Healthcare Hygiene magazine January 2020 | Page 32

Q
& A
• UV-C does not remove dust and stains which are
important to patients and visitors, and hence cleaning and
disinfection must precede UV room decontamination.
• Sensitive to use parameters (e.g., wavelength, UV dose
delivered, distance, time)
• Requires equipment and furniture be moved away
from walls
HHM What are some best practices for optimal use
of and improved outcomes from these devices?
WR: Over the last decade, multiple trials have assessed
the efficacy of “no-touch” units for reducing healthcare-as-
sociated infections (HAIs). There are at least six clinical
trials that demonstrate a reduction of HAIs with the use of
hydrogen peroxide systems and seven that demonstrate a
reduction in HAIs with UV-C. One study showed enhanced
room decontamination strategies (i.e., bleach and/or UV-C
decontamination) decreased the clinical incidence of acqui-
sition of target multidrug resistant organisms (i.e., MRSA,
VRE, C. difficile) by ~10 to 30% (p=0.036). 8 Comparing the
best strategy with the worst strategy (i.e., quat vs quat/UV)
revealed that a reduction of 94 percent in epidemiologically
important pathogens (i.e., 60.8 CFU per room vs 3.4 CFU per
room) led to a 35 percent decrease in colonization/infection
(2.3 percent vs 1.5 percent). These data demonstrated a
decrease in room contamination was associated with a
reduction in patient colonization/infection. Based on this,
hospitals should use a “no-touch” device for terminal room
decontamination, after discharge of patients on Contact
Precautions. Given the multitude of options, Infection
preventionists should read the peer-reviewed literature and
purchase devices with demonstrated bactericidal capability,
and ideally those shown to reduce HAIs. 4
HHM What are the advantages of UV-C technology?
WR: Over the last decade, substantial scientific evidence
indicates contamination of environmental surfaces in hospital
rooms plays an important role in the transmission of key
healthcare-associated pathogens. A growing number of
clinical studies have demonstrated that ultraviolet devices
and other “no touch” technologies when used for terminal
disinfection can reduce colonization or HAIs in patients
admitted to these hospital rooms. 7
UV-C systems’ advantages include:
• Studies show use of UV-C reduces HAIs
• Reliable microbiocidal activity against a wide range of
healthcare-associated pathogens
• Room surfaces and equipment decontaminated
• Room decontamination is rapid (5-25 minutes) for
vegetative bacteria
• Effective against C. difficile spores, although requires
longer exposure (10-50 minutes)
• HVAC (heating, ventilation and air conditioning) system
does not need to be disabled and the room does not need
to be sealed
• UV is residual free and does not give rise to health or
safety concerns
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• Good distribution in the room of UV energy via an
automated monitoring system
• No consumable products so operating costs are low
(key cost = acquisition and staff time)
HHM There have been many claims made by man-
ufacturers of UV-C technology, some of which have
been refuted by studies, some have been confirmed
by science – how do end users cut through all of this
“white noise” and focus on the science?
WR: Research shows that surfaces in hospital rooms
are often insufficiently cleaned during terminal cleaning/
disinfection. Although methods of assessing the adequacy
of cleaning/disinfection varied (e.g., adenosine triphosphate
bioluminescence, fluorescent dye), studies have demonstrated
that <50 percent of room surfaces were properly cleaned.
Numerous reviews concluded that improved cleaning/
disinfection leads to reductions in HAI. 10 Importantly, the
studies that have assessed interventions to improve cleaning/
disinfection have reported that after the intervention,
approximately 5 percent to 30 percent of surfaces remain
potentially contaminated. Because of the demonstrated
failure of interventions to achieve consistent and high rates of
cleaning and disinfection of room surfaces, new “no-touch”
methods of room disinfection have been developed. 7
When focusing on the science, there appears to be
substantial consistency across many studies regarding the
effectiveness of UV-C. However, it is worth noting that most
studies have used the same device 7 with only a few of the
commercially available devices having actually been studied.
Notably, the time needed to inactivate pathogens has been
shown to be shortened by use of UV reflective wall paint
for multiple different UV-C devices. 7,11
As mentioned above, data shows that hospitals will
benefit from using a “no touch” device for terminal room
decontamination. The key is to ensure the “no-touch” device
chosen has demonstrated the ability to reduce HAIs. 4,6,7
HHM
This technology can be expensive; how can
end users make a business case to their institutional
leadership?
WR: It has been estimated that 1.7 million patients
develop a HAI each year in the United States, causing or
contributing to the death of nearly 100,000 people. Excellent
evidence in scientific literature shows that environmental
contamination plays an important role in the transmission
of several key healthcare-associated pathogens including
MRSA, VRE, Acinetobacter and C. difficile.
The problem is multiple studies have demonstrated that
surfaces in hospital rooms poorly cleaned during terminal
cleaning/disinfection put the next patient at risk for the
previous patient’s pathogen. It is promising, however, that
”no-touch” technology used for terminal disinfection
has been shown to reduce 10 percent to 30 percent of
colonization/infection in patients admitted. 6-8
Although a formal analysis should be done, one can
estimate the cost avoided by this technology. For example,
january 2020 • www.healthcarehygienemagazine.com