Opinion: concerns surrounding safety in the 3D printing response to COVID-19

In this column from Candace Moore, Moore discusses the additive response to COVID-19, highlighting key causes for concern and ensuring safe practice.

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Candace Moore

Candace Moore

I am a medical doctor, computer programmer, digital designer and 3D printer. 

Because of my many experiences as a doctor in various settings working with people with limited access to care, including refugees and displaced people, I am passionate about using technology to advance access to medicine. globally.

My research has included creating algorithms related to radiomic texture analysis, machine learning and statistical analysis of algorithms. Recently I have been using my skills as a digital designer and 3D printer to make medical imaging-based illustrations as well as educational toys for ill children and those who care for them.     

Find out more about the additive response to COVID-19 on 3DMedNet

COVID-19 presents unique opportunities and challenges for medical 3D professionals interested in advancing our role as true healers. Many medical printing specialists engage with both the broader 3D printing community and our colleagues providing healthcare, so we are in a unique position to understand the 3D printing response to COVID-19. I have been impressed by many of the resulting innovations, but I have also personally witnessed many problems with the application of 3D printing technology over the last months which I hope we can correct.

As a medical doctor with extensive field experience volunteering for humanitarian organizations, I have seen first-hand that almost any intervention, no matter how well intended, can have negative consequences. I'm writing this as a heartfelt plea for the 3D printing community to fully consider how to avoid any potentially terrible consequences of our response to COVID-19.

Many 3D printers responded reflexively to the COVID-19 epidemic without being prompted. While their actions were often heart-warming, in some cases they also proved dangerous. I spoke with many hobby 3D printers who were producing personal protective equipment that they admitted might be contaminated by the virus. Although I encouraged them to simply box up the equipment for 72 hours before turning it over to hospitals, they told me that they didn’t feel it was necessary based on their personal calculation of risks. 

3D printing specialists lacking a medical background may not even realize that many filaments printed on hobby machines are particularly porous and uneven at baseline, and therefore are capable of harboring many types of pathogens. Therefore, the type of risk calculation some hobby printers chose to undertake is essentially non-mathematical at best and driven by ego at worst. We all have ways of coping with stress and producing life-saving materials is certainly a good one. However, without proper care, materials which are meant to save lives can become deadly.

Find out more about the regulated 3D printing of devices, PPE and components amidst COVID-19:

Find out more about the additive response to COVID-19 on 3DMedNet

Those of us with a medial background have a responsibility to take the lead to educate the broader 3D printing community. There are many issues they demonstrate themselves unaware of. For example, locally where I live almost all hobbyists print on various types of filament that deform in an autoclave. I spoke with several 3D printers who had successfully requested that a local hospital run its autoclave over masks they produced, only to discover this truth, which would have been evident at the outset to anyone who can read a material safety data sheet. In exchange for cleaning the now compromised equipment, this hospital has just wasted time to discover what is already well known to professionals in this area, none of whom were previously contacted. 

Even worse, these printers did not then change their design after they saw it was rendered ineffective by the sterilization method hospital staff wanted to use. They simply decided to keep printing what they made as disposable. It may be argued that in an acute emergency no one has time to think about the environmental impact of equipment, and this response might have been the best they could do. 

Unfortunately, as the situation threatens to become chronic, it is now time to turn the same design skills that created temporary masks into creating versions that do not rely upon printed parts. Indeed, some designers have already built this exact type of mask and even been generous enough to make the plans open source. 3D-printed options are becoming a costly and environmentally unfriendly alternative, which, of course, points to an even larger problem.

Beyond technical material concerns there is a larger issue about the misuse of the technology. The truth is that 3D printing is not the answer to every problem. 3D printing shines when manufacturers are in the prototype or small-scale production phase. Once we switch to a more intense model requiring quantities of thousands, options like injection molding, CNC (computer numerical code) machines or even laser cutting are far more efficient.

I pointed out the need for communication with CNC producers and injection molding producers to many hobbyists and they stated that together they could produce a lot on 3D machines by working together. This is true, but it also meant entire batches of potentially contaminated masks and other personal protective equipment would be made, as small runs of dozens were assembled by hobbyists putting their runs together to give to hospitals. It also meant that more hobbyists would be breaking quarantine to access their equipment - it is rumored (and in fact documented on social media) that some enthusiastic members of the 3D community may have even met with each other in close contact, unmasked. 

The risks here may be small if healthcare workers clean their equipment properly. Yet the potential for a disastrous outcome is huge, as when even one healthcare worker is affected the downstream effects multiply. Moreover, there are some risks we simply do not need to take. 

COVID-19 dies on non-biological surfaces with the simple passage of time. Hospitals should choose to either refuse 3D-printed donations that are not in a box with a date on it, or have a protected staff member box up donations and date them

If we as members of the 3D printing community want to see our profession shine, or at the very least are unwilling to let contaminated equipment cast our entire profession in a bad light by spreading disease, we must step in and take responsibility for safety.

None of this will be new information to doctors. Still, I urge healthcare providers to place a priority on protecting yourselves whenever you interact with printers who deliver personal protective equipment or any other equipment. While donations of this nature cannot be guaranteed to be clear of the virus, based on the best evidence we have, risks will be greatly reduced if the items are kept isolated for several days. I also encourage you to ask hobby printers about their practices and teach these individuals how to act responsibly. 

As a strong voice for following public health regulations, I have paid a price. At one point, I helped close a ‘Maker-space’ (a place where hobby 3D printers congregate) so that people would not infect each other there. One printer there even threatened to have my medical license taken away. This person could not understand shutting down a production space which encouraged people to come together was not 'doing nothing', as he angrily put it. 

Even in this world of increasing technology, it is paradoxically often the case that the most basic of public health measures have the most profound impact on the spread of infectious disease over the globe. It's a known phenomenon that as you become skilled at using a particular tool, you suddenly want to use it to solve everything, but we could perhaps stand to be a bit humbler in the technologically advanced community.

Quite frankly, methods developed centuries ago, like handwashing, are not only still relevant but essential and accessible in a way that 3D printing is not at present, so printers can help the situation most by taking more care to follow and promote basic public health measures. While it is less glamorous and technological, every one of us should consider the nearly endless essential work to be done that can save lives from calling an elderly neighbor and offering to help with grocery issues (many cannot so much as navigate ordering online) to raising public consciousness about the importance of hygiene to helping enforce public health regulations.

Nothing guarantees that enforcing public health regulations will make you popular, and indeed, in the broader 3D printing community, it is almost guaranteed to make you unpopular. Nonetheless, we must never forget our calling if we work in any kind of medical capacity, whether as printers, technologists or direct clinicians, we should be healers first and innovators afterwards. As for healthcare providers, enforcing public health regulations is unlikely to make you popular within the broader 3D printing community. It goes without saying that we must never forget our calling. If we work in any kind of medical industry, we should be healers first and innovators afterwards.

The opinions expressed in this feature are those of the author and do not necessarily reflect the views of 3DMedNet or Future Science Group.

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Go to the profile of Candace Makeda Moore

Candace Makeda Moore

Medical Doctor, N/A

I am a medical doctor, computer programmer who loves imaging.

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