Deployment of a touchless ultraviolet light robot for terminal room disinfection: The importance of audit and feedback

Awareness of health care workers with appropriate infection control practices related to multi-patient use of Close Loop Medication Administration device

Background

Portable computerized devices represent a potential source of healthcare infections. The objective was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) toward infection control practices used with Close Loop Medication Administration (CLMA) devices. Additionally, to quantify the impact of education and training on the bacterial burden on CLMA devices.

Methods

The study design consisted of two steps: a cross-sectional study was conducted among HCWs working in a tertiary care center in Riyadh, Saudi Arabia. A 32-item questionnaire was used to assess KAP information. The second step was environmental samples collected from the surfaces of CLMA devices before and after implementing a multifaceted intervention.

Result

A total of 325 HCWs were included in the study. The mean age was 32.6±7.4 years. The majority were females (92%) and nurses (91.3%). The overall KAP score was 74.8%, 74.2% adequate knowledge, 79.3% positive attitude, and 71.3% appropriate practices. KAP score was better (≥ median KAP score) among HCWs working in laboratory and organ transplant units (P<0.001). It was also better among those with a longer duration of work experience (P<0.001) and those who received related training (P<0.001). Approximately 75% of HCWs expressed their need for more information about CLMA. Post-interventional samples had much lower bacterial burden, with the positive rate reduced from 51.4% before intervention to 16.8% after intervention (P<0.001).

Conclusions

Awareness and behavior of HCWs about appropriate infection control practices related to portable devices is still inadequate. A multifaceted intervention including education and training significantly reduces the bioburden on portable devices.

A Reinforcement Learning Based Dirt-Exploration for Cleaning-Auditing Robot

Cleaning is one of the fundamental tasks with prime importance given in our day-to-day life. Moreover, the importance of cleaning drives the research efforts towards bringing leading edge technologies, including robotics, into the cleaning domain. However, an effective method to assess the quality of cleaning is an equally important research problem to be addressed. The primary footstep towards addressing the fundamental question of “How clean is clean” is addressed using an autonomous cleaning-auditing robot that audits the cleanliness of a given area. This research work focuses on a novel reinforcement learning-based experience-driven dirt exploration strategy for a cleaning-auditing robot. The proposed approach uses proximal policy approximation (PPO) based on-policy learning method to generate waypoints and sampling decisions to explore the probable dirt accumulation regions in a given area. The policy network is trained in multiple environments with simulated dirt patterns. Experiment trials have been conducted to validate the trained policy in both simulated and real-world environments using an in-house developed cleaning audit robot called BELUGA.

COVID-Bot: UV-C Based Autonomous Sanitizing Robotic Platform for COVID-19

This paper presents the design and implementation of COVID-Bot, an open-source robotic platform for sanitizing single plant environments such as offices, houses, apartments, among others. This development seeks to create a tool that contributes to the global fight against the COVID-19 pandemic, from a low-cost and easy-to-replicate robot, which disinfects surfaces through type C ultraviolet radiation. The platform is based on a differential robotic base, an RGB-D camera, a tracking camera, three UV-C lamps, and an embedded computer running the ROS-based control software. In addition, this paper presents the description of the hardware used, the software implemented, and the tests carried out to corroborate the operation of the integrated system. These tests demonstrated that the system is adequate to autonomously cover a one-floor apartment, based on the theoretical radiation distance of the used lamps.

An Autonomous Robot-Aided Auditing Scheme for Floor Cleaning

Cleaning is an important factor in most aspects of our day-to-day life. This research work brings a solution to the fundamental question of “How clean is clean” by introducing a novel framework for auditing the cleanliness of built infrastructure using mobile robots. The proposed system presents a strategy for assessing the quality of cleaning in a given area and a novel exploration strategy that facilitates the auditing in a given location by a mobile robot. An audit sensor that works by the “touch and inspect” analogy that assigns an audit score corresponds to its area of inspection has been developed. A vision-based dirt-probability-driven exploration is proposed to empower a mobile robot with an audit sensor on-board to perform auditing tasks effectively. The quality of cleaning is quantified using a dirt density map representing location-wise audit scores, dirt distribution pattern obtained by kernel density estimation, and cleaning benchmark score representing the extent of cleanliness. The framework is realized in an in-house developed audit robot to perform the cleaning audit in indoor and semi-outdoor environments. The proposed method is validated by experiment trials to estimate the cleanliness in five different locations using the developed audit sensor and dirt-probability-driven exploration.

Internet of Things and Robotics in Transforming Current-Day Healthcare Services

Technology has become an integral part of everyday lives. Recent years have witnessed advancement in technology with a wide range of applications in healthcare. However, the use of the Internet of Things (IoT) and robotics are yet to see substantial growth in terms of its acceptability in healthcare applications. The current study has discussed the role of the aforesaid technology in transforming healthcare services. The study also presented various functionalities of the ideal IoT-aided robotic systems and their importance in healthcare applications. Furthermore, the study focused on the application of the IoT and robotics in providing healthcare services such as rehabilitation, assistive surgery, elderly care, and prosthetics. Recent developments, current status, limitations, and challenges in the aforesaid area have been presented in detail. The study also discusses the role and applications of the aforementioned technology in managing the current pandemic of COVID-19. A comprehensive knowledge has been provided on the prospect of the functionality, application, challenges, and future scope of the IoT-aided robotic system in healthcare services. This will help the future researcher to make an inclusive idea on the use of the said technology in improving the healthcare services in the future.

Systematic review on use, cost and clinical efficacy of automated decontamination devices

BACKGROUND

More evidence is emerging on the role of surface decontamination for reducing hospital-acquired infection (HAI). Timely and adequate removal of environmental pathogens leads to measurable clinical benefit in both routine and outbreak situations.

OBJECTIVES

This systematic review aimed to evaluate published studies describing the effect of automated technologies delivering hydrogen peroxide (H202) or ultra-violet (UV) light on HAI rates.

METHODS

A systematic review was performed using relevant search terms. Databases were scanned from January 2005 to March 2020 for studies reporting clinical outcome after use of automated devices on healthcare surfaces. Information collected included device type, overall findings; hospital and ward data; study location, length and size; antimicrobial consumption; domestic monitoring; and infection control interventions. Study sponsorship and duplicate publications were also noted.

RESULTS

While there are clear benefits from non-touch devices in vitro, we found insufficient objective assessment of patient outcome due to the before-and-after nature of 36 of 43 (84%) studies. Of 43 studies, 20 (47%) used hydrogen peroxide (14 for outbreaks) and 23 (53%) used UV technology (none for outbreaks). The most popular pathogen targeted, either alone or in combination with others, was Clostridium difficile (27 of 43 studies: 63%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (16 of 43: 37%). Many owed funding and/or personnel to industry sponsorship (28 of 43: 65%) and most were confounded by concurrent infection control, antimicrobial stewardship and/or cleaning audit initiatives. Few contained data on device costs and rarely on comparable costs (1 of 43: 2%). There were expected relationships between the country hosting the study and location of device companies. None mentioned the potential for environmental damage, including effects on microbial survivors.

CONCLUSION

There were mixed results for patient benefit from this review of automated devices using H202 or UV for surface decontamination. Most non-outbreak studies lacked an appropriate control group and were potentially compromised by industry sponsorship. Concern over HAI encourages delivery of powerful disinfectants for eliminating pathogens without appreciating toxicity or cost benefit. Routine use of these devices requires justification from standardized and controlled studies to understand how best to manage contaminated healthcare environments.

Effects of environmental cleaning bundles on reducing healthcare-associated Clostridioides difficile infection: a systematic review and meta-analysis

Environmental contamination with Clostridioides difficile plays an important role in the transmission of C. difficile infection (CDI) in healthcare and long-term care facilities, which results in prolonged length of stay, higher risk of mortality and increased healthcare costs. Environmental cleaning bundles are introduced to improve environmental cleanliness. This study aimed to evaluate whether environmental cleaning bundles applied in hospital, community and long-term care settings reduce the incidence of healthcare-associated CDI compared with conventional cleaning practices. Relevant databases, websites and trial registration platforms were searched. Two reviewers conducted study screening and selection, data collection, risk of bias assessment and evidence quality assessment independently. Meta-analyses were conducted using Review Manager 5.3. Ten eligible studies [one randomized controlled trial (RCT) and nine non-RCTs] were included. No significant effect of environmental cleaning bundles on the CDI incidence rate was found [risk ratio (RR)=0.96, 95% confidence interval (CI) 0.71-1.29; studies=2; I²=49%; very low quality]. However, the removal of surface markers was improved significantly (RR=1.55, 95% CI 1.30-1.84; studies=3; I²=98%; very low quality), and the percentage of CDI rooms with positive cultures of C. difficile (RR=0.16, 95% CI 0.08-0.31; studies=4; I²=7%; moderate quality) was reduced significantly after the implementation of environmental cleaning bundles. Environmental cleaning bundles may consequently be helpful in improving the thoroughness of cleaning of environmental surfaces in hospital and long-term care settings. More well-conducted RCTs are expected to provide stronger evidence.

Wall-Following Behavior for a Disinfection Robot Using Type 1 and Type 2 Fuzzy Logic Systems

Infectious diseases are caused by pathogenic microorganisms, whose transmission can lead to global pandemics like COVID-19. Contact with contaminated surfaces or objects is one of the major channels of spreading infectious diseases among the community. Therefore, the typical contaminable surfaces, such as walls and handrails, should often be cleaned using disinfectants. Nevertheless, safety and efficiency are the major concerns of the utilization of human labor in this process. Thereby, attention has drifted toward developing robotic solutions for the disinfection of contaminable surfaces. A robot intended for disinfecting walls should be capable of following the wall concerned, while maintaining a given distance, to be effective. The ability to operate in an unknown environment while coping with uncertainties is crucial for a wall disinfection robot intended for deployment in public spaces. Therefore, this paper contributes to the state-of-the-art by proposing a novel method of establishing the wall-following behavior for a wall disinfection robot using fuzzy logic. A non-singleton Type 1 Fuzzy Logic System (T1-FLS) and a non-singleton Interval Type 2 Fuzzy Logic System (IT2-FLS) are developed in this regard. The wall-following behavior of the two fuzzy systems was evaluated through simulations by considering heterogeneous wall arrangements. The simulation results validate the real-world applicability of the proposed FLSs for establishing the wall-following behavior for a wall disinfection robot. Furthermore, the statistical outcomes show that the IT2-FLS has significantly superior performance than the T1-FLS in this application.

The learning hospital: From theory to practice in a hospital infection prevention program

The learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.

Decontamination devices in health care facilities: Practical issues and emerging applications

"No-touch" decontamination devices are increasingly used as an adjunct to standard cleaning and disinfection in health care facilities. Although there is evidence that these devices are effective in reducing contamination, there are several areas of controversy regarding their use. This review addresses some of the questions frequently posed by infection prevention and environmental services personnel about decontamination devices.

Hospital-Acquired Infections Under Pay-for-Performance Systems: an Administrative Perspective on Management and Change

PURPOSE OF REVIEW

The purpose of this review is to explore the impact of hospital-acquired infection on payment under pay-for-performance systems, and provide perspective on the role of administrators in infection prevention.

RECENT FINDINGS

Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viability of healthcare facilities under pay-for-performance systems. There is mixed evidence that use of pay-for-performance systems leads to prevention of hospital-acquired conditions. Use of evidence-based guidelines has been shown to reduce hospital-acquired infections. Increasing use of pay-for-performance (PFP) systems results in potential loss of reimbursement for healthcare organizations that fail to prevent hospital-acquired infections (HAI). Healthcare administrators must work with front-line providers and infection control staff to establish and maintain evidence-based infection prevention policy. Additionally, infection control policy should be regularly updated to reflect best practices, and proper change management techniques should be employed in order to mobilize and empower staff to increase their ability to prevent hospital-acquired infections.