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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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Resendiz M, Blanchard D, West GF. A systematic review of the germicidal effectiveness of ultraviolet disinfection across high-touch surfaces in the immediate patient environment. J Infect Prev 2023; 24:166-177. [PMID: 37333872 PMCID: PMC10273798 DOI: 10.1177/17571774231159388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background There is not yet a consensus regarding the in-use effectiveness of ultraviolet irradiation (UV-C) as a supplementary tool for terminal room disinfection. Aims and Objectives To summarize and evaluate literature detailing the germicidal effectiveness of UV-C disinfection on high-touch surfaces in the patient environment. Methods A literature search was carried out utilizing PRISMA guidelines. Studies were included if intervention included UV-C after standard room disinfection in hospital rooms evaluated microbiologically by surface type. Findings/Results Twelve records met our criteria for inclusion. Studies predominantly focused on terminal disinfection of patient rooms, including five reports carried out in isolation rooms and three studies including operating room (OR) surfaces. Bedrails, remote controls, phones, tray tables, assist rails, floors, and toilets were the most commonly reported surfaces. Across study designs, surfaces, and room types, flat surfaces tended to showcase UV-C effectiveness best, particularly isolation room floors. In contrast, handheld surfaces (i.e., bed controls and assist bars) tended to show reduced efficacies (81-93%). In the OR, complex surfaces similarly demonstrated reduced UV-C effectiveness. Bathroom surfaces demonstrated 83% UV-C effectiveness overall, with surface characteristics uniquely impacted depending on the room type. Isolation room studies tended to include effectiveness comparison with standard treatment, reporting UV-C superiority most of the time. Discussion This review highlights the enhanced effectiveness of UV-C surface disinfection over standard protocols across various study designs and surfaces. However, surface and room characteristics do appear to play a role in the level of bacterial reduction.
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Affiliation(s)
- Marisol Resendiz
- Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI, USA
| | - Dawn Blanchard
- Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI, USA
| | - Gordon F West
- Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center, Tacoma, WA, USA
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Ghosh N, De J, Choudhury AR. Experimentation and Mathematical Modelling of Process Parameters for Prevention of Infectious Disease Caused by Staphylococcus aureus Bacteria in Indoor Environment. WATER, AIR, AND SOIL POLLUTION 2023; 234:317. [PMID: 37192998 PMCID: PMC10162909 DOI: 10.1007/s11270-023-06333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
Performance optimization using process parameters of an indoor air filtration system is a requirement that has to be established through experimental and analytical means for increasing machine efficacy. A closed casing containing a motor-driven blower is placed in a glass-encapsulated control volume. Air flows axially through an inlet filter and is thrown radially by the blower. In the radial path, air is treated with free radicals from the UVC-irradiated nano-TiO2 coated in the inner wall of casing. A known quantity of Staphylococcus aureus bacteria is populated (Courtesy: EFRAC Laboratories) in the glass-encapsulated control volume. The bacterial colony count is measured at different time intervals after the machine is switched on. Machine learning approaches are applied to develop a hypothesis space and the hypothesis based on best R2 score is used as a fitness function in genetic algorithm to find the optimal values of input parameters. The present research aims to determine the optimum time for which the setup is operated, the optimum air flow velocity in the chamber, the optimum setup-chamber-turning-radius affecting the air flow chaos, and the optimum UVC tube wattage, which when maintained yields the maximum reduction in bacterial colony count. The optimal values of the process parameters were obtained from genetic algorithm using the hypothesis obtained from multivariate polynomial regression. A reduction of 91.41% in bacterial colony count was observed in the confirmation run upon running the air filter in the optimal condition.
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Affiliation(s)
- Niloy Ghosh
- Department of Aerospace and Applied Mechanics, Indian Institutes of Engineering Science and Technology, Shibpur, Howrah, West Bengal India
| | - Jhumpa De
- Academy of Technology, Hooghly, West Bengal India
| | - Amit Roy Choudhury
- Department of Aerospace and Applied Mechanics, Indian Institutes of Engineering Science and Technology, Shibpur, Howrah, West Bengal India
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van der Starre CM, Cremers-Pijpers SAJ, van Rossum C, Bowles EC, Tostmann A. The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation. Antimicrob Resist Infect Control 2022; 11:149. [PMID: 36471395 PMCID: PMC9724435 DOI: 10.1186/s13756-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices. METHODS The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H2O2 vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy. RESULTS In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes. CONCLUSION Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.
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Affiliation(s)
- Caroline M. van der Starre
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Suzan A. J. Cremers-Pijpers
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carsten van Rossum
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Edmée C. Bowles
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Alma Tostmann
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Jennings JM, Johnson RM, Brady AC, Stuckey WP, Pollet AK, Dennis DA. Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field. Arthroplast Today 2022; 17:53-57. [PMID: 36032796 PMCID: PMC9399380 DOI: 10.1016/j.artd.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Periprosthetic joint infection may result from pathogen to patient transmission within the environment. The purpose of this study is to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean. Methods Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as “clean” (>75%), “partially clean” (26%-74%), or poorly cleaned (<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study. Results A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P < .001. Only the OR back table (75%) had a rating of clean. Partially clean areas included Mayfield table (72%), overhead lights (70.1%), infusion pump (61.1%), clock reset button (58.3%), table remote control (50%), tourniquet machine (50%), and the OR table (33.3%). Poorly cleaned surfaces included anesthesia medication cart (21.8%), door handles (20.8%), phone (16.7%), electrocautery unit (16.7%), foot pedal (16.7%), anesthesia cart (16.2%), nurses’ station (14.1%), and supply cabinet doors (6%). Conclusions Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed.
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Affiliation(s)
- Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Corresponding author. Colorado Joint Replacement, 2535 S. Downing St Suite 100, Denver, CO 80210, USA. Tel.: +1 720 524 1367.
| | | | | | | | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Bosco R, Cevenini G, Gambelli S, Nante N, Messina G. Improvement and standardization of disinfection in Hospital Theatre with UV-C technology. J Hosp Infect 2022; 128:19-25. [PMID: 35820555 DOI: 10.1016/j.jhin.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The level of disinfection between operating sessions is important to prevent cross-contamination risk in Operating Theatres (OTs). The aim was to assess the difference in microbial contamination between different disinfection levels (DLs), before T(0) and after T(1) application of a UVC Device (UVC-D). METHODS A cross-sectional study was conducted between December 2019 and August 2020 in a Clinic. Three DLs: no disinfection after surgery (DL0), after in-between cleaning (DL1), and after terminal cleaning (DL2), were compared to assess the reduction of microbial presence before T(0) and after T(1), the use of UVC-D that was used for 5-3 minutes per bedside. 260 Petri dishes (PD), divided into a preliminary phase followed by a probabilistic model-driven experiment, were used in 3 OTs, and Colony Forming Units (CFU) were counted. The Mann-Whitney test was performed in the preliminary phase to establish UVC exposure time. Using the probabilistic model, we calculated descriptive statistics and % and log10 reduction. The MANOVA analysis for repeated measure was performed to verify the 95% statistical difference between T(0) and T(1), combined with the DLs and different OTs. RESULTS The Mann-Whitney showed no CFU difference between 3-5 minutes of UVC exposure time; the MANOVA test for showed no significant difference between DLs in T(0)-T(1) CFU reduction with a mean CFU reduction of 72% (CI95% 61.7 - 84.9%) regardless of the DL applied before. CONCLUSION UVC-D enhanced environmental disinfection under any initial conditions. In concert with sainting procedures improves and standardizes the level of environmental hygiene.
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Affiliation(s)
- R Bosco
- Post Graduate School in Public Health, Department of Molecular and Developmental Medicine, University of Siena, Italy, MD
| | - G Cevenini
- Department of Medical Biotechnologies, University of Siena, Italy, EngD
| | - S Gambelli
- Rugani Hospital Monteriggioni, Siena, Italy, MD
| | - N Nante
- Department of Molecular and Developmental Medicine, University of Siena, Italy MD
| | - G Messina
- Department of Molecular and Developmental Medicine, University of Siena, Italy MD.
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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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8
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Alvarenga MOP, Veloso SRM, Bezerra ALCA, Trindade BP, Gomes ASL, Monteiro GQDM. COVID-19 outbreak: Should dental and medical practices consider uv-c technology to enhance disinfection on surfaces? - A systematic review. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2022; 9:100096. [PMID: 34931181 PMCID: PMC8674638 DOI: 10.1016/j.jpap.2021.100096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
AIMS During the COVID-19 pandemic the search for complementary methods to enhance manual disinfection in dental and medical practices raised relevance. We sought evidence for the addition of ultraviolet-C (UV-C) disinfection to manual cleaning protocols -and whether it improves the logarithmic (log) reduction of surface pathogen colonies. METHODS This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD420200193961. Six electronic sources were consulted looking for clinical trials performed in healthcare environments in which pathogens were quantified by colony-forming unit (CFU)-enumeration before and after interventions, all databases were last consulted on May 2021. We assessed the risk of bias using an adapted Revised Cochrane Risk of Bias Tool (RoB 2). The certainty of the evidence was qualified according to the Classification of Recommendations, Evaluation, Development, and Evaluation (GRADE) approach. RESULTS We identified 1012 records and 12 studies fulfilled the inclusion criteria. All included studies reported enhanced disinfection in the UV-C arm; most of them reported 1-log to 2-log reduction in approximately 10 to 25 min. Only three studies reached a 5-log and 6-log reduction. When manual cleaning was performed alone, only two studies reported a 1-log reduction using a chlorine-based disinfectant. We detected a high risk of bias in 1 study. Certainty of evidence was classified as moderate and low. CONCLUSIONS The evidence points out the effectiveness of UV-C technology in reducing manual cleaning failures, enhancing the logarithmic reduction of surface pathogen colonies. However, the safety and success of these devices will depend on several physical and biological factors. A judicious project must precede their use in clinical and medical offices under the supervision of a physicist or other trained professional.
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Affiliation(s)
- María Olimpia Paz Alvarenga
- Dental School, Universidade de Pernambuco, Instituto de Tecnologia de Pernambuco, Faculdade de Odontologia da, Cidade Universitária, ITEP/ Bloco B 1o. andar, Av. Prof. Luis Freire, 700 - Recife-PE CEP, , Pernambuco 50740-540, Brazil
| | - Sirley Raiane Mamede Veloso
- Dental School, Universidade de Pernambuco, Instituto de Tecnologia de Pernambuco, Faculdade de Odontologia da, Cidade Universitária, ITEP/ Bloco B 1o. andar, Av. Prof. Luis Freire, 700 - Recife-PE CEP, , Pernambuco 50740-540, Brazil
| | - Ana Luisa Cassiano Alves Bezerra
- Dental School, Universidade de Pernambuco, Instituto de Tecnologia de Pernambuco, Faculdade de Odontologia da, Cidade Universitária, ITEP/ Bloco B 1o. andar, Av. Prof. Luis Freire, 700 - Recife-PE CEP, , Pernambuco 50740-540, Brazil
| | - Benoît Paul Trindade
- School of Robotic and Interactive Systems, Faculté des Sciences et Ingénierie, Université Toulouse III, Haute-Garonne, France
| | | | - Gabriela Queiroz de Melo Monteiro
- Dental School, Universidade de Pernambuco, Instituto de Tecnologia de Pernambuco, Faculdade de Odontologia da, Cidade Universitária, ITEP/ Bloco B 1o. andar, Av. Prof. Luis Freire, 700 - Recife-PE CEP, , Pernambuco 50740-540, Brazil
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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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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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Abstract
Traditionally, advances in robotic technology have been in the manufacturing industry due to the need for collaborative robots. However, this is not the case in the service sectors, especially in the healthcare sector. The lack of emphasis put on the healthcare sector has led to new opportunities in developing service robots that aid patients with illnesses, cognition challenges and disabilities. Furthermore, the COVID-19 pandemic has acted as a catalyst for the development of service robots in the healthcare sector in an attempt to overcome the difficulties and hardships caused by this virus. The use of service robots are advantageous as they not only prevent the spread of infection, and reduce human error but they also allow front-line staff to reduce direct contact, focusing their attention on higher priority tasks and creating separation from direct exposure to infection. This paper presents a review of various types of robotic technologies and their uses in the healthcare sector. The reviewed technologies are a collaboration between academia and the healthcare industry, demonstrating the research and testing needed in the creation of service robots before they can be deployed in real-world applications and use cases. We focus on how robots can provide benefits to patients, healthcare workers, customers, and organisations during the COVID-19 pandemic. Furthermore, we investigate the emerging focal issues of effective cleaning, logistics of patients and supplies, reduction of human errors, and remote monitoring of patients to increase system capacity, efficiency, resource equality in hospitals, and related healthcare environments.
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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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Soler M, Scholtz A, Zeto R, Armani AM. Engineering photonics solutions for COVID-19. APL PHOTONICS 2020; 5:090901. [PMID: 33015361 PMCID: PMC7523711 DOI: 10.1063/5.0021270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 05/04/2023]
Abstract
As the impact of COVID-19 on society became apparent, the engineering and scientific community recognized the need for innovative solutions. Two potential roadmaps emerged: developing short-term solutions to address the immediate needs of the healthcare communities and developing mid/long-term solutions to eliminate the over-arching threat. However, in a truly global effort, researchers from all backgrounds came together in tackling this challenge. Short-term efforts have focused on re-purposing existing technologies and leveraging additive manufacturing techniques to address shortages in personal protective equipment and disinfection. More basic research efforts with mid-term and long-term impact have emphasized developing novel diagnostics and accelerating vaccines. As a foundational technology, photonics has contributed directly and indirectly to all efforts. This perspective will provide an overview of the critical role that the photonics field has played in efforts to combat the immediate COVID-19 pandemic as well as how the photonics community could anticipate contributing to future pandemics of this nature.
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Affiliation(s)
- Maria Soler
- Nanobiosensors and Bioanalytical Applications
Group (NanoB2A), Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, BIST
and CIBER-BBN, Barcelona, Spain
| | - Alexis Scholtz
- Department of Biomedical Engineering, University
of Southern California, Los Angeles, California 90089,
USA
| | - Rene Zeto
- Mork Family Department of Chemical Engineering and
Materials Science, University of Southern California, Los Angeles,
California 90089, USA
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14
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Maximizing efficiency in a high occupancy setting to utilize ultraviolet disinfection for isolation rooms. Am J Infect Control 2020; 48:903-909. [PMID: 32407825 DOI: 10.1016/j.ajic.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ultraviolet (UV) disinfection decreases nosocomial disease rates in acute care settings; effective program implementation is poorly understood. We developed a program to UV-disinfect rooms following discharge of patients in transmission-based precautions (TBP) and assessed its effect on hospital-acquired infection (HAI) rates. METHODS An isolation room housed a patient in any type of TBP. A priority room was an isolation room in TBP for multidrug resistant organisms or Clostridioides difficile infection. Percent rooms disinfected and HAI rates were calculated monthly. The two-robot program was started by Infection Prevention utilizing a single environmental services employee. Efficiency was increased by granting environmental services' personnel oversight, increasing coverage, and modifying shift-based goals. Our primary goal was disinfection of all discharged priority rooms. Our secondary goal was disinfection of all discharged isolation rooms. RESULTS The program achieved 6-month disinfection averages of 85.7% of isolation, and 87.7% priority rooms, respectively. Using a dedicated UV disinfection team and setting isolation room per shift goals improved coverage. HAI rates decreased by 16.2% following program implementation. CONCLUSIONS We implemented an effective UV disinfection program, and observed HAI reduction, by focusing on broad coverage and efficient deployment of assets without affecting patient flow or expanding the robot fleet.
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15
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Otter J, Yezli S, Barbut F, Perl T. An overview of automated room disinfection systems: When to use them and how to choose them. DECONTAMINATION IN HOSPITALS AND HEALTHCARE 2020. [PMCID: PMC7153347 DOI: 10.1016/b978-0-08-102565-9.00015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.
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Affiliation(s)
- J.A. Otter
- NIHR Health Protection Research Unit (HPRU) in HCAIs and AMR at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, United Kingdom
| | - S. Yezli
- Global Centre for Mass Gatherings Medicine, WHO Collaborating Centre for Mass Gatherings Medicine, Ministry of Health-Public Health Directorate, Riyadh, Kingdom of Saudi Arabia
| | - F. Barbut
- National Reference Laboratory for C. difficile, Infection Control Unit, Hôpital Saint Antoine, Paris, France,INSERM S-1139, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - T.M. Perl
- Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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16
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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17
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10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients. J Infect 2018; 77:38-46. [DOI: 10.1016/j.jinf.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/20/2018] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
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18
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Zeber JE, Pfeiffer C, Baddley JW, Cadena-Zuluaga J, Stock EM, Copeland LA, Hendricks J, Mohammadi J, Restrepo MI, Jinadatha C. Effect of pulsed xenon ultraviolet room disinfection devices on microbial counts for methicillin-resistant Staphylococcus aureus and aerobic bacterial colonies. Am J Infect Control 2018; 46:668-673. [PMID: 29655672 DOI: 10.1016/j.ajic.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inadequate environmental disinfection represents a serious risk for health care-associated infections. Technologic advancements in disinfection practices, including no-touch devices, offer significant promise to improve infection control. We evaluated one such device, portable pulsed xenon ultraviolet (PX-UV) units, on microbial burden during an implementation trial across 4 Veterans Affairs hospitals. METHODS Environmental samples were collected before and after terminal room cleaning: 2 facilities incorporated PX-UV disinfection into their cleaning protocols and 2 practiced manual disinfection only. Specimens from 5 high-touch surfaces were collected from rooms harboring methicillin-resistant Staphylococcus aureus (MRSA) or aerobic bacteria colonies (ABC). Unadjusted pre-post count reductions and negative binomial regression modeled PX-UV versus manual cleaning alone. RESULTS Seventy samples were collected. Overall, PX-UV reduced MRSA and ABC counts by 75.3% and 84.1%, respectively, versus only 25%-30% at control sites. Adjusting for baseline counts, manually cleaned rooms had significantly higher residual levels than PX-UV sites. Combined analyses revealed an incident rate ratio of 5.32 (P = .0024), with bedrails, tray tables, and toilet handrails also showing statistically superior PX-UV disinfection. CONCLUSIONS This multicenter study demonstrates significantly reduced disinfection across several common pathogens in facilities using PX-UV devices. Clinical impact of laboratory reductions on infection rates was not assessed, representing a critical future research question. However, such approaches to routine cleaning suggest a practical strategy when integrated into daily hospital operations.
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Affiliation(s)
- John E Zeber
- Central Texas Veterans Health Care System, Temple, TX; Center for Applied Health Research, Baylor Scott & White Healthcare, Temple, TX.
| | | | | | | | - Eileen M Stock
- Cooperative Studies Program Coordinating Center, Department of Veterans Affairs, Perry Point, MD
| | - Laurel A Copeland
- Center for Applied Health Research, Baylor Scott & White Healthcare, Temple, TX; VA Central Western Massachusetts Healthcare System, Leeds, MA
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19
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Penno K, Jandarov RA, Sopirala MM. Effect of automated ultraviolet C-emitting device on decontamination of hospital rooms with and without real-time observation of terminal room disinfection. Am J Infect Control 2017; 45:1208-1213. [PMID: 28757085 DOI: 10.1016/j.ajic.2017.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND We studied the effectiveness of an ultraviolet C (UV-C) emitter in clinical settings and compared it with observed terminal disinfection. METHODS We cultured 22 hospital discharge rooms at a tertiary care academic medical center. Phase 1 (unobserved terminal disinfection) included cultures of 11 high-touch environmental surfaces (HTSs) after terminal room disinfection (AD) and after the use of a UV-C-emitting device (AUV). Phase 2 (observed terminal disinfection) included cultures before terminal room disinfection (BD), AD, and AUV. Zero-inflated Poisson regression compared mean colony forming units (CFU) between the groups. Two-sample proportion tests identified significance of the observed differences in proportions of thoroughly cleaned HTSs (CFU < 5). Significant P value was determined using the Bonferroni corrected threshold of α = .05/12 = .004. RESULTS We obtained 594 samples. Risk of overall contamination was 0.48 times lower in the AUV group than in the AD group (P < .001), with 1.04 log10 reduction. During phase 1, overall proportion of HTSs with <5 CFUs increased in AUV versus AD by 0.12 (P = .001). During phase 2, it increased in AD versus BD by 0.45 (P < .001), with no significant difference between AD and AUV (P = .02). CONCLUSIONS Use of UV-C with standard cleaning significantly reduced microbial burden and improved the thoroughness of terminal disinfection. We found no further benefit to UV-C use if standard terminal disinfection was observed.
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