ABSTRACT
Beyond an exceptional human toll, one of the most evident impacts of the ongoing COVID-19 pandemic is that of disrupted supply chain dynamics. Lessons learned here might help ameliorate the ability of frontline workers to secure personal protective equipment (PPE) such as N95 filtering facepiece respirators (FFRs) to prevent similar issues in future pandemics. A related concern is FFR waste streams, and the ability to recycle N95s using chemical or physical germicidal methods would greatly contribute to lessening PPE scarcity and providing relief to overall supply chains for all essential services. Early in 2020, the U.S. Food and Drug Administration (FDA) issued official guidance for sterilizers, disinfectant devices, and air purifiers with regards to the COVID-19 pandemic as a public health emergency bulletin. This guidance provided nonbinding recommendations for PPE and FFR decontamination processes, involving a wide spectrum of chemical and physical methods of sterilization. Many of the sterilization methods employ high heat or utilize polar chemical disinfectants that can compromise either the physical structure or the electrostatic properties of FFR fibers, thus attenuating the overall protection provided to the frontline worker. Ultraviolet germicidal irradiation (UVGI) has been employed for nearly a century to sterilize instruments and whole environments. UVGI offers numerous advantages as it is transitory by nature, leaving no chemical residue on the treated artifact. UVGI is also rapid, and depending on illumination sources, UVGI can easily scale to provide coverage to large areas. Here we provide an analysis of the regulatory aspect related to the use of UVC devices and describe our engineered design of a cost-efficient sterilization chamber that utilizes UVC for decontamination. Our design stresses a low-cost price point to facilitate easy manufacture for not only rapid deployment but also minimal impacts on supply chains. The device is intended to be easy to use, without any specialized training, and thus targets the general public for sanitizing non-washable materials, including PPE, FFR and other potential fomites, including electronic devices of daily use, that otherwise might harbor bacterial, viral and fungal pathogens. Copyright © 2022 by ASME.
ABSTRACT
A review was undertaken of locally available energy and nutrient-dense foods used in the management of undernourished children in India. Suitability of the 42 food products identified was examined in terms of nutrient profile, palatability, safety, cost-effectiveness, shelf life and feasibility for scale-up of production. Results showed that there is potential to supplement several existing products with additional foods, multivitamins and mineral mixes to enable their use as therapeutic foods in the management of uncomplicated severe acute malnutrition (SAM) in the community. Based on these findings, an existing locally produced product (Balamrutham) was adapted (Balamrutham+) to provide improved energy, protein and nutrient density to enable its use in SAM treatment. To test Balamrutham+, the product was given to uncomplicated moderate and severe malnutrition cases in children under five years old admitted to a government supplementary feeding programme in a district in Telangana state. Follow-up was only possible for two weeks due to the COVID-19 pandemic. After two weeks of supplementation, 22.3% of children with moderate acute malnutrition (MAM) reached discharge criteria and 17.7% of severe acute malnutrition (SAM) children reached MAM criteria. Production of Balamrutham+ has since been scaled up and is being used in treatment across Telangana state according to pre-existing plans as the food was found acceptable by the children in the community. COVID-19-related adaptations include use of mid-upper arm circumference (MUAC)-only protocols for treatment and a separate strategy for follow-up visits in designated containment zones for COVID.