Hygiene Best Practices in Medical Device Manufacturing with Charlie Webb from Van Der Stahl Scientific
Welcome to The Wash, your trusted resource for the latest and greatest in public health and hygiene, where we will tackle topics like hand hygiene, best practices in footwear sanitization, creating an employee hygiene program, and more!
In this week's episode, we invite Paul Barnhill, the Chief Technology Officer and head engineer here at Meritech, and Charlie Webb, founder and CEO of Van Der Stahl Scientific, to discuss hygiene best practices for the medical device packaging industry.
You can listen to the podcast using the media player or read the podcast transcript below:
Joe: Hello. And thank you for joining us for another episode of the wash, your trusted resource for the latest in public health and hygiene. This podcast is brought to you by Meritech the leader in automated hygiene technology. I'm your host, Joe Johnson. And I'm joined by Paul Barnhill, the chief technology officer and head engineer here at Meritech and Charlie Webb, the founder and president of Van Der Stahl scientific.
Charlie is a lifetime certified packaging professional, CPPL certified through the Institute of packaging professionals, as well as a Six Sigma Master Black Belt. As a member of a scientific review board, he co-developed microsurgical devices that broke away from the conservative innovation models. Charlie has been in sterile device packaging for 25 years and has been involved in numerous FDA and ISO audits as a regulatory advisor.
He is also a certified internal auditor and as the quality manager for Van Der Stahl Scientifics demanding, ISO and IEC 17025 accreditation. Charlie is a member of the IOPP medical device packaging technical committee, and the ASTM F02 technical committee. And has multiple granted and pending patents on medical device packaging machinery and pouch testing systems. Thanks for joining us Charlie !
Charlie: [00:01:21] my pleasure. Thanks for inviting me.
Joe: [00:01:24] So today we're going to talk a little bit about, medical device manufacturing and to just dive right in. I would love to just hear about some of the challenges and common problems that are being faced by people in those industries right now, particularly, in terms of managing bio burden.
Charlie: [00:01:44] Well, as you can imagine, when you're building medical devices, one of our customers are doing, device manufacturers are doing implants. So, they have to validate their process and bio burden is one of the things that have to be managed. So if you're developing any cleanroom and you have a certain level of cleanliness, then that sort of has to be codified and validated.
So, I think one of the challenges is just trying to keep everything clean, even though, you know, now we're talking, it used to be just the cleanroom. Now we're talking about the facility wide. So, you know, what are we dragging into our building in general that may somehow be impactful to the packaging and the manufacturing of medical devices?
So I think one of the things that we're always looking at, you know, now healthcare associated infections are becoming a big issue, well they've actually been an issue for years and years. And we're just now sort of, kind of getting our head around where these vectors may be in our hospital, but medical device sterilization obviously has to look upstream of everything that's going to happen when you sterilize the device.
So for instance, if you have a medical device and you're packaging it, how much they're gonna radiate that device is based on, you know, the form factor of the device and what class medical cleanrooms at a class medical cleanroom like ISO7. You know, so it has to be managed where you're looking at all factors that could affect the cleanliness of that device posts or pre sterilization in order to get the results post sterilization so obviously you don't make patients sick.
Joe: [00:03:29] I know you mentioned, HAI's or healthcare acquired infections, and I was just wondering if you could shed a little bit more light into that and the problems that they cause.
Charlie: [00:03:41] Yeah. You know, they're, something like a 1.7. Million people get sick and hospitals that was not connected to the reason they walk in that door in the first place.
the vector sometimes maybe is a little bit unknown. A lot of these are surgery site infections, but it seems that healthcare associated infections are principally from the handling of the human through that process of your life. So not washing hands, any sort of a touch point where a clinician is connecting with the patient is always a concern.
So there's been so many devices and methodologies and good practices that have bloomed out of this problem. We have sort of, we have systems that actually monitor when a clinician walks into a room for instance, and they're sort of beat to told to wash their hands or sanitize their hands.
So there's a lot of sort of forced compliance systems that have come through the, at least patent chain. I haven't seen a lot of these that are actually out working, but mostly what they've discovered through healthcare associated infection is that, it's the human connection to the patient is causing the problem.
And so obviously any way that they can deal with sort of firewalling, any infections or any pathogens rather that's on the healthcare workers hands or body to the patient has improvement. And through training both through OSHA and hospital good practices through a variety of associations, like the AORN, the American Academy of Operating Room Nurses and other good organizations like that.
They've codified some practices that help to manage that problem of bringing. Disease on to patients. I mean, something like, it's really kind of amazing when you look at the numbers, you're looking at a hundred thousand people each year die from healthcare associated infections. I mean, if you overlay that stat to the the COVID-19 event.
It makes you wonder why more people aren't talking about it. So it's huge. They are seeing some progress being made, but it's still a long road ahead in order to identify where these leaks are happening in the hospital and how the best ways to manage that process.
Joe: [00:06:09] So how are people attempting to manage these issues now?
Charlie: [00:06:13] Well, again, I think, you know, training is a big part of that. Unfortunately, a lot of people who were coming into the hospital or coming in as sort of nascent hospital workers. They're coming out of a career program that got them into the hospital.
So they may be very new to washing their hands and to how to manage a contamination because you're coming in again, outside of medicine. And so the first thing that they have to do really the director of nursing. And so they really have to drive in to the, the minds of these new hires that you're in a completely different work environment.
You know, it's sort of like the food industry. Unfortunately, there's a corollary between the people that have perhaps the highest level of sort of fusible link, the highest likely hood to cause a dirty event are often the times the least trained people. It's a sort of the same thing that's happened in corporations on telephones, in management.
And I come from a management consulting background as well. And we so discovered through trace backs that the people are the first contact to your company are the least trained, least in service, least prepared. And that's that first fusible link into your company. Similarly, in hospitals, you have the people who have got the least amount of training sometimes.
I mean, if you look at the SPD department, the sterile processing departments or the VA calls in the SPS departments. These are amazing people that do incredible stuff. They're cleaning instruments and they're sterilizing instruments, and they have good training in house, but a lot of them don't require high levels of certification.
And I find that surprising. I mean, you're taking in surgical devices that are going to be at the most critical point. And again, a lot of these infections are surgery site infections. So you're taking these devices, you're putting it into what the, the SPD departments are famously downstairs in the hospital. They're completely disconnected with the clinical side of the hospital. And so that, that siloing between these departments. And the sort of downplay of the importance of the sterile processing departments at hospitals causes a huge disconnect.
I'm working with a group called the Kilmer innovations and packaging. And as a group of professionals, it's a think tank. And we're looking at better ways to manage and break down these silos. Because again, you have people who really can get on the job training at a very entry level. And these people can affect the outcome to open heart surgery, for instance. So you can see that, you know, training is a, is a huge piece to it. And also how these departments are developed. Pay grade also plays into it. SPDs tend to not get paid that much. They don't attract higher levels of people. So these are the kinds of breakdowns that hospitals are working to manage right now in order to get more commensurate of skill levels of these departments that are critical to patient outcomes.
Joe: [00:09:33] Paul do you feel like automation would be a great answer to a lot of these issues that they face with HAI's in hospitals?
Paul: [00:09:46] Automation is absolutely one of those ways that you can really assist in the challenges of that HAI reduction rates. You know, HAI's for many, many years is, is Charlie had mentioned you at least kind of been on the rise and we're still trying to pinpoint exactly what is causing them.
But one of the things that I've noticed recently, a lot more communication is happening. And honestly what we get through from the current situation that we're in, in the world is learning a little bit. When you shut down the amount of visitors coming into the facility, if we're able to control an HAI's, maybe a little bit better, that's another area that a lot of hospitals and facilities are looking at of exactly how do we control that environment as well? You know, they're doing a really good job about doing the education and the training and, and putting in instant sanitizers and hand-washing both manual and automated throughout some facilities to assist with the staff. But additional means. Need to be put in place to help and, and really guide those visitors when coming in as well. You know, there's many opportunities that a visitor may be coming in, coming to visit a sick or ill person and with that in HAI my spread from there, or they may spread that and it comes back and goes to another area in the hospital.
You know, those are, those are concerns that have to look at, but yes, automation can definitely help.
In that challenge of increasing the number of hand hygiene events that are actually happening. It's also a good way to break, that what I call sanitizer barrier, you know, every, you know, five to 10 applications of an instant sanitizer, you start to get that biofilm buildup of that Amalia layer on the skin.
It starts to feel uncomfortable. You may get, again, your resident Florida might start thriving underneath that that was not, previously killed. So it's best to wash your hands and break that cycle. Every five to 10 instant sanitizing events, just to make sure that your hand is staying clean and healthy longterm.
Charlie: [00:11:53] Yeah, Paul, you make a good point. I, you know, at any given time there could be 20 to 30% of that building is containing people from outside. So it's not just the clinicians that need to be trained. And obviously you can't expect visitors to go through a onboarding in-servicing session every time they walk into a hospital.
So that that's, that is a challenge and you're right. And you have people coming out on the street. These are have, these are people that maybe never even been into a hospital and from all sorts of different levels of sort of hand washing cultures of whether or not that's important to them. So, you're right.
I think that's an important, a potential vector and a. I think, you know, systems like yours that you and I talked about, previously, having hand washing systems in lobbies, would certainly be a great way to go beyond just the simple hand sanitizer.
Paul: [00:12:49] I agree. And, and, you know, as, as you and I both know, just putting on instant sanitizer, doesn't always guarantee that you're going to get those results as published.
You know, it depends on how long they're staying on wedded. How much product did you use so forth? How many touch points are from a to B. I'm a large proponent, especially within medical settings, of creating hygiene zones. And these hygiene zones are incredibly important. So before you're entering those critical areas, like the NICU SICU, PICU, you can actually create a hygiene zone.
And prior to the entrance into these zones, you make sure that everyone entering that zone, typically, these are our visitors are going through a hygiene event. That's a critical step. Now we're asking people, yep. You need to wear a mask. You can do all that hygienic zoning, similar to what we do in food manufacturing, in that.
And you go through this daunting period, which also includes a hygiene event. That would be a way to really start controlling the environment and setting a culture.
And, you know,
Charlie: [00:13:49] we talked about, you and I had a conversation about forced compliance. I think that's another part of this because you know, the hand washing, even on the hand sanitizer, these are volunteers.
I was at the grocery store yesterday and I watched a half a dozen people as we go through our new routines in this new reality, call it what you will. And, I saw probably half of them that opted out of sanitizing their hands. So opt-outs are our problem when you're looking for, in a system where conformance is everything.
And so I think, you know, systems like in the medical device, packaging, cleanroom, for instance, where you're not leaving it up to the sort of discretion of the individual, to make that hand event, hand cleaning event happened. You talk about turnstiles for instance. And I thought about that in our discussion that you and I have before, and I thought, wow, you know, going into a store like that, if they really want to be, have a compliance system, well, there should be some sort of a gating or what we call in our industry of forced compliance event.
Like we have in some of our packaging system where requires testing every say hour or every thousand packages, we don't leave it to the worker. Well, because a facility, people always have the same that, terrible things happen at 2:00 AM in your clean room. Because we can't always be there. Right? So in systems where if you want to gain access, you have to go through a process in order to do it.
I know there was some discussion at one time. I remember seeing it years ago to where there was a motion sensing process where the, you were hand movement from the soap to the water, to the towel was somehow monitored. And only when that event went through, then there was a compliance to this system. And again, I've seen so many of these systems out in the, the IP world and a lot of them never seem to reach fruition, but it was a terrific idea.
And I believe those are the sort of things that maybe is the future of entering a hospital. Maybe it's something where we have to gate people into the hospital. After we know they've gone through. Because you know, people oftentimes will go to the lowest common denominator. And if it's easier to keep moving, they will keep moving.
Or they may have just an issue where for whatever reason, whatever personal reason, they don't want to go through that compliant event of sanitizing their hands or washing their hands. We're in the land of the free and off they go. But sometimes we have to look at those freedoms and say, You're free to do what you will, but unfortunately, in systems where we have to manage people's safety, just like speed limits, we have to have some sort of a gating for conformance, I would think.
Paul: [00:16:39] Absolutely. And I think one of the biggest things is obviously, you know, what we're talking about, you know, is really, again it's about that human behavior piece. And how do you overcome and solve that human behavior piece, you know, within the industrial spaces, commercial spaces that we can do. We can put up these gating systems, you know to where you can't proceed until you've met a certain event or criteria, automating that hand hygiene event like Meritech has done is one way to do that.
When you look at areas like the public venue, like you described in the produce area and getting people to wash and so forth, you know, that really, really difficult to try to gate that. But how you work with that. And it's a, it's really the long game, is you work on, on, correct signage, correct marketing creep, correct messaging, correct placement.
And, and people start to conform in time. You know, I remember early on as an early engineer and going through it and actual architectural class, I had an instructor tell me, he goes, when you build a building and you design a parking lot, don't ever design the sidewalk from the parking lot to the building.
And I said why? And he goes, because do it a month later, the people will tell you where the sidewalks need to be. You just follow their footprints. The same thing happens in regards to hand hygiene, as long as you start to get and build this culture, and you give these subtle, subtle reminders and say, Hey, please wash your hands before handling the fruits and vegetables. we've given you this super cool piece of equipment over here to do this or a sink to do this. That's one way of starting to create that culture. And it really boils down to that. So when you want to address behavior, obviously we use automation to do that, but you also want to address that culture piece and that then you're able to kind of create a full circle that works for everybody.
Charlie: [00:18:26] And there's some, you know, social signaling with those. And you know, when I was in Japan, this goes back 26 years ago, I spent a lot of time in Japan and I was at, McDonald's getting a cup of coffee and I walked through the door and to my left, there was a full sink, soap and towels. Not a hand sanitizer, but a complete wash station.
And I thought, you know, not only does this give you the opportunity to do the hygiene thing that you were supposed to be doing before and after you order But maybe more overt its value could, could, might be said that it was sort of this model. If it said, Hey, hand washing is important. It's so important that we brought it into the front of the house. It's right there in queue. And I think that sort of social signal to everyone that enters the building. Wash your hands.
Paul: [00:19:13] I think it's going to be now a new social responsibility based on what we've been seeing, going on around the world. I think every aspect of every business is looking at that in a different light.
In what you said, there are some countries that are far more advanced than what we've done here domestically in the United States. But I think the world is paying attention now that there are ways that we should, as, as groups of people, as business owners be able to make for healthier, safer place for everyone by providing very simple means like hand hygiene in these public venue areas like airports, grocery stores, front of house at a restaurant, so forth.
Charlie: [00:19:52] I agree.
Joe: [00:19:55] So to bring us back a little bit. We were talking about how automation fits into hospital settings, in terms of managing HAI's. Paul, could you talk a little bit about how automation could benefit the medical device packaging world and those businesses?
Paul: [00:20:22] Well, I, I think as, as Charlie has mentioned before, I mean, everything is about creating processes and procedures and so forth. And that's about compliance.
One of the challenges when it comes to medical device, packaging and so forth when it comes to the human piece and about hygiene. You're, you're looking at at how do I, how do I document that? And one of the key words within that medical device packaging world is how do we validate. How are we going to validate this process? How are we going to validate this is happening.
One of the difficulties with manual hand hygiene is it's incredibly difficult to validate unless you police the behavior. Okay. You can do it every once in a while and so forth. You can say that you're getting compliance when I'm monitoring that. And when I'm policing it, you can do some statistical measures of maybe somebody's resonant flora and so forth to see exactly. Am I getting a reduction load of pathogens and so forth? When you, when you take that manual method away and you automate that method, now you start to get some data. Okay. And the data pieces are very simple.
One, you know, how many hygiene events are actually being performed. The system in our automated system, like Meritech produces. We actually count every hygiene event. As Charlie had mentioned earlier, we can gate systems and doors and, and turnstiles and so forth. So then you get 100% positive control that that event actually took place.
One of the other validations with it, you can actually validate the system is actually performing the hygiene event based to the efficacy data that's been collected and performed over the years for the technology as well. So you can validate that is doing its job as well as then you can do personal validation.
And, you know, we can give and have designed procedures so that plants and operations can actually validate their hand hygiene processes, meeting their statistics, meeting their goals and, and, and achieving basically a quality controled hand hygiene event for their plant and operation something that they can stand behind that when they go through either a third party inspection or something, they have some data that is solid that they can stand behind to present that inspector on that.
The reason to automate that is to, to, to remove that human variable, to make it a simpler, easier process for everyone.
Charlie: [00:22:36] You said it right, Paul, they, to be able to. Prove that these events happen. I mean, anything that happens in the cleanroom going into the cleanroom has to go through a validation process as you said. It goes to the IQ OQ PQ process. Number one is the IQ is the installation qualification. So when you're presenting anything into a medical device manufacturer, and you're, first of all, have to have equipment that is validatable or verifiable, and you have to write a protocol for that. So if I'm writing out my validation, for my packaging plan for my medical device.
I have to understand what class cleanroom I'm packaging that device in. So I understand how many particulates are in the room and what, how they may be impactful based on whatever sterilant that I'm going to be using post packaging to be assured that that sterile barrier system and that device, excuse me, it makes it to the point of care, safe and sterile. That's the name of the game for us.
So when you're able to have systems, I mean, really. I've been in, I'm an internal certified internal auditor for ISO 17025 laboratories. And when I'm performing my internal audit, everything has to come with that evidence piece. So we can talk about SOP's is all day long or in the hospitals I have used instructions for use, but those become somewhat evanescent when we realize that these are great systems given that they are bought in by the person who was expected to buy into them. And a lot of times that doesn't happen unless we can show that there's some system, as you mentioned, Paul, to count or gate what has been going on.
And to validate. If we're saying that our workers are coming into the cleanroom, we have a high level cleanroom we're putting, we're putting together a medicated arterial stent, or whatever that critical implantable device might be.
We need to understand what is coming in that cleanroom. How's the environment potentially change by the human connection. And to be able to say, well, we have a hand-wash system, it's using this solution and the solutions being verified, and the solution has been shown to have X kill rate. And we can even do, I think you told me before, like invitro talks, studies where you can even determine how much, by putting on the hands.
I think I saw a video on your website where. You did the study to show what the kill rate was on the human hand. So when we can understand all of those parts and know for sure that that system can meet an installation qualification and a purchase specification as outlined by the ISO 11607, now the 2019 revision. We can prove that we have a system in place and it's it's available and that's what it's all about in medical device packaging, for sure.
Joe: [00:25:28] So both of y'all mentioned the importance of validating this process. Can y'all talk about the regulation that puts the force behind the reason for validating it .
Charlie: [00:25:41] Well, every medical device manufacturer is going to be an ISO 1345 certified facility. And the FDA also courses you have to be an approved FDA facility as well. There's some reciprocity between ISO and the FDA to where it's all sort of codified into the sort of this master 1345 plan and basically the document or the regulation states that you have controls. Like I stated before that you have to be able to prove everything.
I mean, in our industry, like in aviation, redundancy is an important piece. For instance, in my laboratory I validated all of our calibrations, whereas after we do a calibration on a piece of equipment, and this is critical equipment, so we have to have high levels of calibration. We do a redundant calibration on a different meter, and even on a different probe. So the likelihood of that information being inaccurate is very, very low. And we can add some statistical math to determine want the failure rate is, and it's in the tiny points of the percentage.
So anything in medical device, manufacturing and medical device packaging has to meet up against that litmus test of provability. And sustainability. It has to be a system that is going to continue to go. Sometimes the FDA calls this the life cycle approach, where we know that the systems that we put together, we're going to continue to perform, they're robust programs and their performance is pretty much a short because it's sturdy science, it's vettable science.
These are everything that touches that cleanroom is calibrated, verified, qualified. And even from the very beginning, when we buy something for a medical device cleanroom, we are, have to go through a purchase specification process that makes sure that all of the purchase specifications that are required under whatever ISO process that we're doing, it meets spec.
Then we have to make sure that the vendor that we're buying this equipment from, they meet spec. They have to have a quality system. When we have an outside company calibrate our calibrators, they too have to be an accredited ISO 17025 facility. If not, they have to go through a pretty thick vetting process through us where we send them a questionnaire. We may even have to audit that facility to make sure they meet our specs.
So you can see it's very dense in terms of the regulatory side. And redundancy, but this is how, you know, airplanes stay up in the sky and never come crashing into the ground, or rarely do they, because of redundant systems, a vendor qualifications, inspection, inspection inspection, and those are the types of things that make medical systems work and make aviation work.
Joe: [00:28:33] Do y'all have any predictions about where medical device packaging is going to be heading in terms of better practices and technologies? And we've talked a lot about what we're doing now, but looking forward, what do you all see in the future?
Charlie: [00:28:51] Well, I think Paul's made, and discussed this before. I think the, the gating of hand-washing may indeed be an important part of the cleanroom entry process. I believe that's also in hospitals. I think we're, we're now, you know, a lot of good came out of the COVID-19 event, that we all can agree on. We all got caught up on Netflix and got some stuff done around the house, but we also learned a lot.
So I think one of the big takeaways for me is that, you know, there's. I mean, look at us, we're in the grocery store with masks on where sanitizing our hands. Why are we doing it? Because there's a risk of spread only become when it, when it becomes important, do things tend to change only when it sort of affect you do we look at it a little bit harder? I think that's what this event is told is it said, Hey, there are germs out there. We do have to manage those. Obviously we can't hide under a rock in a bubble, but at the end of the day, there are systems in place that could really help that experience.
And on the industrial side, not only is it just sort of a, a friendly, good thing to do whilst we're out, it's an important part of new policies and new procedures that are, you're going to start seeing. I mean, we're, if we're seeing now, cleanroom companies are now making enclosures between employees.
I mean, we're not that far from the, the bubble boy dynamic here, right? So we're, we're making firewalls between humans. And when I see this, I think, you know, probably the, one of the best firewalls that we have is cleanliness personal cleanliness is, is, and responsibility is probably the first place to start.
Then we can go through some more sort of a brute force kind of containment systems to keep humans away from each other. But at the end of the day, you know, more simple systems. I mean, come on, this is a this is the stuff we learned in kindergarten, wash your hands. You know, those sorts of things. We, we know that, we're going to have to look a little bit closer about the way we've done things in the past.
We know that, you know, germs are army president and we're not going to escape them. But the best thing that we can do is to have systems that make sure that we're doing what we're supposed to do. And again, on the industry side, I no longer think that that's going to be a volunteer process. It's going to be mandated.
It needs to be mechanized. I drive a Ford Raptor truck, and if I try to leave the lane it turns me back into the lane. It's a forced compliance thing that saves my life because I'm spacing it out half the time. So it's a great system. That's been integrated into a vehicle, and those are the kinds of things that I'm excited about.
I don't think we should relinquish responsibility of everything we do to have everything be automated. But having said that automation plays an important role in keeping us safe. And this is a perfect example of where automation can really sort of drive the future of disease prevention spreading.
I think it's exciting stuff, Paul, I guess that was your message as well. Yeah
Paul: [00:32:00] It absolutely is. I mean, not a bit automation. Isn't evolution. Mean, we see that in everything that we've done from, you know, just evolving as human beings as we have, to just every tools that we use in our life every single day.
Like I say, often I cannot remember the last time I picked up a map because I don't, because I just plug in an address to my phone and I go where I need to go. My phone tells me exactly what I need to do. And hygiene is no different, you know, there's one commonality about everything that we deal with and that's human behavior and human behavior is very much different.
We are somewhat procrastinators until we have something like what we're dealing with now in the world. An event that we have to then put in measures in place to address it. And what do we do from that? We've learned. So there's many, many lessons learned in the last, you know, let's call it five six months of exactly,how do we want to address this going forward?
I guarantee you going forward. We'll do things differently than what we did in the early months of the situation we're going on. When you're looking at, when you're looking at, at the industrial spaces, like in, in medical device, packaging, and you're looking at, what we call hygiene zones.
Those hygiene zones have been evolving over the years. They are going to continue to evolve. And one of those things that they have to think about, and one of the things I've personally communicated and consulted with with a lot of both food manufacturing companies, pharmaceutical manufacturing, even medical device manufacturing, sometimes that cleanroom entry point or that donning area is, is really the same as they're doffing.
Where could there be a cross contamination event? Potentially from those two areas co-mingling and that's something that people need to think about of how do I protect the environment from coming in? How do I protect the environment coming out and cross contaminating that. You know, I, I joke often about the magic bench in the floor, within the, the, the cleanroom entryways to where, you know, you got a line and you got a bench in the floor and you know, on one side is considered the dirty zone the other side is considered the clean zone.
And let me, let me be honest, bacterial pathogens, don't see that line. They kind of migrate and go wherever they need to go. And so you have to think about those things in a little bit different way. To me, you, you, you can put a lot of procedures and processes like they're already established and have to be in place.
That's about compliance and meeting some, regulatory standard that's required, but it doesn't address the cultural piece. And that cultural piece always has to be looked at when you're dealing with people and how you move them and process them through an event and making sure that their stage gates in place, to make sure that you're getting the quality effects that you need, that if you identify pitfalls and circumvention points that are risk factor. And I think this is going to evolve, especially in medical device packaging, they always do a really good job, but there's always ways to improve every process control.
And I think that's where the evolution Joe is really kind of going in Charlie summed it up very correctly. We are going to see this changing throughout many dynamics in our lives in our day to day lives, in work and outside of work or what we call from away from home.
Joe: [00:35:15] Fantastic. Thank you both for providing such great insight into these topics. Charlie, I want to thank you for joining us today and providing your area of expertise.
Charlie: [00:35:28] Thank you for having me. I appreciate it.
Joe: [00:35:30] And Paul, thanks again for always being on the wash.
Paul: [00:35:34] Well thank you, I always enjoy it.
Joe: [00:35:37] Thanks for joining us for another episode of The Wash and we'll see you next time.
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