In this month’s interview we had the pleasure of speaking to key opinion leader Michael Rollins. Michael is a leading independent consultant specialising in the validation and implementation of healthcare hygiene technology and environmental Infection prevention and the creator of EnviroGuard. He has worked globally and, in the UK, a key role being with the UCLH Infection Directorate in as Project manager for Dept of Health commissioned research studies into emerging cleaning technologies.
Today, he is an active member of the Hospital Infection Society UK, Patron of the National Association of Healthcare Cleaning professionals (AHCP) UK and member of the Education and Training advisory group (NHS Improvement National Standards, Institute of Apprenticeships – Health Care Cleaning Operative Training) and a strong advocate for emerging technologies in hygiene and infection control.
His latest project is the design of an integrated approach to infection prevention, “EnviroGuard”, which combines three evidence-based technologies, including HOCl.
What’s your background and experience of infection control?
I have enjoyed a diverse work history starting initially as a visual communications designer in advertising agencies quickly moving into the strategic marketing management side of account direction working primarily for clients specialising in healthcare and pharma.
I subsequently joined my largest client as VP Marketing North America, moving from New Zealand to support export market development, based in Boston and Toronto. it was while working in the US I met a chemist from DuPont who was a specialist in carpet and furnishing textiles soiling products, StainMaster being one, and chemists from Dow Corning who developed antimicrobial surface coatings for the food industry and applications in healthcare focussed on biofilm and mould remediation. I became aware of the serious concerns relating to sick building syndrome and took an interest in environmental maintenance and how building hygiene could be maintained without contamination by chemicals.
This struck a chord with me and when I returned to the UK, I brought back the SoilFree and anti-microbial technologies which we went on to successfully evaluate at the University College London Hospital Department of Microbiology.
I was subsequently employed as Projects Manager for Healthcare Environmental Research within the UCLH Infection Directorate, tasked to evaluate cleaning and disinfection practices and evaluate emerging technologies. At the time, we were seeing escalating rates of healthcare acquired infection with MRSA and C. difficile, and we needed answers to the contribution of the healthcare environment in acquisition of infection and what was needed to improve patient safety. Over four years our research team was able to undertake investigation and extensive long-term trials into environmental infection prevention within the healthcare setting.
For example, hypochlorite disinfection is still the disinfectant gold standard, but the damage caused in typical use, over time, and issues of user safety to long term exposure to chlorine remain serious concerns.
In our research we were able to study materials sourced from both the old Middlesex and new UCLH hospitals and compare the ‘cleanability’ of the new and old surface materials disinfected by hypochlorite and the assess the degradation of those materials over time. We discovered that the deleterious effect on the surface characteristics inhibited effective cleaning and disinfection. In particular, the residual accumulation of dry biofilm was problematic, potentially leading to increased risk of cross-contamination between hands and surfaces.
Through multiple research investigations we gleaned several insights but unfortunately research projects are often by their nature myopic and rigid in scope. Notionally we identified potential synergies within the emerging technologies but within our scope of funding did not fully explore the potential for a multi-modal approach.
The accumulation of research evidence and insights has led me on a journey to pursue the optimal integration of products, application techniques and technical training to upskill and deploy the right tools aimed at improving quality performance in environmental hygiene and Infection Prevention. With the additional challenge of concurrently meeting our goals for environmental sustainability and personnel wellbeing.
What is your current role?
While I have moved outside of the NHS front line, I remain engaged with NHS Improvement advisory work groups and as a Patron of the Association of Healthcare Cleaning professionals. I work as a consultant on a project basis supporting commercial R&D, and quality improvement guidance and training within the healthcare sector.
This year has been slightly different with projects outside of Healthcare, providing support to facilities management in essential services in response to SARS CoV-2
I see my role as an architect; planning, developing, and measuring performance in Environmental Infection Prevention, very much in a quality improvement role. My focus remains primarily on end user applications, but I benefit from commercial affiliations both in product development and testing, enabling collaboration between OEM manufacturers and integration of technologies.
What was your first experience of hypochlorous as a disinfectant?
It was during my time at UCLH and working on the research and evaluation of emerging technologies that I was briefed by Professor Stephanie Dancer. A colleague and a prolific environmental researcher and publisher of numerous healthcare hygiene papers. It was Stephanie who alerted me to the stabilisation of hypochlorous which was exciting news. One of the chemistries we evaluated at UCLH was hypochlorous. At the time this was primarily used within our Central Sterile Services Dept for endoscope processing. We decided it would be a good idea to look at the potential for environmental use. We found it had extraordinary performance qualities; it was quite startling with rapid activity and efficacy, particularly with spores which we did not anticipate. The disappointment was that at that time, it was not a stabilised hypochlorous and therefore impractical for use for environmental surfaces disinfection. So, I filed it away in my wish list of products that I wanted to work with in the future.
The ethos that evolved within the UCLH environmental research group was what can we do to work with nature rather than against it? Adopting the definition of the perfect disinfectant which should be rapid acting, short contact time, easy and safe for our staff in long term use and exposure and have no deleterious effects on the environment.
We therefore stopped looking at traditional disinfectants and rather what we achieve with water alone; with emerging technologies such as microfibre textiles, dry steam vapour cleaning, Ultrasonic immersion, etc. This reminded us of electrolysed water so when Aqualution came along with the ability to manufacture stable hypochlorous it was a gift to infection prevention and control and that has led me to work with the technology very closely ever since and look at where I can integrate it into infection prevention protocols.
You have been an exponent on the use of hypochlorous for a number of years. Why do you promote its use and what future do you think hypochlorous has in the infection control industry?
Hypochlorous is one of those hidden gems that has been on my horizon for 15 years. Salvesan, the own-label product by the leading manufacturer of HOCl Aqualution, is at the centre of the programme that I have developed integrated with surface modifying antimicrobial treatment and advanced microfibre smart textiles. Together, they are extremely powerful high-impact tools in performant and sustainable environmental hygiene practices.
Salvesan hypochlorous a broad-spectrum disinfectant with universal application; high efficacy against all the test organisms and ticks all the boxes for the standards of disinfection at a high level of 5 or 6 log reduction to almost sterile levels. And the fact that it is very safe to use on all surface types, including textiles, is non-irritant, with little off-gassing ticks the boxes for safety.
I see hypochlorous as wide open for growth with different applications and uses across all sectors.
I see the role of hypochlorous supporting the protection of contact surfaces combining long term antimicrobial protection with periodic rapid cleaning disinfection. This process maintains a low burden and mitigates the risk of cross contamination to hands.
There is particularly room for improvement in rapid acting, hand sanitisation that is compatible with good skin health. HOCl has those credentials; it is fast acting, and it is not going to damage the skin. Whilst alcohol-based hand rub is the gold standard between hand washing opportunities, the Royal College of Nursing Skin Health research recognises that alcohol sanitisers can cause irritation and impact on skin health, with occupational dermatitis potentially leading to serious health and practice issues within the healthcare sector.
As someone with longstanding experience in this sector, what are the key changes you have seen in the past 18 months with the Covid-19 pandemic?
It’s been both positive and negative. Interpretation of Environmental Hygiene Guidance and process has been varied with a significant increase in chemical disinfection and disposable materials and their respective consequences. Understandably we were not certain as to what we were dealing with at the outset of the Covid-19 pandemic. At the same time evidence-based emerging technologies have had a challenging time coming to the surface quickly through the due process of peer-reviewed published papers, institutional recognition, and adoption. It is a frustration when you recognise a real opportunity for performance and quality improvement.
In comparison, we have seen a huge acceleration in the development of Smart technology tools as a response to Covid-19. Regrettably, we do not see the same advancements in hygiene practice and recognition of product innovation.
I am hoping that this new awareness of the importance of hygiene will accelerate moving forward with the standards and updating guidance to existing, new and better processes and technologies.
A positive has been that in the last 6 months there has been much more openness to collaboration, opening the opportunity to accelerate synergistic development between technologies and methodologies to make significant improvements. Progressive technology-led companies are now sharing information much more freely and working in collaboration to produce verifiable performance and outcome.
Once the vaccine roll-out has finished what do you think will be the ongoing challenges?
I am hopeful that lessons will be learned and an appetite for positive change will come out of this pandemic. There has been an increase in the awareness of the important contribution of good personal hygiene practice and the important role that cleaning staff played in managing infection prevention within the built environment.
The risk is, that once the pandemic is fully under control, the lessons learned will not translate fully into progressive action. The economic impact could lead to further austerity and restricted investment in environmental hygiene and protection.
It is vital to promote and support the education of cleaning staff through Apprenticeship training. We need to match this investment with the introduction of the emerging technologies and methodologies and continue to empower our cleaning staff with advanced training and induction with these innovative tools.
The professional bodies working with Government need to review the experiences gained through the pandemic and critically evaluate the evidence for improvement that these emerging technologies provide and promote a culture of innovation and fast track adoption.
Do you think that attitudes have changed forever?
It’s fascinating that in a recent article in the European Cleaning Journal the top standard for consumers now choosing a restaurant in the US is not the food or service but cleanliness and safety.
I believe hand hygiene awareness and compliance will continue. Mask wearing may have become embedded within sections of our community and will continue for the foreseeable future in public spaces. Combined with multiple hygiene interventions (the swiss cheese effect) masks are effective and will likely remain evident as is the case in Far East countries.
Many companies are also keen to have staff wellbeing at the forefront of their return-to-work planning. The office environment and how it is used will likely have to change permanently. We are already seeing a physical change in layout design and digital monitoring of activity and security within the building. This duty of care requires not only investment and but also engagement with HR and individuals to modify behaviour and comply with good hygiene and infection prevention practices.
A danger, however, particularly in the public buildings has been over-indulgence of cleaning with disinfectants which has often tripled exposure to staff to potentially damaging chemicals without really understanding the impact and whether it is necessary.
Winter will also be another challenging period for us differentiating between seasonal colds or more infectious disease. This will have an impact of the return to work and balancing personnel safety while limiting the economic impact of absenteeism.
You have created an infection control programme called EnviroGuard – please explain what this is and how it works?
EnviroGuard is a concept developed several years ago based on the research investigating healthcare associate infection. The EnviroGuard programme is founded on the collaboration of technology leaders and synergistic integration of their proprietary products; antimicrobial coatings, hypochlorous and Smart microfibre textiles.
Antimicrobial technology is something I looked at 20 years ago with Aegis, developed by chemists at Dow Corning. We conducted numerous surface modification trials at UCLH, which were successful however we also discovered that nano coating needs to be maintained to an extremely high standard of cleanliness or the accumulation of residue inhibited the antimicrobial performance. This was at the time prior to the introduction of microfibre textiles and standard janitorial cloths could not clean effectively at the nano scale.
However, with the development of microfibre textile technology, high performance cleaning combining mechanical action, conformity to irregular surfaces and efficient soil removal, antimicrobial coatings can be maintained to the required standard.
When I looked at new iterations, they all had inhibiting factors to practical implementation, but I became excited about Zoono from New Zealand. They have developed a state-of-the-art water based anti-microbial surface coating that we can practically work with.
My search was then how to combine this with cleaning methodology and process; Salvesan hypochlorous was the ideal product because of its speed, effectiveness, safety, the ability to use in different ways plus the fact that is dissipates to water at the end of its process with no residue, a critical factor in maintaining the antimicrobial performance. EnviroGuard is the synergies of each of these products working together – Zoono antimicrobial surface protection, mechanical cleaning action soil removal and absorption by Decitex microfibre, then the application of 6-log disinfection performance of Salvesan.
Who is using EnviroGuard now and what are your ambitions?
I am working with the collaborating technology partners to develop a Certified Application Standard, incorporating training, technical support and auditing and aligned with the wholistic WELL Building Certification.
Nexus, a Fortel Group Company is the first to become operational. They currently have trained teams to provide national coverage within the infrastructure construction industry and as an added value service within the Nexus commercial office relocation division.
The expanding integration of the EnviroGuard programme is within EnviroSmart. A digital technology-based system which generates data to monitor personnel safety and wellbeing within the built environment. The integrated artificial intelligence digital tools identify, verify, and highlight behavioural exceptions anonymously such as compliant secure access, automated hand hygiene, air quality, identification of pinch points within buildings, overcrowding, movement of people, track and trace, automated monitoring of hygiene scheduling and frequency compliance of cleaning protocols.
As of May we have a pilot EnviroSmart installation in Workplace House in London, and we will be monitoring activity and the data generated to provide the validation and assurance to personnel in their safe return to the workplace.
For more information on the EnviroGuard programme go to https://gonexus.co.uk/enviroguard