Coronavirus Destruction System: a new device for air filtering
INTRODUCTION
The advent of the pandemic has severely tested the effectiveness of healthcare facilities globally. Still today, the gaps present for years within the health system and the inefficiency of some health policies adopted so far continue to emerge.
However, the current pandemic context has led to a review of the health organization worldwide and to its modernization, bringing to light new solutions and new protocols for the management of health systems.
In particular, in this paper we will focus our attention on the Italian healthcare sector, which was initially one of the most affected by the coronavirus. The Italian model can be considered as a valid example to show how in a situation of absolute emergency it is possible to develop new management models and formulate ingenious ideas that led to a controlled management of the virus within hospital structures.
In this regard, the innovative project proposed by the Adiramef company was taken into consideration, which worked on the management of the ventilation systems inside the hospital structures which represent one of the critical points that favor the contamination of doctors and patients at the inside the structure. Before explaining in detail the new filter system taken into consideration, an overview of the Italian healthcare sector will be shown and a brief description of the Adiramef company, creator of the project, will be provided.
1) The Italian Healthcare sector
Before going into the data and numbers that describe the quality of Italian hospitals, let’s remember that the national health system has not always existed but is rather a relatively recent achievement. It was in fact established in 1978.
At its base, since its birth, the Italian national health system (Ssn) has three fundamental principles: universality (i.e. the extension of health services to the whole population), equality (access to care without any discrimination) and equity (equal access in relation to equal health needs).
One of the most important, though not the only, elements when it comes to health policies is obviously health expenditure.
Based on the most updated data of the Organization for Economic Co-operation and Development (OECD), in 2018 Italy allocated economic resources equal to 8.8 per cent of GDP to healthcare, a percentage that drops to 6.5 per cent if we consider the health expenditure financed only with public funds.
This figure – falling in recent years, from 7 percent in 2010 – is however close to the OECD average of 6.6 percent.
Large European countries such as Germany (9.5 per cent), France (9.3 per cent) and the United Kingdom (7.5 per cent) in 2018 recorded higher percentages of public spending on health compared to the GDP.
Again on the basis of OECD data, we can also analyze the per capita expenditure for the Italian national health system. In 2018, this figure was around 2,545 dollars (approximately 2,326 euros), up from 2,434 dollars (approximately 2,225 euros) in 2010. Large European countries such as Germany (5,056 dollars), France (4,141 dollars) and the United Kingdom ( $ 3,138) two years ago they spent more than Italy.
An important figure in the health sector certainly concerns the number of doctors and nurses.
According to the report “State of Health in the EU: Italia, Profilo della sanità 2019”, in Italy the number of doctors per inhabitant is higher than the European average: 4.0 per 1,000 inhabitants, against 3.6 in the EU (data for 2017).
The number of doctors practicing in public hospitals and as family doctors is decreasing, and more than half of active doctors are over the age of 55: this situation raises serious concerns about the future shortage of staff “, they underline however OECD and EU.
As for nurses, however, our country uses less than the European average: 5.8 per 1,000 inhabitants, compared to 8.5 in the EU.
It is important to highlight that the EU Commission and the OECD take into consideration three aspects to evaluate the performance of a health system:
– Effectiveness;
– Accessibility;
– Resiliency (i.e. the ability of a healthcare system to adapt effectively to changing contexts or to sudden shocks and crises).
1.1 Effectiveness
As for the effectiveness of our National Health Service, according to the EU and OECD data (relating to 2016) Italy records among the lowest preventable and treatable mortality rates in the whole EU.
In 2016, in our country 110 out of 100 thousand inhabitants died from preventable mortality causes (second best figure in the EU, after Cyprus), against a European average of 161 out of 100 thousand, while 67 out of 100 thousand died from mortality causes negotiable (fourth best figure), against a European average of 93.
Another positive result comes from the rates of hospitalizations carried out in our country for chronic diseases (for example diabetes and asthma), among the lowest in the EU, and the cancer survival rate, higher (albeit slightly) than to the rest of the other European countries.
“This result is due to the robustness of the primary care delivery system, in which family doctors perform a gatekeeper function for access to secondary care,” write OECD and EU.
1.2 Accessibility
As regards accessibility to care, according to OECD and EU data, in 2017 about 2 percent of the population residing in Italy (in line with the European average) reported “an unmet health need”. Among the reasons – as we have verified in the past – in addition to cost problems, there are also those related to long waiting times.
In fact, after the economic crisis of the past years, the share of payments in healthcare expenditure directly charged to patients increased by 2.5 percentage points, from 21 percent in 2009 to 23.5 percent in 2017. In the rest of Europe, the average is 16 percent.
Secondly, as we have already mentioned above, the obstacles present in Italy for the training and hiring of new doctors, as well as the potential for expanding the role of nurses, “raise concerns”.
1.3 Resiliency
As we have seen, Italy spends less than others on public health, a dynamic that in recent years has suffered greatly from the effects of the economic crisis.
This, according to OECD and EU, raises legitimate concerns regarding the ability to cope with sudden crises, not only future but also current.
For example, between 2000 and 2017 in Italy the number of hospital beds per capita fell by 30 percent, from 3.9 per 1,000 inhabitants to 3.2, compared to an EU average close to 5 per 1,000 inhabitants (also down from 5.7 in 2000).
According to some observers, the reduction of beds, on the one hand, could increase efficiency by pushing for a better use of resources and greater appropriateness in choosing the treatment path (ordinary regime, day hospital, territorial clinics) and, from the on the other hand, it risks reducing the quantity and quality of services.
In general, however, it is necessary to highlight that according to Eurostat data for 2017, Italy has the second highest life expectancy in the EU, with 83.1 years, behind only 83.4 years in Spain (compared to a community average of 80.9 years).
Still on the subject of life expectancy, its inequalities, connected for example to socio-economic conditions, are lower in Italy than most other EU states, although they are still significant.
1.4 Conclusion
On the basis of the most recent data from OECD and Eurostat, the picture emerging on Italian health system is overall very positive, with some elements of concern.
On the one hand, it is true that Italian healthcare – compared to other developed countries, in particular to European ones – shows good data regarding mortality and hospitalization rates and life expectancy, but the reduction of resources could cause problems, especially as has happened in recent months for the current pandemic.
About ADIRAMEF GROUP
Adiramef Srl is a qualified and consolidated business reality present on the Italian market since 1984 as a sole proprietorship, and then since 2001 as a S.r.l., born from the collaboration of Eng. Ramaglia Michele and the entrepreneur Ambra Maria.
The company deals with technical assistance for electrical and electronic equipment in the healthcare and non-healthcare sectors, as well as the design, construction and maintenance of technological systems.
The company’s activity finds its fulcrum in the technical skills of Eng. Ramaglia Michele, particularly specialized in the management of plants in the health, biotechnological and industrial sector.
Adiramef, leader in the Campania Region in the provision of multivendor services, was founded when the concepts of global management, both of clinical engineering and multi-brand maintenance were unknown.
A forward-looking initiative, born from a solid experience in the maintenance of biomedical equipment, related plants and from the intuition that after-sales services in this sector could completely free themselves from the sale of the same equipment. Service has therefore always been the core business of Adiramef, developed and optimized according to the needs and requirements of customers.
Thanks to this industrial strategy, the company has faced the reorganization of the healthcare market in the last decade, reaching a high degree of competitiveness throughout the Italian territory.
The aforementioned technical skills have allowed the company to obtain privileged relationships with entities and companies operating in the healthcare sector.
Thanks to some patents, made with internal resources, as well as to the experience gained in the field, serving a specialized and highly demanding clientele, the company was able to start the production of some innovative equipment.
Another company activity is that of maintenance and technical assistance of technological and electromedical systems, for which there are outstanding contracts of considerable importance, in large hospital companies such as A.o. dei Colli, Asl NA 2 Nord, Asl Bari, I.S.S. Rome, CIRA, Cardarelli.
Finally, the company in the industrial sector manages the entire product creation process: cutting, bending, welding, finishing surface treatment, assembly.
Adiramef srl is, therefore, a service company specialized in providing healthcare facilities, public and private entities, with support for the efficient management of technology, both in terms of safety of the biomedical equipment installed, and for aspects related to cost containment, maintenance and operation.
The results are in an average annual growth of 30% in the last five years and in a positioning that sees the company among the top ten players at national level.
Adiramef has over 80 employees of whom about 10% graduates in the biomedical disciplines and 5% graduates in the electrotechnical and mechanical disciplines, in addition to a dozen external consultants between engineers and technicians.
In addition to the Carinaro headquarters, the company has branches in Bari and Rome and boasts effective partnerships with the main manufacturers of biomedical technologies and sanitary systems. It has also entered into agreements with the University of Naples Federico II and Pegaso through which it aims to obtain important contributions in terms of ideas and human resources for the further growth of the company.
To date, the company has 170 employees and is widely branched out on Italian territory with as many as 17 centers scattered throughout most of the nation.
CORONAVIRUS DESTRUCTION SYSTEM: a new device for air filtering
After the outbreak of the Coronavirus emergency, air filtering systems are becoming increasingly important to protect public health and consequently to improve the quality of the workplace.
Air filtration, as well as ventilation and air conditioning, can be part of a global risk mitigation approach as a certain reduction in exposure to the disease can be reasonably deduced, especially based on the ability to remove particles that could potentially contain the virus. In order for the filters to have an impact on the transmission of infectious diseases, these must be properly designed and installed and correctly inserted in the structural context of the building.
Engineer Michele Ramaglia, shareholder of Adiramef S.r.l. has recently designed an air treatment device called (CD 19-23) capable of destroying Covid-19 and any other pathogen.
The Adiramef S.r.l. after carrying out careful studies with his designers, to treat air of air conditioning systems already in operation, has designed and built a “trap filtering system”, not mechanical, along the current of the air flow, to destroy all pathogens.
A new system was necessary, cause it was not possible to use additional traditional mechanical filters (ULPA / HEPA) which would have drastically reduced the efficiency of the plants themselves.
What is the problem?
Particulate matter in the air, whether in solid or liquid form, can affect our health.
Particularly those particles below 2.5 micrometers (also known as microns; μm) represent a hazard, as they are able to enter our bloodstream.
Nanoparticles can be as small as 0.1 right down to 0.001 μm.
Sizes of some well-known bacteria and viruses are as follows:
– Influenza A virus: 0.08 – 0.12 μm;
– HIV: 0.08 μm;
– Hepatitis C virus: 0.05 μm ;
-Mycobacterium tuberculosis 1.0 μm;
– The very common staphylococci (e. g. staphylococcus aureus) are spherical
cells of about 1 μm that grow in clusters;
– The coronavirus species COVID-2019, MERS-CoV and SARS-CoV range in
size from 0.06 to 0.2 μm
It is widely believed that HEPA filters are only capable of capturing particles sized 0.3 μm or larger.
The fact is that particles of around 0.3 μm are the hardest to catch.
For larger particles, the HEPA filter acts like a net as we would expect.
Particles greater than 0.3 μm in size simply cannot get through: either they do not fit through the holes or they hit the filter fibers due to inertia.
For smaller particles, on the other hand, it would seem logical that they can simply go through the holes. However, we must consider the phenomenon that the tiny mass of particles less than 0.3 μm means they do not fly straight; instead, they are bounced off other molecules as they collide with them and thus move in completely random patterns.
As a result, they hit the filter fibers and then remain stuck in them (this is the principle of Brownian movement). Despite this phenomenon, tests carried out by the NASA showed that HEPA filters are highly effective in capturing an extremely high percentage of up to 100% of nanoparticulate contaminants, as well as the larger particles greater than 0.3 μm.
For particles of around 0.3 μm there is just a drop in efficiency.
Furthermore, it is necessary to point out that in addition to the use of not very efficient filters, Eng. Ramaglia has identified a series of additional problems such as that relating to the fact that most hospitals have a ventilation system that filters the air only during the intake phase.
The problem that according to Eng. Ramaglia showed up in many hospitals in Lombardy, the region in which the highest number of Covid-19 infections occurred, is essentially attributable to the following important factors:
• Probably and almost certainly due to inadequate air changes in ICU
environments;
• probably due to the lack of negative pressure filter areas that prevent the
escape of contaminated air outside the environments where there are
patients;
• systems probably not with all primary air, but with recirculation;
•Air intake systems from contaminated environments, which supply air into a free atmosphere, and many times in technical areas on the terraces of buildings, adjacent to the shooting of other air treatment systems for other departments, causing cascade contamination, throughout the hospital structure (wards, corridors, lobbies, halls, but also external areas such as
pedestrian walkways inside the structures and underground parking) served by the aeraulic systems themselves;
• Lack or misuse of PPE (Personal Protective Equipment);
• Poor maintenance of the aeraulic systems;
• Promiscuous intensive care units;
• Clean and dirty paths not well separated;
• Promiscuous first aid acceptances.
For these reasons, to destroy Coronavirus and any other type of pathogen, by not modifying the plants already existing in hospital structures, and more generally in all the air treatment plants for rooms, it was necessary to study and design a specific treatment system without mechanical filters ( ULPA / HEPA) on the expulsion of air, so that the latter could introduce clean and uncontaminated air into the atmosphere.
By not using mechanical filters, large pressure drops have been avoided. Therefore, a series of traps system was created for the treatment of air flow without mechanical obstacles, capable of adequately treating the expelled air, thus destroying all the pathogens contained in it.
It is very important to highlight once again that the circumstances in which we live required a quick and economic solution. In fact, the need for this new system arises from the customers’ request to carry out a plant requalification of premises to be used for intensive care for the creation of a COVID department.
The efficiency and above all the effectiveness of this project lies in the fact that the new plant does not work with new technologies for which their performance had to be verified. On the contrary, already existing and verified technologies were used with which it was possible to formulate a combined and valid action.
How does the system CD 19-23 works?
The CD 19-23 system (name attributed in patent application No. 202020000001318) is divided into three sections:
– Trap A, UV-C filter;
– Trap B, Electrostatic Filter;
– Trap C, Thermal Filter (which can go from 40 to 100 degrees centigrade).
The cascade use of these traps – correctly correlated to the flow rate and flow velocity
– acting on DNA, RNA, SPIN and Thermolability, allows the molecular destruction of the Virus and any other pathogen
The destruction process consists in creating a conduit in which the joint action of the three traps in succession is able to treat bacteria and / or viruses homogeneously, investing them with strong doses of UV-C light, strong electrostatic fields and lethal doses of heat.
The system must be designed, built and integrated with the existing system, based on the flow rates, the speeds and the thermal jumps of the air flows inside the channels, both during the introduction into the treated environment and during the recovery phase. and expulsion into the atmosphere. In fact, a very important aspect concerns the speed of the air flow that circulates within the system. In order for the process to function properly, the speed must be 1.2 ~ 1.5 m / s.
The logic of the succession of the chain of traps adapts to each specific need, guaranteeing very low pressure drops (corresponding to a few hundred Pascals).
This property allows the CD 19-23 system to be used on all air treatment systems already installed at any structure, without affecting their correct functioning.
Being a system without mechanical filters, it will no longer be necessary to use the waste disposal chain. The system has unlimited life and will only have to undergo routine maintenance.
To certify the patent application filed by the company (R. Patent N. 202020000001318), it was necessary to interface with different figures from the academic world. The theoretical results have been truly surprising and are scientifically proven having expertly assembled technologies tested and used for over a hundred years in the most disparate sectors.
What is truly innovative is the approach to a sequential trap filtering method, which does not compromise the efficiency and effectiveness of the existing plant.
Therefore with this system, the system does not lose its performance, but guarantees an expulsion and / or introduction of air, without the presence of pathogens and without altering the operation and technical configuration of the existing systems.
Below are the results of the analyzes that have been carried out to verify the effectiveness of the system and which show how this device is capable of performing a germicidal action by eliminating any pathogen present in the air flow.
Below are the results of the analyzes that have been carried out to verify the effectiveness of the system and which show how this device is capable of performing a germicidal action by eliminating any pathogen present in the air flow.
The implementation costs
Nowadays, many hospitals have requested to renew their ventilation systems through the installation of this new device. In particular, the Cotugno hospital in Naples was the first health system in the Campania region to use the CD 19-23.
It is in the public domain that the Cotugno Hospital, thanks to its health procedures for the treatment and containment of infections, did not register any contagion among the medical, health and professionals, during this terrible emergency. And this is an extraordinary achievement to say the least, to which part of the merit must certainly be attributed to the use of this innovative ventilation system.
The calculation of the implementation costs of this new system must consider a series of very important factors which have strongly contributed to the composition of the final cost.
In fact, it is right to highlight that the current context in which we are living requires advanced anti-contagion security measures, which have required the payment of thousands of euros only for the supply of devices suitable for professionals. In detail, thanks to the data provided by Eng. Mario Ramaglia, General Manager of the Adiramef Group, it was possible to quantify these expenses in safety devices which amount to approximately 15.000€ .
Still in the preliminary construction phase of the plant, it was necessary to clean the entire ventilation channel in which it was necessary to operate. This operation was carried out through the use of a robot which had a germinocidal action which allowed the workers to work in complete safety and without the risk of contamination. This expense proved to be very expensive and contributed greatly to the composition of the final cost.
In addition to having to cover all the necessary safety measures, another problem with which the Adiramef company had to face was the weather. In fact, the Cotugno hospital in Naples is indicated as the best in Italy for the organization and quality of the service offered.
The recognition comes from Sky News UK, which has broadcast a long report on the Neapolitan structure in Great Britain. And also the New York Times has given wide echo to the treatments tested at the Pascale Cancer Institute, conducted together with Cotugno.
The Neapolitan hospital deserves general acclaim for the way it has coped with the coronavirus emergency. And it has the great merit of being one of the few hospitals where no contagion between doctors and nurses has been recorded.
For these reasons, the renewal of the ventilation system of this structure had to be completed very quickly. This was possible thanks to a strong investment in extraordinary manpower that had to work day and night to ensure that the hospital could continue its treatment action against COVID 19 at full capacity.
Considering all these extraordinary cost items and adding the technical costs, the amount of the final cost is approximately 400.000 €. A figure that must be shared at 50% for the devices necessary for the construction of the plant and for the other 50% for the extraordinary manpower that was necessary to finish the works in short terms and in full compliance with safety standards.
Acknowledgments
Thanks to Eng. Mario Ramaglia, General Manager of Adiramef, for having dedicated his time to me through long videoconferences and for having provided me with the data and documents necessary for the realization of this study.
I thank the Adiramef company for the research work carried out and for providing us with a device that can be very significant in our battle against this terrible pandemic.
A big applause to the Cotugno Hospital in Naples for saving thousands of lives and for filling us with pride by showing itself as Italian and world excellence
References
1. Perry J.L., Agui J.H., Vijayakumar R. Submicron and Nanoparticulate Matter Removal by HEPARated Media Filters and Packed Beds of Granular Materials. NASA/TM—2016–218224
https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20170005166.pdf
2. European Standard EN 1822-1:2009, “High efficiency air filters (EPA, HEPA and ULPA)”, 2009
3. American Society of Mechanical Engineers, ASME AG-1a–2004, “Addenda to ASME AG-1–2003
Code on Nuclear Air and Gas Treatment”, 2004.
4. “State of Health in the EU: Italia, Profilo della sanità 2019” published last December by the OECD,
the EU Commission and the European Observatory on health systems and policies.
5. “Michele Ramaglia: un nuovo dispositivo di filtraggio per coronavirus” by Roberta Imbimbo.
Article published in the magazine “PANORAMA”, 2020.
