Healthcare Hygiene magazine January 2020

Q & A Automated Room Disinfection Technology: A Q&A with William Rutala William A. Rutala, PhD, MPH, CIC Healthcare Hygiene magazine spoke with William A. Rutala, PhD, MPH, CIC, the associate chief medical officer for the UNC Medical Center; medical director of the Departments of Hospital Epidemiology and Occupational Health Service; and director of the North Carolina Statewide Infection Control Program (SPICE), about the role that automated room disinfection technol- ogy plays in environmental hygiene. HHM Why is rigorous manual cleaning critical before the use of automated room disinfection technology? WR: Surface disinfection of noncritical surfaces and equipment is normally performed by manually applying a liquid disinfectant to the surface with a cloth, wipe, or mop. Recent studies have identified substantial opportunities in hospitals to improve the cleaning/disinfection of frequently touched objects in the patient’s immediate environment. For example, of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48 percent) were cleaned by terminal room cleaning/disinfection. Studies have also shown that patients admitted to rooms previously occupied by individuals infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridioides difficile (C. difficile) are at significant risk of acquiring these organisms from contaminated environmental surfaces. These data have led to the development of room decontamination units that address the lack of thoroughness of terminal cleaning/ disinfection activities in patient rooms. 1 The rationale for rigorous manual cleaning/disinfection before the use of ultraviolet-C (UV-C) technology is that organic material can interfere with disinfection technologies, including UV-C. Thus, surfaces must be cleaned/disinfected prior to “no touch’ room decontamination technology such as UV-C. HHM UV-C has long been positioned as an adjunct measure to proper and rigorous surface cleaning and disinfection; is there reason to believe that it could eventually supplant manual cleaning, or will it always be supplemental? WR: There is no reason to believe that UV-C would eventually supplant manual cleaning/disinfection. UV-C will likely remain supplemental to manual cleaning/disinfection with “no-touch” room decontamination technologies 30 following the process as a second step. Since there is no technology currently available that will effectively clean elevated, irregular surfaces in a patient room of dirt and debris, manual cleaning/disinfection is key. While one study demonstrated that UV-C reduced aerobic bacterial counts in the absence of manual cleaning/ disinfection, this data should not support the abandonment of manual disinfection as it removes dirt and debris that are not eliminated by “no touch” technologies. 3 However, there likely will be improvements, including mechanical robots, that reduce staff time. Robots have already assisted healthcare staff in a variety of tasks such as transporting supplies and medications. It is plausible a robot can transport a UV-C device between rooms, find the geometric center of the room, activate the UV-C system and ensure the room is blocked to entry from patients and staff while operating. HHM Has the shadowed-areas dilemma been addressed by new generations of UV-C technology, or is this still an unresolved issue? What are the potential disadvantages/challenges to UV-C technology and what are some best practices for optimal use of and improved outcomes from these devices? WR: Since UV-C is less effective in shadowed or indirect line-of-sight areas, some UV-C devices have monitored UV-C in shadowed areas. Several studies have demonstrated a greater log 10 reduction with direct line-of-sight compared to shadowed or indirect line-of-sight. For example, one study, using a device with UV sensors, found UV-C radiation was more effective when there was a direct line-of-sight to the contaminant, but meaningful reductions (3.3-3.9 mean log 10 reduction for bacteria) occurred when the contaminant was “shadowed” and not directly exposed to the UV-C (e.g., back of computer, back of the head of bed). 1 HHM What are some of the disadvantages or challenges associated with UV-C? WR: All technologies and products have advantages and disadvantages. Some of the challenges associated with UV-C include: 5-6 • All patients and staff must be removed from the room prior to decontamination • Decontamination can only be accomplished at terminal disinfection • Capital equipment costs are high january 2020 • www.healthcarehygienemagazine.com

Healthcare Hygiene magazine January 2020 | Page 30