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Nazeer MNM, Aholaakko TK. Using photon disinfection technologies for reducing bioburden in hospitals. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:818-825. [PMID: 37737852 DOI: 10.12968/bjon.2023.32.17.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Environmental cleaning and disinfection is the basis of the prevention of healthcare-acquired infections (HAIs). AIM This study aimed to describe photon disinfection technologies (PDTs), report their impact on inactivating micro-organisms and preventing HAIs and to create recommendations for their implementation in hospital settings. METHODS An integrated literature review was completed to evaluate and report the impact of PDTs in hospital settings. The quality of 23 articles were assessed, their contents analysed and results reported according to the PICOT model. FINDINGS The microbiological impact of the PDT varied by micro-organism, settings and according to the used devices. It was crucial that environmental cleaning was completed before the disinfection. CONCLUSION The implementation of PDT in the hospital setting requires inquiry from the viewpoints of microbiological, environmental, occupational, technical and human safety. To enhance the safe implementation of PDTs, the construction and use of evidence-based global standards for PDT are crucial.
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Affiliation(s)
| | - Teija-Kaisa Aholaakko
- Principal Lecturer, Development Unit Education, Laurea University of Applied Sciences, Vantaa, Finland
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2
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Schaffzin JK, Sickbert-Bennett EE, Deloney VM, Weber DJ. Implementation should be a standard component of practice guidelines and guidance documents. Infect Control Hosp Epidemiol 2023; 44:1365-1368. [PMID: 36858810 DOI: 10.1017/ice.2022.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Joshua K Schaffzin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, UNC- Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, UNC Medical Center, Chapel Hill, North Carolina
| | - Valerie M Deloney
- Society for Healthcare Epidemiology of America (SHEA), Arlington, Virginia
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, UNC- Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, UNC Medical Center, Chapel Hill, North Carolina
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3
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Sun Y, Wu Q, Liu J, Wang Q. Effectiveness of ultraviolet-C disinfection systems for reduction of multi-drug resistant organism infections in healthcare settings: A systematic review and meta-analysis. Epidemiol Infect 2023; 151:e149. [PMID: 37644902 PMCID: PMC10540170 DOI: 10.1017/s0950268823001371] [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: 04/25/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
This study aimed to summarise the findings of the studies assessing the effectiveness of ultraviolet C (UV-C) room disinfection in reducing the incidence rate of healthcare-associated multi-drug-resistant organism (MDRO) infections. A systematic screening was conducted using PubMed, EMBASE, and Scopus for randomised controlled trials (RCTs), quasi-experimental studies, and before-after studies, which assessed the efficacy of the UV-C disinfectant system in reducing the incidence of MDRO infections. A random-effects model was used for the analysis. Effect sizes were described as incidence rate ratio (IRR) with 95% confidence intervals (CI). Nine studies were included, all of which were conducted in the USA. No statistically significant reduction in Clostridioides difficile (CD) (IRR: 0.90, 95% CI; 0.62-1.32) and vancomycin-resistant enterococcal (VRE) infection rates (IRR 0.72, 95% CI; 0.38-1.37) was observed with the use of UV-C, but the risk of Gram-negative rod infection was reduced (IRR 0.82, 95% CI; 0.68-0.99).
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Affiliation(s)
- YanLin Sun
- Day Surgery Center, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Qi Wu
- Department of Infection Management, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Jinzhi Liu
- Department of Gastroenterology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Qian Wang
- Department of Infection Management, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
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4
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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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5
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Linam WM, Trivedi KK, Schaffzin JK. Don't just do it-Conducting and publishing improvement science in infection prevention and antibiotic stewardship. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e33. [PMID: 36310783 PMCID: PMC9614962 DOI: 10.1017/ash.2021.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 06/16/2023]
Affiliation(s)
- W. Matthew Linam
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Kavita K. Trivedi
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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McGinn C, Scott R, Ryan C, Donnelly N, Cullinan MF, Beckett M. Rapid disinfection of radiology treatment rooms using an autonomous ultraviolet germicidal irradiation robot. Am J Infect Control 2022; 50:947-953. [PMID: 35065149 DOI: 10.1016/j.ajic.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising adjunct to manual cleaning, however, their potential to shorten cleaning times remains unexplored. METHODS A <10-minute disinfection procedure was developed using a robotic UVGI platform. The efficacy and time to perform the UVGI procedure in a CT scan treatment room was compared with current protocols involving manual disinfection using biocides. For each intervention, environmental samples were taken at 12 locations in the room before and after disinfection on seven distinct occasions. RESULTS The mean UVC dose at each sample location was found to be 13.01 ± 4.36 mJ/cm2, which exceeded published UVC thresholds for achieving log reductions of many common pathogens. Significant reductions in microbial burden were measured after both UVGI (P≤.001) and manual cleaning (P≤.05) conditions, with the UVGI procedure revealing the largest effect size (r = 0.603). DISCUSSION These results support the hypothesis that automated deployments of UVGI technology can lead to germicidal performance that is comparable with, and potentially better than, current manual cleaning practices. CONCLUSIONS Our findings provide early evidence that the incorporation of automated UVGI procedures into cleaning workflow could reduce turnaround times in radiology, and potentially other hospital settings.
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Yang H, Balakuntala MV, Quiñones JJ, Kaur U, Moser AE, Doosttalab A, Esquivel-Puentes A, Purwar T, Castillo L, Ma X, Zhang LT, Voyles RM. Occupant-centric robotic air filtration and planning for classrooms for Safer school reopening amid respiratory pandemics. ROBOTICS AND AUTONOMOUS SYSTEMS 2022; 147:103919. [PMID: 34703078 PMCID: PMC8530773 DOI: 10.1016/j.robot.2021.103919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/17/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Coexisting with the current COVID-19 pandemic is a global reality that comes with unique challenges impacting daily interactions, business, and facility maintenance. A monumental challenge accompanied is continuous and effective disinfection of shared spaces, such as office/school buildings, elevators, classrooms, and cafeterias. Although ultraviolet light and chemical sprays are routines for indoor disinfection, they irritate humans, hence can only be used when the facility is unoccupied. Stationary air filtration systems, while being irritation-free and commonly available, fail to protect all occupants due to limitations in air circulation and diffusion. Hence, we present a novel collaborative robot (cobot) disinfection system equipped with a Bernoulli Air Filtration Module, with a design that minimizes disturbance to the surrounding airflow and maneuverability among occupants for maximum coverage. The influence of robotic air filtration on dosage at neighbors of a coughing source is analyzed with derivations from a Computational Fluid Dynamics (CFD) simulation. Based on the analysis, the novel occupant-centric online rerouting algorithm decides the path of the robot. The rerouting ensures effective air filtration that minimizes the risk of occupants under their detected layout. The proposed system was tested on a 2 × 3 seating grid (empty seats allowed) in a classroom, and the worst-case dosage for all occupants was chosen as the metric. The system reduced the worst-case dosage among all occupants by 26% and 19% compared to a stationary air filtration system with the same flow rate, and a robotic air filtration system that traverses all the seats but without occupant-centric planning of its path, respectively. Hence, we validated the effectiveness of the proposed robotic air filtration system.
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Affiliation(s)
- Haoguang Yang
- Polytechnic Institute, Purdue University, United States of America
| | | | - Jhon J Quiñones
- School of Mechanical Engineering, Purdue University, United States of America
| | - Upinder Kaur
- Polytechnic Institute, Purdue University, United States of America
| | - Abigayle E Moser
- School of Mechanical Engineering, Purdue University, United States of America
- Department of Aerospace Engineering, Iowa State University, United States of America
| | - Ali Doosttalab
- School of Mechanical Engineering, Purdue University, United States of America
| | | | - Tanya Purwar
- School of Mechanical Engineering, Purdue University, United States of America
| | - Luciano Castillo
- School of Mechanical Engineering, Purdue University, United States of America
| | - Xin Ma
- Polytechnic Institute, Purdue University, United States of America
| | - Lucy T Zhang
- Mechanical Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, United States of America
| | - Richard M Voyles
- Polytechnic Institute, Purdue University, United States of America
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8
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Automated room decontamination: report of a Healthcare Infection Society Working Party. J Hosp Infect 2022; 124:97-120. [DOI: 10.1016/j.jhin.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 01/24/2023]
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Birchansky B, Dexter F, Epstein RH, Loftus RW. Statistical Design of Overnight Trials for the Evaluation of the Number of Operating Rooms That Can Be Disinfected by an Ultraviolet Light Disinfection Robotic System. Cureus 2021; 13:e18861. [PMID: 34804714 PMCID: PMC8597859 DOI: 10.7759/cureus.18861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective The number of ultraviolet light disinfection robot systems that are needed for a facility’s surgical suite(s) and/or procedure suite(s) depends in part on how many rooms need to be disinfected overnight by each robot and how long this will take. The answer needs to be determined separately for each surgical and procedure suite because those variables vary both among facilities and among operating rooms or procedure rooms within facilities. In this study, we consider statistical designs to assess how many rooms a facility can reliably (≥90% chance) disinfect overnight using an ultraviolet light disinfection robot system. Methods We used 133,927 observed disinfection times from 700 rooms as a population from which repeated samples were drawn with replacement in Monte-Carlo simulations. We used eight-hour and 10-hour shift lengths being multiples of 40 hours for full-time hourly employees. Results One possible strategy that we examined was to estimate total disinfection times by estimating the mean for each room and then summing up the means. However, that did not correctly answer the question of how many rooms can reliably be available for the next day’s first case. Summing up a percentile (e.g., 90%) instead also was inaccurate, because the proper percentile depended on the number of rooms. A suitable strategy is a brief trial (e.g., nine nights or 19 nights) with the endpoint being the daily number of rooms disinfected. Empirically, the smallest count of rooms disinfected among nine nights or the second smallest count among 19 nights are 10th percentiles (i.e., ≈90% probability that at least that number of rooms can be disinfected in the future). The drawback is that while this approach gives the probability of a night with fewer rooms disinfected, it does not give information as to how many fewer rooms may either skip ultraviolet decontamination or start late the next workday because disinfection was not completed. Our simulations showed that there is a substantial probability (≥95%) of at most two rooms fewer or one room greater than the 10th percentile with a nine-night trial and one room fewer or greater with a 19-night trial. Conclusions Because probability distributions of disinfection times are heterogeneous both among rooms and among treatments for the same room, each facility should plan to perform its own trial of nine nights or 19 nights. This will provide results that are within two rooms or one room of the correct answer in the long term. This information can be used when planning purchasing decisions, leasing, and technician staffing decisions.
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Affiliation(s)
| | | | - Richard H Epstein
- Anesthesiology, University of Miami Miller School of Medicine, Miami, USA
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10
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Savage TJ, Sandora TJ. Clostridioides difficile Infection in Children: The Role of Infection Prevention and Antimicrobial Stewardship. J Pediatric Infect Dis Soc 2021; 10:S64-S68. [PMID: 34791402 DOI: 10.1093/jpids/piab052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022]
Abstract
There are 2 primary approaches to prevent Clostridioides difficile infection (CDI) in children: prevent transmission and acquisition of the organism and prevent the progression from colonization to disease. The most important interventions to reduce the risk of transmission include contact precautions, hand hygiene, and environmental disinfection. Glove use minimizes contamination of the hands by spores and is associated with reductions in CDI incidence. Hand hygiene with soap and water and disinfection with a sporicidal agent are recommended as the best approaches in hyperendemic settings. Because antibiotic exposure is the most important modifiable risk factor for CDI, antimicrobial stewardship focused on identified high-risk antibiotic classes (including clindamycin, fluoroquinolones, and third- and fourth-generation cephalosporins) is critical to preventing progression from colonization to infection. Despite clear evidence that antimicrobial stewardship programs (ASPs) are associated with reduced CDI rates in adults, data demonstrating the ASP impact on pediatric CDI are lacking.
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Affiliation(s)
- Timothy J Savage
- Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas J Sandora
- Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Yu X, Zheng J, Zhou Z, Chen Q, Hong M, Fu H. Study on polyurethane‐acrylate/cerium dioxide modified by 3‐(Methylacryloxyl)propyltrimethoxy silane and its
UV
absorption property. J Appl Polym Sci 2021. [DOI: 10.1002/app.50760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Xiaochen Yu
- College of Chemistry Fuzhou University Fuzhou China
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter Chinese Academy of Sciences Fuzhou China
| | - Jia Zheng
- College of Chemistry Fuzhou University Fuzhou China
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter Chinese Academy of Sciences Fuzhou China
| | - Zhaoxi Zhou
- School of Chemistry and Chemical Engineering South China University of Technology Guangzhou China
| | - Qihui Chen
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter Chinese Academy of Sciences Fuzhou China
| | - Maochun Hong
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter Chinese Academy of Sciences Fuzhou China
| | - Heqing Fu
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter Chinese Academy of Sciences Fuzhou China
- School of Chemistry and Chemical Engineering South China University of Technology Guangzhou China
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12
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Scaggs Huang F, Schaffzin JK. Rewriting the playbook: infection prevention practices to mitigate nosocomial severe acute respiratory syndrome coronavirus 2 transmission. Curr Opin Pediatr 2021; 33:136-143. [PMID: 33315687 DOI: 10.1097/mop.0000000000000973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Given the limited evidence and experience with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this novel pathogen has challenged the field of infection prevention. Despite uncertainty, infection prevention principles and experience with similar diseases have helped guide how to best protect providers and patients against disease acquisition. RECENT FINDINGS Guidance to date has relied on data from SARS-CoV-1 and MERS-CoV to guide practices on patient isolation and personal protective equipment (PPE) use. Although a face mask and eye protection are likely adequate for most clinical scenarios, published guidelines for PPE can be confusing and conflicting. Consensus for what constitutes a high-risk aerosol-generating procedure (AGP) is lacking, but most agree providers performing procedures such as bronchoscopy, intubation, and cardiopulmonary resuscitation would likely benefit from the use of an N95 respirator and eye protection. SUMMARY Needed research to elucidate the predominant SARS-CoV-2 mode of transmission is not likely to be completed in the immediate future. Recommendations for PPE to mitigate procedure-associated risk remain controversial. Nonetheless, implementation of existing measures based on basic infection prevention principles is likely to prevent transmission significantly.
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Affiliation(s)
- Felicia Scaggs Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joshua K Schaffzin
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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