Dr. Allen Hanouka, Co-Founder and Joint CEO of GAMA

Co-Founder and Joint CEO of GAMA Healthcare, the infection prevention specialist

We sat with Dr. Allen Hanouka, co-founder and joint CEO of GAMA Healthcare, to discuss their priorities and solutions around patient solutions within healthcare. Before co-founding GAMA with Dr Guy Braverman, Allen was an Ophthalmologist at the Royal Free Hospital, London. Guy and Allen left clinical practice to start GAMA in 2004, which, 17 years later, has become an internationally recognised infection prevention specialist.

Could you tell us about your company’s products or solutions that enhance patient safety?

Including our head office in Hemel Hempstead, UK, we now have offices in six cities across three continents. Since we developed the world’s first universal disinfectant wipe under the Clinell brand, we have become the largest wet wipes supplier to hospitals in the UK and Australia, and export our products to over 70 countries worldwide.

During the early days of our practice, we were conscious of the lack of hygiene practised at key touchpoints within the hospital. This led us to invent our first breakthrough product in 2006, Clinell Universal Wipes, which is still a best seller and is used by over 91% of NHS hospitals in the UK. Our products focus on the different touchpoints throughout a patient’s journey when inside a hospital, from the surfaces that the patient interacts with– whether it is the hospital infrastructure or instruments used by GPs and surgeons. Surface disinfection is now a cornerstone of infection prevention policies.

Patients are the most common source of microorganisms in a hospital setting. Infected and colonised patients (and hospital staff) shed bacteria, viruses, and spores into the hospital environment1. Studies have shown that within 48hrs of admission, 39% of patients have at least one hospital-associated pathogen on their hands2. Our antimicrobial hand wipes for cleaning and disinfecting hands have a patented formula that kills 99.999% of microorganisms without needing soap and water. PATIENTS ARE THE MOST COMMON SOURCE OF MICROORGANISMS IN A HOSPITAL SETTING. INFECTED AND COLONISED PATIENTS (AND HOSPITAL STAFF) SHED BACTERIA, VIRUSES, AND SPORES INTO THE HOSPITAL ENVIRONMENT1 . STUDIES HAVE SHOWN THAT WITHIN 48HRS OF ADMISSION, 39% OF PATIENTS HAVE AT LEAST ONE HOSPITALASSOCIATED PATHOGEN ON THEIR HANDS2 . Our recent focus has been on reducing the spread of infections via air transmission. That’s why we created Rediroom, the world’s first pop-up isolation room, designed to combat the spread of healthcare-associated infections (HCAIs) within healthcare environments.

Rediroom is a temporary, single-patient, isolation room designed to isolate infectious patients under contact of droplet precautions. It’s a cost and time-effective method of isolating infectious patients. We’ve also invested in producing an instant air purification device, Rediair, that makes poorly ventilated areas safer.

Pathogens, particulates and odours linger in poorly ventilated spaces. Breathing, talking, and coughing can spread pathogens such as influenza or coronavirus via the generation of aerosols or droplets, which can remain in the air for over an hour3. That’s why we created Rediair to trap the airborne contaminants right away.

Nearly three years on from the start of the pandemic, how has patient safety changed?

The COVID-19 pandemic has reinforced the importance of IPC. Specifically, the fundamentals such as hand hygiene, environmental decontamination, use of PPE and patient isolation have been reinforced to reduce the risk of transmission of various infectious diseases. There’s a wealth of evidence supporting how IPC fundamentals can reduce the risk of transmission of infections.

Recently, the spotlight has been shone on ventilation and how good ventilation can play a role in reducing the risk of airborne transmission of infections. Poor ventilation has been highlighted as a risk factor for the transmission of various respiratory pathogens (such as SARS-CoV-2 and influenza) as infectious aerosols (which are expelled when people breathe or cough) can build up in poorly ventilated areas4 . Improving ventilation has been a significant challenge for healthcare providers, workplaces, and homes across the globe. Still, it can be achieved through natural means (opening of windows) and mechanical means (use of air filtration units for example).

Could you shed light on any future plans?

We have a large R&D centre called the Fellows Research Centre (FRC), based in Halifax, West Yorkshire, that is permanently engaged in discovering and developing new innovative products and improving existing ones. This enables us to find practical solutions and remain at the forefront of infection prevention innovation. Our upcoming products include Redihood, which protects the staff and aims to reduce the risk of spreading infections via the medical practitioner. We plan to increase our market share across all our brands while accelerating the growth of the categories we operate in.

Anything else you would like to add?

The Middle East & Africa are one of GAMA’s central growth regions. We’ve increased our investments by adding resources to this underserved market, and we’ll be providing training and clinical education for our customers in the area. GAMA will deliver best practices gained from years of experience in Infection Prevention and share clinical studies to gain valuable insights for our customers to learn and improve their practices.

GAMA Healthcare is an infection prevention expert working to reduce the risk of infection to help save and improve lives. For more information about our business and products, please visit WWW.GAMAHEALTHCARE.COM

1. Lai J, Coleman KK, Sheldon Tai SH, et al. Evolution of SARS-CoV-2 Shedding in Exhaled Breath Aerosols. medRxiv. Published online January 1, 2022:2022.07.27.22278121. doi:10.1101/2022.07.27.22278121 2. Loveday HP, Tingle A, Wilson JA. Using a multimodal strategy to improve patient hand hygiene. American Journal of Infection Control. 2021;49(6):740-745. doi:10.1016/j.ajic.2020.12.011 3. Wilson NM, Norton A, Young FP, Collins DW. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia. 2020;75(8):1086-1095. doi:10.1111/ anae.15093 4. Pirkle S, Bozarth S, Robinson N, et al. Evaluating and contextualizing the efficacy of portable HEPA filtration units in small exam rooms. American Journal of Infection Control. 2021;49(12):1506-1510. doi:10.1016/j. ajic.2021.08.003 THE MIDDLE EAST & AFRICA ARE ONE OF GAMA’S CENTRAL GROWTH REGIONS. WE’VE INCREASED OUR INVESTMENTS BY ADDING RESOURCES TO THIS UNDERSERVED MARKET, & WE’LL BE PROVIDING TRAINING AND CLINICAL EDUCATION FOR OUR CUSTOMERS IN THE AREA.

Green Hospitals

Treating the sick and protecting the healthy

Ahospital provides treatment to patients based on their medical condition so they can resume their normal activity following the treatment. It does not aim to turn healthy people into sick ones. Hence, the green hospital concept was established, which is a hospital that promotes public health by continuously reducing its environmental impact and ultimately eliminating its contribution to the burden of disease. Green hospitals aim to save energy, conserve resources and be environmentally friendly. The focus is mainly on keeping people healthy, not just treating them when they are sick.

Mines, various facilities and heavy industries started searching for ways to mitigate the damage resulting from their work in order to protect humans and the environment. Consequently, the “Green Hospital” concept emerged and it THE “GREEN HOSPITAL” CONCEPT EMERGED AND IT AIMS TO REDEFINE HOW HEALTHCARE FACILITIES ARE BUILT TO PROTECT THE ENVIRONMENT WHILE SAVING HUMAN LIVES. aims to redefine how healthcare facilities are built to protect the environment while saving human lives. The “Green Hospital” concept is based on providing healthcare without causing any harm to the environment and the healthcare worker. The importance of the green hospital lies in the fact that caring for the environment is no less than caring for the safety and well-being of patients. Thus, the idea of health safety expanded beyond the hospital in order to protect healthy people in their homes, workplace and parks, before they turned into patients, and then they will have to treat them with drugs and surgeries at an inestimable financial and moral cost.

Motives and Goals

In the health sector, the “Green Hospital” is a concept that is beginning to redefine how

care facilities is largely centered on reducing the carbon burden in hospitals while ensuring that the occupants - staff and patients - are kept safe. More and more hospital administrators are beginning to involve architects in incorporating green concepts into hospital design. In fact, according to a report by SBI Energy, green building renovations will experience a significant increase. Hospitals utilize more resources and produce more waste materials than most other commercial buildings of a similar size. Healthcare facilities consume more than 315 gallons of water per bed every day and an average US hospital consumes 103.600 Btu of natural gas per square foot annually. Several design features have been initiated to achieve a green working environment. One of such features is the use of a low-flow plumbing system in a bid to save three million gallons of water every year for the state of California, which many experts have said may experience a long period of drought.

In a typical healthcare centre, lighting, water heating and space heating account for more

healthcare facilities are built to protect the environment while saving human lives. The greater the amount of energy consumed in a hospital, the greater the release of toxic wastes to the environment, causing damage which may put human lives at risk of other diseases and death.

What is the motive and purpose behind transforming hospitals into green hospitals?

The transformation of hospitals into eco-friendly buildings began by displaying the hazardous healthcare waste as well as harmful effects and then treating them one by one to reach the desired goal. This aims to ensure physical and psychological safety.

Hence began the sanitary disposal of medical waste and the effects resulting from the operation process on the one hand, and modifying practices in workplaces, patient rooms and hospital surroundings, in a way that brings psychological comfort to the patient without harming the healthy.

The shift to constructing sustainable health-

than 65% of the energy consumption. Therefore, it remains fundamental for the construction of healthcare facilities to involve incorporation of green designs and concepts into the process to reduce the impact on the environment, cut down operational costs and increase energy efficiency. Hospital administrations have teamed up with designers, architects and construction companies to achieve the Leadership in Energy and Environmental Design, also called LEED. It is a system developed by the United States Green Building Council to rate a building and certify it as “green” based on design, construction and operations of the building.

Initiatives to achieve safety

Core measures adopted for green buildings include the use of energy-efficient lighting HOSPITAL ADMINISTRATIONS HAVE TEAMED UP WITH DESIGNERS, ARCHITECTS AND CONSTRUCTION COMPANIES TO ACHIEVE THE LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN, ALSO CALLED LEED. systems and medical equipment and use of tech-enhanced renewable energy systems. In addition to using energy more efficiently, hospitals are looking at how to create designs that allow more daylight exposure and natural ventilation into the environment. Improving the air quality is an essential element of designing a green hospital. Hospitals are exploring efficient ways of reducing the air content of toxins and contaminants across all corners of the building. The California Pacific Medical Center (CPMC), for example, has initiated several design features to achieve a green working environment. Some international companies have started implementing an initiative to capture rainwater from the roof and use it to irrigate the landscaping, a measure, which they say, would save 180,000 gallons of drinkable water every year.

In addition, the collected rainwater will also be used to operate cooling towers which the hospital uses for their air conditioning system. For energy efficiency, CPMC has implemented a number of green design initiatives to achieve energy consumption at a level, 14 percent less than that of the average US hospital. Some of these design features include use of high-efficiency windows, super insulated roofs, use of sensors which automatically turn the lights off or on in a room depending on whether it is occupied. In addition to these, the patient rooms have been redesigned to allow more exposure to natural light and ventilation. The Children's Hospital of Pittsburgh, a division of the University of Pittsburgh Medical Center, has also adopted ways to cut energy consumption and minimize environmental pollutants in two of its buildings for which it received the LEED certification. The Children's Hospital achieved this structural shift largely by using green materials and design instead of conventional systems. Some of the adopted green designs include systems for monitoring carbon dioxide levels in the atmosphere, use of wood products and renewable materials in its research building, water-efficient landscaping, minimizing on-site light pollution, elimination of hydrochlorofluorocarbons (HCFCs) and halons, and use of local and regional construction material to reduce transport burden. Hospital operations were also modified in light of the green initiative. Some of the best operational practices adopted by the hospital to make it sustainable include the use of non-toxic cleaning chemicals and microfiber mops, discontinuation of use of mercury-containing solutions and medical devices, and use of paper products made from recycled material. The hospital also established a recycling program for lab chemical wastes of toxic solutions, as well as for paper, plastic waste, light bulbs, batteries, and cardboard.

Benefits and Returns

The World Green Building Council groups the benefits of green buildings into three - environmental, economic, and social benefits.

According to a report by the council, green buildings in Australia which received the “Green STUDIES HAVE SHOWN THAT WORKERS IN GREEN BUILDINGS REPORTED A 101 PERCENT IMPROVEMENT IN COGNITIVE SCORES. IN ADDITION, EMPLOYEES IN GREEN BUILDINGS WITH WELLVENTILATED OFFICES REPORTED SLEEPING AN AVERAGE OF 46 MINUTES MORE EVERY NIGHT.

star certification” by the Green Building Council of Australia led to a 62% reduction in greenhouse gas emissions when compared with the average Australian building. On a global level, green buildings will save as much as 84 gigatonnes of carbon dioxide by 2050. Green building also offers a lot of economic benefits globally, on a country level, and on a building level. Some of the benefits include cost savings on utility bills, lower costs of construction, a higher property value for estate developers, and job creation.

Building owners note, as reported in a report by Dodge Data & Analytics, that green buildings - whether newly constructed or renovated - created a 7 percent increase in asset value compared to traditional buildings. Socially, the green building offers a number of benefits to occupants. Studies have shown that workers in green buildings reported a 101 percent improvement in cognitive scores.

In addition, employees in green buildings with well-ventilated offices reported sleeping an average of 46 minutes more every night. As healthcare evolves and administrators and providers explore strategies to promote better healthcare and lower administrative costs, constructing or renovating hospitals using green building design initiatives remains one of the core strategies, which no doubt has immense benefits not only for the hospital and immediate environment but for the world at large.

In this context, it is necessary to address the hospitals in the Gulf countries, where the existing ones are rapidly transforming into environmentally and human-friendly, and the ones under construction are adopting advanced construction strategies that take into account the health, aesthetics, technical and economic aspects, as they have become pioneering models for the future health and hospitalization concepts.

How to achieve this?

In order to achieve this paradigm shift to building green hospitals, hospitals have developed their business as well as their engineering methods. In Peru, for instance, more than 40 healthcare facilities are receiving training to join SOME OF THE BEST OPERATIONAL PRACTICES ADOPTED BY THE HOSPITAL TO MAKE IT SUSTAINABLE INCLUDE THE USE OF NONTOXIC CLEANING CHEMICALS AND MICROFIBER MOPS, DISCONTINUATION OF USE OF MERCURYCONTAINING SOLUTIONS AND MEDICAL DEVICES, AND USE OF PAPER PRODUCTS MADE FROM RECYCLED MATERIAL. the Global Green and Healthy Hospital Network. In a joint effort with the General Directorate of Disaster Risk Management and National Defense in Health (DIGERD) of the Ministry of Health of Peru, a total of 41 health establishments in that country began the process to join the Global Green and Healthy Hospitals (GGHH) network with the aim of lowering their greenhouse gas emissions and reducing their environmental footprint. During three days, the Health Care Without Harm team in Latin America provided information on the different tools and resources that they can access as members of GGHH and the initiatives that they can join as part of the transformative process they are starting.

It is noteworthy that the education and engagement of people who work in the sector is integral to success. It should be noted that this training program seeks to offer technical assistance to the government of Peru in fulfilling its decarbonization commitments under the COP26 Health Program.

An agreement was also made between the Ministry of Health and Social Protection of Columbia and Health Care Without Harm to promote decarbonization of the Colombian health system. After signing a memorandum of understanding, they will work on a project for estimating the carbon footprint of health facilities. The Ministry of Health and Social Protection of the Republic of Colombia and Health Care Without Harm announced the signing of a mem-

orandum of understanding to carry out a project that will allow estimating the climate footprint of the Colombian national health system at the facility level.

The project focused on three main pillars:

1. The identification of a representative sample of hospitals and health centers of the Colombian health system 2. Training the teams of those establishments to use the Climate Impact Checkup tool developed by Health Care

Without Harm 3. Technical support so that the establishments that make up the sample can determine the size and composition of their climate footprint.

With the analysis of the data obtained from this exercise, an estimate was made of greenhouse gas emissions from the Colombian health sector at the national level. Based on these findings, a series of specific recommendations will be prepared, which will serve as input for the process of preparing the Comprehensive Sectoral Climate Change Management Plan (PIGCCS) for the Colombian health sector. It is worth noting that with this project, Colombia will become the first South American country to carry out a comprehensive exercise to estimate the carbon footprint of its national health system, including both public and private establishments. More than 50 countries from different regions have committed to developing climate-resilient, sustainable and low-carbon health systems. Work is underway to design a schedule of activities and advance the implementation of the project to transform hospitals into environmentally friendly. The results are expected in early 2023.

... Thus, it is becoming evident day after day how great is the process of transforming hospitals into green buildings and how common this has become around the world after everyone noticed its human and material importance on health institutions, individuals and the entire world. BY MAKING THIS PROJECT SUCCESSFUL, WE CAN HELP PAVE THE WAY FOR OTHER NATIONAL AND SUBNATIONAL GOVERNMENTS TO DO THE SAME.

Josh Karliner,

International Director of Program and Strategy of Health Care Without Harm

How remote healthcare technologies can tackle climate crisis

by Ehab Zawaideh - General Manager | Middle East, GE Healthcare

With the 27th session of the Conference of the Parties (COP 27) to the UNFCCC around the corner, the global healthcare community’s voices need to be heard at the climate negotiations. Companies can – and must – play a crucial role to address climate change by fulfilling their purpose and following through on their ESG commitments. This has never been more important than it is right now with the growing threat of climate change, systemic inequality and global health disparities posing a real threat to people, communities, and the planet.

The healthcare sector is responsible for 4.44.6% of worldwide greenhouse gas emissions. If the global healthcare sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet, according to a report by Health Care Without Harm in collaboration with Arup. As such, it is imperative we turn our attention to healthcare technologies that can contribute to enabling earlier, better, and faster diagnosis AS A LEADING MEDICAL TECHNOLOGY AND DIAGNOSTICS INNOVATOR, WE ARE DEVELOPING EFFICIENCY FEATURES AND LEVERAGING DIGITAL TO TURN EVEN THE LARGEST PIECES OF MEDICAL EQUIPMENT INTO DEVICES THAT MAKE A SMALLER MARK ON OUR PLANET. and treatment for more people in need, while reducing or eliminating our impact on the environment. One of the many ways to tackle the ongoing climate crisis is to improve access to healthcare globally, especially to the half of the world’s population that is underserved and cannot access essential health services through digital and remote healthcare solutions.

To support a more sustainable future in the healthcare sector, we must look for ways to help health systems improve efficiency and reduce waste. With staffing shortages and an increasing number of patients intensified by the pandemic, the healthcare industry must find ways to better use existing resources to deliver care to more patients. Digital and remote healthcare technologies is positively contributing to environmental change by removing the ‘care miles’ of patients traveling to and from healthcare facilities as well as reducing the need for single-use personal protective equipment that has a high global warming potential.

As a leading medical technology and diagnostics innovator, we are developing efficiency features and leveraging digital to turn even the largest pieces of medical equipment into devices that make a smaller mark on our planet. We are supporting the Middle East’s healthcare industry with solutions that provide a real-time,

comprehensive view of patients' status across a selected care area, hospital, or the entire health system. By doing so, we are enabling the healthcare industry to reduce its carbon footprint and support countries to achieve their climate goals while also helping clinical teams to deliver responsive, timely, and compliant care.

In remote and rural hospitals of the Middle East, for example, ICU patients are benefiting from 24/7 monitoring with advanced software that gathers patient data from multiple sources and continually watches for signs the patient is in trouble. If any deterioration is detected, an alert is sent to a specialized tele-ICU team, which contacts the hospital’s bedside team and supports them in immediately delivering the right care. This tele-ICU solution has been deployed in Saudi Arabia and is supporting the Kingdom to reach net zero by 2060. The remote consulting solution is also in use in other countries such as Qatar and Turkey.

From a maintenance and repair perspective, our existing remote service technologies kept healthcare equipment running throughout the pandemic and continues to do so today. Across Middle East, Northeast Africa and Turkey (MENEAT), there are more than 250 GE Healthcare field service engineers supporting the growing demands of the region’s healthcare industry, who have resolved approximately one-third of service issues remotely.

In other instances, the power of remote monitoring can be seen in the case of cardiac patients being transported by ambulance to the hospital. An ECG exam can be done while on the road and immediately transmitted to the receiving facility and doctor, for quick evaluation of the patient’s condition, supporting decision-making on the appropriate treatment.

Remote solutions also address the issue of application training limitations, which played a critical role during the pandemic. Our Digital Expert solution, which is a new approach to application training with live and customized face-to-face sessions, was delivered through a AT GE HEALTHCARE, CLIMATE ACTION IS AN INTEGRAL PART OF OUR MISSION TO IMPROVE OUTCOMES FOR PATIENTS, HEALTHCARE PROVIDERS AND RESEARCHERS AROUND THE WORLD, AND IT IS OUR RESPONSIBILITY TO INTENSIFY OUR ACTIONS TO FURTHER REDUCE OUR EMISSIONS. mobile tablet that easily connected to the system.

For years, we have focused its efforts on developing medical equipment with best-in-class image quality and advanced software to increase diagnostic confidence, but we are challenging ourselves to be better. One example is the development of a new magnetic resonance system, which is designed to lower the use of helium in the system, a scarce and non-renewable resource, by up to 67%. The current version of the magnet is 2 tons lighter than its predecessor. We have also enabled medical staff to easily decrease the power consumption of the MR and reduce scan time by up to 50%, saving both resources and improving the patient experience.

With emissions from the healthcare industry exacerbating climate change and its negative health impacts, it is important to find sustainable solutions and adopt more green initiatives to move the needle on climate change. For healthcare systems to successfully become more sustainable, public and private sector collaboration must become the norm. Without this, the full potential of remote healthcare technologies cannot be realized.

At GE Healthcare, climate action is an integral part of our mission to improve outcomes for patients, healthcare providers and researchers around the world, and it is our responsibility to intensify our actions to further reduce our emissions. To support the healthcare sector in the region to meet its sustainability ambitions, we have committed to the Science Based Targets Initiative (SBTi) and setting ambitious Scope 1 and 2 targets for our own operations in addition to developing develop Scope 3 targets that align with limiting global warming to below 1.5 degrees Celsius.

With the ongoing pandemic and other health concerns continuing to impact global healthcare industry, certain actions to protect people and the planet will take longer to realize. However, changing the way healthcare is currently delivered around the world will contribute to a more sustainable future for all.