Environmental hygiene learnings of the COVID-19 pandemic from the perspective of an IPC solution provider

Building stronger pandemic preparedness

Four connected priorities emerging from our experience.

Learning from experience

In the UK COVID-19 Inquiry, some of Baroness Hallett’s findings from Module 1, which examines resilience and preparedness, include:

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 Strategy.¹

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 stockholding 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 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 year.²

Causes of pandemics and likelihood of recurrence

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 environments.³

Global warming is also increasing infection risks from waterborne pathogens in different parts of the world. For example, communities in arid climates are increasingly forced to drink water from unsafe sources, while communities located nearer to sea level experience rising sea levels whilst also expanding in lower-lying areas, increasing the risk of flooding.

Widening social inequalities across the globe also prevent poorer communities accessing critical IPC products, placing them at greater risk and 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 and escalating rates of transmission, infection and 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 in order for a pathogen to spread: the host, the pathogen and the environment.

The aforementioned examples affect all three components simultaneously, which in combination significantly escalate risk, with pathogens able to spread faster and further, evolving at accelerated rates and increasing the likelihood of encountering future strains which can be:

• More infectious.
• More dangerous.
• 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 seven million people died globally, government and industry owe it to those we lost to learn the lessons.⁹

SARS-CoV-2 virus

The SARS-CoV-2 virus — severe acute respiratory syndrome coronavirus 2 — was responsible for COVID-19 disease, or coronavirus 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 viruses, including SARS-CoV-2.⁸

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, mycobactericidal, sporicidal, yeasticidal and fungicidal activity.

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 UK’s 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.

Keeping critical support structures operational

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 and 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 onto 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.

A recent example of an effective approach for product consolidation was GV Health’s Life Protected Cleaner (LPC), which, due to its 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 drew on 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 for 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.

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 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.

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.

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 Whitty to the Chair of the Public Accounts Committee on 21 January 2025, he states: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 into 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 the 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 of 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.

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:

New IPC products

When considering the attributes of an IPC product to facilitate the strategies summarised in the previous section, three themes emerge:

It’s neither a coincidence nor a surprise that all three themes relate to reduction.

Solid waterless chemical technologies

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 and 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.

Advancing materials for waste management and protective equipment

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 and storage volume, presenting further opportunity to apply 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.

References

1. UK Parliament:
   
   UK Biological Security Strategy — written statement,
   12 June 2023.
   
2. GOV.UK:
   
   Quarterly epidemiological commentary: mandatory
   Gram-negative bacteraemia, MRSA, MSSA and C. difficile
   infections — data up to April to June 2024.
   
3. House of Lords Library:
   
   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. Terregino, F. Bonfante, S. Belluco,
   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., 2020, 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. BSI:
   
   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. World Health Organization:
   
   COVID-19 dashboard — deaths.
   
10. UK Parliament:
    
    Correspondence to the Public Accounts Committee,
    21 January 2025.
    
11. Department of Health & Social Care:
    
    Commercial procurement pipeline, November 2024.