Many facilities seek to reduce healthcare-associated infections
( HAIs ) and transmission of viruses , multidrug-resistant organisms ( MDROs ), Clostridioides difficile ( C . difficile ) and other pathogens . The COVID-19 pandemic has highlighted the importance of environmental cleaning . To properly disinfect , one must manually clean visibly dirty surfaces prior to disinfection , use an EPA-approved , hospital-grade disinfectant , and follow the application and dwell time instructions on product labels . There may be practice gaps in environmental cleaning practices , knowledge gaps in disinfection methods , and product variability due to supply chain challenges .
Supplemental no-touch disinfection methods provide an additional level of environmental decontamination following routine surface cleaning and disinfection . Here we will discuss considerations for implementing two of these technologies : Ultraviolet-C light ( UV-C ) and hydrogen peroxide vapor ( HPV ). Studies have shown when used after manual cleaning , UV-C and HPV disinfection methods significantly reduce contamination on environmental surface pathogens such as MDROs and C . difficile .
Supplemental disinfection devices decrease reliance on operators and potentially improve the efficacy of environmental surface cleaning , and specifically , terminal room disinfection . These devices are intended to supplement robust cleaning protocols already in place , not to replace routine cleaning and disinfection .
How it works UVC Technology
200-280nm light damages DNA / RNA to prohibit replication of microorganisms
Different methods are available :
● Low pressure mercury :
254nm
● UV LEDS : 260-280nm
● Pulsed xenon : broad spectrum
● Far-UV : 200-230nm
Effectiveness depends on dose : Total dose = Intensity x Time
Intensity may be reduced by distance from the UV-C light source , shadowing by objects , and soil load on a surface infection prevention
By Margaret M . Miller , BS MT ( ASCP ) M CIC FAPIC
What You Need to Know when Considering Supplemental Methods for Terminal Room Disinfection : Ultraviolet-C Light Versus Hydrogen Peroxide Vapor
HPV Technology
Disperse approximately 57-400 parts per million ( ppm ) HPV to decontaminate porous and nonporous surfaces within an enclosed , unoccupied space
Break down HPV into water vapor and oxygen after the required contact time
Implementation and operational considerations
Workflows for UV-C and HPV methods are similar ; however , HPV requires additional steps and precautions . Both supplemental methods require the room to be unoccupied , manual cleaning and disinfection performed , room preparation , and cycle time . Key criteria for UV-C room disinfection are dose delivery , motion sensors with auto shut-off for safety , maneuverability , and lamp damage protection . HPV devices may be mobile or permanently installed in a space . HPV requires heating , ventilation , air conditioning vents and smoke detectors be blocked . Doors to the space must be sealed with tape to prevent HPV leakage . After the HPV cycle , a hydrogen peroxide sensor is used to verify the chemical concentration is less than one part per million ( the exposure limit permitted by the Occupational Safety and Health Administration ) prior to room entry .
Relative advantages and disadvantages of UV-C and HPV disinfection
Regardless of the type of supplemental disinfection device , thorough cleaning is required before the device is used because inorganic and organic materials that remain on surfaces interfere with the effectiveness of the process .
For UV-C technology , advantages include ease of use , the documented studies showing pathogen reduction in the environment after outbreaks and with high-risk pathogens in high-risk units , and the relatively quicker cycle times compared to HPV technology . As considerations for disadvantages , UV-C technology requires time , energy and expenses to implement effectively . Use increases room downtime between patients , compared to no supplemental disinfection , and its effectiveness may vary based on positioning in the area and system settings . Lastly , UVC disinfection is limited to solid surfaces , and some pathogens ( Candida auris , C . difficile ) may require longer exposure times .
For HPV technology , the system ’ s effectiveness is not affected by physical constraints or shadows and thus can effectively disinfect an enclosed space within one cycle . Unlike UV-C disinfection , HPV can be used with both compatible porous and non-porous surfaces . For disadvantages compared to UV-C disinfection , use of HPV increases room downtime and may last several hours depending on size and the need for the operator to seal all HVAC vents , smoke detectors , and outer doors . Lastly , HPV may damage medical and nonmedical equipment if hydrogen peroxide is not approved for use in manufacturer ’ s instructions for cleaning . Items not compatible must be appropriately covered or removed from the room during disinfection .
In summary , the COVID-19 pandemic has increased interest in supplemental disinfection devices for use in various healthcare