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Crall VD, Lewis CL, Dickman DJ, Grinage DW, George T, Ayres AM, Ciccone C, Snyder GM. Strategies for deployment of ultraviolet disinfection in an acute care facility: A quality improvement initiative. Am J Infect Control 2023; 51:1230-1236. [PMID: 37116712 DOI: 10.1016/j.ajic.2023.04.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Mobile ultraviolet (UV) disinfection uses UV-C light to render microorganisms nonviable and reduce environmental transmission of pathogens in hospital settings. Optimal strategies for deployment must consider the cost, physical layout, and staffing resources. The aim of this quality improvement study was to increase UV disinfection utilization by developing novel deployment strategies without adding resources. METHODS A novel deployment strategy and tools were developed by a multidisciplinary group that included infection prevention, environmental services, and nursing unit staff. Utilization was tracked via a manufacturer-supported database. The infection prevention team analyzed the weekly UV disinfection minutes, cycles, and proportions of cycles completed in defined areas across 4 periods: baseline, pilot, baseline 2, and intervention. RESULTS The median (range) disinfection cycle times per week during a geographically confined pilot (4,985 minutes [3,476-6,551] minutes) and the intervention period (1,454 [512-3,085] minutes) were lower than either baseline period (5,394 [3,953-6,987] and 6,641 [2,830-7,276] minutes, respectively). Cycles per week were lower in the intervention period than in the preceding 3 periods. CONCLUSIONS Use of UV disinfection in acute care settings should be guided by multidisciplinary groups balancing resources against efficacy and using tailored tools to promote efficiency.
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Affiliation(s)
- Victoria D Crall
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Casey L Lewis
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Daniel J Dickman
- Department of Environmental Services, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Darnell W Grinage
- Department of Environmental Services, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Trish George
- Department of Patient Safety and Innovation, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Ashley M Ayres
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Carl Ciccone
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Graham M Snyder
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA; Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Kreitenberg A, Polacci L. Would it be helpful to infection control professionals to have the FDA regulate whole-room UVC devices? Am J Infect Control 2023; 51:340-342. [PMID: 36044949 DOI: 10.1016/j.ajic.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Abstract
A 2-question survey was performed at the 2022 Annual Meeting of the Association of Professionals in Infection Control (APIC) regarding whole-room ultraviolet C (UVC) disinfection devices. Ninety-six questionnaires were completed. About 82.3% indicated FDA regulation of UVC devices would help them, 5.2% responded they would not, and 12.5% were neutral. About 84.4% ranked thoroughness of disinfection as the most important attribute of a whole-room UVC device. And 13.5% indicated ease of use and time required as most important.
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Perception of Professionals from Different Healthcare Units Regarding the Use of Spray Technology for the Instantaneous Decontamination of Personal Protective Equipment during the Coronavirus Disease Pandemic: A Short Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Within the context of the coronavirus disease (COVID-19) pandemic, different disinfection technologies have been developed to efficiently exercise microbial control, especially to minimize the potential risks that are associated with transmission and infection among healthcare professionals. Thus, the aim of this work was to evaluate the perception of professionals regarding the use of a new technology (chamber) for the instantaneous decontamination of personal protective equipment before the doffing stage. This was a cross-sectional descriptive study where the study data were obtained by using a questionnaire with qualitative questions. In total, 245 professionals participated in the study in three hospitals. Healthcare professionals represented 72.24% (n = 177) of the investigated sample. Approximately 69% of the professionals considered the disinfection chamber as a safe technology, and 75.10% considered it as an important and effective protective barrier for healthcare professionals in view of its application before the doffing process. The results found in this study demonstrate that the use of spray technology in the stage prior to the doffing process is acceptable to professionals, and that it can be an important tool for ensuring the additional protection of the professionals who work directly with patients who are diagnosed with COVID-19.
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Mascarenhas LAB, Dos Santos LMC, Oliveira FO, Rodrigues LDAP, Neves PRF, Moreira GAF, Santos AAB, Lobato GM, Nascimento C, Gerhardt M, Machado BAS. Evaluation of the microbial reduction efficacy and perception of use of an ozonized water spray disinfection technology. Sci Rep 2022; 12:13019. [PMID: 35906472 PMCID: PMC9335460 DOI: 10.1038/s41598-022-16953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
The development of new approaches for the decontamination of surfaces is important to deal with the processes related to exposure to contaminated surfaces. Therefore, was evaluated the efficacy of a disinfection technology using ozonized water (0.7-0.9 ppm of O3) on the surfaces of garments and accessories of volunteers, aiming to reduce the spread of microbial pathogens in the workplace and community. A Log10 microbial reduction of 1.72-2.40 was observed between the surfaces tested. The microbial reductions remained above 60% on most surfaces, and this indicated that the disinfection technology was effective in microbial log reduction regardless of the type of transport used by the volunteers and/or their respective work activities. In association with the evaluation of efficacy, the analysis of the perception of use (approval percentage of 92.45%) was fundamental to consider this technology as an alternative for use as a protective barrier, in conjunction with other preventive measures against microbiological infections, allowing us to contribute to the availability of proven effective devices against the spread of infectious agents in the environment.
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Affiliation(s)
- Luis Alberto Brêda Mascarenhas
- University Center SENAI/CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), Salvador, Bahia, 41650-010, Brazil
| | - Laerte Marlon Conceição Dos Santos
- University Center SENAI/CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), Salvador, Bahia, 41650-010, Brazil
| | - Fabricia Oliveira Oliveira
- University Center SENAI/CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), Salvador, Bahia, 41650-010, Brazil
| | - Leticia de Alencar Pereira Rodrigues
- University Center SENAI/CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), Salvador, Bahia, 41650-010, Brazil
| | - Paulo Roberto Freitas Neves
- University Center SENAI/CIMATEC, SENAI Computational Modeling and Industrial Technology, Salvador, Bahia, 41650-010, Brazil
| | - Greta Almeida Fernandes Moreira
- University Center SENAI/CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), Salvador, Bahia, 41650-010, Brazil
| | - Alex Alisson Bandeira Santos
- University Center SENAI/CIMATEC, SENAI Computational Modeling and Industrial Technology, Salvador, Bahia, 41650-010, Brazil
| | - Gabriela Monteiro Lobato
- China Three Gorges Corporation-CTG Brazil, Rio Paraná Energia S.A. Rodovia MS-444 s/nº km 58, Ilha Solteira, Selviria, MS, Brazil
| | - Carlos Nascimento
- China Three Gorges Corporation-CTG Brazil, Rio Paraná Energia S.A. Rodovia MS-444 s/nº km 58, Ilha Solteira, Selviria, MS, Brazil
| | - Marcelo Gerhardt
- China Three Gorges Corporation-CTG Brazil, Rio Paraná Energia S.A. Rodovia MS-444 s/nº km 58, Ilha Solteira, Selviria, MS, Brazil
| | - Bruna Aparecida Souza Machado
- University Center SENAI/CIMATEC, SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), Salvador, Bahia, 41650-010, Brazil.
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Scott R, Joshi LT, McGinn C. Hospital surface disinfection using ultraviolet germicidal irradiation technology: A review. Healthc Technol Lett 2022; 9:25-33. [PMID: 35662749 PMCID: PMC9160814 DOI: 10.1049/htl2.12032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising alternative to biocides as a means of surface disinfection in hospitals and other healthcare settings. This paper reviews the methods used by researchers and clinicians in deploying and evaluating the efficacy of UVGI technology. The type of UVGI technology used, the clinical setting where the device was deployed, and the methods of environmental testing that the researchers followed are investigated. The findings suggest that clinical UVGI deployments have been growing steadily since 2010 and have increased dramatically since the start of the COVID-19 pandemic. Hardware platforms and operating procedures vary considerably between studies. Most studies measure efficacy of the technology based on the objective measurement of bacterial bioburden reduction; however, studies conducted over longer durations have examined the impact of UVGI on the reduction of healthcare associated infections (HCAIs). Future trends include increased automation and the use of UVGI technologies that are safer for use around people. Although existing evidence seems to support the efficacy of UVGI as a tool capable of reducing HCAIs, more research is needed to measure the magnitude of these effects and to establish recommended best practices.
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Affiliation(s)
- Robert Scott
- Department of Mechanical, Manufacturing, and Biomedical EngineeringTrinity College DublinDublinIreland
| | | | - Conor McGinn
- Department of Mechanical, Manufacturing, and Biomedical EngineeringTrinity College DublinDublinIreland
- Akara RoboticsDublinIreland
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Resendiz M, Blanchard DM, Lustik MB, Horseman TS, West GF. Effect of SARs-CoV-2 pandemic on infection prevention behaviors and bacterial burden of high touch surfaces in a medical/surgical setting. Sci Rep 2022; 12:5561. [PMID: 35365725 PMCID: PMC8973674 DOI: 10.1038/s41598-022-09548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/24/2022] [Indexed: 12/22/2022] Open
Abstract
This study aimed to determine the longitudinal efficacy of ultraviolet germicidal disinfection (UV-C) in a non-terminal disinfection context. Moreover, factors influencing enhanced infection prevention behaviors during the SARS-CoV-2 pandemic were evaluated. Sixty nursing staff from three medical/surgical wards in a large military hospital were recruited for a survey and microbiological sampling of high-touch surfaces (stethoscope, personal electronic device, common access card, and hospital ID badge) and portable medical equipment (wheelchairs and mobile commodes). Surveys included hand hygiene estimates, frequency/method of cleaning items of interest, perception of UV-C, and factors influencing the use of enhanced disinfection tools. Surveys and microbiological samples were performed prior to and after the installation of a rapid, automated ultraviolet disinfection enclosure for staff use. Both time points preceded the SARS-CoV-2 pandemic in the United States. A final survey/sampling time point was carried out eight months after the declaration of the COVID-19 pandemic. Participants' hand hygiene frequency did not increase throughout the study, with > 80% reporting a minimum of 4 hand hygiene events per patient hour. The cleaning frequency of high-touch surfaces (non-clinical) but not portable medical equipment increased after installation of a UV-C disinfection tool and was sustained eight months into the COVID-19 pandemic. While a modest decrease in bacterial burden was observed after UV-C intervention, a more significant reduction was observed across all surfaces during pandemic time sampling, though no detectable decrease in pathogenic contamination was observed at either time point. Motivators of UV-C use included fear of SARS-CoV-2 contamination and transmission, ease of device use, and access to rapid, automated disinfection tools while deterrents reported included technical concerns, lack of time, and preference for other disinfection methods. Automated, rapid-cycle UV-C disinfection can be efficacious for high-touch surfaces not currently governed by infection prevention and control guidelines. The introduction of enhanced disinfection tools like UV-C can enhance the overall cleaning frequency and is correlated with mild decreases in bacterial burden of high-touch surfaces, this is enhanced during periods of heightened infection threat. Evidence from this study offers insights into the factors which prompt healthcare workers to internalize/dismiss enhanced infection prevention procedures.
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Affiliation(s)
- Marisol Resendiz
- Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI, USA
| | - Dawn M Blanchard
- Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI, USA
| | - Michael B Lustik
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, HI, USA
| | - Timothy S Horseman
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, HI, USA
| | - Gordon F West
- Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA.
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Dancer SJ, King MF. Systematic review on use, cost and clinical efficacy of automated decontamination devices. Antimicrob Resist Infect Control 2021; 10:34. [PMID: 33579386 PMCID: PMC7881692 DOI: 10.1186/s13756-021-00894-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/21/2021] [Indexed: 03/20/2023] Open
Abstract
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.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire, G75 8RG, Scotland, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK.
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Han Z, Pappas E, Simmons A, Fox J, Donskey CJ, Deshpande A. Environmental cleaning and disinfection of hospital rooms: A nationwide survey. Am J Infect Control 2021; 49:34-39. [PMID: 32798634 DOI: 10.1016/j.ajic.2020.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND As an important reservoir for hospital-acquired infections, environmental surfaces have long been targeted by interventions to improve cleaning and disinfection. Differences in disinfection practices across US hospitals, however, are still unclear. METHODS We conducted a nationwide survey of environmental services (EVS) personnel in the United States regarding their environmental surface disinfection practices from January 2019 to June 2019. We developed and pilot tested the survey in conjunction with EVS specialists. Survey questions inquired about choices of disinfectants and cleaning equipment during daily and terminal disinfection of both contact isolation and non-contact isolation rooms. We contacted 273 EVS personnel by phone and email to participate in the survey. RESULTS Fourty-seven EVS personnel representing different hospitals from 26 US states were included in the analysis. Hypochlorite (bleach) and quaternary ammonium compounds were the most frequently used disinfectants. Most respondents reported using microfiber-based cloths and mops to carry out disinfection. High-touch surfaces in contact isolation rooms were frequently disinfected using bleach (81%, n = 38); floors, however, were not disinfected as frequently in patient rooms. The vast majority of respondents reported use of sporicidal disinfectants for contact isolation rooms but not regular rooms. CONCLUSIONS While frequently used to disinfectant contact isolation rooms, sporicidal agents are rarely used to disinfect regular rooms. Patient room floors are inconsistently disinfected compared to high-touch surfaces.
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Affiliation(s)
- Zheyi Han
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Ethan Pappas
- Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
| | - Adrienne Simmons
- Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
| | - Jacqueline Fox
- Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
| | - Curtis J Donskey
- Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Abhishek Deshpande
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH; Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH; Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH.
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