A “no-touch touchscreen” developed for use in cars could also have widespread applications in a post-COVID-19 world, by reducing the risk of transmission of pathogens on surfaces.

The patented technology, known as “predictive touch,” was developed by engineers at the University of Cambridge as part of a research collaboration with Jaguar Land Rover.

It uses a combination of artificial intelligence and sensor technology to predict a user’s intended target on touchscreens and other interactive displays or control panels, selecting the correct item before the user’s hand reaches the display.

More and more passenger cars have touchscreen technology to control entertainment, navigation or temperature control systems. However, users can often miss the correct item – for example due to acceleration or vibrations from road conditions – and have to reselect, meaning that their attention is taken off the road, increasing the risk of an accident.

In lab-based tests, driving simulators and road-based trials, the predictive touch technology was able to reduce interaction effort and time by up to 50% due to its ability to predict the user’s intended target with high accuracy early in the pointing task.

As lockdown restrictions around the world continue to ease, the researchers say the technology could also be useful in a post-COVID-19 world.

Many everyday consumer transactions are conducted using touchscreens: ticketing at rail stations or cinemas, ATMs, check-in kiosks at airports, self-service checkouts in supermarkets, as well as many industrial and manufacturing applications.

Eliminating the need to actually touch a touchscreen or other interactive display could reduce the risk of spreading pathogens – such as the common cold, influenza or even coronavirus – from surfaces.

In addition, the technology could also be incorporated into smartphones, and could be useful while walking or jogging, allowing users to easily and accurately select items without the need for any physical contact.

It even works in situations such as a moving car on a bumpy road, or if the user has a motor disability which causes a tremor or sudden hand jerks, such as Parkinson’s disease or cerebral palsy.

“Touchscreens and other interactive displays are something most people use multiple times per day, but they can be difficult to use while in motion, whether that’s driving a car or changing the music on your phone while you’re running,” said Professor Simon Godsill from Cambridge’s Department of Engineering, who led the project. “We also know that certain pathogens can be transmitted via surfaces, so this technology could help reduce the risk for that type of transmission.”

The technology uses machine intelligence to determine the item the user intends to select on the screen early in the pointing task, speeding up the interaction.

It uses a gesture tracker, including vision-based or RF-based sensors, which are increasingly common in consumer electronics; contextual information such as user profile, interface design, environmental conditions; and data available from other sensors, such as an eye-gaze tracker, to infer the user’s intent in real time.

“This technology also offers us the chance to make vehicles safer by reducing the cognitive load on drivers and increasing the amount of time they can spend focused on the road ahead.

This is a key part of our Destination Zero journey,” said Lee Skrypchuk, Human Machine Interface Technical Specialist at Jaguar Land Rover.

It could also be used for displays that do not have a physical surface such as 2-D or 3-D projections or holograms.

Additionally, it promotes inclusive design practices and offers additional design flexibilities, since the interface functionality can be seamlessly personalized for given users and the display size or location is no longer constrained by the user ability to reach-touch.

“Our technology has numerous advantages over more basic mid-air interaction techniques or conventional gesture recognition, because it supports intuitive interactions with legacy interface designs and doesn’t require any learning on the part of the user,” said Dr. Bashar Ahmad, who led the development of the technology and the underlying algorithms with Professor Godsill.

“It fundamentally relies on the system to predict what the user intends and can be incorporated into both new and existing touchscreens and other interactive display technologies.”

This software-based solution for contactless interactions has reached high technology readiness levels and can be seamlessly integrated into existing touchscreens and interactive displays, so long as the correct sensory data is available to support the machine learning algorithm.

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Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by SARS-CoV-2 (COVID-19 virus). The COVID-19 virus is transmitted mainly through close physical contact and respiratory droplets, while airborne transmission is possible during aerosol generating medical procedures.1

At time of publication, transmission of the COVID-19 virus had not been conclusively linked to contaminated environmental surfaces in available studies. However, this interim guidance document has been informed by evidence of surface contamination in health-care settings2 and past experiences with surface contamination that was linked to subsequent infection transmission in other coronaviruses.

Therefore, this guidance aims to reduce any role that fomites might play in the transmission of COVID-19 in health-care3 and non-health care settings.4

Environmental surfaces in health-care settings include furniture and other fixed items inside and outside of patient rooms and bathrooms, such as tables, chairs, walls, light switches and computer peripherals, electronic equipment, sinks, toilets as well as the surfaces of non-critical medical equipment, such as blood pressure cuffs, stethoscopes, wheelchairs and incubators.5

In non-healthcare settings, environmental surfaces include sinks and toilets, electronics (touch screens and controls), furniture and other fixed items, such as counter tops, stairway rails, floors and walls.

Environmental surfaces are more likely to be contaminated with the COVID-19 virus in health-care settings where certain medical procedures are performed.6-8

Therefore, these surfaces, especially where patients with COVID-19 are being cared for, must be properly cleaned and disinfected to prevent further transmission. Similarly, this advice applies to alternative settings for isolation of persons with COVID-19 experiencing uncomplicated and mild illness, including households and non-traditional facilities.9

Transmission of the COVID-19 virus has been linked to close contact between individuals within closed settings, such as households, health facilities, assisted living and residential institution environments.10

In addition, community settings outside of health-care settings have been found vulnerable to COVID-19 transmission events including publicly accessible

buildings, faith-based community centres, markets, transportation, and business settings.10,11 Although the precise role of fomite transmission and necessity for disinfection practices outside of health-care environments is currently unknown, infection prevention and control principles designed to mitigate the spread of pathogens in health-care settings, including cleaning and disinfection practices, have been adapted in this guidance document so that they can be applied in non-health care setting environments.

 In all settings, including those where cleaning and disinfection are not possible on a regular basis due to resource limitations, frequent hand washing and avoiding touching the face should be the primary prevention approaches to reduce any potential transmission associated with surface contamination.21

Like other coronaviruses, SARS-CoV-2 is an enveloped virus with a fragile outer lipid envelope that makes it more susceptible to disinfectants compared to non-enveloped viruses such as rotavirus, norovirus and poliovirus.22

Studies have evaluated the persistence of the COVID-19 virus on different surfaces. One study found that the COVID-19 virus remained viable up to 1 day on cloth and wood, up to 2 days on glass, 4 days on stainless steel and plastic, and up to 7 days on the outer layer of a medical mask.23

Another study found that the COVID-19 virus survived 4 hours on copper, 24 hours on cardboard and up to 72 hours on plastic and stainless steel.24 The COVID-19 virus also survives in a wide range of pH values and ambient temperatures but is susceptible to heat and standard disinfection methods.23

These studies, however, were conducted under laboratory conditions in absence of cleaning and disinfection practices and should be interpreted with caution in the real-world environment.

The purpose of this document is to provide guidance on the cleaning and disinfection of environmental surfaces in the context of COVID-19.

This guidance is intended for health-care professionals, public health professionals and health authorities that are developing and implementing policies and standard operating procedures (SOP) on the cleaning and disinfection of environmental surfaces in the context of COVID-19.

Principles of environmental cleaning and disinfection

Cleaning helps to remove pathogens or significantly reduce their load on contaminated surfaces and is an essential first step in any disinfection process. Cleaning with water, soap (or a neutral detergent) and some form of mechanical action (brushing or scrubbing) removes and reduces dirt, debris and other organic matter such as blood, secretions and excretions, but does not kill microorganisms.25

Organic matter can impede direct contact of a disinfectant to a surface and inactivate the germicidal properties or mode of action of several disinfectants. In addition to the methodology used, the disinfectant concentration and contact time are also critical for effective surface disinfection.

Therefore, a chemical disinfectant, such as chlorine or alcohol, should be applied after cleaning to kill any remaining microorganisms.

Disinfectant solutions must be prepared and used according to the manufacturer’s recommendations for volume and contact time. Concentrations with inadequate dilution during preparation (too high or too low) may reduce their effectiveness. High concentrations increase chemical exposure to users and may also damage surfaces.

Enough disinfectant solution should be applied to allow surfaces to remain wet and untouched long enough for the disinfectant to inactivate pathogens, as recommended by the manufacturer.

Health-care settings environment

Environmental cleaning and disinfection in clinical, non- traditional facilities and home-based health-care settings

should follow detailed SOPs with a clear delineation of responsibilities (e.g. housekeeping or clinical staff), regarding the type of surfaces and frequency of cleaning (Table 3).

Particular attention should be paid to environmental cleaning of high-touch surfaces and items, such as light switches, bed rails, door handles, intravenous pumps, tables, water/beverage pitchers, trays, mobile cart rails and sinks, which should be performed frequently.

However, all touchable surfaces should be disinfected. Cleaning practices and cleanliness should be routinely monitored. The number of cleaning staff should be planned to optimize cleaning practices.

Health workers should be made aware of cleaning schedules and cleaning completion times to make informed risk assessments when performing touch contact with surfaces and equipment, to avoid contaminating hands and equipment during patient care.46

Table 3. Health-care setting: Recommended frequency of cleaning of environmental surfaces, according to the patient areas with suspected or confirmed COVID-19 patients.

Patient area	Frequency a	Additional guidance
Screening/triage area	At least twice daily	Focus on high-touch surfaces, then floors (last)
Inpatient rooms / cohort – occupied	At least twice daily, preferably three times daily, in particular for high-touch surfaces	Focus on high-touch surfaces, starting with shared/common surfaces, then move to each patient bed; use new cloth for each bed if possible; then floors (last)
Inpatient rooms – unoccupied (terminal cleaning)	Upon discharge/transfer	Low-touch surfaces, high-touch surfaces, floors (in that order); waste and linens removed, bed thoroughly cleaned and disinfected
Outpatient / ambulatory care rooms	After each patient visit (in particular for high-touch surfaces) and at least once daily terminal clean	High-touch surfaces to be disinfected after each patient visitOnce daily low-touch surfaces, high-touch surfaces, floors (in that order); waste and linens removed, examination bed thoroughly cleaned and disinfected
Hallways / corridors	At least twice daily b	High-touch surfaces including railings and equipment in hallways, then floors (last)
Patient bathrooms/ toilets	Private patient room toilet: at least twice daily Shared toilets: at least three times daily	High-touch surfaces, including door handles, light switches, counters, faucets, then sink bowls, then toilets and finally floor (in that order)Avoid sharing toilets between staff and patients

Selecting a disinfectant product for environmental surfaces in health-care settings should consider the logarithmic (decimal order of magnitude) reduction for the COVID-19 virus, and also for other health care-associated pathogens, including Staphylococcus aureus, Salmonella sp, Pseudomonas aeruginosa, Acinetobacter baumannii, and hepatitis A and B viruses.

In some contexts, environmentally persistent organisms, such as Clostridioides difficile and Candida auris, that are resistant to certain disinfectants, should also be considered when selecting a disinfectant. Thus, appropriate disinfectants need to be carefully selected for health-care facilities.47

After cleaning, the following disinfectants and defined concentrations can be used on environmental surfaces to achieve a >3 log10 reduction of human coronavirus,33 and they are also effective against other clinically relevant pathogens in the health-care setting.22

• Ethanol 70-90%
  • Chlorine-based products (e.g., hypochlorite) at 0.1% (1000 ppm) for general environmental disinfection or 0.5% (5000 ppm) for blood and body fluids large spills (See section: The use of chlorine-based products)
  • Hydrogen peroxide >0.5%

Contact time of a minimum of 1 minute is recommended for these disinfectants21 or as recommended by the manufacturers. Other disinfectants can be considered, provided the manufacturers recommend them for the targeted microorganisms, especially enveloped viruses. Manufacturers’ recommendations for safe use as well as for avoiding mixing types of chemical disinfectants should always be considered when preparing, diluting or applying a disinfectant.

Non-health care settings environment

There is no evidence for equating the risk of fomite transmission of the COVID-19 virus in the hospital setting to any environment outside of hospitals. However, it is still important to reduce potential for COVID-19 virus contamination in non-healthcare settings, such as in the home, office, schools, gyms or restaurants. High-touch surfaces in these non-health care settings should be identified for priority disinfection. These include door and window handles, kitchen and food preparation areas, counter tops, bathroom surfaces, toilets and taps, touchscreen personal devices, personal computer keyboards, and work surfaces. The disinfectant and its concentration should be carefully selected to avoid damaging surfaces and to avoid or minimize toxic effects on household members or users of public spaces.

The environmental cleaning techniques and cleaning principles should be followed as far as possible. Surfaces should always be cleaned with soap and water or a detergent to remove organic matter first, followed by disinfection. In non-health care settings, sodium hypochlorite (bleach) may be used at a recommended concentration of 0.1% (1000

ppm).5 Alternatively, alcohol with 70%-90% concentration may be used for surface disinfection.

Personal safety when preparing and using disinfectants

Cleaners should wear adequate personal protective equipment (PPE) and be trained to use it safely. When working in places where suspected or confirmed COVID-19 patients are present, or where screening, triage and clinical consultations are carried out, cleaners should wear the following PPE: gown, heavy duty gloves, medical mask, eye protection (if risk of splash from organic material or chemicals), and boots or closed work shoes.48

Disinfectant solutions should always be prepared in well- ventilated areas. Avoid combining disinfectants, both during preparation and usage, as such mixtures cause respiratory irritation and can release potentially fatal gases, in particular when combined with hypochlorite solutions.

Personnel preparing or using disinfectants in health care settings require specific PPE, due to the high concentration of disinfectants used in these facilities and the longer exposure time to the disinfectants during the workday.49

Thus, PPE for preparing or using disinfectants in health care settings includes uniforms with long-sleeves, closed work shoes, gowns and/or impermeable aprons, rubber gloves, medical mask, and eye protection (preferably face shield). In non-health care settings, resource limitations permitting, where disinfectants are being prepared and used, the minimum recommended PPE is rubber gloves, impermeable aprons and closed shoes.34 Eye protection and medical masks may also be needed to protect against chemicals in use or if there is a risk of splashing.

References

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