Healthcare Hygiene magazine January 2020 | Page 33

if three UV-C units were purchased and three environmental services staff were hired to transport and The rationale for operate the unit, the first year’s cost would be approximately $405,000 rigorous manual (covering equipment and personnel) cleaning/disinfection and the second year’s cost would be approximately $150,000 (staff before the use only). If the UV-C reduced HAIs for of ultraviolet-C patients on Contact Precautions (approximately 20 percent of (UV-C) technology patients) by 10 percent to 30 percent is that organic as demonstrated in a randomized material can interfere trial, 8 the number of infections prevented in a 900-bed hospital with disinfection with an infection rate of about technologies, 4 per 1,000 patient days would be approximately 18-55 per year. If including UV-C. each HAI cost $24,000 on average, 14 the hospital would need to prevent only 23 HAIs in the first two years to cover the acquisition and operational costs of the UV-C program for two years. If the hospital prevented 10 percent of infections per year (18 per year) for two years, the cost savings would be $309,000. If 30 percent of infections were prevented per year (55 per year) for two years, the cost savings would be $2,085,000. In an independent analysis, Pegues, et al. calculated a cost savings for C. difficile of $348,528 to $1,537,000 per fiscal year. 15 HHM What is the next frontier for this technology in terms of the clinical/cleaning challenges that can be addressed? WR: While “no- touch” technologies are effective, they have limits as they require rooms without people. Also, surfaces in patients’ rooms can rapidly become re-contam- inated and may be persistently contaminated despite room cleaning/disinfection. 16 The hands of healthcare providers can become colonized by touching contaminated environmental surfaces and patient-care equipment and can transfer pathogens by inadequate hand hygiene or inappropriate glove use. Since routine disinfection of room surfaces is frequently inadequate, continuous room decontamination methods are being evaluated. This technology is intended is to make surfaces hygienically clean (not sterile), and free of pathogens in sufficient numbers to prevent human disease. The technologies include: visible light disinfection (high-intensity narrow-spectrum light); 17 low-concentration hydrogen peroxide; 18 continuously active disinfectant; 16 and self-disinfection surfaces (e.g., copper). 19 These methods are under active investigation and need to be assessed for their ability to reduce HAIs. 16-20  References: 1. Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol 2010;31:1025-9. www.healthcarehygienemagazine.com • january 2020 Q & A 2. Cadnum JL, Tomas ME, Sankar T, Jencson A, Mathew I, Kundrapu S, Donskey CJ. Effect of variation in test methods on performance of ultraviolet-C radiation room decontamination. Infect Control Hosp Epidemiol. 2016;37:555-560. 3. Jinadatha C, Villamaria FC, Ganachari-Mallappa N, et al. Can pulsed xenon ultraviolet light systems disinfect aerobic bacteria in the absence of manual disinfection? Am J Infect Control 2015;43:415-7. 4. Rutala WA, Weber DJ. Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach. Am J Infect Control. 2019;47:A96-A105 5. Rutala WA, Weber DJ. Disinfectants used for environmental disinfection and new room decontamination technology. Am J Infect Control. 2013;41 (Supplement):S36-S41. 6. Weber DJ, Kanamori H, Rutala WA. “No touch” technologies for environmental decontamination: Focus on UV devices and hydrogen peroxide systems. Current Opinions Infect Dis. 2016;29:424-431. 7. Weber DJ, Rutala WA, Anderson DJ, Chen LF, Sickbert-Bennett EE, Boyce JM. Effectiveness of UV devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials. Am J Infect Control 2016;44:e77-e84. 8. Anderson D, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett P, Blocker M, Becherer P, Schwab JC, Knelson LP, Lokhnygina Y, Rutala WA, Sexton DJ, and CDC Prevention Epicenter Program. The benefits of enhanced terminal room (BETR) disinfection study: A cluster randomized, multicenter crossover study with 2x2 factorial design to evaluate the impact of enhanced terminal room disinfection on acquisition and infection caused by multidrug-resistant organisms (MDROs). The Lancet. 2017;389:805-814. 9. Rutala WA, Kanamori H, Gergen MF, Knelson LP, Sickbert-Bennett EE, Chen LF, Anderson DJ, Sexton DJ, Weber DJ, CDC Prevention Epicenters Program. Enhanced disinfection leads to a reduction in microbial contamination and a reduction in patient infection and colonization. Infect Control Hosp Epidemiol. 2018;39:1118-1121. 10. Donskey CJ. Does improving surface cleaning and disinfection reduce healthcare-associated infections? Am J Infect Control. 2016;41:S12-S19. 11. Rutala WA, Weber DJ, Gergen MF, Tande BM, Sickbert-Bennett EE. Does coating all room surfaces with an ultraviolet-light C nanoreflective coating improve decontamination compared to coating only the walls? Infect Control Hosp Epidemiol. 2014;35:323-325. 12. Cadnum JL, Jencson AL, Gestrich SA, Livingston SH, Karaman BA, Benner KJ, Wilson BM, Donskey CJ. A comparison of the efficacy of multiple ultraviolet light room decontamination devices in a radiology procedure room. Infect Control Hosp Epidemiol 2019;40:158-163. 13. Institute for Healthcare Improvement (IHI). What zero looks like: Eliminat- ing Hospital-acquired infections. http://www.ihi.org/resources/Pages/Improve- mentStories/WhatZeroLooksLikeEliminatingHospitalAcquiredInfections.aspx 14. Zimlichman E, Henderson D, Tamir, Franz C, Song P, Yamin CK, Keohan C, Denham CR, Bates DW. Health care-associated Infections” A meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039-2046. 15. Pegues DA, Han J, Gilmar C, McDonnell B, Gaynes S. Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among heamatology-oncology patients. Infect Control Hosp Epidemiol 2017;38:39-44 16. Rutala WA, Sickbert-Bennett EE, Anderson DJ, Weber DJ, CDC Prevention Epicenters Program. Antimicrobial activity of a continuously active disinfectant against healthcare pathogens. Infect Control Hosp Epidemiol. 2019:doi:10.1017/ice.2019.260. 17. Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE, Sexton DJ, Anderson DJ, Laux J, Weber DJ, CDC Prevention Epicenters Program. 2018. Antimicrobial activity of a continuous visible light disinfection system. Infect Control Hospi Epidemiol 39:1250-1253 18. Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE, Anderson DJ, Sexton DJ, Weber DJ, CDC Prevention Epicenters Program. Evaluation of dilute hydrogen peroxide technology for continuous room decontam- ination of multidrug-resistant organisms. Infect Control Hosp Epidemiol. 2019:doi:10.1017/ice.2019.261. 19. Salgado CD1, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, Sharpe PA, Michels HT, Schmidt MG. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit Infect Control Hosp Epidemiol. 2013;34:479-86 20. Weber DJ, Rutala WA, Sickbert-Bennett EE, Kanamori H, Anderson D, CDC Prevention Epicenters Program. Continuous Room Decontamination Technologies. Am J Infect Control. 2019; 47:A72-A78 33