 |
| 5 | F. Marzoli, A. Bortolami, A. Pezzuto, E. Mazzetto, R. Piro, C. Terreginob, F. Bonfante b, S. Bellucoa, Sci. of the Tot. Env., 2021, 778, 146191 |
| 6 | F. Carraturo, C. Del Giudice, M. Morelli, V. Cerullo, G. Libralato, E. Galdiero, M. Guida, Env. Poll., 20220, 265, 115010 |
| 7 | A. Dargahi, F. Jeddi, M. Vosoughi, C. Karami, A. Hadisi, S. A. Mokhtari, H. Ghobadi, M. Alighadri, S. B. Haghighi, H. Sadeghi, Env. Research, 2021, 195, 110765 |
| 8 | https://knowledge.bsigroup.com/products/chemical-disinfectants-and-antiseptics-quantitative-suspension-test-for-the-evaluation-of-virucidal-activity-in-the-medical-area-test-method-and-requirements-phase-2-step-1 |
| 9 | https://data.who.int/dashboards/covid19/deaths |
| 10 | https://committees.parliament.uk/publications/46399/documents/234864/default/ |
| 11 | https://assets.publishing.service.gov.uk/media/6728eea4541e1dfbf71e8b35/dhsc-commercial-procurement-pipeline-november-2024.csv/preview |
