“My thanks to everyone involved. A fantastic example of individuals coming together to overcome a significant challenge.”

University Hospital Southampton senior manager responsible for PPE provision, ITU, Theatres & Sterile Services

Identifying and resolving issues in PPE supply

Challenge / problem identified

During COVID-19, a priority area for health and social care has been to ensure a consistent supply of suitable Personal Protective Equipment (PPE).

At the start of the pandemic, there was an urgent need for additional sources of PPE to ensure trusts had appropriate levels of protection readily available for staff. This resulted in trusts individually searching for additional suitable suppliers, and inevitably many different organisations engaging with the same suppliers.

There was an identified need to assist health and care organisations to ensure a reliable supply of suitable PPE and to explore options for more reusable PPE.

Actions taken

Sourcing additional supplies of PPE

Oxford AHSN engaged with all health partners, care organisations and local trusts in the region to understand the level of need for different PPE items and where the gaps were.

The AHSN worked with science parks, universities and manufacturers to source additional supplies of PPE. This included working with companies who would not normally manufacture PPE, but who in response to the pandemic wanted to provide support. They worked with a couple of manufacturers who could supply face visors and facilitated discussions with NHS organisations to review the products before being used, as well as providing the company with information on the volume required within hospitals.

The practical support offered by the AHSN included:

  • Support to new manufacturers to share their manufacturing protocols and sample visors with the appropriate hospital teams
  • Contacting multiple suppliers to understand availability of PPE supplies, requesting technical specifications (and samples if necessary) to share with procurement teams
  • Arranging PPE samples to be delivered to a hospital and then sharing the outcomes of that review with all hospitals across the region
  • Daily update of database of possible suppliers.

Supporting innovation

  • Oxford and Wessex AHSNs have been supporting innovators producing new PPE products, for example the Oxford box, a reusable aerosol box to reduce risk to staff from aerosol generating procedures – adopted at Oxford University Hospitals. Wessex AHSN has been supporting the manufacturer of PeRSo, a respirator that has been adopted at University Hospital Southampton.

Developing the potential of reusable PPE

To explore the potential of reusable PPE, Wessex and Oxford AHSNs convened a group of relevant NHS leaders and industry experts to share knowledge around alternative sources and scope for reprocessing. Early contributors were University Hospital Southampton (UHS) and Inivos Ltd, a supplier of space-disinfection equipment.

Inivos were offering an untested solution for PPE decontamination using vaporised hydrogen peroxide (VHP), while UHS recognised the risk of immediate shortage with daily deliveries lasting only a day or so, placing acute services at risk.

PPE reprocessing requires physical cleaning, microbial decontamination, and demonstration that protective integrity is maintained across repeated cycles. UHS had already solved cleaning by installing washers and dryers, and had assessed which garment types withstood low-temperature cleaning through physical testing. However microbial status was unknown. The challenge was to apply Inivos’ technology to decontamination and develop methods to test its efficacy.

Wessex AHSN identified the opportunity for a real-world study at UHS with support from Trust managers and the Director of Infection Prevention & Control. The hospital was able to rapidly secure commercial agreement for Inivos to provide materials, equipment and expertise in exchange for on-site support and facility. The AHSN seconded a staff member with recent industry experience of the technology and microbiological testing methods, and in parallel with preparatory discussions they developed the testing methods and protocol, and defined the criteria for identifying and converting a suitable facility.

The Trust released lab microbiologist staff to the project for method development and testing, and Estates staff converted an office identified for use in a single day.

From initial brokering on Monday 20 April the test protocol was approved, commercials completed, facilities converted and Inivos’ equipment was on site by Friday 24 April. On-site testing took place on Saturday 26 April, undertaken Wessex AHSN, Inivos, and UHS Microbiology, with active support from Trust managers and staff from Sterile Services and Estates. Preliminary results were available on Monday 27 April after sample processing on the Sunday, and a further test run was undertaken on Tuesday 28 April.

With some analytical support from Southampton University, the full results and finalised report were published on 13 May and presented to the Wessex and Oxford AHSNs. Recommendations for implementation elsewhere were also developed and presented, and with the report and protocol are available on request from info@oxfordahsn.org.

Eight AHSNs are now working with the NHS Sustainability Unit and sharing knowledge on solutions for reusable PPE, for example gowns and masks.

Impacts / outcomes

The Oxford AHSN helped drive the accelerated uptake of new supplies of PPE, used by frontline NHS services across the region. This in turn helped trusts ensure a more consistent supply of suitable PPE.

Wessex AHSN demonstrated that it is possible to safely and effectively decontaminate the PPE garments using vaporised hydrogen peroxide in controlled conditions. The procedures and decontamination facilities were then held in readiness should PPE supplies fail, enabling clinical services to be maintained without additional risk to staff. Although the process has not yet been required for live use, having it available has given assurance to Trust managers that services would not fail through a lack of PPE.

Lessons learned

Within a fast paced, evolving situation such as a pandemic, early coordination across organisations is key. This enables a clear understanding of the need, critical gaps in provision and understanding of roles so there is no duplication of effort.

Technical lessons from the UHS real-world study were fed into the national programme led by NHS England and the Health and Safety Executive investigating PPE re-use and re-processing. Practical learning was applied by Inivos at their subsequent PPE decontamination study at Addenbrooke’s Hospital, developing a method for FFP3 masks.

Rapid decision-making is possible without compromising business or clinical rigour.

“Thank you for your support in identifying potential suppliers of PPE – this has been really helpful.”

Director of Finance at an Acute Trust

Future plans / next steps

The AHSNs will maintain their PPE knowledge sharing group. The focus is likely to shift to innovation around fully re-usable PPE, as the supply of single-use items becomes more secure. A webinar on the results of reprocessing masks using vaporised hydrogen peroxide by Inivos in collaboration with Addenbrookes is planned on 8 September. The AHSNs are also linked to the national teams which are developing new sources of UK supply for reusable PPE. They will continue to share best practice and opportunities to improve the resilience of the PPE supply chain, reducing environmental impact and support economic growth of UK manufacturers and support services.

“Oxford AHSN has been instrumental in making the connections that got all of this started.”

Manufacturer of face shields