UV-C effectiveness is also impacted by the angle of incidence . UV-C light intensity decreases when the light strikes surfaces at flatter angles . Full energy is delivered when a device is perpendicular to the surface ( 90 degrees ). At a 45-degree angle , the effectiveness of the energy drops to 70 percent . And a 22-degree angle cuts efficiency to 38 percent . Anything that reduces the dose delivered reduces efficacy , which includes distance to surface and angle of incidence . Efficacy is measured by the total dose of UV-C delivered to a surface , and hence , is a function of bulb intensity , distance of a surface to the bulb , angle to the surface , and time of exposure .
UV-C device makers address these factors by :
• Moving the unit on a robotic base ; however , these types of these units typically do no stay in one place long enough to provide significant efficacy
• Adding more and more bulbs to the device , trying to shorten the overall exposure time within the area
• Implementing longer cycle times . While this can increase the dose delivered , it can also cause surface damage over time , especially to objects closer to the bulb system , and the longer cycle time can add to delays in reusing the room .
Additional issues to factor in concerning the use of UV-C devices include :
• Shadowing : This is when UV light cannot strike a surface directly , so it receives less energy , reducing efficacy . UV light does not reflect ( bounce ) very efficiently ( as the distance issue above becomes more pronounced ). UV-C reflective paints have been suggested , but the distance the light has to travel , and the corresponding reduction in power , is still a factor .
• Overexposure : High amounts of UV-C for extended periods on certain plastics , such as ABS , may yellow these materials over time .
• Soil residue : Soil on surfaces reduces efficacy of UV light . Cleaning surfaces before UV-C disinfection is highly recommended .
At a recent Association for Professionals in Infection Control and Epidemiology ( APIC ) conference , a focus panel with infection preventionists around UV-C selection criteria found that turnaround time of the room was the most important consideration for a UV-C device ( 26 percent of participants ). This was followed by cost ( 18 percent ), efficacy ( 18 percent ), ease of use ( 9 percent ) and portability ( 9 percent ). Other criteria included prep time ( 6 percent ), cycle reporting capabilities ( 6 percent ), evidence / studies of effectiveness ( 5 percent ) and user safety ( 3 percent ).
Assuming a hospital wants to move forward with a UV-C device acquisition , questions about funding sources will likely arise . The first thing to do is create an awareness around the need for UV-C . Be sure to identify the problem ( s ) to be solved .
Funds for these types of devices can typically be found in capital equipment budgets , the government , foundations , community interest groups , private funding ( i . e ., families and others ), online campaigns and lobbying in local news and radio .
To justify funding , follow the rules of the SBAR format :
• Situation : Describe the circumstances ; bring something unique to the funding source , talk about the need for a non-chemical insurance plan .
• Background : Tell a story ; draw a picture , use data from articles to show that cleaning and disinfection may not be 100 percent .
• Assessment : Bring data to the story . Everyone has needs , illustrate why UV-C is so important and will ultimately make the community better .
• Recommendation / request : Do not be shy ; ask for what you need .
Another funding avenue is through creating a purchase / procurement policy to leverage grant funding . To assure no bias in the process , several key policy items need to be considered :
• Ensure procurement procedures are well documented
• Adopt a clear conflict-of-interest policy
• Avoid the purchase of unnecessary or duplicative items
• Provide full and open competition
• Establish micro and simple acquisition thresholds that are in line with federal rules and reflect internal operations
• Plan for formal procurement
• Non-competitive procurement would be a last resort
Also worth looking into :
• The government ’ s Emergency Grants for Rural Health Care ’ program . As part of President Biden ’ s COVID-19 relief package announced in March , $ 500 million is set aside for grants that will help rural hospitals ’ efforts around COVID-19
• In April HHS announced $ 1 billion from the American Rescue Plan for construction and renovation projects at healthcare centers
• In May , the U . S . Department of the Treasury announced the American Rescue Plan will deliver $ 350 billion for eligible state , local , territorial , and Tribal governments to respond to the COVID-19 emergency and bring back jobs
In summary , contaminated surfaces play a significant role in the spread of pathogens , and manual cleaning and disinfection may not always be optimal or consistent . UV-C is a proven and effective chemical-free technology to reduce contamination , risk and process variance .
Evaluation of key criteria can help determine the UV-C device that best fits a facility ’ s needs and workflows . Staff and patients appreciate the investment in technology to keep them safe and resources are available to help with purchase and funding .
Jim Gauthier is senior clinical advisor for infection prevention at Diversey . Funding information provided by Reagan Lynch .
References :
Bernstein DA , Salsgiver E , Simon MS , Greendyke W , Eiras DP , Ito M , Caruso DA , Woodward TM , Perriel OT , Saiman L , Furuya EY and Calfee DP . Understanding Barriers to Optimal Cleaning and Disinfection in Hospitals : A Knowledge , Attitudes , and Practices Survey of Environmental Services Workers . Infect Control Hosp Epidemiol . 2016 Dec ; 37 ( 12 ): 1492-1495 . DOI : 10.1017 / ice . 2016.206 . Epub 2016 Sep 13 . DOI : 10.1017 / ice . 2016.206
Carling PC , Parry MF , Von Beheren SM . Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals . Infect Cont Hosp Epidemiol 2008 ; 29 ( 1 ): 1-7 . DOI : 10.1086 / 524329
Wong T , Woznow T , Petrie M , Murzello E , et al . Postdischarge decontamination of MRSA , VRE , and Clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-C-emitting devices . Am J Infect Control . 2016 ; 44:416-20 . http :// dx . doi . org / 10.1016 / j . ajic . 2015.10.016
www . healthcarehygienemagazine . com • july 2021
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