International Journal of Engineering, Applied and Management Sciences Paradigms (IJEAM)

Volume 54 Issue 11 April 2020 42 ISSN 2320-6608

Ultraviolet Lamps Laced Patient Suits For Rapid Surface Disinfection While Giving A

Positive Feel –In This Covid Pandemic Dr.Venkata Satya Kiran Kumar NANDIVADA

Department of Orthopedics Research wing of Krushi Orthopedic Welfare Society, Visakhapatanam, Andhra Pradesh,INDIA

Dr. NandavinamaniShivanand Raghavendra Department of Orthopedics

Life Care hospital, Abu Dhabi, UAE.

Dr. Nandivada Nikhil Bharadwaja General physician

Research wing of Krushi Orthopedic Welfare Society Visakhapatanam, Andhra Pradesh,India.

Dr. Vaishnavi Nandivada Dental Surgery

Research wing of Krushi Orthopedic Welfare Society Visakhapatanam, Andhra Pradesh,India.

Abstract - "ULTRAVOILET LAMPS LACED PATIENT SUITS FOR RAPID SURFACE DISINFECTION WHILE GIVING A POSITIVE FEEL –IN THIS COVID PANDEMIC “ , WHICH HAS MUTATED MANY TIMES ALREADY TO SURVIVE AND EFFECT HUMANITY FOR A VERY LONG TIME TO COME ,,,AND THIS INNOVATIVE SUIT MAY BE USEFUL IN PATIENTS WITH OTHER INFECTIONS ALSO ). Keywords: Suits, covid-19, pandemic, infection, ultraviolet ,patient.blanket, home therapy, ICU.under developed countries , ventilators, health care workers,doctors,,nurses,patients,nosocomial infections, super spreaders, prevention, awareness

I. INTRODUCTION AIMS OR PURPOSE of this paper: ( A ) (PREVENTION IS BETTER THAN CURE ., COST OF PREVENTIONBY THIS PATIENT SUIT MODALITY IS 0.005 % COMPARED TO TREATMENT WHICH IS AT 100% THAT TOO , WITH AN UNCERTAIN SURVIVAL CHANCES OF THE VERY SICK PATIENT , especially when Ventilators are operated by undertrained staff ). 1)To prevent infection to new individuals .,( room and public space aerosol u v light disinfection ) ( to prevent innocent super spreader state in normal looking individuals ) 2)Disinfect the infection in the asymptomatic carriers , 3)Disinfect the symptomatic patients to prevent spread of this deadlyCovid-19 virus . 4)By dealing at an individual level ,,this pandemic may be controlled because it already claimed several lakhs of lives globally till date and this unseen and unknown virus can be controlled at the PREVENTION LEVEL by air/surface/body surface sterilization . ( B ) REASONS WHY THIS SIMPLER TOOL OF PATIENTS SURFACE DISINFECTION MUST BE PLANNED AS A STUDY OF A GROUP OF COVID POSITIVE VOLUNTEERS - THIS MAY PROVE TO BE A SIMPLER SOLUTION : This uv patient suits can be made from the simplest plastic or available cloth material with porous

material for skin ventilation and the patient or in case of unfortunate demise the patients skin surface can be rapidly disinfected within a few seconds resulting in safer treatment or transfer to the morgue can be

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more respectful as the viral load would be lessor and the staff can give the patient a human touch to the service they provide ,,,,as its documented that this virus persists in the mortal remains even after demise ,,.becoming a source of continuing infection .and that’s why U V LIGHT THERAPY which has been proved since many decades as effective surface disinfectant of all bacteria and viruses .s

As the treatment for this Covid -19 infections is still in the research trials and volunteers stage of medication, plasma treatment, vaccine stage .,my proposal for a patient suits with u v light therapy may prove to be very beneficial if a larger trail on active patients enrolled as volunteers is studied .

RECENTLY IT WAS STATED THAT THIS COVID-19 VIRUS HAS MUTATED MORE THAN 30 TIMES ,,,SO ITS DEFINITIVE TREATMENT IS STILL RESEARCH BASED WHILE U V LIGHT THERAPY HAS ALWAYS BEEN USED IN ROOM. PUBLIC SPACES SURFACE ANDAEROSOL DISINFECTION AND TIME PROVED SINCE SEVERAL DECADES.Í

During this global pandemic ,,world’s best developed countries are showing high positive case numbers and also daily rate of fatalities,,and now due to various reasons have landed themselves in a dire state of ordering lakhs of ventilators,,,,,EACH IN INDIA WOULD COST MORE THAN 8 – 10 LAKHS,,and each would need atleast 12 staff members to operate each of them….so low on staff…a hurried short course on preparing staff from all medical and surgical branches will only create more fatalities as the positive pressure ventilation or oxygen that is pushed into a breathless deseased ,,,giving up lungs need a care of a gentle interventionist not the powerful forces of a crushing over filling oxygen load which has been documenting increase of the incidence of lung bullae and injury prompting our Indian doctors to avoid ventilation and depend more on just oxygen masks . so when I describe this scary scenario ,,,iam sure all would agree on a preventive body disinfection at Also the W.H.O has stated that this corona virus is going to be within our communities now for a very long time .

My innovative proposal of surface disinfection of a patient may hold good BECAUSE IT IS RECENTLY OBSERVED THAT THE SUNLIGHT IS DE ACTIVATING THE VIRUS …and if so then I am right in this proposal as the sunlight is having the ultraviolet light in its electromagnetic spectrum ,..Hence PREVENTION is BETTER THAN CURE ,which at present is not there yet .

II. BACKGROUND

During any serious contagious infection as in this covid-19 pandemic,its urgent for Nations to develop innovative &rapid disinfecting methods which are cost effective and are basically preventive in nature till the effective treatment is developed . So till the cure if found ,,,Its prudent not to neglect the aerosol and surface disinfection methods .,which were proved in many useful therapeutic ways and published by various authors around the world establishing the proven use of ultraviolet rays in various wave lengths for specific diseases and as a tool F A R ultraviolet light rays were proven not to harm the human skin in the wavelength of 202 – 222 nm but at this wavelength the u v light ray penetrated the cell wall of the viruses and bacteria disintegrating them in a matter of few less than 30 seconds. THESE AIR STERILIZERS in the form of commercially available grills with u v lights ..robots with U V LIGHT S in public places, are in use already .Like any other modality U V LIGHT SURFACE THERAPY has its limitations,,,its mentioned that a layer of organic matter makes it difficult for the uv light rays to penetrate,,but usage of a comfortable thin layered blanket was done to cover the neonates who accepted the phototherapy very well and from this concept this innovation has been constructed as people of all walks of life once they are suspected of harboring an infection would be resting and neglecting their needs of hygiene,,,,and end up being a spreader .This applies to all sick people not only covid-19 patients. Moreover usage of a patient suit makes them feel comfortable ,can have special provisions for book reading and being flexible the patient inside partially opens the suite up like in a travelling bag and sits up and watches T V , or just out of window making them feel positive and happy~.,because treatment needs to give a happy feeling too. In patients who are dependant like those in the I C U on a ventilator the demands of care increase and somebody else has to assist him or her and while doing so the risk of spread or cross infection increases,,,,risking the life and careers of a health worker . more importantly as far as covid-19 infection is concerned there is still no complete understanding of the life cycle of this virus …so PREVENTION IS WISE and in our viewpoint ,,,,these UV LIGHT PATIENT SUITS ARE THE BEST WAY of preventing spread . ,BECAUSE THEY COVER AND LIMIT VIRAL LOAD TO THE PATIENT AND NOT LET LOOSE THE VIRUS AS A AEROSOL AROUND which may settle on the surface of the medical attendant This innovative idea of using patient suits with FAR ultraviolet rays is visualized to achieve the following : 1) to sterilize the surface of the patients skin - stems from the usage of ultraviolet rays in innumerable

conditions like physiological jaundice

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2) atopic dermatitis 3) Lichen planus 4) Open infected wounds 5) Certain type of cancers 6) dental infections 7) in some patients for mood elevation Endoscopy usage of u v light to sterilize the gut ,,while using

increased probiotics to compensate and stimulate the normal return of the beneficial gut bacteria , has made this innovative idea of using patient suits as they can be put on by the patient and with a hand held switch turned on specific dosage of u v light therapy be taken or given by attendants at home or under supervision by the health workers in the hospital so that they can treat themselves or with the assistance from their caretakers.,and this can have a specific time exposure as most of the aerosol and surface bacteria and viruses are de activated in less than 30 seconds of time.

8) U V lamp therapy was tried for the elderly for skin stimulation of vit D In elderly homes.( ref-18) 9) UN Blood irradiation was EXTENSIVELY practice before the advent of potent antibitiocs since 60 years

and slowly combined with antibiotics (ref :17 ).

III. SUPPORTIVE STUDIES AVAILABLE TILL DATE Material & methods: Study of available literature on room and public areas Aerosol sterilization( 9),

surface sterilization ( 10).News reports on the latest findings from non journal published sources were also taken into consideration keeping in view of the pandemic ,, NO HUMAN STUDY was conducted.THERE ARE VARIOUS COUNTRIES ON A TOTAL LOCKDOWN WHILE SOME ARE OPTING TO OPEN UP….AND THE RESULT HAS TO WAITED TO SEE WHO IS RIGHT . Meanwhile SURFACE AND AIR STERILIZATION COMBINED with personal suits with u v light therapy is our choice to present increase and spread.

Discussion : These ULTRAVIOLET light ray PATIENT SUITS CAN BE FITTED WITH SELF OPERATED SWITCHES IN THE FOLLOWING GROUPS : 1) Patient with suspicion of developing the covid-19 symptoms. 2) Asymptomatic Covid-19 positive patient. 3) Symptomatic Covid-19 positive patient in self home isolation. 4) Symptomatic hospital inmates. 5) Serious patients admitted in intensive care unit who are on a ventilator accumulate sweat, secretions and

release infective viral load ,become a health hazard to the attending hospital staff (the result would be that the government has to seal the hospital for containment of the pandemic )which poses many problems for patients of various other illnesses,trauma.

6) The dome container that is applied to the head and neck of the patient after intubation in the intensive care unit can be LACED with these u v light sources to give pulsed u v therapy with eyes protected with eye covers ( 11 ) like eye blinds or UV PROTECTIVE SPECTACLES which as available in the market .

7) MULTI organ failure patients . 8) LOW immunity patients due to chronic diseases.' Review about the ultraviolet rays are best understood in two major works done by : (A) (14)The National Institutes of Health (NIH), Burroughs Wellcome Fund (BMF) and Howard Hughes

Medical Institute (HHMI)..The patient must be educated about the ultraviolet light ray therapy because like in any other treatment modality ,this too has certain uses and certain limitations and adverse effects which can be understood in the following way : This publication stated that in certain wavelengths, ULTRA VOILET rays can cause adverse inflammation in individuals while at a different wavelength they can cause beneficial effects, like stimulating the VIT D production, Activation of the immune system .

(B) Light, Including Ultraviolet (15)Light has visible and invisible spectrums. Light we see actually is an electromagnetic radiation having a wavelength, energy and frequency and all of these are related to each other as: the wave length is inversely proportional to both frequency and energy.. and as the wavelength decreases,,the light or the electromagnetic radiation becomes called as 1) radio waves

International Journal of Engineering, Applied and Management Sciences Paradigms (IJEAM)

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2)micro waves,3)terahertz radiation,4) infrared radiation,visible light , u v light, x rays , gamma rays . ULTRAVIOLET radiation can be divided into UVC, U VB, U V A ,,,,The U VB light in the electromagnetic spectrum possesses larger energy than the U V A ...

( C ) Mechanism of action of the ULTRA VIOLET LIGHT RAY :The u v light ray at a specific wave length at specific length of exposure and for specific length of time can penetrate the outer cell wall of the bacteria and the viruses as seen in various aerosol chamber studies (1) where the RNA and the DNA UNDERGO changes which results in its de-activation (The DNA (deoxyribonucleic acid = genetic information carrier) of the bacteria and viruses present are damaged by the UV-C rays as the light penetrates through the cell wall into the microorganism and causes a reaction with the DNA of the cell, breaking up the carbon bonds within the DNA strands.)

IV. RESULTS FROM LITERATURE

˜After exposure to the surface the viral and bacterial cell walls inless than 30 seconds the cell count fell remarkably .Antiviral efficacy of different low doses of 222-nm far-UVC light. The viruses were exposed in aerosolized form in the irradiation chamber to doses of 0, 0.8, 1.3 or 2.0 mJ/cm2 of 222-nm far-UVC light. Infected cells fluoresce green .THE RESULTS SHOWED A MARKED DECREASE IN THE VIRAL LOAD .( 11 ) A recent publication (12 ) showed a microscope picture of virulent Covid-19 virus particles from a recovered & discharged covid-19 patient,( NIAID ). These active and virulent covid-19 particles stay active in recovered Symptomatic individual who has become Asymptomatic ,, HE or SHE STILL SHEDS A VIRUS LOAD IN AEROSOLS ,,,spreading the corona virus to contacts, strangers by direct contact or by touching and leaving the virus on the various household and public utilities unknowingly till the virus becomes inactive in seven to ten days ,,,,but being a new unknown viral disease it is only a postulation that it would cease to be infective ,,..only with time the world would know its real viral character and life cycle. So even at home or in public and religious places it is prudent to have aerosol sterilizers using u v light gadgets ( 1)BECAUSE IN ITALY IT WAS FOUND THAT SEWERS SAMPLING HAD REVEALED A HIGH CORONA VIRUS COUNT,,,,meaning there were a unaccounted asymptomatic carriers of this virus in the community being under study . Use of ‘ Personalized U V patient suits’.is a good modality ,So that theactivities need not be hampered and the user remains happy and positive .This is an innovative idea making it relevant to its self usagein persons able to understand the significance ,proper usage, precautions like avoiding over usage and reporting back any adverse effect felt which usually is rare.,,and the most important thing in this is that these u v light therpay patient suits must never be shared .( as a precaution of cross infections ,,however one may clean it later ).

In seriously ill Ventilator dependant patients there is high likeliness of them developing additional nosocomial infections as shown in a study (16) of 242 patients admitted for more than 48 hoursin the intensive care unit it was fund that the nosocomial rate infection (16) rate was 11.98& in which pneumonia was most frequent (62.07% )followed by urinary tract infection,and central veinous catheter infection sprading to the blood stream . and this in initself leads to prolonged ICU STAY and further risk to the patient and to the health care worker ,..so our patient suit localizes and limits the patients viral and bacterial load to self and does not spread it to others or into the aerosol ˆ( that’s why more room U V LIGHT sterilizers must be arranged to sterilize the circulating air ).

In corona virus patients,,,already if in a state of poor general health with co-morbidities like diabetes ,renal or other diseases like immune suppression…this dependent state will increase risk to life as the nosocomial infections add up to the pneumonia causing tendency of the covid-19 virus .

Recent NEWS UPDATE that heat of 60 degreesFahrenheit has not inactivated the virus count is a bad news in this pandemic as it is now forecasted to be persisting seasonal disease which would pose a threat for an uncertain time ,,,,meaning this virus will have to be prevented more than letting it infect us while research is going on to find a cure when the therapeutic products would one day treat the covid-19 infection. As several countries are now on the verge of an economic plunge and deciding on opening their markets to prevent collapse,,,the cheapest alternative is PREVENTION by air and personal body surface sterilization whenever the self doubt arises with a simple solution Patient suit with u v light …but there will be certain adverse effects which must be looked out for .

International Journal of Engineering, Applied and Management Sciences Paradigms (IJEAM)

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Adverse effects of U V light therapy on skin : ALLERGIES, DERMATITIS, RARELY CANCERS ,Others… so precautions have to be followed ¬

1) Education. 2) Consent. 3) Demonstration. 4) Trial usage of a disposable dummy U V patient suit with dummy switches.. 5) During the initial 72 hours …patient must note down any skin irritation or other adverse effects

whenever they occur. 6) Not to be used continuously and never during sleeping hours as the patient has no control on the

time of exposure. 7) The suit needs regular surface cleaning in the outer coat of the suit . 8) Each patient must have a personal uv light suit,,,not on sharing or re -use basis .

V. CONCLUSION

This INNOVATIVE IDEA of using ‘Patient Suits’ is an extended usage asthe available literature provides surface disinfection for the patients skin and decreases the bacterial and viral shed diminishing risk of spread through cross contamination and risk to the patient and the hospital staff and as it was not in use till date,, this is a innovative model for preventing cross contamination to others attending on the patient and Nosocomial infections from infecting and increasing risk additionally to the already suffering patients. Moreover during this covid-19 pandemic….some countries do not have enough staff to give proper and standard hospital care as the number of inpatients and icu patients are increasing in unexpected volumes as we have seen in some countries where the ICU beds had to be arranged on the roads and the breathless patients had to sit under trees waiting for the admission in the hospital… in such a unimaginable tragedy…this proposal of a ultraviolet light rays patient suit is the best available solution…. (PREVENTION IS BETTER THEN CURE ., COST OF PREVENTION IS 0.005 % COMPARED TO TREATMENT WHICH IS AT 100% THAT TOO , WITH AN UNCERTAIN SURVIVAL CHANCES OF THE VERY SICK PATIENT ). So far,,, aerosol sterilization is seen everywhere in every small or huge country but emphasis on using ultraviolet light rays for the room and public spaces, religious spaces is not being highlighted….houses also need U V grill chambers like we see being used in restaurants . The best follow up to this work would be a comparative study of 100 patients in the different groups between untreated patients and u v light therapy patient suit users over a period of three months to see the effectiveness and applicability, cost effectiveness and mass usage possibility keeping in mind that this innovative patient suit could be made into regular wear camouflaging the medical purpose so that the patient is aware but stays happy and isolated ….and does not infect his family or outsiders alike .,,becoming a responsible citizen for the country by not acting like a SUPER SPREADER.> AUTHORS AFFILIATIONS: This is a study made behalf of KRUSHI Orthopaedic Welfare Society ,a Voluntary organization in Visakhapatnam,Andhra Pradesh ,India. EACH AUTHOR IS affiliated to separate job occupancies as mentioned in the affiliations column . AUTHORS CONTRIBUTIONS: 1)Thecorresponding author : Dr.N.V.S Kiran Kumar,orthopedic surgeon is the founder of voluntary organization KRUSHI O W S.As a Corresponding author he has a Major part of the study, in the form of combining established studies into a simple solution- U V LIGHT PATIENT SUIT and He acknowledges the published articles and encloses them in the references without any conflict of interest .He can be contacted on

mail: drkiranindia@gmail.com. Orcid number id number is 0000-0002-6947-6520 2)Co-AUTHOR: Dr .N.S.RAGHAVENDRA ,Orthopedic surgeon ,co-authored ,read the manuscript and sequenced the study . 3)Co- AUTHOR and Data research coordinator : Dr.N.NikhilBharadwaja ,Medicine Graduate Incharge of the research wing of KRUSHI Orthopedic Welfare Society ,Visakhapatanam ,Andhra Pradesh ,INDIA assisted in the coordinated search and read the final work . 4) Contributor ,RESEARCH and DATA assistant , KRUSHI Orthopedic Welfare Society ,Visakhpatanam ,Andhra Pradesh ,INDIA :Dr.N.Vaishnavi ,Dental surgeon,searched and coordinated the online DATA and paper work while arranging the paper as needed for publication.

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